Understanding the Journey: Navigating the Stages of Hearing Loss

If you or a loved one have hearing loss, you are probably used to hearing words like ‘I lost 40% hearing in my right ear’ or ‘my doctor told me I have a mild hearing loss’ or (our personal pet peeve) ‘they said my hearing is normal for my age’. Frankly—each of these is wrong. No member of the Excellence In Audiology™ hearing healthcare network will use any of these terms when describing hearing loss to a patient. And just to clarify—there is no such thing as ‘age-adjusted hearing loss’— you either have hearing loss or you don’t. There is no ‘sliding scale’ because of your age and there is no such thing as ‘normal hearing loss’—that is an oxymoron.

Understanding your diagnosis is the first step in any successful treatment plan. Using terms like ‘mild’ or ‘moderate’ do not have much meaning. Additionally, making incorrect statements like ‘40% loss’ does not help anybody and are inaccurate—until you are dead, and somebody goes poking around your ears and brain, a percentage should not be assigned to a hearing loss.

Like nearly all major medical conditions, a hearing loss diagnosis must be ‘staged’ to be best understood and to lay out realistic expectations and prognosis for treatment.

Stage 1

Early-stage hearing loss (15-40 decibels of loss) with some impact on cognitive function.

Patients with Stage 1 hearing loss are caught at the earliest phase of the disorder: thus, having the greatest prognosis for treatment. At this early stage, hearing loss may be beginning to show early signs of impacting cognitive function with some impacts on memory recall and name finding.

Although many people living with this hearing loss may consider it ‘just a nuisance’, it is important to understand that hearing loss is a progressive degenerative disorder that can significantly increase your risk of dementia, falling, and a host of other comorbid disorders.

Even at this earliest stage, these test results indicate marked damage to the nerves that connect the ear to the brain—which can have a host of downstream impacts, including tinnitus, difficulty following a conversation, and implication for memory loss and forgetfulness. Patient symptoms often include noticeable tinnitus (heard in the ears and/or head), subtle difficulty with details of speech (missing the beginning or end of what others are saying), some loss of environmental auditory awareness (i.e., difficulty hearing knocking at the door, the refrigerator, alarm, etc.). In addition, the person will notice conversation is becoming more difficult to follow in background noise (and when watching TV). Patients with Stage 1 hearing loss must be applauded for not waiting and catching this destructive disorder early—before it can fully infiltrate and wreak havoc on the brain.

Stage 1 hearing loss is correlated with a near 200% increased risk of developing cognitive decline and dementia. While that may be a shock to you, what is most important is to understand that research indicates that the early treatment of hearing loss can dramatically reduce that increased risk of dementia (and slow the progression of the disorder). Also, Stage 1 hearing loss significantly increases the risk of falling by 140% (the #1 cause of hospitalizations in older adults). However, with treatment and access to the entire auditory environment, this risk of falling decreases significantly.

Stage 2

Mid stage / signiﬁcant hearing loss (40-70 decibel of loss) with noted impact on cognitive function.

Patients with Stage 2 hearing loss have most likely waited anywhere from 3-6 years before reporting their symptoms and deciding to act. Fortunately, for most patients with Stage 2, the prognosis for treatment remains high. Although there is notable damage to the neural connections from the ear to the brain, there remains enough treatable hearing to provide proper cognitive stimulation and overcome deficits in clarity, tinnitus, and auditory deprivation.

Patients with Stage 2 hearing loss often report the following host of symptoms: annoying tinnitus (sound heard in the ears and/or head), difficulty hearing others (missing when somebody is speaking to you), lack of ability to hear environmental auditory cues (difficulty hearing when people are walking towards you, safety alarms in the home, a grandchild crying from the other room). With this stage of hearing loss, it is a significant struggle to follow a conversation when with a group of more than 2 and in restaurants.

With Stage 2 hearing loss, the goal is to provide maximum neurocognitive stimulation, which the brain needs to run on all cylinders. In fact, living with untreated hearing loss is like driving 60 mph in second gear—which, over time will wear down the system and cause significant damage. The treatment of hearing loss can dramatically improve cognitive function—this has been shown in numerous studies and it is certainly something our patients have to look forward to!

Stage 2 hearing loss is correlated with a near 300% increased risk of developing cognitive decline and dementia. Again, what is most important is to focus on the positive—which is that research indicates that the early treatment of hearing loss can reduce that increased risk of dementia (and slow the progression of the disorder). Also, Stage 2 hearing loss significantly increases the risk of falling (the #1 cause of injury-related death in older adults). However, with treatment and access to the entire auditory environment, the risk of falling can decrease dramatically.

Stage 3

Mid-late stage / severe hearing loss (70-90 decibels of loss) with signiﬁcant impact on cognitive function.

Patients with Stage 3 hearing loss often wait an average of 7-10 years before reporting their symptoms and seeking treatment.

While prognosis is still positive and a successful treatment plan is anticipated, hearing loss at this stage can begin to show a significant impact on cognitive function. At this stage, there is marked damage to the neural connections from ear to brain— which expand beyond the auditory centers and reach deep into the memory, sensory and emotional portions of the brain.

As a result of the neural damage, the patient will experience a myriad of symptoms, including bothersome tinnitus (sounds in the ears and/or head that interfere with hearing, sleep, etc.,), inability to hear what others are saying (even in a quiet environment), lack of ability to hear important environmental auditory sounds (i.e., difficulty hearing the phone, smoke / CO2 alarms). At Stage 3 hearing loss, most patients will begin to avoid social gatherings and isolate themselves as they will not be able to converse and interact in a restaurant or any social setting with 2 or more people.

The auditory stimulation provided at this stage will focus on the areas with the most damage, as well as the portions of the brain that remain most active for hearing. Although individual prognoses may vary, outcomes will be positive and provide access to conversation, even in noisy situations.

Stage 3 hearing loss is correlated with an approximate 400% increased risk of developing cognitive decline and dementia. Although this may seem like a ‘late stage’, all research indicates positive outcomes that can work to reduce the risk of cognitive decline and dementia (and potentially slow the progression of the disorder). Also, Stage 3 hearing loss dramatically increases the risk of falling. However, even at this stage, with treatment and access to the entire auditory environment, the risk of falling can decrease.

Stage 4

Late stage / profound hearing loss (90+decibels of loss) with substantial impact on cognitive function.

Patients with the most advanced stage of hearing loss will benefit from treatment. Period. Despite the significant neural and cognitive damage.

With many medical conditions, ‘Stage 4’ is often thought of as the ‘untreatable’ stage; this does not apply to hearing loss. At Stage 4, there is significant damage to nearly the entire hearing structure and the nerves that connect the ear to the brain. Fortunately, it is less often that we see a ‘first-timer’ patient who presents with Stage 4 on day one.

When left untreated this hearing loss is truly disabling to the person and their family. At this point in the disorder, patients will experience symptoms that alter everyday life, including constant interfering tinnitus (sounds in the ears and/or head that make hearing, sleeping, etc. difficult) inability to hold a conversation with loved ones, lack of ability to hear life-threatening environmental sounds (i.e., inability to hear smoke / CO2 alarms, emergency vehicles). Left untreated, patients with Stage 4 hearing loss will avoid social gatherings and isolate themselves as they are unable to interact with others.

Stage 4 hearing loss is correlated with a near 500% increased risk of developing cognitive decline and dementia. Although it may seem that all hope is lost at this stage, there are tremendous advances in recent technology that can help with the most profound degree of hearing loss to hear well again. All research indicates positive benefits of treatment that may reduce the risk of cognitive decline and dementia (and potentially slow the progression of the disorder). Also, Stage 4 hearing loss severely increases the risk of falling. However, even at this stage, with treatment and access to the auditory environment, the risk of falling can be decreased.

Always be sure that you understand your diagnosis and prognosis before moving forward with your recommended treatment plan.