Ask the Doctors: Hearing tests should be part of regular checkups

Dear Doctors: My wife’s insurance company is suggesting that she get a hearing test. She is only 51, and her hearing is fine. Does she really need to get this screening? 

A. Although hearing loss is often associated with growing older, it can begin at any age. In some cases, it begins as early as the 30s and 40s, and it increases over time. 

Hearing loss, which can occur in the outer, middle or inner ear, falls into a few major categories. In conductive hearing loss, sound is unable to move from the outer or middle ear into the inner ear. This can often be repaired medically. Sensorineural hearing loss refers to damage to the nerves involved in hearing. This type of hearing loss is irreversible. Some people have a combination of the two. This is known as mixed hearing loss. Age-related hearing loss is associated with physical changes to the hearing apparatus that occur as we grow older. 

Additional causes of hearing loss can include injury, high fever, diabetes, viral infections such as measles or mumps, stroke, certain medications, repeated exposure to loud noise and heredity. An obstruction, such as a buildup of wax in the outer ear or fluid in the middle ear, can also diminish hearing.

It is recommended that young adults have a hearing test when they reach their mid-20s. The results provide a baseline against which future tests can be measured. Once someone reaches their 50s, it’s a good idea for an annual hearing test to become part of their preventive care. You can arrange this via your health care provider or seek out an audiologist. 

The most common form of hearing test, known as a sound test, checks someone’s response to a range of sounds, tones, pitches, volumes and spoken words. Another type of test, known as a tympanometry test, evaluates the movement of the eardrum. This is used to check for infection, the buildup of wax or fluid, and for damage, such as a hole or tear, to the eardrum.

The initial indications of age-related hearing loss, which affects about one-third of older adults, can be subtle. Speech becomes a bit difficult to understand, particularly when there is background noise. This leads to the need for repetition. Softer and higher voices become harder difficult to hear. Words that include high-pitched “s” and “th” sounds seem muffled. Some people with age-related hearing loss begin to develop the ringing sound of tinnitus. The volume settings on electronic devices can be a useful gauge in the onset of hearing loss. If you find yourself consistently turning up the volume, it can be an indicator that something is amiss.

A decrease in hearing can separate someone from the world around them. It can make it more difficult to communicate, to process information and to participate in group activities. Diminished hearing has also been linked to an increased risk of cognitive decline. Even if your wife’s hearing is perfectly fine, it’s a good idea for her to have a hearing test to set a baseline for the future.

Dr. Eve Glazier and Dr. Elizabeth Ko are UCLA Health internists.