How Did We Get Here

a very brief overview of hearing

George A. Gates, M.D.

Medical Director
Hearing Health Foundation
 HEARING LOSS
Overview
3rd most common disability (10%)
Age-related hearing loss (presbycusis)
affects 36 M in U.S. Increases with age
Aging, noise toxicity, drugs, genetics
are major factors; smoking, vascular
disease, diabetes also decrease hearing.
Affects everyone who lives long
enough to some degree.
 HEARING LOSS
Hearing vs. Vision
Hearing loss separates you from people;
vision loss separates you from things.
(Helen Keller)
Social stigma: HL associated with aging
and decreased ability.
NIH research budget for vision is 6x
greater than for hearing! HRP relies on
benevolence and generosity
 AUDITORY SYSTEM
Overview
Complex system: the ear listens,
the brain hears
Four parts:
Outer ear gathers sound
Middle ear conducts sound
Inner ear (cochlea) transforms sound
Central pathways interpret sounds
 HEARING MEASURS

The loudness (intensity) of sound is

noted on the decibel scale (dB)
The pitch of sound is described in
cycles/second or Hertz (Hz). 4,000 Hz
is the top note on a piano
The audiogram plots hearing threshold
in dB vs. Hz
http://www.pacificaudiology.com
 CLINICAL AUDIOGRAM

-20

0
dB HL re ANSI 1969

20
Mild
40

60 Moderate

80 Severe

Audiometric 0
100
Profound Mild Strial Presbycusis
Severe Strial Presbycusis
120
250 500 1000 2000 4000 8000
Hz
 AUDITORY SYSTEM
Inner Ear (cochlea)
Outer hair cells are tiny muscles that
amplify soft sound waves
Inner hair cells detect the wave motion
and convert their energy into nerve
impulses
Auditory nerve transmits impulses to
brain
 IHC

Outer
Hair
Cells
Tip Links - Jim Pickles
 Median Thresholds by Decade
Men, No Notch Women, No Notch
0
80 60 40 20

40s 40s
50s 50s
60s 60s
70s 70s
100

80s 80s

Men, 3-6k Notch Women, 3-6k Notch

0
80 60 40 20

40s 40s
50s 50s
60s 60s
70s 70s
100

80s 80s

250 500 1000 2000 4000 8000 250 500 1000 2000 4000 8000
Hz
Graphs by sex and notch
 AUDITORY SYSTEM
Central Auditory Function
Primary and secondary auditory cortex
for perception and meaning
Brain processing of sounds decrease
with age and cognitive disorders
Difficulty hearing in noise is the
hallmark of this problem
Hearing affected before cognitive loss
Auditory
association areas
 AUDITORY SYSTEM
Reprise
The ear listens, the brain hears
Loss of hair cells is the key cause of
hearing loss
Current research is aimed at regrowing
or restoring missing cells in the ear
More scientists working in this area
than ever before.