Definition
Definition
Hearing loss is a decreased ability to hear. There are 2 types of hearing loss, conductive and sensorineural. The type of hearing loss depends on the cause.
Anatomy of the EarCopyright © Nucleus Medical Media, Inc.
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Causes
Causes
Conductive hearing loss is caused by the interference or inability of sound to travel along the pathway from the outer to the middle or inner ear.
Sensorineural hearing loss is caused by damage to:
- The cochlea—the major organ in the ear responsible for hearing
- The 8th cranial nerve—the major nerve pathway and/or area of the brain responsible for hearing
Hearing loss can be the result of genetics, aging, infection, blockage, disease, or injury. In many cases, the cause of sensorineural hearing loss is unknown.
Risk Factors
Risk Factors
Hearing loss is more common in older adults. Factors that may increase your chance of hearing loss include:
Problems that affect the ear, such as:
- Impacted ear wax
- Recurrent or poorly treated ear infections
- Perforated eardrum
- Fluid in the middle ear
- Inner ear disorders, such as Meniere’s disease or labyrinthitis
- Changes the bone structure of the ear—otosclerosis
- Birth defects affecting the structure of the ear
- Tumors
Other factors, such as:
- Family history or certain genetic disorders
- Occupational or environmental exposure to excessive noise
- Cardiovascular diseases that affect blood flow to the ear and brain
- Certain medications, such as loop diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), or antibiotics
- History of infections, such as mycoplasma or meningitis
- Stroke
- Trauma
- Previous brain or ear surgery
- Neurological disorders, such as migraine headaches or multiple sclerosis
- Autoimmune disorders, such as systemic lupus erythematosus or Cogan syndrome (rare)
- Not receiving all recommended immunizations
- Obesity
Symptoms
Symptoms
Hearing loss may cause a decreased ability to hear:
- Higher pitched sounds
- Lower pitched sounds
- All sounds
- Speech when there is background noise
Hearing loss may also cause:
- The sensation of spinning when standing still—vertigo
- Ringing or other sounds in the ears—tinnitus
- Problems with balance
- In children, hearing loss may cause difficulty learning to speak.
When Should I Call My Doctor?
Call your doctor if you notice hearing loss. You should especially call if you also have:
- Ear pain
- Vertigo
- Tinnitus
- Problems with speech or balance
- Sensitivity to sound
Diagnosis
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done.
A complete evaluation of the ears will be done. Tests may include:
- Weber test or Rinne test—To help distinguish conductive from sensorineural hearing loss
- Audiometric tests—A direct test of hearing
- Tympanometry—This test measures the pressure in the middle ear and examines the middle ear’s response to pressure waves
- Electrocochleography—This tests the function of the cochlea and the auditory nerve.
Images may be taken of your ears and surrounding structures. This can be done with:
The electrical response of your brain to sound may be tested. This can be done with brain stem auditory evoked response testing.
Treatment
Treatment
When hearing loss is caused by other medical conditions, it may be possible to improve hearing by treating those conditions. Other treatment options include:
Non-surgical Treatment
Non-surgical treatment options are not invasive and may help improve your hearing. These include:
- Earwax removal
- Modifying any dietary deficiencies
- Hearing aids
- Assisted listening devices that enhance the abilities of your hearing aid or cochlear implant to make sounds clearer and easier to hear
Medications
Oral or injected corticosteroids may be used to help treat certain types of hearing loss. They are used to:
- Decrease inflammation and promote fluid drainage
- Suppress the effects of the immune system
If medications are suspected as a cause of hearing loss, your doctor will alter your prescriptions to see if hearing improves.
Lifestyle Changes
If you have hearing loss, some changes may help you maximize your ability to hear. Follow these guidelines when talking to other people:
- Face the person that you are talking to. This will allow you to see their facial expressions and watch their lips move.
- Ask other people to speak loudly and more clearly.
- Turn off background noise, such as the TV or radio.
- In public places, choose a place to sit that is away from noise.
- Work with a special trainer to learn how to lip read. Lip reading involves paying close attention to how a person’s mouth and body are moving when they talk.
It is common to feel isolated and removed in social situations. This can lead to feelings of depression or social anxiety. Part of managing hearing loss may include counseling or a support group.
Surgery
Surgery may be done in some cases of conductive hearing loss to correct the middle ear problem, such as in otosclerosis, ossicular damage or fixation, and ear infections. Procedures may include:
- Stapedectomy—The stapes bone is removed or drilled and replaced with a prosthetic.
- Tympanoplasty—Repair of a ruptured eardrum or the correction of a defect of the middle ear bones.
- Myringotomy—Incision of the eardrum to allow entrapped fluid to drain. Tubes may be placed in the ear to promote continuous drainage.
A cochlear implant directly stimulates part of the brain and uses a tiny computer microprocessor to sort out incoming sound. It can be for certain types of hearing loss that affect the inner ear.
Prevention
Prevention
To help reduce the chance of hearing loss:
- If you smoke, talk with your doctor about the best ways to quit.
- Adequately treat ear infections.
- Get all appropriate immunizations.
- Treat all medical conditions as directed by your doctor.
- Avoid exposure to excess noise.
- Use adequate ear protection when using noisy equipment.
RESOURCES:
American Tinnitus Association http://www.ata.org
CANADIAN RESOURCES:
Canadian Society of Otolaryngology—Head and Neck Surgery http://www.entcanada.org
References:
Hearing loss prevention. Better Hearing Institute website. Available at:
http://www.betterhearing.org/hearingpedia/hearing-loss-prevention
Accessed August 5, 2015.
Lee SH, Chang Y, Lee JE, Cho JH. The values of diffusion tensor imaging and functional MRI in evaluating profound sensorineural hearing loss. Cochlear Implants International. 2004;5 Suppl 1:149-152.
Living with hearing loss. Hearing Loss Association of America website. Available at:
http://www.hearingloss.org/content/living-hearing-loss
Accessed August 5, 2015.
Sudden sensorineural hearing loss. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated May 19, 2015. Accessed August 5, 2015.
2/1/2007 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed
: Durga J, Verhoef P, Anteunis L, Schouten E, Kok F. Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial. Ann Int Med. 2007;146(1):1-9.
Last Updated: 8/5/2015