Understanding Hearing Loss: Causes, Symptoms, and Treatments

Hearing loss, a prevalent health issue, affects millions of people worldwide. It ranges from mild to profound, affecting communication and quality of life. Various factors, including ageing, noise exposure, and genetics, contribute to its development. Early diagnosis and intervention can mitigate its effects, with hearing aids and cochlear implants as potential solutions.

Table of Content

1. The Importance of Understanding Hearing Loss
2. The Causes of Hearing Loss
3. The Symptoms of Hearing Loss
4. The Diagnosis and Testing for Hearing Loss
5. Treatments for Hearing Loss
6. The Prevention and Maintenance of Hearing Loss

Hearing loss is a prevalent issue that affects millions of people worldwide.

It is crucial to understand the importance of recognising and addressing hearing loss, as it can significantly affect an individual’s quality of life.

By increasing our awareness and knowledge about hearing loss, we can foster a more inclusive society and improve the lives of those affected.

Understanding hearing loss is essential for its early detection and intervention.

Early identification of hearing loss allows prompt access to treatment and support services, such as hearing aids or cochlear implants.

This can mitigate the negative effects of hearing loss on speech, language, and cognitive development, especially in children.

Hearing loss can lead to social isolation and loneliness, as individuals may struggle to communicate effectively with others.

By understanding the challenges faced by those with hearing loss, we can create more inclusive environments and foster empathetic relationships.

This includes implementing facilities such as assistive listening devices, visual aids, and sign language interpreters.

Understanding hearing loss is important for hearing health and prevention.

By raising awareness of the causes of hearing loss, such as noise exposure, we can encourage individuals to take proactive measures to protect their hearing.

These include using earplugs in noisy environments, limiting the volume of personal audio devices, and scheduling regular hearing check-ups.

Lastly, understanding hearing loss helps reduce the stigma and misconceptions surrounding this condition.

By debunking myths and promoting accurate information, we can create a more accepting and supportive society for people with hearing loss.

The causes of hearing loss can be categorised into three types: conductive, sensorineural, and mixed.

Conductive hearing loss results from problems in the outer or middle ear, such as ear infections, fluid build-up, or compacted earwax, which obstruct sound conduction.

Sensorineural hearing loss is caused by damage to the inner ear or auditory nerve because of ageing, noise exposure, viral infections, head trauma, or ototoxic medications.

Mixed hearing loss is a combination of conductive and sensorineural factors that occur when issues are present in the outer, middle, and inner ear or auditory nerves simultaneously.

Conductive Hearing Loss

Conductive hearing loss is when there are problems with the outer or middle ear which are preventing sound from being conducted in the inner ear.

This type of hearing loss can often be treated with medical or surgical interventions.

Causes

• Ear infections: Infections in the outer or middle ear can cause inflammation and swelling, which can block the passage of sound.
• Fluid in the middle ear: Fluid build-up in the middle ear, often as a result of colds or allergies, can prevent sound from being conducted efficiently.
• Allergies: Allergic reactions can cause inflammation and swelling in the middle ear, obstructing the passage of sound.
• Impacted earwax: Excessive earwax build-up can block the ear canal, preventing sound from reaching the middle and inner ear.
• Perforated eardrum: A hole or tear in the eardrum can prevent sound from being conducted to the middle ear.
• Malformation of the ear structures: Abnormal development or damage to the outer or middle ear structures can hinder sound conduction.

Sensorineural Hearing Loss

Sensorineural hearing loss is when any damage to the inner ear (cochlea) or the auditory nerve may have taken place.

This type of hearing loss is usually permanent and cannot be reversed.

Causes

• Ageing (presbycusis): Age-related hearing loss, or presbycusis, is a gradual decline in hearing ability due to the degeneration of inner ear structures and the auditory nerve.
• Noise-induced hearing loss: Exposure to loud noises over time can damage the hair cells in the cochlea, leading to permanent hearing loss.
• Viral infections: Certain viral infections, such as measles, mumps, or meningitis, can cause damage to the inner ear or auditory nerve.
• Head trauma: Injuries to the head can lead to damage of the inner ear structures or the auditory nerve, resulting in hearing loss.
• Tumours: Tumours in the auditory nerve or brain can cause hearing loss by compressing or damaging the nerve.
• Ototoxic medications: Some medications, including certain antibiotics, chemotherapy drugs, and diuretics, can damage the inner ear and cause hearing loss.

Mixed Hearing Loss

This is a combination of both conductive and sensorineural hearing loss.

This means that there is a problem with both the conduction of sound through the outer and middle ear and the processing of sound in the inner ear or auditory nerve.

For example, a person may have a perforated eardrum (conductive) and age-related degeneration of the inner ear (sensorineural) at the same time.

Hearing loss symptoms can vary, but common signs include difficulty understanding speech, muffled sounds, and trouble hearing in noisy environments.

Individuals may turn up the volume on devices or experience tinnitus, a persistent ringing in the ears.

Dizziness, balance issues, and withdrawal from social situations may also occur.

These symptoms can significantly affect an individual’s quality of life, making communication and social interaction challenging.

If you suspect hearing loss, consult an audiologist or healthcare professional for a comprehensive evaluation and proper treatment options to improve your hearing and overall well-being.

Perhaps you or someone you know experiences one or more of the following situations:

• Difficulty understanding speech: People with hearing loss often struggle to understand what others are saying, especially when multiple people are talking or there is background noise. They may often ask others to repeat themselves or speak more slowly.
• Muffled sounds: Sounds may seem unclear or muffled, making it difficult to distinguish words or specific noises.
• Difficulty hearing in noisy environments: Noisy environments, such as restaurants or crowded gatherings, can pose significant challenges for individuals with hearing loss, as they struggle to hear and understand conversations.
• Turning up the volume on devices: If you find yourself consistently increasing the volume on your television, phone, or other devices, this may be a sign of hearing loss.
• Tinnitus (ringing in the ears): Tinnitus is a common symptom of hearing loss, characterised by a persistent ringing, buzzing, or hissing sound in one or both ears.
• Dizziness or balance issues: Hearing loss can sometimes be accompanied by dizziness or balance problems, as the inner ear plays a crucial role in supporting balance.
• Withdrawal from social situations: As hearing loss makes communication more challenging, individuals may begin to withdraw from social situations, avoiding gatherings and conversations to minimise frustration and embarrassment.

If you or a loved one are experiencing any of the above, it is essential to consult with an audiologist or healthcare professional for a comprehensive hearing evaluation and treatment options.

Hearing loss can significantly affect an individual’s quality of life, which is why early diagnosis and testing are crucial.

Various tests and examinations can be conducted to find the type and extent of hearing loss.

Here are some of the most common methods used to diagnose and test for hearing loss:

Hearing Tests

• Pure-tone Audiometry: Pure-tone audiometry is a standard test that measures an individual’s hearing sensitivity across various frequencies via headphones. The audiologist records the softest sounds the patient can hear, creating an audiogram that shows the individual’s hearing threshold.
• Speech Audiometry: Speech audiometry measures an individual’s ability to hear and understand speech. The test involves listening to spoken words or sentences at different volumes and repeating them back. This helps decide the speech reception threshold (SRT) and the speech discrimination score (SDS), which are essential factors in assessing hearing loss.
• Tympanometry: Tympanometry is a test that evaluates the middle ear’s function by measuring the movement of the eardrum in response to changes in air pressure. This test can help identify issues such as fluid build-up, eardrum perforation, or problems with the small bones in the middle ear.
• Otoacoustic Emissions (OAE): Otoacoustic emissions (OAE) testing measures the sounds generated by the inner ear’s hair cells in response to sound stimulation. The presence of OAEs indicates that the hair cells are functioning correctly, while their absence may suggest damage to the inner ear or a blockage in the middle ear.
• Auditory Brainstem Response (ABR): This is a test measuring the electrical activity of the brainstem and auditory nerve in response to sound. Electrodes are placed on the patient’s head, and auditory stimuli are presented through headphones. This test can help identify issues with the nerve pathways responsible for hearing.

Physical Examination

A healthcare professional will examine the patient’s ears using an otoscope, which allows them to look inside the ear canal and assess the eardrum’s condition.

They will also check for any visible abnormalities, signs of infection, or blockages, such as impacted earwax.

Medical History

A thorough medical history can provide valuable information about potential causes of hearing loss.

The healthcare professional will ask questions about the patient’s exposure to loud noises, family history of hearing loss, history of ear infections, medications, and any other factors that may contribute to hearing problems.

Diagnosing and testing for hearing loss involves a combination of hearing tests, physical examination, and medical history assessment.

Early detection and intervention are essential to minimise the impact of hearing loss on an individual’s quality of life.

Treating hearing loss involves various approaches depending on the type and cause of the condition.

Medical treatments include antibiotics for infections, steroids for inflammation, and earwax removal.

Surgical interventions, such as tympanoplasty, stapedectomy, and myringotomy, can repair or improve ear structures.

In cases of sensorineural hearing loss, hearing aids or cochlear implants may be recommended.

Early intervention, regular hearing evaluations, and addressing underlying health conditions are crucial for successful treatment.

Consultation with an audiologist or otolaryngologist is essential to decide the most effective treatment plan for each individual’s hearing loss.

Conductive Hearing Loss Treatments

Problems with the middle or outer ear, preventing sound from reaching the inner ear is usually recognised as conductive hearing loss.

There are several treatments available for conductive hearing loss, depending on the cause and severity of the condition.

Medications

• Antibiotics for ear infections: In cases where the hearing loss is caused by an ear infection, antibiotics may be prescribed to treat the infection and reduce inflammation. This can help to restore hearing by allowing sound to pass through the ear more effectively.
• Steroids for inflammation: Steroids can be used to reduce inflammation in the ear, which may be causing hearing loss. This can help to improve hearing by reducing swelling and allowing sound to pass through the ear more effectively.

Earwax removal

Excessive earwax can cause conductive hearing loss by blocking the ear canal. Earwax removal can be performed by a healthcare professional using specialised tools or using over-the-counter earwax removal products.

Surgical interventions

In some cases, surgery may be necessary to treat conductive hearing loss.

There are several surgical options available, depending on the cause of the hearing loss.

• Tympanoplasty (eardrum repair): Tympanoplasty is a surgical procedure used to repair a perforated eardrum or a collapsed eardrum. This can help to restore hearing by allowing sound to pass through the eardrum and into the middle ear.
• Stapedectomy (middle ear bone replacement): Stapedectomy is a surgical procedure used to replace the stapes bone in the middle ear, which is responsible for transmitting sound vibrations from the eardrum to the inner ear. This can help to restore hearing by improving the transmission of sound through the middle ear.
• Myringotomy (ear tube placement): Myringotomy is a surgical procedure that involves creating a small hole in the eardrum and inserting a small tube to allow air to enter the middle ear. This can help to equalise pressure in the ear and improve hearing, particularly in cases where the hearing loss is caused by chronic ear infections or fluid build-up in the middle ear.

Sensorineural Hearing Loss Treatments

Sensorineural hearing loss is when hearing loss is because of damage to the inner ear, the auditory nerve, or the brain’s hearing centre.

There are several treatments available to help improve hearing and communication for individuals with sensorineural hearing loss.

Hearing Aids

• Behind-the-ear (BTE): These hearing aids have a small case that rests behind the ear, with a tube connecting to an earmold or earpiece in the ear canal.
• In-the-ear (ITE): These devices fit completely inside the outer ear and are custom-made to fit the individual’s ear.
• In-the-canal (ITC): These hearing aids are smaller than ITE devices and fit partially in the ear canal.
• Completely-in-the-canal (CIC): These are the smallest hearing aids, fitting entirely inside the ear canal and are nearly invisible.

Benefits:

• Amplify sound to improve hearing in various environments
• Can be customised to suit individual needs
• Some models offer advanced features such as noise reduction and Bluetooth connectivity

Limitations:

• Does not restore normal hearing
• Some individuals may find them uncomfortable or difficult to adjust to
• Can be expensive, and may not be covered by insurance

Cochlear Implants

Cochlear implants are electronic devices that bypass damaged hair cells in the inner ear and directly stimulate the auditory nerve.

Candidates for cochlear implants typically have severe to profound sensorineural hearing loss and receive limited benefit from hearing aids.

The implant procedure involves surgically placing an internal component under the skin behind the ear and an external component worn on the outside of the head.

Benefits:

• Can significantly improve hearing and speech understanding in individuals with severe to profound hearing loss
• May allow users to hear sounds they previously could not detect

Limitations:

• Requires surgery and a period of adjustment to the new sound quality
• Not all people that have sensorineural hearing loss are contenders for cochlear implants

Assistive Listening Devices

Assistive listening devices (ALDs) are designed to improve hearing in specific situations, often by reducing background noise and amplifying the desired sound source.

• FM Systems: These systems use radio waves to transmit sound from a microphone worn by the speaker to a receiver worn by the listener. FM systems can be used with or without hearing aids and are often used in classrooms or lecture halls.
• Infrared Systems: Infrared systems transmit sound using infrared light. These systems are often used in theatres, places of worship, and other public venues. The listener wears a receiver that picks up the infrared signal and converts it to sound.
• Induction Loop Systems: Induction loop systems use a loop of wire placed around a room to create a magnetic field that transmits sound directly to a hearing aid with a telecoil (T-coil) or a separate receiver. These systems can be found in various public places, such as theatres and conference rooms.

Communication Strategies

• Lip Reading: Lip reading, or speechreading, involves watching a speaker’s mouth and facial expressions to understand spoken language. This skill can be helpful for individuals with hearing loss to improve communication in various settings.
• Sign Language: Sign language is a visual language that uses hand gestures, facial expressions, and body movements to convey meaning. For individuals with severe to profound hearing loss, learning sign language can be an effective way to communicate with others who also know sign language.

Mixed Hearing Loss Treatments

Treatment for mixed hearing loss often involves a combination of approaches to address both the conductive and sensorineural components of the hearing loss.

Conductive Treatments

• Medication or Surgery: For conductive hearing loss caused by infections, fluid build-up, or other medical conditions, medications or surgical procedures may be used to treat the underlying issue and improve hearing.
• Earwax Removal: If earwax build-up is causing conductive hearing loss, a healthcare professional can safely remove the earwax to restore hearing.
• Bone Conduction Devices: These devices bypass the outer and middle ear by sending sound vibrations directly to the inner ear through the skull. They can be helpful for individuals with conductive hearing loss who cannot benefit from traditional hearing aids.

Sensorineural Treatments

• Hearing Aids: These devices amplify sound to improve hearing in various environments and can be customised to suit individual needs. They are often used to treat sensorineural hearing loss.
• Cochlear Implants: For individuals with severe to profound sensorineural hearing loss, cochlear implants can be used to bypass damaged hair cells in the inner ear and directly stimulate the auditory nerve.
• Assistive Listening Devices: These devices, such as FM systems, infrared systems, and induction loop systems, can improve hearing in specific situations by reducing background noise and amplifying the desired sound source.

When treating mixed hearing loss, a combination of these treatments may be necessary to address both the conductive and sensorineural components of the hearing loss.

A healthcare professional, such as an audiologist or otolaryngologist, will work with the individual to determine the most appropriate treatment plan based on the specific causes and severity of their mixed hearing loss.

In some cases, addressing the conductive component of the hearing loss may improve hearing enough that additional sensorineural treatments are not needed.

In other cases, a combination of treatments may be required to achieve the best possible improvement in hearing and communication.

Preventing and maintaining hearing loss is essential for preserving good hearing health and overall quality of life.

Several strategies can help protect your hearing and minimise the risk of developing hearing loss.

Protecting Your Ears from Loud Noises

Loud noises exposure is a frequent cause of hearing loss.

To protect your ears from loud noises, follow these tips:

• Wear earplugs or earmuffs: When exposed to loud environments, such as concerts, construction sites, or loud machinery, use earplugs or earmuffs to reduce the noise level and protect your ears.
• Follow the 60/60 rule: When listening to music through headphones or earbuds, keep the volume at no more than 60% of the maximum level and limit listening time to 60 minutes per day.
• Maintain a safe distance: Keep a safe distance from loud noise sources, such as speakers or machinery, to reduce the risk of hearing damage.
• Give your ears a break: After exposure to loud noises, give your ears a rest to allow them to recover and minimise the risk of hearing loss.

Regular Hearing Check-ups

Regular hearing check-ups are important for early detection and treatment of hearing loss.

Schedule a hearing test with an audiologist or healthcare professional if you:

• Suspect you may have hearing loss
• Are over the age of 50
• Have a family history of hearing loss
• Work in a noisy environment

Managing Chronic Health Conditions

Some chronic health conditions, such as diabetes and high blood pressure, can increase the risk of hearing loss.

To maintain good hearing health, manage your chronic health conditions by:

• Following your healthcare provider’s recommendations for treatment and management
• Eating a balanced diet and exercising regularly
• Monitoring your blood pressure and blood sugar levels
• Taking medications as prescribed

Avoiding Ototoxic Medications When Possible

Ototoxic medications are drugs that can cause damage to the inner ear, leading to temporary or permanent hearing loss.

To minimise the risk of hearing loss from ototoxic medications:

• Talk to your healthcare provider about the potential risks and benefits of any medications you are prescribed
• Ask if there are alternative medications available that are less likely to cause hearing damage
• Follow your healthcare provider’s instructions for taking medications and report any changes in your hearing immediately

By following these prevention and maintenance strategies, you can help protect your hearing and minimise the risk of developing hearing loss.