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Could Sleep Apnea Affect Your Hearing?

Woman wearing CPAP machine for sleep apnea

Study suggests people with the disorder should have their hearing tested.

Sleep apnea may not only affect the quality of your sleep. New research suggests that the sleep disorder may be linked to hearing loss as well.

The study found that sleep apnea was associated with hearing impairment at both high and low frequencies. That finding held true even after the researchers adjusted the data for other possible causes of hearing loss.

These findings give further support to the idea that sleep apnea likely doesn’t occur in isolation. Instead, it may be a sign of other underlying health conditions, the researchers said.

“Sleep apnea is more of a systemic and chronic disease than just something that happens when you’re sleeping,” said one of the study’s authors, Dr. Neomi Shah, an associate director of the pulmonary sleep lab at Montefiore Medical Center in New York City.

“It probably affects multiple different organs, so I would probably urge we start thinking about sleep apnea as more like a chronic disease with vascular and inflammatory issues,” Shah added.

Sleep apnea is a common disorder that affects about 18 million Americans, according to the National Sleep Foundation. Typically signaled by snoring with periodic gasping or “snorting” noises, sleep apnea interrupts sleep and can cause excessive daytime fatigue and other symptoms. The condition also has been associated with generalized inflammation, cardiovascular and endocrine problems.

What might the connection be between sleep apnea and hearing loss? It might be a combination of factors that cause inflammation and abnormal functioning in the blood vessels, according to Shah. “The ear is prone to this kind of injury,” explained Shah.

The study tapped data from almost 14,000 U.S. participants in the Hispanic Community Health Study/Study of Latinos. About 53 percent were women and on average the subjects were 41 years old. All completed in-home sleep studies and audiometric (hearing) testing.

About 10 percent of the study volunteers had sleep apnea. Around 30 percent had some form of hearing impairment, according to the study.

The researchers took into account age, gender, Hispanic/Latino backgrounds and health-related issues such as high blood pressure, diabetes, fat levels in the blood, cigarette and alcohol use, history of hearing loss or snoring, and noise exposure.

People in the study were more likely to have hearing impairment if they were of Cuban and Puerto Rican backgrounds, had a higher body mass index (an indication of being overweight), were people who snored, or had been diagnosed as having sleep apnea.

The study authors found that sleep apnea was associated with a 31 percent increase in high frequency hearing impairment and a 90 percent increase in low frequency hearing impairment. Sleep apnea was also linked to a 38 percent increase in both high and low frequency hearing loss. Speech tends to fall in the low frequency range, according to Shah.

The research is slated to be presented May 20 at the American Thoracic Society annual meeting in San Diego, Calif. Because the study has not yet been published in a peer-reviewed journal, the data and conclusions should be viewed as preliminary.

Some experts urged caution in interpreting the results of the study, however.

“The number one thing I always say is, correlation is not causation; it doesn’t mean if you have sleep apnea you’re at risk for hearing impairment,” said Rebecca Spencer, a neuroscientist and associate professor in the department of psychological and brain sciences at the University of Massachusetts, Amherst. “You wouldn’t know if one comes before the other: sleep apnea appears before hearing loss, or hearing loss appears before sleep apnea and maybe they don’t come together at all. They may not be related except by a third factor.”

Because a possible link has been discovered between sleep apnea and hearing loss, the next step should be a smaller study that looks more closely at the question of whether sleep apnea actually causes hearing loss, said Spencer.

She also pointed out that the data drew only from people of Hispanic and Latino descent. It would be important to look at the association between hearing loss and sleep apnea among a broader ethnic and geographical group, she added.

Only one thing can be concluded from the study, Spencer said: “There is the potential that treating sleep apnea may improve hearing loss.”

Shah, the research author, said people with sleep apnea should be screened for hearing impairment since it has been shown to be associated with the disorder. “Get evaluated,” she urged.

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Surprising Ways Hearing Affects Your Health

portrait of a mature man trying to hear something

Hearing loss is more than an auditory problem.

When Dianne Lange first stepped outdoors wearing a hearing aid, she was surprised by the high-pitched call of the chickadee birds — something she hadn’t heard in years. Lange’s age-related hearing loss, a condition known as presbycusis, had developed so gradually that she never noticed how sounds were simply fading away.

“I put off having my hearing checked until my mishearing what people said, and repeatedly asking people to repeat themselves, became just too embarrassing,” says Lange, 67, a Lake Tahoe, Nevada-based journalist and Everyday Health contributing writer. “It made me wonder what I’ve been missing in human conversations. But hearing people, I discovered, was only part of what I was missing. Now, when I go on a hike, my ears are as sensitive to the environment as my eyes.”

Lange is not alone. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), one in four Americans between ages 65 and 74, and half of those 75 and older, have disabling hearing loss. It is the third most prevalent chronic condition affecting the elderly, after high blood pressure and arthritis.

Hearing loss is more than an auditory problem. Research has shown that it affects quality of life, emotional health, and even raises the risk for dementia.

Hearing and Brain Health
One study, in which the cognitive function of 253 older men and women was tested over a period of 20 years, found a greater decline in memory and other mental abilities in those who had moderate-to-severe hearing impairment.

“We found a difference…equal to approximately a three-year increase in age,” says study co-author Jennifer A. Deal, PhD, director of graduate studies in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

A separate study found that restoring hearing by use of a cochlear implant — a surgically implanted electronic device that does the work for damaged portions of the ear — improved cognitive function in elderly patients. Attentiveness, memory, and mental flexibility scores increased among seriously deaf seniors within a year of cochlear implantation.

Noise-Induced Hearing Loss
Not all hearing loss is age-related. It can be caused by infections, head trauma, abnormal bone growths, tumors such as an acoustic neuroma, and certain medications. Loud noises, like an explosion or prolonged exposure to music at a high volume, can cause acoustic trauma — or damage to inner ear structures — leading to hearing loss.

According to the U.S. Centers for Disease Control and Prevention (CDC), some 15 percent of American adults under age 70, and 16 percent of teenagers, have hearing loss that may have been caused by exposure to noise at work or through other activities.

The Occupational Safety and Health Administration (OSHA) notes that noise-induced hearing loss is a common occupational illness that is frequently ignored because it occurs gradually and usually without accompanying pain.

Through the “It’s a Noisy Planet” program, the National Institutes of Health (NIH) provides guidelines on how loud is too loud and tips to protect your hearing.

The NIH suggests that your hearing is at risk if you have to raise your voice to be understood by someone close by, if a noise hurts your ears, if you develop a buzzing or ringing in your ears, or if you don’t hear as well as you normally do even hours after the noise stops.

So How Is Your Hearing?
The Hearing Health Foundation offers a self-assessment quiz to help you determine if you may have hearing loss. If you answer yes to three of the following 10 questions, you are advised to make an appointment for testing:

  • Do you have a problem hearing over the telephone?
  • Do you have difficulty following a conversation when two or more people are speaking?
  • Do people complain that you turn the TV volume up too high?
  • Do you have to strain to understand conversation?
  • Do you have trouble hearing in a noisy background?
  • Do you find yourself asking people to repeat themselves?
  • Do many people you talk to seem to mumble?
  • Do you misunderstand what others are saying and respond inappropriately?
  • Do you have trouble understanding the speech of women and children?
  • Do people get annoyed because you misunderstand what they say?

If you have any concerns about potential hearing loss, consult a hearing healthcare professional, such as an audiologist.

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Hearing Loss, the Forgotten Disability

Female nurse is speaking in senior woman ear

The Americans with Disabilities Act (ADA) was enacted 25 years ago, yet we are still discussing the same issues for people with hearing loss. The terms “disability” and “access” have morphed into just meaning physical disability and physical access. The ADA symbol for people with disabilities is a person using a wheelchair rather than a symbol showing multiple disabilities, but a wheelchair can’t visibly represent all disabilities.

The LGBT community uses initials for all the individual groups to form the name and a rainbow to reflect the diversity of the group. They didn’t select one segment to represent the entire community. Likewise, the Hispanic or Latino community didn’t choose one country to represent all the nationalities. Why is the wheelchair symbol used to represent people with hearing loss, visual impairments, and cognitive disabilities? It reinforces the misconception that the only disability of consequence is the one requiring physical access.

Part of the problem is that hearing loss isn’t perceived as a “real” disability. Hearing aids, unlike wheelchairs, are mostly inconspicuous, so hearing loss is an invisible disability. Even the means of access are seldom seen–they are a bunch of wires or a small captioning device, whereas ramps are highly visible. As a result, hearing loss access needs are often overlooked.

There is also confusion about the forms of access that people with hearing loss need. A recent Disability Pride Parade chose at first to use only a wheelchair symbol and then added the American Sign Language (ASL) symbol to represent hearing loss, even though the vast majority of people with hearing loss do not use ASL.

The US Access Board develops ADA guidelines for the built environment, and these guidelines form the basis for the Department of Justice (DOJ) ADA Standards. DOJ also oversees other aspects of the ADA, including programmatic access, auxiliary aids and services, and effective communication.

Places of public accommodation often have no idea what they should or shouldn’t implement for communication. Physical access is clear–build something this high and this wide. In comparison, spelling out what “effective communication” is fuzzy. Who decides what is effective or not? Determining this can require filing complaints and/or litigation. The reason? Despite DOJ being the enforcement agency overseeing compliance, the process is primarily complaint driven. While the health department in various cities cites restaurants for violations, DOJ is not driving around and checking for ADA compliance in a similar fashion. The burden therefore shifts primarily to the people who need the protection, and there are few if any penalties for lack of compliance.

Both the Access Board and DOJ are able to form Federal Advisory Committees to help them with rule making, but only the Access Board does. Therefore, people with or parents of children with hearing loss are not inherently involved in developing DOJ rules.

The lack of clarity concerning “effective communication” permits companies to develop hearing access equipment that may not have the best interests of people with hearing loss in mind. Some are selling handheld captioning devices for watching films or live theater. It is well known that people cannot drive and text simultaneously because their eyes can only see one place at a time, so it seems incomprehensible that museums, theaters or entertainment venues expect people with hearing loss to watch two places at one time.

Businesses can provide substandard communication access, such as note writing, as long as the meaning gets transmitted. A major coffee corporation refused to provide hearing induction loops for hearing access at its counters and then rolled out a campaign to discuss race relations, failing to recognize that discrimination does not only involve race. In contrast, a bank decided to pilot hearing induction loops in New York City so customers with hearing loss could hear at the teller window and service desk and in the conference room; the bank is now expanding the program to all renovated and new locations. Two different companies have two different definitions of effective communication for people with hearing loss, who are thus reliant on companies to do the right thing.

Although state and local governments are covered by the ADA, federal government agencies are covered instead by section 504 of the Rehabilitation Act, which was the model for the ADA. Even among federal agencies there is a discrepancy in what is provided. The National Park Service’s Guidelines require hearing induction loops at its service desks and videos; the US Holocaust Memorial Museum (which is a quasi-federal agency) added them to its videos; and The Pentagon required the Intrepid Sea, Air & Space Museum to add induction loops to its space shuttle exhibit in order to receive the shuttle. Yet, the Smithsonian Institution (another quasi-federal agency) refuses to add hearing induction loops to its videos. Different federal agencies have conflicting definitions of effective communication.

There should be ONE central place to file complaints for lack of ADA compliance. The burden should shift to the government to determine which agency is responsible for addressing the lack of access and not the person seeking the accommodation. The Access Board should have full oversight for drafting standards for all access whether built in or programmatic. This will eliminate the loopholes. The DOJ’s role should be strictly enforcement. The ADA should clarify that effective communication for people with hearing loss means full spectrum including audible, visual AND qualified interpretation. There should be vigorous enforcement for lack of compliance. Advisory committees should be convened to provide clarity about what people with hearing loss need.

Otherwise, the promises of the ADA and Section 504 of the Rehabilitation Act will remain aspirations rather than becoming a reality. People with hearing loss deserve to have this clarity and access, which is the intention of the ADA and the mandate it was meant to be.

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Generation Deaf: Doctors Warn of Dangers of Ear Buds

black and white earbuds isolated on white background

Hearing loss began early for Josh Musto, triggered at first by a heavy metal concert and worsened by years of playing guitar in two bands. Listening to loud music constantly through ear buds may be to blame for a ringing in his ears.

“I’ve been a musician forever,” said Musto, now 21 and a junior at the New School in New York City. “There’s a lot of noise in my life.”

Musto is not alone. Doctors warn that a steady onslaught of loud noise, particularly through ear buds, is damaging the hearing of a generation wired for sound — although they may not realize it for years.

Earlier this year the World Health Organization warned that 1.1 billion young people are at risk of hearing loss because of personal audio devices, such as smartphones, and damaging levels of sound at entertainment venues like electronic dance music festivals, where noise levels can top 120 decibels for hours.

“Probably the largest cause [of hearing damage] is millennials using iPods and [smartphones],” says Dr. Sreekant Cherukuri, an ear, nose, and throat specialist from Munster, Indiana.

Hearing loss among today’s teens is about 30 percent higher than in the 1980s and 1990s, Cherukuri estimates.

“You (once) had a Walkman with two AA batteries and headphone thongs that went over your ears,” he told NBC News. “At high volume, the sound was so distorted and the battery life was poor. Nowadays, we have smart phones that are extremely complex computers with high-level fidelity.”

Cherukuri tells young patients to stop wearing headphones — especially earbuds, which place the sound closer to the ear drum, enhancing volume by as much as 9 decibels.

“It’s very easy to achieve unknowingly,” he said.

According to the National Institutes of Health, repeated exposure to sound over 85 decibels can cause hearing loss. Permanent damage can happen in minutes, experts say, and when the damage is done, it’s irreversible.

“Noise exposure in kids is a growing concern,” said Nicole Raia, a clinical audiologist at University Hospital in Newark, New Jersey.

Raia said she sees more tinnitus in young people, an early sign of hearing loss, but, “we don’t catch them until they are in their 20s and 30s.”

And because audio-screening protocols are not that sophisticated, many children with subtle damage pass hearing tests, she added.

A study published in 2014 revealed that nerve synapses can be more vulnerable to damage than hair cells in the inner ear. When young animals were exposed to loud noise, even just once, they had accelerated hearing loss later in life.

“Within minutes of exposure, the points between the hair cells and the neurons were injured and the loss was permanent,” said co-author Sharon Kujawa, director of the department of audiology at Massachusetts Eye and Ear Infirmary.

The problem is when there is exposure to excessive noise, it goes away within a few hours.

This “hidden” hearing loss is not picked up by standard threshold tests on which all national standards are based.

Experts say the best way to protect young ears is to apply the “60/60” rule: Keep the volume on the MP3 player under 60 percent and only listen for a maximum of 60 minutes a day.

When using headphones in a noisy place like a school bus or subway, the tendency is the turn the volume up, so use headphones that cover up outside noise.

And to protect your kids, use Apple’s parental control setting to set lower sound levels on iPhones and iPods, locked in place with a password.

For small children at loud sporting events, music concerts or riding on the subway, buy ear protection.

As for Musto, he said he “got a lot smarter.”

After seeing a doctor, he only uses over-the-ear headphones and protects his ears from loud noise with customized ear plugs. He gave up earbuds a long time ago.

Today, he continues to play in two bands and interns at Sirius XM radio, doing interviews and some DJing.

“If I couldn’t hear, I wouldn’t be able to do this,” he said.

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Hearing Loss Halloween: Safety Tips for Your Trick-or-Treater With Hearing Aids

Little girl in witch costume and baby boy in huge pumpkin playing in autumn park. Kids at Halloween trick or treat. Toddler with jack-o-lantern. Children with candy bucket in forest.

Halloween may be the one night of the year when the dead roam the streets of the living, but that should be the only reason you and your children have to fear while going door-to-door in search of your favorite candy this year. Running around in the streets after dark, especially with masks and hoods that limit your eyesight, can present some challenges.

But Halloween is meant to be fun, with memories your children will cherish for the rest of their lives. So stay safe this Halloween by following a few simple guidelines to keep you and your little ones out of harm’s way. Cars are the biggest worry, but losing track of your kids is also a concern, especially once the sun has set. Have a conversation with them before you head out to make sure they understand the potential harm in not listening to your instructions and just for safe measure, check the status of any hearing devices to be sure they’re functioning at full capacity.

Before you head out the door with your child in tow, check out these Halloween safety tips!

Hearing aid pre-check

If your children have hearing aids, perform a thorough check on the mechanism before you let them run out the door. Make sure the aid is working properly, and check the batteries. Put a small hearing aid emergency kit in your bag or pocket with an extra set of batteries in case you run into problems along the trick-or-treat route, which can sidestep any possible deviations in your Halloween fun!

If you have a child with cochlear implants, it’s important to make sure they’re running predictably as well, before leaving the house.

Wear bright colors

If possible, dress your children in bright, distinctive costumes that are easy for both you and drivers on the road to see. Children run the risk of being struck by cars whose drivers are frequently unable to see the little demons after dark. That’s not always possible, of course, so look into purchasing some reflective tape or a blinking light for the back of your little ones’ costumes. While drivers may be vigilant, a little visual aid never hurts.

Keep them close

When the sugar rush hits, your children might be a little more difficult to control. But don’t let them get too far ahead of you when they dash away from the latest door; the excitement of trick or treating can cause children to forget to check both ways before running out into the street. Keeping them close to you may be tough, but it’s important. Keep a few tricks up your sleeve in getting them to behave, like stopping them from running directly to the next house by asking them to stop and show you what treats they just collected.

Devise a plan

Plan out a route ahead of time and make sure your kids know the plan. When it’s dark, young children can easily lose their way, even if its within their own neighborhood. Fear can trigger panic, causing them to become disoriented. If you get separated, pick a designated meeting place they can remember how to reach, like a neighborhood landmark. Playgrounds, street signs, stores or even brightly colored houses can serve as a meeting place they will remember.

Halloween is one day your children look forward to all year. If you plan accordingly, there will be nothing to fear come All Hallow’s Eve. Nothing but the ghosts and goblins, that is.

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