by Carson-DeWitt R

Hearing Loss

Definition

Hearing loss is a decreased ability to hear.
The Anatomy of the Ear
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Causes

There are two main categories of hearing loss:
  • Conductive hearing loss is caused by something interfering with the sound passing to the 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
Causes of conductive hearing loss may include:
Causes of sensorineural hearing loss is unknown in most people. Some causes may include:
  • Otosclerosis affecting the inner ear
  • Vascular disease that affects blood flow to the ear
  • Previous brain, ear surgery, or viral infection causing damage to the inner ear
  • Trauma

Risk Factors

Factors that may increase your risk of hearing loss include:
  • Increasing age
  • Family history
  • Exposure to excess noise
  • Exposure to medications, such as antibiotics, diuretics, or heart medications:
  • Having certain health conditions, such as
  • Not receiving all recommended immunizations
  • Obesity

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:
  • Vertigo
  • Ringing sounds in the ears
  • 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
  • Ringing or other sounds in your ear
  • Problems with speech or balance
  • Sensitivity to sound
If you think you have an emergency, call for medical help right away.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
  • Weber test or Rinne test—To can 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.
  • CT scan or MRI —This may be done to check for a tumor or bone injury.
  • Brain stem auditory evoked responses—Measures the electrical response of the brain to sound to test hearing
  • Electrocochleography—This tests the function of the cochlea and the auditory nerve.

Treatment

When hearing loss is caused by other medical conditions, it may be possible to improve hearing by treating those conditions. Other treatment includes:

Non-surgical Treatment

Non-surgical treatment options are not invasive and may help improve your hearing. Options include:
  • Earwax removal
  • Changing or stopping medications that affect your hearing
  • 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

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.
A cochlear implant directly stimulates part of the brain and uses a tiny computer microprocessor to sort out incoming sound.

Home Care

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.

Prevention

To help prevent hearing loss, take these steps:
  • 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 Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org

American Tinnitus Association http://www.ata.org

CANADIAN RESOURCES

The Canadian Hearing Society http://www.chs.ca

Canadian Society of Otolaryngology http://www.entcanada.org

References

Hansen MC. Otosclerosis and sensorineural hearing loss. A clinical study. Archives of Otolaryngology Head and Neck Surgery. 1983;109(9).

Hearing loss prevention. Better Hearing Institute website. Available at: http://www.betterhearing.org/hearing%5Floss%5Fprevention/index.cfm . Accessed September 20, 2013.

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;149-152.

Living with hearing loss. Hearing Loss Association of America website. Available at: http://www.hearingloss.org/content/living-hearing-loss . Accessed September 20, 2013.

DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : 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.

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