Dr. Roach: An expert’s help with hearing aid is critical

Keith Roach
To Your Health

Dear Dr. Roach: What can help a senior citizen with profound hearing loss? Many audiologists say a hearing aid can definitely help, but it seems it never happens. Mild and moderate hearing loss do well with amplification, but severe and profound are a different ballgame. What about a cochlear implant?

— G.P.

Dear G.P.: Hearing loss is measured in decibels (dB). The decibel is a little hard to understand, but it’s necessary in order to distinguish differences in hearing loss.

A person with normal hearing can just barely hear a sound of zero decibels, which is very, very quiet. Sounds of negative decibels are so quiet that most people can’t hear them. Mild hearing loss is when a person can hear only louder sounds. There are various definitions, but the World Health Organization defines them as follows:

Mild hearing loss is 30-40 dB. A person with this degree of hearing loss has difficulty hearing a whisper.

Moderate hearing loss is 41-70 dB, difficulty hearing conversation at home.

Severe hearing loss is 71-90 dB, generally unable to hear a loud television.

Profound hearing loss is greater than 90 dB, where the person is unable to hear all but the loudest sounds, and even these may be perceived only as vibration.

Every 10 dB louder is twice as loud, so profound hearing loss is about 64 times worse than mild hearing loss. You are right that the two situations are very different. Only about 11% of all people with hearing loss have severe to profound.

Hearing loss may be due to damage to the sensory cells in the cochlea, called sensorineural hearing loss; damage to the conduction system, such as the bones in the middle ear (conductive hearing loss); or both (mixed).

The answer to your question — Can hearing aids help? — is probably yes, but how much depends on the frequencies affected and your ability to recognize speech. Even in the best case, hearing aids are unable to fully compensate for profound hearing loss. The hearing will never be near normal for a person with severe to profound loss, even if it is much improved.

I have often written that the expertise of the professional who helps you with a hearing aid is critical. This is particularly true in people with severe or profound hearing loss.

Cochlear implants are an option for people with severe to profound sensorineural hearing loss. Multiple studies have shown that cochlear implants improve hearing and quality of life when used in appropriate patients. Bone anchored hearing systems are an option for people with severe conductive hearing loss, where the cochlea works but sound can’t get there.

Many readers have written me that they were helped by the local chapters of the Hearing Loss Association of America, which you can find at www.hearingloss.org.

Dear Dr. Roach: I seem to remember a case a few years ago of a person developing abnormal sexual behavior due to a brain tumor, which went away when the tumor was surgically removed. Is there any truth to this? Is it medically possible for a brain tumor to cause sexual deviance or abnormal sexual attractions?

— W.I.L.

Dear W.I.L.: There are numerous case reports of people having dramatic changes to their sexual behavior in association with brain tumors, bleeding aneurisms, seizures and encephalitis, stroke and medication for Parkinson’s disease. While these cases are well-documented, in the vast majority of people these neurological conditions have no effect on their sexual behaviors, so I would be cautious about saying sexual behavior is a result of a neurological abnormality.

However, a dramatic change in sexual behavior, or any other personality trait, should lead a clinician to suspect a structural brain abnormality.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.