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Hearing loss is a decreased ability to hear. There are 2 types of hearing loss, conductive and sensorineural. There may also be a mixture of the 2.
|Anatomy of the Ear|
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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. This can include problems along the ear canal, ear drum, and the small internal bones.
Sensorineural hearing loss is caused by damage to the inner ear:
- The cochlea—the major organ in the ear responsible for hearing
- The eighth 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 such as loud noise or head trauma. In many cases, the cause of sensorineural hearing loss is unknown.
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 earwax
- Recurrent or poorly treated ear infections
- Perforated eardrum
- Fluid in the middle ear
- Inner ear disorders, such as Meniere disease or labyrinthitis
- Changes the bone structure of the ear—otosclerosis
- Birth defects affecting the structure of the ear
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 medicines, such as loop diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), or antibiotics
- History of infections, such as mycoplasma or meningitis
- 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
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
- Problems with speech or balance
- Sensitivity to sound
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—This test helps distinguish conductive from sensorineural hearing loss.
- Audiometric tests—These are 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.
When hearing loss is caused by other medical conditions, it may be possible to improve hearing by treating those conditions. Other treatment options include:
Nonsurgical 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
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 medicines are suspected as a cause of hearing loss, your doctor will alter your prescriptions to see if hearing improves.
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.
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.
To help reduce the chances 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.
American Academy of Otolaryngology—Head and Neck Surgery
American Tinnitus Association
Canadian Hearing Society
Canadian Society of Otolaryngology—Head and Neck Surgery
Cochlear implants. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at: https://www.nidcd.nih.gov/health/cochlear-implants. Updated March 6, 2017. Accessed September 25, 2017.
Hearing loss prevention. Better Hearing Institute website. Available at: http://www.betterhearing.org/hearingpedia/hearing-loss-prevention. Accessed September 25, 2017.
Living with hearing loss. Hearing Loss Association of America website. Available at: http://www.hearingloss.org/content/living-hearing-loss. Accessed September 25, 2017.
Sudden sensorineural hearing loss. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/sudden-sensorineural-hearing-loss. Updated August 25, 2017. Accessed September 25, 2017.
- Reviewer: EBSCO Medical Review Board Marcie L. Sidman, MD
- Review Date: 09/2018
- Update Date: 10/22/2020