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- Types of hearing loss
- Symptoms
- Causes
- Risk factors
- Diagnosis
- Treatment
- Living with hearing impairment
Hearing Loss
It is beneficial to know the physiological mechanisms through which we perceive sounds to understand hearing loss.
How do we hear?
The ear consists of three primary parts: the outer, middle, and inner ear. When sound waves enter the outer ear, they vibrate the eardrum. The eardrum connects to three small bones of the middle ear -- the malleus, incus, and stapes. Together with the eardrum, they amplify the sound wave vibration before passing it to the cochlea, an inner ear structure. The fluid-filled cochlea contains numerous minute hair cells innervated by hearing nerves. These hair cells play a crucial role in converting vibratory sound waves into electrical signals that travel to the brain, allowing us to perceive sound.
Gradual hearing loss that occurs with age, known as presbycusis, is a common occurrence. Aging and exposure to loud noises can contribute to the degeneration of hair cells, causing sensorineural hearing loss, which is typically irreversible. However, a proper diagnosis and rehabilitation can improve overall hearing ability.
Types of hearing loss
- Conductive Hearing Loss: Abnormal conditions in the outer ear (ear canal) or the middle ear impede the transmission of sound waves to the inner ear.
- Sensorineural Hearing Loss: Damages to the hair and nerve cells in the inner ear over time cause sensorineural hearing loss. Sudden sensorineural hearing loss (SSHL) or deafness can also occur, but this is rare.
- Mixed Hearing Loss: Problems in the middle and outer ear causing conductive hearing loss and sensorineural hearing loss in the inner ear occur together.
Symptoms
- Hearing a muffled sound.
- Difficulty understanding conversation, especially in noisy environments.
- Struggle to make out the consonant sounds.
- Frequently asking other people to speak more slowly, clearly, and loudly.
- Often turning up the volume of the television or radio.
- Experiencing ringing in the ears.
Signs of hearing loss in infants
- No startle reflex to loud sound.
- Not turn to look at the source of a sound after six months of age.
- Not uttering single-sound words like “mama” or “dada” by age 1.
- Not respond when calling their name.
Signs of hearing loss in children
- Frequently say “huh”.
- Have speech development delay.
- Do not speak clearly.
- Struggle to follow instructions.
- Ask to increase the volume of television often.
Causes
- Outer ear blockage, such as accumulation of ear wax, ear canal stenosis, and tumor or wax in the ear canal
- Tympanic membrane perforation (ruptured eardrum) can result from exposure to loud noises, sudden changes in pressure, penetration of the eardrum by foreign objects, or infections. Eardrum rupture can lead to a loss of hearing.
- Middle ear disorders such as otitis media and ossicular chain fixation or disruption
- Inner ear damage can occur due to aging and exposure to loud noises, which can lead to degenerative changes of the delicate hairs or nerve cells within the cochlea, causing inefficient electrical transmission to the brain and resulting in hearing loss, which can manifest as muffling of higher-pitched tones and difficulty distinguishing words from background noise.
Risk factors
- Aging: As time passes, the inner ear naturally undergoes deterioration.
- Loud Noise: Exposure to persistent loud noise at work, such as construction or factory sites, can damage the inner ear. Acute irreversible hearing loss can occur due to exposure to loud sounds of an explosion, firearms, or jet engines. Noise generated by motorcycles or listening to loud music can also pose a risk of hearing loss.
- Heredity: Genetic factors may predispose the inner ear to damage by loud noises.
- Medications: Certain medications, including gentamicin, sildenafil, and some cancer treatment drugs, have the potential to harm the inner ear. High doses of aspirin, other pain relievers, antimalarial medications, or loop diuretics may induce temporary hearing issues and tinnitus.
- Illnesses: Meningitis can induce high fever and damage the hair cells within the inner ear.
Diagnosis
- History taking and physical exam for signs of earwax building or middle ear infections. The structural malformation of your ear can also cause hearing problems.
- Tuning fork test: A tuning fork is a metal instrument with two prongs that vibrate at fixed frequencies when struck. It can help identify the location of ear damage.
- Audiometry tests: You will wear headphones and listen to sounds or words to determine the sound loudness threshold you can first hear. An audiologist conducts this test in a specialized soundproof room.
Treatment
- Earwax Removal: Hearing loss caused by earwax blockage is reversible by using either suction or a specialized tool with a looped end to remove the earwax.
- Surgical Interventions: Certain forms of hearing loss are correctible through surgical procedures. For instance, recurrent middle ear infections can lead to fluid buildup. The doctor may insert small tubes to facilitate ear drainage.
- Hearing Aids: In cases of inner ear damage contributing to hearing loss, hearing aids can be a valuable solution. An audiologist can help determine the benefits of hearing aids and discuss the available options.
- Cochlear Implants: When conventional hearing aids cannot improve your condition, cochlear implants are another option. Unlike hearing aids that amplify sound and direct it into the ear canal, cochlear implants stimulate the auditory nerve in the non-functional inner ear regions.
Living with hearing impairment
- Inform your friends and family about your condition.
- Face the person you are talking to and politely ask them to speak more loudly and clearly if you have difficulty hearing them.
- Turn off a television or radio to minimize background noise when talking with others.
- Use hearing aids or amplification devices for mobile phones.
Preparation before the doctor’s appointment
- Make a list of your symptoms. You can ask your family or friends to write them down because you may be unaware of your symptoms.
- Write down your medical history, recent ear infections, ear injury, or surgery you had.
- Describe your workplace and if it is noisy.
- Bring a friend or family member to help you remember the doctor’s instructions.
- Compile a list of inquiries you may want to pose to your doctors, such as:
- What is the underlying cause of my symptoms?
- Are any diagnostic tests or examinations necessary to determine the extent of my condition?
- Do I need to make any adjustments to my current medication regimen or discontinue any medications?
- What treatment options are available for my condition, and what are the associated risks and benefits?
Anticipate and formulate responses to inquiries your doctor might pose, including:
- Have you recently encountered any ear discomfort or discharge?
- When did you first notice the onset of these symptoms?
- Do you perceive any persistent ringing in your ears?
- Are you experiencing episodes of dizziness?
- Have you been grappling with balance issues?
- Do you find it challenging to hear others?
- Are you frequently required to increase the volume on your television or radio?
- How often do you ask people to repeat their words or speak louder?
- Would you be interested in exploring the option of using a hearing aid?
FAQ
- What’s the difference between hearing loss and deafness?
People with hearing loss can still hear sounds and engage in a conversation. The condition can improve with hearing aids or treatments. Deaf people have little or no hearing at all. Conventional hearing aids cannot help them; they must communicate via other techniques.
A note from MedPark Hospital
Hearing loss can be a temporary or permanent condition. Living with hearing loss can make life more challenging. You may feel discouraged that you cannot hear as clearly as you used to. If you suspect your hearing has changed, it is advisable to seek a thorough evaluation, diagnosis, and appropriate treatment to restore and enhance your overall quality of life.
