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Hearing Loss by Rosalyn Carson-DeWitt, MD

En Español (Spanish Version) More InDepth Information on This Condition

Definition

Hearing loss is a decreased ability to hear. There are two main categories of hearing loss:

Conductive hearing loss due to something interfering with the sound passing to the inner ear.
Sensorineural hearing loss due to damage to:
- The major organ in the ear responsible for hearing (the cochlea)
- The major nerve pathway (8th cranial nerve) and/or area of the brain responsible for hearing

The Anatomy of the Ear

Causes

Causes of conductive hearing loss include:

Impacted ear wax
Fluid in the middle ear
Ear infections
Perforation of ear drum
Stiff bones in the middle ear ( otosclerosis )
Injury
Loose or fractured bones in the middle ear
Missing bones from the middle ear due to previous surgery
Congenital anomaly causing complete closure of the ear canal (atresia)
Tumors

Causes of sensorineural hearing loss include:

Excess noise
Aging
Family history
Exposure to toxic substances, including such drugs as:
- Streptomycin
- Gentamicin
- Chemotherapy drugs
- Diuretics
- Steroids
- Heart medicines
- Anesthetics
- Quinine
- Aspirin-containing drugs
Acoustic neuroma
Cardiovascular disease
Multiple sclerosis
Viruses ( measles , mumps , adenovirus , rubella )
History of meningitis or syphilis
Neurologic diseases such as multiple sclerosis and stroke
Inner ear disorders such as Meniere’s disease
Otosclerosis affecting the inner ear
Previous brain or ear surgery causing damage to the inner ear
Trauma

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for hearing loss include:

Family history
Aging
Meniere's disease
Not receiving all recommended immunizations
Repeated or poorly treated ear infections
Exposure to loud noise, music, or machinery
Use of certain antibiotics and chemotherapy drugs
Diseases that may result in blocked blood flow, including atherosclerosis , problems with blood clots, and collagen vascular diseases

Symptoms

Symptoms may include:

Decreased ability to hear any of the following:
- Higher pitched sounds
- Lower pitched sounds
- All sounds
- Speech when there is background noise
Dizziness
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
Dizziness
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 and perform a physical exam. Tests may include:

Weber test—a tuning fork sounded and placed on your forehead or teeth. This can help distinguish conductive from sensorineural hearing loss.
Rinne test—a tuning fork sounded and placed in front and then behind of the ear. This can help distinguish conductive from sensorineural hearing loss.
Audiometric tests —These involve listening to tones in a soundproof room and reporting whether or not you hear the tones.
Tympanometry—This test measures the pressure in the middle ear and examines the middle ear's response to pressure waves.
Computed tomography (CT) or magnetic resonance imaging (MRI) scan of the head —a type of imaging study that uses a computer to make pictures of the inside of the head. This may be done to check for a tumor or bone injury.
Brain stem auditory evoked responses—electrodes attached to the scalp and used to measure the electrical response of the brain to sound
Electrocochleography—This tests the cochlea and the auditory nerve.

Treatment

Treatment includes:

Earwax Removal

This is probably the simplest, easiest treatment for hearing loss.

Hearing Aids

There are many types. Digital technology has created tiny devices that cause little distortion.

Devices

One example of a device is the FM trainer. With this device, a person speaks into a microphone. The sound is then transmitted by radio waves directly to the earphone set worn on your ear. This can be particularly helpful if you have trouble hearing speech when there is background noise. FM trainers can also help children with hearing loss to understand their teachers.

Cochlear Implant

The cochlear implant is surgically implanted. It directly stimulates part of the brain and uses a tiny computer microprocessor to sort out incoming sound.

Treat Other Medical Illnesses

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

Discontinue or Change Medications

If your hearing loss may be caused or worsened by a medication, talk to your doctor about stopping that particular drug or changing to a drug that does not affect hearing.

Address Nutritional Deficiencies

It may be possible to slow age-related hearing loss in elderly persons through dietary modification. For example, if you are deficient in folic acid , this supplement may be helpful for you. Talk to your doctor.

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.

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 (eg, TV, 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:

Stop smoking.
Adequately treat ear infections.
Get all appropriate immunizations.
Treat all medical conditions.
Avoid exposure to excess noise.
Use adequate ear protection when using noisy equipment.

RESOURCES:

American Academy of Otolaryngology–Head and Neck Surgery, Inc. http://www.entnet.org/
American Speech-Language-Hearing Association http://www.asha.org/

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca/
Society of Rural Physicians of Canada http://www.srpc.ca/

References:

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. St. Louis, MO: Mosby; 2000.
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_loss_prevention/index.cfm . Accessed January 25, 2012.
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 January 25, 2012.
Marshall KG. Family Practice Sourcebook: Evidence-Based Emphasis . St. Louis, MO: Mosby; 2000.
Onion DK. The Little Black Book of Primary Care: Pearls and References. 3rd ed. Malden, MA: Blackwell Science; 1999.
Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment. 40th ed. New York, NY: Lange Medical Books/McGraw Hill; 2001.
DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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 reviewed September 2012 by Kari Kassir, MD

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