Hearing Loss in Adults

What is Hearing Loss ?

How Hearing Works in adults
Fig 1: How Hearing Works
Hearing loss or impairment is the measure of decline in the ability to apprehend sounds. Hearing loss can range from partial to total, temporary to permanent, sudden to gradual and can affect one or both the ears. In general, the risk of hearing loss increases with age.

Sound waves enter the ear via the ear canal and strike the eardrum, causing it to vibrate. The vibrations from the eardrum are then amplified in the middle ear by three tiny bones. In the inner ear the vibrations are converted into electrical nerve impulses. These electrical impulses are then transmitted to the brain via chemical signals where they are interpreted as sounds.

Causes of hearing loss

Some of the important causes of hearing in adults are:

  • Middle ear disease (Otitis Media)— A bacterial infection of the middle ear can::

    • injure the eardrum
    • disrupt the middle-ear bones
    • cause fluid build-up
  • Noise — If the ear is exposed to loud sounds over longer and persistent period of time, the delicate hair cells of cochlea can be permanently damaged, leading to the permanent sensorineural hearing loss. Noise induced temporary hearing loss can happen when ears are exposed to extremely loud single brief burst of sound (for example, gunfire or shooting etc.).

  • Otosclerosis — An abnormal overgrowth of one or more bones in the middle ear inhibits the function of the small bones by not letting them move freely, thereby causing conductive hearing loss. Otosclerosis often is hereditary and runs in families.

  • Acoustic Neuroma — This is benign tumour that grow on part of the eighth cranial nerve which carries chemical signals to the brain. Acoustic neuroma often causes giddiness, loss of balance, loss of equilibrium (Vertigo) in addition to gradual hearing loss.

  • Meniere's disease — This typically causes hearing loss along with dizziness, tinnitus (ringing in the ears) and a sensation of pressure and fullness (or stuffiness) in one or both ears. Meniere’s disease is caused by the build of the excess fluids which results the inner ear to swell.

  • Trauma — Many types of accidents which damage or injure eardrum can cause hearing loss. For example, eardrum injured from the force of an explosion or ruptured eardrum in an attempt to clear the ear canal with Q-tip, etc.

  • Sudden Sensorineural Hearing Loss — Anyone who suffers hearing loss over the period of three days or less should seek medical emergency. In majority of cases one ear gets affected, but can also affect both ears. Viral infection may be one of the underlying problems. Use of Viagra is also known to be associated with sudden hearing loss

  • Drugs (Ototoxity) — Many medications (prescription and non-prescription) can damage the ear and cause hearing loss. These include, for example:

    • Antibiotics
    • Antimalarial drugs
    • Aspirin
    • Anticancer chemotherapy drugs
  • Ageing — Age related hearing loss (presbycusis) is a classification for the aggregated effects of aging on ears. Both the ears are affected with hearing loss which usually begins after the age of 60. It is typically harder to hear high pitched tones (breaking glass, violins, women's voices) than low pitched ones (thunder, bass guitar, men's voices). Hearing loss is gradual over a period of years and the person may not realize that he or she is having difficulty hearing.

  • Other causes— There are lots of different causes of hearing loss in adults, ranging in 100's. The most familiar causes which can be reversed are like severe build-up of earwax in the ear canal and the acute infections of the external or middle ear.

Symptoms

If you suffer from sudden and severe hearing loss, you will observe immediately that your capability to hear has decreased dramatically or disappeared totally in the effected ear. On the other hand, your symptoms may become more subtle if your hearing loss is gradual. You may have to struggle with understanding conversation and may ask them to repeat what they say. People may start complaining of your use of loud music or TV.

Some conditions or diseases that can cause hearing loss may produce additional symptoms, including:

  • Ringing in the ears (tinnitus)
  • Deep earache, or pain in the ear canal
  • Discharge or bleeding from the ear
  • Dizziness or problems with balance or equilibrium
  • Pressure or a "stuffy" feeling inside the ears
  • Nausea

Diagnosis

Doctor will examine you and will inquire about your symptoms. He or she may also check about your medical history. Your Doctor may perform hearing test, or may refer you to an audiologist (hearing specialist), an otolaryngologist/ENT (specialist doctor in ear, nose and throat disorders) or an audiovestibular physician (specialist doctor in hearing, balance and communication problems). After you are examined and tested, the audiologist will discuss diagnosis with you, along with recommendations for appropriate treatment:

  • If you have a hearing loss, you should consult an otolaryngologist/ENT (Doctor of Ear, Nose & Throat).
  • Depending on the degree of hearing impairment and nature of the disorder, a hearing aid or other amplification device may be advised. The audiologist will counsel you throughout the procedure of selection, fitting, use and care of these devices.

Treatments

Self-help

You may find it easier to communicate and understand people if you:

  • Tell people in advance that you have hearing loss and don't be embarrassed to ask the person to repeat conversations– that way the person can get your attention before they start speaking.
  • Sit near to the person you’re talking to so that you can see the person’s face and lips clearly.
  • Sit so that your better ear is positioned closer to the person you’re talking to.
  • Although it can be frustrating, stay calm and patient, it’s important to keep calm so that you are not stressed or confused and can follow what is being said

Medicines

Bacterial infection in the middle ear can sometimes be treated with antibiotics. Consult your doctor for advice and carefully read the patient information leaflet that accompany with your medicine.

Non-surgical treatments

If your outer or middle ears are clogged by the build-up of ear wax or fluid caused by an ear infection, a nurse will often be able to remove the blockage with special equipment's after it has been softened.

If the hearing loss is not curable, for example gradual hearing loss due to ageing, a hearing aid for one or both of you ears may be helpful. With the modern technology there are lots of hearing devices which can work with for both conductive and senorineural hearing loss. Your audiologist will counsel you through the procedure of selection of device.

Surgery

If you are injured with a large perforation of ear, you may to have surgery to repair it. An acoustic neuroma may need only monitoring, but if needed, it can be removed with surgery or radiotherapy treatment. Ossicles damaged by otosclerosis can sometimes be treated with surgery.

If a hearing aid provides little benefit (e.g. in profound deafness), your doctor may suggest for a cochlear implant. This is an electronic medical device which is surgically implanted and functions by energizing cells of the auditory spiral core (inside inner ear) to deliver sound (in the form of electrical signal to brain).