My father was very hard of hearing in his old age. In addition to the hearing loss, he had a difficult time recognizing where sounds were coming from, and he had trouble distinguishing television sounds from real-life sounds. (For example, if there was a phone ringing on a TV show, he would think it was our phone ringing.) I'm 48 and have no hearing loss but recently have developed those other two symptoms. Are those early signs of hearing loss? Is hearing loss hereditary, and can I do anything to preserve my hearing?

M.

Yes, these are early signs of hearing loss. Both symptoms suggest an inability to localize sound; this, in turn, suggests that you may have a different degree of hearing loss between your left and right ear. Only a hearing test (audiogram) can demonstrate the type and degree of your hearing loss. I recommend that you see a licensed audiologist for testing.

When I make this recommendation, I usually hear the following: "What difference does it make? I'm not deaf enough to need a hearing aid; I'm doing okay for now. I'll get tested in the future, if things get even worse." Here are my responses to these comments:

• Some forms of hearing loss are preventable. For example, if the audiogram suggests that you suffer from noise-induced hearing loss, this may encourage you to use sound protection in the future.
  

• If your hearing loss is due to occupational or military noise exposure, regular audiograms may be the only way to prove this. If you are lucky enough to have had a hearing test before starting work (or military service), you might be able to prove that your employer (or the federal government) is responsible for your hearing loss. Hearing aids are expensive, and most health insurance plans do not include this in their coverage.
  
• Some forms of hearing loss are treatable. One example is otosclerosis, a condition in which the third middle ear bone, the stapes, loses its ability to vibrate. Otosclerosis can be treated very effectively with an operation, or you may choose to use hearing aids; but at least you will know all of your options.
  

• Some forms of hearing loss indicate the presence of other illnesses. An excellent example of this is acoustic neuroma, a tumor that arises from one of the auditory nerves. Acoustic neuromas are true brain tumors. Miss this diagnosis and you may have more to worry about than just your hearing.
  
• Is hearing loss hereditary? It can be. There are many rare and unusual forms of hearing loss that have a strong genetic component. More common forms of hearing loss, such as noise-induced hearing loss and presbyacusis (age-related hearing loss), may also have hereditary factors. (Obviously, noise is environmental, but the threshold at which noise causes permanent damage is, in part, hereditary.)

Can you do anything to preserve your hearing? Protect your ears from noise! You need to be concerned about brief noise that is very loud (such as weapon fire) and long duration noise that is not as loud (for example, a truck driver who is constantly exposed to the noise from a diesel engine). An audiologist can advise you regarding the best ways to protect your ears from unavoidable noise, but it is also important to eliminate avoidable noise. Medications (particular antibiotics and diuretics, for example) can also cause permanent hearing loss, as can head trauma. Depending on your medical history and lifestyle choices, you may be able to eliminate some of your risk factors.