Exostoses, Hearing Aids, and Brain Training
This case report discusses the importance of periodic audiological examination in the presence of stable hearing loss, decreasing signal to noise ratio (SNR) ability, and age-related cognitive decline.
EW is an 86-year-old male who presented in the clinic more than a decade ago for a diagnostic audiological examination. The patient had a long history of noise exposure while serving in the military as a Navy pilot. His medical history was negative for familial adult-onset hearing loss or any medical issue that could contribute to the hearing loss. There was no history of medications (prescribed or over-the-counter) that may have contributed to the hearing loss. At 74 years of age, the patient reported slight hearing difficulties in daily listening situations: hearing his wife, some social situations, and listening to the television. He also reported being an avid swimmer in his youth and upon otoscopic examination exostoses were identified bilaterally in his ear canals. The exostoses in the right ear were greater in size and number than noted in the left ear. Exostoses are a reactive tissue process borne of long-term exposure to cold water or cold air. They are excessive growth of the tympanic bone; typically seen in multiples, in both ear canals and are benign. Patients are generally asymptomatic unless the growths become large enough to block the ear canal and cause hearing loss or recurrent infection. In addition to the identification of the exostoses in the ear canals, EW was diagnosed with bilateral mild to moderate hearing loss and amplification options were discussed. Initially, EW chose not to treat the hearing loss, and there was no recommended treatment for the exostoses. Periodic audiological testing, approximately every 2 years, indicated a fairly stable hearing loss (air conduction thresholds) in each ear. The patient eventually tried one custom-made hearing aid, which he wore for nearly 6 years with reported success. Eventually speech-in-noise testing was added to the periodic evaluations. Although the patient performed within normal limits initially, his speech-in-noise ability began to deteriorate. Binaural hearing aids were eventually used, and the patient began at-home brain-training exercises to help, primarily, with his memory skills. The complementary effects of consistent binaural hearing aid usage and cognitive training resulted in a positive outcome for the patient in terms of improved auditory function and processing.