Hearing Aids for Cognitive Decline

One of the most common reversible causes of hearing loss is a buildup of earwax. Earwax is entirely normal, and if it doesn’t cause symptoms, it should be left alone. It only starts to interfere with hearing acuity once it blocks at least 80 percent of the ear canal. Ironically, hearing aids—like anything else you stick in your ear, such as in-ear headphones—are a risk factor for more earwax because they stimulate the earwax glands. And something else ironic: so do cotton swabs, which two thirds of all people use to clean their ears. You think you’re improving something, but the exact opposite can happen. Even just removing the protective wax layer can make the ear canal dry out, itch, and hurt, and you can develop “cotton swab otalgia,” a term the Journal of the American Medical Association coined for ear pain caused by cotton swabs. You shouldn’t have to clean your ear canals at all, because the earwax should come out on its own.

Ears are self-cleaning. The wall of the ear canal runs from the eardrum outward, so earwax and any trapped dirt should eventually be conveyed outward as if on a conveyor belt. However, this self-cleaning mechanism can fail in one out of every 20 younger adults and in one out of every three older adults, resulting in excessive earwax accumulation or plug formation without those affected always noticing. 70 percent of respondents whose both ears were completely blocked believed they could hear well, but when their ears were cleaned, they suddenly heard better. Removing wax plugs can also relieve irritation and pressure symptoms, but what is the best way to do it?

Not with cotton swabs under any circumstances. If you stick anything into the ear canal, you may make everything worse, because you can push the wax even further in or injure the ear canal, leading to abrasions, infections, and in rare cases perforation of the eardrum. There is even a case report in which a cotton swab caused a brain abscess and fatal meningitis, though wood splinters suggested the swab had broken off in the ear. The packaging already warns against inserting cotton swabs into the ear canal, but perhaps it should be clearer, in the words of one doctor: “Do not use in the ear opening—better yet, do not use in the ear at all.”

Aren’t there drops that remove earwax? There are dozens on the market, but no agent is better than another, and they don’t work any better than saltwater or plain tap water. But in one out of five cases (22 percent), the earwax disappears after five days of treatment; if you do nothing at all, ears clean themselves over that period in only 5 percent of cases. At least drops can soften the earwax before it is flushed out with a bulb syringe.

In this procedure, the earwax is flushed out with a gentle stream of warm water (body temperature). This works in 70 to 90 percent of cases, and if it doesn’t, doctors have sophisticated devices that can be used to remove earwax manually under direct visualization. You can also try flushing at home. 50 percent of subjects randomized to conveniently use a bulb syringe at home managed to unclog their ears, and equipped with this skill, it was significantly less likely that they would still need to go to a clinic to have them flushed. Serious complications occur in only about one out of every 1000 at-home flushings.

Do not use an oral irrigator. There are scientific papers that describe such attempts and their catastrophic consequences in dramatic terms. Experiments on fresh cadavers showed that even one third of the pressure can perforate the eardrum. Anyone who insists on using an oral irrigator despite this prohibition should at least set it to the lowest level, use a tip with as many openings as possible, and aim the water stream only at the wall of the ear canal, never directly at the eardrum, but I still strongly warn against it.

And ear candles?

Ear candles (or ear cones) are promoted as an inexpensive and effective treatment for earwax, but as I document in see.nf/candling, a series of experiments showed that they not only do no good, but make everything worse and can even seriously injure you.

Hearing Loss Is Not Inevitable

Earwax is one thing, but can age-related hearing loss somehow be prevented? It is considered a natural part of the aging process, but we used to think that about diseases like high blood pressure as well. A large majority of people develop high blood pressure at some point, just as a large majority eventually hear worse, so that must be inevitable when you get old, right?

Then it turned out there were rural populations in Africa, Asia, and the Amazon who ate and lived more healthfully and in whom this unstoppable rise in blood pressure with age did not occur. So high blood pressure was more related to lifestyle and perhaps not an attribute of aging at all—and the same could be true for hearing loss.

Members of the Mabaan tribe in the Sudanese bush retain their hearing well into old age. Another study of the isolated population group on Easter Island found that contact with a modern environment undermines this advantage. What is it about our civilization that is responsible for our losing our hearing as we age?

Age-related hearing loss occurs when the sensory hair cells in the inner ear, which convert vibrations into electrical signals and transmit them to the brain, die prematurely. Once they’re dead, no others grow back, which is why prevention is crucial. And what kills them? A study of more than 2000 twin pairs found that age-related hearing loss is only 25 percent hereditary, so most risks are not genetic.

Risk factors include smoking, ototoxic medications, and repeated noise exposure. The earlier in life you’re exposed to noise, the more at risk the inner ear is in old age. Animal experiments suggest that even low but constant noise above 60 decibels is harmful. This hasn’t been tested in humans, but if you use white noise as a sleep aid, it can’t hurt to turn it down to under 50 decibels. Aminoglycoside antibiotics such as streptomycin, amikacin, neomycin, and kanamycin are among the medications with the highest risk of a toxic effect on the sensory hair cells, but loop diuretics (for example furosemide, marketed as Lasix) and nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen are also associated with progressive hearing loss. The key to preserving hearing among older members of the Mabaan tribe may lie in their diet, however.

How about cell phone radiation?

Your inner ear may be most frequently and most directly exposed to cell phone radiation. Does that have a negative effect on hearing? Long-term cell phone users are measurably, but not noticeably, harder of hearing compared to nonusers. This impairment was measured in both ears, which points more toward an effect of the radiation than toward constant noise exposure in one ear. I discuss all the studies in see.nf/phones, but in short, researchers found nothing in their subjects after half an hour of cell phone use, whereas an hour impaired the hearing threshold for certain frequencies. Bluetooth was more innocuous, probably because it emits only one thousandth as strongly.