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What is hearing loss?
Hearing loss can be a sudden or gradual decrease in how well you can hear. Depending on the cause, it can be mild to severe, temporary or permanent. 

Gradual hearing loss: 
Can affect people of all ages.
• Is the third most common long-term health problem in older Americans.
• Affects up to 40 out of 100 people age 65 and older.
• Affects up to 80 out of 100 people older than 85.

If you have hearing loss, you may not be aware of it, especially if it has happened over time. Your family members or friends may notice that you're having trouble understanding what others are saying. 

There are ways you can deal with hearing loss. And hearing instruments and other devices can help you hear.

What causes hearing loss?
In adults, the most common causes of hearing loss are:
• Noise. Noise-induced hearing loss can occur suddenly or happen slowly over time. Being exposed to everyday noises, such as listening to very loud music or using a lawn mower, can lead to hearing loss over many years. 
• Age. In age-related hearing loss, changes in the inner ear that happen as you get older cause a slow but steady hearing loss. The loss may be mild to severe, and it is always permanent.
Other causes of hearing loss include earwax buildup, an object in the ear, injury to the ear or head, ear infection, a ruptured eardrum, and other conditions that affect the middle or inner ear.

What are the symptoms?
Common symptoms of hearing loss include:
• Muffled hearing and a feeling that your ear is plugged. 
• Trouble understanding what people are saying, especially when other people are talking or when there is background noise, such as a radio.
• Listening to the TV or radio at a higher volume than in the past. 
• Avoiding talking with or being around other people.
• Depression. Many adults may become depressed because of how hearing loss affects their social lives. 

Other symptoms may include: 
• A ringing, roaring, hissing, or buzzing in the ear, called tinnitus.
• Ear pain, itching, irritation, or fluid leaking from the ear. 
• A feeling that you or your surroundings are spinning (vertigo).

How is hearing loss diagnosed?
Hearing loss is diagnosed using diagnostic audiometers to evaluate both the intensity and frequency of sounds while the patient is seated in a sound booth. The person being tested (baby, child, or adult) is placed in a special, soundproof room. The audiologist may be visible through the window.

The person being tested sits in the booth wearing either headphones, hearing instruments/implants, or nothing over their ears at all. The audiologist asks them to signal when they can hear a sound. This signaling is usually done by raising the hand or pressing a button on a hand-held signaler.

The audiologist plays recorded frequencies or sound tones at different volumes or levels, testing each ear separately or both ears at the same time. The sounds are made louder or softer until a response occurs. (Of course, if there is no response, it means the sound is not heard).

Also as part of the testing, the audiologist will often do a test to check the ear drums tympanogram, and a bone conduction test.

Sounds are emitted through the headphones for the patient to detect. The sounds are high- and low- pitched "squeal-like" sounds. The sounds used are specified by organizations such as the International Organization for Standardization. In addition, audiometric testing is always done at frequencies of 125 Hz to 8000 Hz. The audiometric testing booths themselves may comply with the standards set by the "American National Standards Institute, which specifies the maximum permissible ambient noise levels allowed in an audiometric test room. 

The part of the hearing test that people with hearing loss readily identify with is the spondee speech recognition test. In this part of the test, your audiologist covers his or her mouth so you can not see by lipreading. Your audiologist then says words from a selected list. These two-syllable words have been selected for their vowel sounds, which are either two long syllables or two stressed syllables. The words are usually "ice cream, baseball, cowboy, hotdog, airplane, playground," etc. The person being tested tells the audiologist what they think the word sounded like. 

After a hearing test is done, the person has an audiogram. An audiogram shows what level a sound must be at in order to be heard. An audiogram is set up as a chart with the horizontal X axis representing frequencies, or Hertz (Hz). The X axis is divided into two parts: On the left side of the "divide" are the low frequencies. On the right side of the "divide" are the high frequencies. 

The vertical Y axis represents decibels. Decibels represent the hearing level, or how loud it is. The number of decibels are lower at the top of the chart, and get higher as you go downward. It is divided into three parts: The top part of the chart is the softer sounds, the middle part is the moderate sounds, and the bottom part is the louder sounds. 

The audiologist tests your hearing at a range of frequencies. The audiologist is checking to see what the softest sound you can hear at each frequency is. For example, at 125 Hz you may be able to only hear the sound at 10 decibels. 

A completed audiogram will have X's and O's on it. Each X stands for your left ear. Each O stands for your right ear. Look at the audiogram to see where the X's and O's line up with the decibel axis. 

• Normal-hearing people will have X's and O's that don't go above 20 decibels.
• People with a mild hearing loss will have X's and O's in the 20 to 40 decibel range.
• A moderate loss is 40 to 60 decibels.
• Severe hearing loss falls in the 60 to 80 decibel range.
• A profound hearing loss is anything greater than 80 decibels.

Can you prevent hearing loss?
You can prevent noise-related hearing loss by:
• Avoiding loud noise, such as noise from machines at your work, power tools, very loud music, and very loud motorcycles. 
• Wearing hearing protection, such as earplugs or earmuffs. 

Is hearing loss hereditary?
Some forms of hearing loss can be inherited. Not all inherited forms of hearing loss take place at birth, however. Some forms can show up later in life. Approximately 60 percent of hearing loss( HL) is estimated to be due to mutation in genes. This is further broken down into syndromic hearing loss, estimated at about 30 percent of genetic HL , and nonsyndromic HL , comprising about 70 percent of hereditary hearing loss.

At least 400 syndromes have been described with HL, with the more prevalent ones being Usher syndrome and Waardenburg syndrome. Many more genes responsible for HL remain to be found. New techniques, including the revolutionary "deep sequencing", where we can sequence the entire genome of an individual in one sitting, is paving the path for more discoveries. The mystery of genetics of HS may soon be solved, heralding the path for deeper understanding of the causes of hearing impairment.
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