Fly Well

“N-RUDEF, for the third time, descend and maintain three thousand.” Sometimes there’s too much chatter; sometimes traversing the wild blue one simply misses a call. Sometimes it’s something else. I often harp about protecting your health first and dealing with your flying privileges later, but when failure to hear the harp is concerned, the two are intimately entwined. Without hearing well you will not be flying well—if at all—representing a threat to yourself and others. According to the National Institutes of Health, about one-third of folks over age 65 have some hearing loss, rising to 50 percent at 75—after heart disease and arthritis, the most common physical affliction. Given the average pilot is well over age 50, I should not have to shout to get your attention. Or maybe I do.

The sense of hearing is truly miraculous: The ear drum (tympanic membrane) vibrates with sound waves—just like a drum skin. Movements are transmitted via three tiny bones, malleus, incus, and stapes (hammer, anvil, and stirrup), in turn communicating oscillations into the inner ear and the coiled, tubular cochlea, endowed with legions of tiny hairs (cilia). Their movements are sensed by the auditory nerve and sent to the brain, which interprets the sound as “Honey, will you take out the trash?”—which you, of course, cannot hear. Anything affecting one element can impair sound perception. Hearing loss is gradual, so don’t discover this at your flight physical; FAA standards demand the ability to hear a conversational voice six feet behind your back. If you dread noisy restaurants, often ask people to repeat statements, think others mumble, or frequently miss ATC calls, you may have a problem. I recommend checking your hearing regularly, maybe with an online test.

When young, the range of sounds one can detect is impressive, but aging diminishes the frequency range we hear. Although some are born with varying degrees of deafness because of genetic defects or maternal alcohol use, loud noise exposure hastens range reduction. Presbycusis, the $100 word doctors use, describes hearing loss occurring with aging. Attending rock concerts, listening to loud music with headphones, firearm use, and environmental noise take their toll. So does hanging around airplanes. Noise damage is cumulative and is a function of volume, measured in decibels and time. The alphabet-soup groups (OSHA, EPA, et cetera) recommend various noise-exposure tables (jet engine at 100 feet produces 140 dB) but personal responsibility, awareness, and ear protection should be employed liberally whether in your personal life, at the airport, or when airborne. Please also protect your passengers’ and pets’ ears with suitable devices.

One has to define why there is hearing loss and wax build-up is common and eminently treatable. However, the old aphorism rings true: Never put anything smaller than your elbow into your ear. Cotton bud sticks are a health hazard in my opinion. If wax cannot be cleaned by cautious wiping, use an over-the-counter wax-softening product or see a doctor for warm-water syringing. A practice I have seen suggested, ear wax candling, employs a beeswax wick and funnel placed into the ear, which is then lit and the attendant heat and vacuum is supposed to draw out the wax. I never tire of hearing loopy ideas! Other symptoms attending hearing loss include pain (especially if my elbow advice is ignored), tinnitus (ringing in the ears), vertigo, or discharge. Other causes of hearing loss include lodged foreign objects, infections (e.g. measles, mumps, and meningitis), ear drum perforation, various drugs, infections, tumors, and several neurological conditions.

Hearing loss is usually from damage to the bones and eardrum, the conductive mechanism described previously, or sensineural loss when nerves interpreting mechanical movements in the ear are afflicted because of issues with the cochlea, nerve, or brain. Loss of volume, audible frequency range, and speech clarity all affect the patient. If only one ear is affected, the ability to detect sound location is compromised.

If you suspect diminished hearing, see your doctor promptly—an evaluation, including a peek in your ear—will exclude other causes, followed by a hearing test with an audiologist. If you do have age- or noise-related loss, this can be managed with a hearing aid; there are many different models available today. It is important to choose carefully, ensure a good fit, and persevere because adjustment takes time. Some states allow an evaluation period, and some insurances cover hearing services.

This is a good time to use Internet assets to make sound purchasing decisions. One alternative is surgical implantation of a device to treat profound loss; initially reserved for children born with hearing loss before the acquisition of language, these phenomenal devices are now finding a wider audience.

If a pilot requires an aid, the aviation medical examiner may issue a medical limitation statement, “Must wear hearing amplification.” Current guidance on implants is awaited, but AOPA and your AME can probably help, and pulling together surgical and hospital records will be useful. So listen to the doctor and protect your ears, because none of us tires of hearing “cleared for the option.”

Dr. Jonathan M. Sackier is a private pilot and practicing surgeon. Email the author at [email protected].