Eh? Speak up!

Philip J. Goscienski, M.D.

May 2013

If you have ever found yourself saying "Speak up!" or wondering if you're missing something in conversation, maybe it's time for a hearing test. Hearing loss is usually so subtly progressive that we don't become aware of it until someone else brings it to our attention.

A hearing screening should definitely be done during the newborn period, at school entry and during mid-life, e.g., at about age 50 if there are no risk factors. These screening tests are perhaps among the most cost-effective, especially when they reveal a hearing deficit in early childhood.

About one person in six between the ages of 45 and 65 has some hearing loss and the number rises steadily after that. Several factors that occurred in the past half-century will certainly lead to even greater numbers of hearing aid candidates as our population ages. During the wars in Korea and Viet Nam thousands of military personnel were exposed to ear-damaging noise levels and hearing protection was not always available or even recommended. As big bands gave way to rock and roll, sound levels reached ear-damaging levels. The sponge-covered earphones of the Sony Walkman have been replaced by ear buds, a boon for music fidelity and also to the manufacturers of hearing aids.

Hearing hazards abound in our daily lives. Users of lawnmowers and leaf-blowers, motorcycles and power tools should wear ear protection but they usually don't.

Shooting range rules require hearing protection but outdoor recreational shooters often consider then unnecessary. They are not. Every exposure to excessive noise, even if brief, causes microscopic damage that cumulatively, over years, could diminish hearing.

Medications such as aspirin can cause temporary hearing loss but treatment with certain antibiotics and cancer drugs can lead to permanent damage. Second-hand smoke has been noted to produce hearing loss in adolescents, who rarely notice that their perception of sound has changed.

Although about one third of persons over the age of 65 have some degree of hearing impairment, screening tests are not routinely covered by Medicare. Many primary care physicians can do a preliminary screen in the office and refer patients for covered audiology services if the screen reveals a defect.

There are plenty of jokes about the hearing-impaired elderly but it's not so funny when it interferes with the quality of life or our relationships with loved ones. It's worth 10 minutes and a few dollars to get a lot more out of life.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at