One in eight people in the United States over age 12 has hearing loss in both ears, according to the National Institute on Deafness and other Communication Disorders, and many younger people are now experiencing problems.

At the same time, only one in five who would benefit from a hearing aid actually uses one. And people with hearing loss wait an average of seven years before seeking help, according to the Hearing Loss Association of America.

“Individuals of all ages could benefit from testing, hearing aids, medication, and other treatments,” says Bess Nagler, AuD, CCC-A, clinical manager of audiology at the Center for Hearing and Balance at Mount Sinai. “Often it is a family member who encourages the person with hearing loss to finally come in for an evaluation.”

Bess Nagler, AuD, CCC-A

The number of people who have difficulty hearing is expected to rise dramatically in the coming decades. Age-related hearing loss usually begins around age 60. However, Dr. Nagler notes that many patients seeking evaluations are in their 40s and 50s.

“We are seeing a younger demographic coming into the office for a hearing exam. The emphasis today on sound quality with respect to music and Bluetooth streaming has underscored this trend,” explains Dr. Nagler. “At Mount Sinai Doctors Faculty Practice, we are also seeing an increased awareness about the importance of testing.”

Types of Hearing Loss

Complications with the physical structure of the ear, the nerves, or the connection between the inner ear and the brain are often the genesis of hearing loss. The three categories are:

• Conductive hearing loss occurs when a problem in the outer or middle ear prevents sound from reaching the inner ear. Some causes include ear wax, middle ear fluid from a cold or allergies, acute or chronic ear infection, foreign body, or a perforation in the eardrum. Medication or surgery can often help this type of hearing loss.
• Sensorineural hearing loss occurs due to a problem with the inner ear or the nerve pathway to the brain. Inner ear hair cell damage that occurs as we age is the most common cause. Some other causes include genetic conditions, loud noise exposure, ototoxic medications, tumor on the acoustic nerve, or illnesses. Hearing aids can often help this type of hearing loss.
• Mixed hearing loss is a combination of both conductive and sensorineural hearing loss.

A common pattern of hearing loss is hearing in the normal range in the lower frequencies, but fading out to a more significant hearing loss in the higher frequencies. “In these cases, you can hear people talking but are unable distinguish every sound or word,” says Dr. Nagler. For example, high frequency sounds include consonants such as the s, f, th, and k. These sounds give speech clarity. When you miss these sounds, you need to rely on context or lip-reading (difficult with a mask!) to fill in what is being said, which can be exhausting over time, and difficult when people are wearing a mask. “Individuals often withdraw from the conversation completely, which can be very frustrating for them and their families,” Dr. Nagler says

How Hearing is Evaluated

Having your hearing tested is simple. First, the audiologist will look inside the ears to see if there is wax, fluid, or infection. Then, an objective middle ear function test is performed, measuring energy transmission through the middle ear. Finally, the audiologist will ask you to identify a variety of sounds and pitches in both ears. You will also be asked to repeat a series of words to evaluate what is known as your speech perception. The results are then reviewed and, when needed, referrals are made to an ear, nose, and throat physician.

Ten Signs You Need a Hearing Test

1. You ask people to repeat themselves. Conversations feel like a struggle—both in person and on the phone.
2. You hear ringing in your ears. Known as tinnitus, these noises are described as a buzzing, roaring, clicking, or hissing in one or both ears. The sensation may come and go or occur all the time. You may also have episodes of dizziness or vertigo.
3. The volume is constantly turned up. You need to crank the TV to be able to hear dialogue or music comfortably, or you rely heavily on subtitles. Family and friends tell you the volume is “too loud.”
4. It sounds like everyone around you is mumbling. You are always telling people to speak more clearly. This is more noticeable in individuals with high-pitched voices.
5. Understanding speech in background noise is more difficult. Filtering out external sounds in a busy environment like a restaurant or a party is challenging.
6. You have trouble following multiple voices. While in a meeting or at the dinner table, it is difficult to differentiate who is talking and when. You frequently need to ask the people around you to take turns speaking.
7. You leave social situations feeling exhausted. You are straining just to hear. You feel fatigued and need to exert extra effort to hear at public events. Your body feels strained and your neck or back may feel tight from twisting and tensing.
8. Everyday sounds are missed. You do not hear the doorbell, alarm clock, or phone ringing. Your loved ones express concerns about safely carrying out everyday tasks.
9. You feel isolated or depressed. A strain has developed on your relationships with family and friends. You feel as though they are frustrated with you. It feels easier to avoid social gatherings or situations where there is a lot of noise.
10. Family members keep telling you that you need a hearing test. Many people with hearing loss do not realize they are missing out on sounds or conversation. The people who live with you or interact with you every day are your best resource. Listen to their advice.

Advancements in Hearing Aids

More than 28 million adults in the U.S. could benefit from hearing aids. However, less than one in three adults, age 70 or older, wear them. There is still a misconception that hearing aids are bulky, squeaky, and cause sound to be distorted. However, hearing aid technology has improved dramatically over the past two decades and continues to advance every year.

A wide variety of hearing aid styles, ranging from invisible to larger behind-the-ear devices, are available today. Most hearing aids are capable of connecting to Bluetooth, have rechargeable batteries, and can work in tandem with each other to provide the best sound in any given environment. Many have different settings that you can control with a smartphone. For example, if you are in a noisy restaurant, you can choose a program that suppresses background noise.

“Hearing aids can dramatically improve the quality of life for people with hearing loss,” says Dr. Nagler. “It is worthwhile to get a baseline exam, especially if you or your loved ones are noticing any hearing difficulty in your daily life.”

To make an appointment with Dr. Nagler, call 212-241-9410 or email ENTpatientservices@mountsinai.org.

Visual impairment is a common condition that affects more than 12 million adults over age 40 in the United States. But low vision—a condition that affects one in six adults throughout the nation—is different. People with low vision have reduced visual acuity (the common clinical measure of eye function) that cannot be corrected by standard glasses, contacts, medication, or surgery.

Leannza Tang, OD, an optometrist and Director of Low Vision Services at New York Eye and Ear Infirmary of Mount Sinai, explains low vision rehabilitation and what patients can do to seek care.

What causes low vision? What are the symptoms?

Low vision can be caused by many different eye conditions. Some of the more common include glaucoma, macular degeneration, and diabetic retinopathy, but there are other  conditions that can lead to vision loss as well.

The most common symptom is blurry vision that cannot be corrected or improved with standard eyeglasses, contact lenses, or eye surgeries. This usually translates to difficulty seeing small print. Patients may have difficulty reading a book; seeing a sign from a distance that they used to be able to; or even watching television.

Some people have distorted or missing spots in their central vision. This might make seeing people’s faces a lot more difficult. Other times, patients report side vision loss, which is what we typically see in glaucoma patients. When someone has severe side vision loss, this can affect their mobility.  Walking around as well as navigating stairs and curbs can be very difficult. These patients are prone to bump or trip over things.

Leannza Tang, OD

Are all low vision patients considered legally blind?

This is a common misconception about low vision patients that may not be true. Legal blindness is defined as someone with a visual acuity of 20/200 or poorer and/or has a visual field of no more than 20 degrees in their better seeing eye. Therefore, not all low vision patients are considered legally blind.

Eye care providers can clarify if you meet the criteria for legal blindness during your eye exam.

What is the difference between a low vision exam and a routine eye exam?

My low vision exams can be very different from a routine eye exam. One of the first things I tell patients is that I’m focused more on how they’re functioning day-to-day. Typically, the results of different scans, side vision tests, eye pressure tests, and dilations are all being managed by their ophthalmologist or optometrist so therefore, it is still very important to follow up with them as instructed.

I am interested in finding out what the patient’s goals or complaints are in relation to their vision. Are they having difficulty reading small print? Are the issues apparent when looking at price and medication labels or when reading a book and watching television? Do they have problems seeing street signs or bus numbers? The list goes on. I typically meet with patients for about one hour in which we discuss how to manage the condition and what devices might make navigating day-to-day life easier.

How do I manage low vision? Will the condition get worse?

I recommend seeing a low vision specialist. Many people think that you need to wait until you have severe vision loss before seeing a specialist but that is not true. Low vision physicians see a range of patients, from profound to more mild vision loss.

Low vision specialists can discuss any additional services that may benefit a patient. This includes orientation and mobility training for those who are having difficulty walking around or traveling independently because of their vision loss. There is training for household tasks like cooking, doing laundry, housework, and so on. There is also training to more efficiently use your personal devices including computers, smartphones, and laptops. If patients already have these devices, a specialist can teach them how to use built in accessibility and other features that might benefit them.

I also show low vision devices to see if they’re suitable to help a patient with their day-to-day tasks. This includes:

• A hand magnifier is probably the most common and familiar low vision device. Hand magnifiers make text bigger and are mostly for spot reading tasks like reading price labels or medication labels. Stand magnifiers are best for if you want to sit down and read a book for an extended period of time. To use it, you slide the device over your reading material while sitting at a desk or table. They come in different magnification powers, so I recommend a low vision evaluation to make sure that you are using the most appropriate device and power.
• Digital magnifiers operate very similar to stand magnifiers. These magnifiers allow you to adjust how big you want the words to appear as well as the color of the text for ease of viewing and reading.
• If patients are having issues seeing objects at a distance, like bus numbers or street signs, we can prescribe telescopes. We can do in-office training so that patients are able to use the device efficiently and comfortably.

It is very difficult to say whether someone’s vision will or will not get worse over time. It really depends on the person’s underlying condition that is causing their low vision. I will stress that it is important to follow up with the provider who is managing your eye condition and continue to take your prescribed medications and eye drops as instructed.

What resources are available for people with low vision?

Dealing with vision loss, whether sudden or gradual, can be very difficult. Some patients express feelings of sadness, frustration or anxiousness. A referral for behavioral health resources can be made to ensure a patient has the support they need.

Mount Sinai has excellent low vision resources. To learn more about low vision services at New York Eye and Ear Infirmary of Mount Sinai, please speak to your eye care provider or visit our website.