Hearing Education

The great Aim of Education is not Knowledge, but Action 

Herbert Spencer

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Your Hearing Health Matters

There is a lot that can be done to prevent hearing loss or reduce the impact. Louise Hugo loves to teach on hearing health matters and has written articles for magazines and newspapers on hearing loss and hearing prevention. She is available for talks at schools or other functions.

Would you like to stay informed about hearing loss causes and prevention?

Hearing Loss and Cancer Treatments.

Physicians are well aware of the many side effects of chemotherapy and radiation treatment. However, only in recent years has research addressed the risk of hearing loss and related conditions (e.g. tinnitus) as reported by numerous post-cancer treatment patients. These studies have revealed a strong link between hearing loss and cancer treatments, especially among certain chemotherapy medications. It is important for both physician and patient to understand the risk of ototoxicity when treating cancer, and its long-term implications, which may include permanent hearing loss.

Ototoxicity and its relationship to cancer treatments.

Certain chemotherapy medications or radiation therapy can cause ototoxicity, which may be manifested as temporary or permanent hearing loss. Ototoxicity resulting in a sensorineural hearing loss (SNHL) refers to drug or chemical damage to the inner ear where cochlear hair cells vibrate in response to sound waves. This damage may affect vital hearing and balance information to the brain, resulting in hearing loss, tinnitus, and/or loss of balance.
Platinum-based chemotherapy medications, particularly cisplatin and carboplatin, are considered the primary “culprits” when it comes to ototoxicity. Other potentially ototoxic chemotherapy drugs include Bleomycin, Vincristine, Vinblastin, Bromocriptine, and Methotrexate Nitrogen mustard.
Chemotherapy from the “platinum” group is frequently used to treat brain, head and neck cancers, as well as lung, bladder and ovarian cancers in adults. It is also commonly used to treat brain, bone and liver cancers in children.

Effects of ototoxicity in adults.

  • Physical effects of hearing loss include balance issues and a greater likelihood of falls over time, especially in older adults. Hearing loss has also been linked to the development of certain forms of dementia and cognitive decline.
  • Psychological fallout, including depression, isolation, anxiety, anger, and poor self-image.
  • Economic impact, which includes the rate of unemployment, difficulty retaining a job or advancing career.

Because of the long-term effects of hearing loss in adult survivors, and the debilitating effects associated with the condition, oncologists will likely do their utmost to mitigate ototoxic exposure during treatment. When aggressive treatment is necessitated, and the patient experiences hearing loss, it is important to consider treatment options such as hearing aids, which can help 95% of patients with hearing loss. As cancer treatments have more success, and cancer patients live longer, hearing loss treatment could improve the patient’s quality of life after cancer treatment.

Effects of ototoxicity in children.

Although limited statistical data is available, researchers believe the number of cancer-surviving children with hearing loss (as a result of ototoxic exposure) is significant. One landmark study of 67 patients age 8 to 23 undergoing chemotherapy found 61 percent developed hearing loss after treatment – most experiencing high-frequency hearing loss (HFHL). HFHL in children primarily affects comprehension, yet children may not realise they are not interpreting speech properly and so the condition goes underreported and undiagnosed. Left untreated, consequences include: 

  • Significant delay in speech and language development
  • Negative impact on cognitive development and educational outcomes
  • Interference with psychosocial development

“And that can lead to development issues. A study that evaluated the educational performance and social-emotional functioning of about 1200 children with minimal hearing loss revealed that 37% failed at least one grade in school compared with the normal 3%. They also had more problems with behavior, energy, stress, and self-esteem.”

Summary.

Hearing loss can be a negative after-effect of certain chemotherapy medications and radiation therapy. While treatment is ongoing, an audiologist can assist with monitoring for ototoxicity and make recommendations for early intervention if possible. As medications improve, more treatment options become available, and survival rates continue to rise, the need for medical professionals to consider the quality of life post-treatment becomes crucial. After treatment is complete, an audiologist should evaluate the patient for ototoxic after-effects and if necessary offer counseling, treatment – which could include hearing aids – and rehabilitation.

Information obtained from Signia Hearing.

Hearing loss and diabetes.

“Hearing loss is about twice as common in adults with Type 2 diabetes compared to those who do not have the disease.”

Researchers have discovered a higher rate of hearing the loss in people with diabetes. Using tests that measure participants’ ability to hear at the low, mid, and high-frequencies in both ears, the results indicated a link between diabetes and hearing loss at all frequencies, with a somewhat stronger association in the high-frequency range. Mild or worse hearing of low- or mid-frequency sounds was about 21 percent in 399 adults with diabetes compared to about nine percent in 4,741 adults without. Mild or greater hearing impairment at high frequencies was 54 percent in those with diabetes compared to 32 percent in those without.

Another significant study examined hearing data from participants in the National Health and Nutrition Examination Survey between 1999 and 2004. Of the more than 5,000 individuals who took part, hearing loss appeared in 15% of those without diabetes and more than 30% in those diagnosed with diabetes. The research team’s report concluded that screening for hearing loss would allow for early medical intervention that could improve hearing for adults with diabetes.

”Diabetics are 2.15 times as likely as people without the disease to have hearing loss…broken down by age, people under 60 had 2.61 times the risk while people over 60 had 1.58 times higher risk.”

Evidence exists that diabetes may lead to sensorineural hearing loss.

Post-mortem studies of diabetic patients have shown evidence diabetes may lead to a sensorineural hearing loss by damaging the nerves and blood vessels of the inner ear due to the pathologic changes that are associated with the condition.

These include:

  • Sclerosis of the internal auditory artery.
  • Thickened capillaries of the stria vascularis.
  • Atrophy of the spiral ganglion.
  • Demyelination of the eighth cranial nerve.

It appears the damage is more common in patients with Type 2 diabetes.

“It is possible that diabetic patients can have a normal or near-normal hearing at the time of the initial identification of diabetes, only to suffer from a progressive form of sensorineural hearing loss.”

Physicians are encouraged to inform their patients about the evident link between hearing loss and diabetes.

Let patients who have not yet been diagnosed with diabetes know that having their hearing tested is important beyond identifying the hearing loss itself – it could be an early indicator of the onset of diabetes or other cardiovascular conditions. Encourage patients to report any suspected or known hearing loss to their primary doctor for the sake of their overall health.

As for patients who have already been diagnosed with diabetes, remind them that hearing loss is a potential complication and encourage them to have their hearing tested annually. The earlier hearing loss is diagnosed, the more effective treatment options, such as hearing aids, are likely to be.

Information obtained from Signia Hearing.

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