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Hearing Loss Information
What Is Hearing Loss?
What Is Hearing Loss?
Hearing loss can affect anyone at any age and could happen suddenly or develop over time. According to the World Health Organization, 430 million people-or 5% of the world's population- require rehabilitation for their hearing loss. By 2050, that number will increase to 700 million.
Hearing loss occurs when there is a problem somewhere in the hearing system. When you have a hearing loss it can be difficult to understand speech or hear sounds in the environment. It may be hard to hear the television, follow along in a business meeting, or speak on the phone. If left untreated, it could affect quality of life, including social interactions, work performance, and emotional well-being.
Do You Have a Hearing Loss?
Do You Have a Hearing Loss?
Signs you or your loved one may have a hearing loss:
Difficulty understanding speech, especially in noisy environments
Thinking people are mumbling
Asking for repetition often
Increasing the volume of the television or phone
Withdrawal from daily activities
Social isolation
Ringing in the ears (tinnitus)
Early detection of hearing loss is important. It enables treatment and aural rehabilitation to improve communication and quality of life. If you think you or a loved one may have a hearing loss, schedule a comprehensive evaluation with an audiologist as soon as possible. If you notice sudden hearing loss, seek medical attention immediately.
Parts of the Ear
Parts of the Ear
Common Causes of Hearing Loss
Common Causes of Hearing Loss
Hearing loss can occur when there is an issue in any of the parts of the hearing system (inner, middle or outer ear). Some causes are treatable; others are permanent and need management.
Outer Ear:
Build-up of wax
Foreign object blocking the eardrum
Outer ear infection (otitis externa)
Congenital malformations of the outer ear
Injury or trauma to the outer ear
Middle Ear
Middle ear infection (otitis media)
Hardening of the middle ear bones (otosclerosis)
Ruptured/perforated eardrum
Eustachian tube dysfunction
Fluid behind the eardrum
Abnormal skin growth in the middle ear (cholesteatoma)
Inner Ear
Aging (presbycusis)
Noise-induced hearing loss
Genetic hearing loss
Medications that damage hearing (ototoxic medications)
Viral or bacterial infections
Head trauma
Tumors affecting the auditory nerve
Types of Hearing Loss
Types of Hearing Loss
The hearing system can be subdivided into three main parts: the outer, middle, and inner ear. Each part plays an important role in collecting, amplifying, transmitting, and processing sound. The outer ear includes the pinna and ear canal, and it's purpose is to collect sounds and amplify them. The middle ear is the eardrum and the space behind it. It contains three tiny bones: the malleus, incus, and stapes. The main job of the middle ear is to amplify sounds and transmit them to the inner ear. The middle ear also contains the Eustachian tube, which equalizes pressure in the middle ear. The inner ear houses your hearing organ, the cochlea, which is filled with fluid and hair cells. These hair cells convert mechanical energy into electrical signals so that the nerve can carry these signals to the brain. A problem in any of these parts could lead to hearing loss, and the location of the problem will determine the type of hearing loss.
Conductive Hearing Loss:
A problem in the outer or middle ear that prevents sounds from reaching the inner ear.
Sensorineural Hearing Loss:
A problem in the inner ear or the hearing nerve that affects how sound is processed and sent to the brain.
Mixed Hearing Loss:
A combination of conductive and sensorineural hearing loss where there is a problem in the middle or outer ear and the inner ear or hearing nerve.
The hearing loss is then subcategorized by severity. The severity range is as follows:
Normal hearing (0-25 dB HL)
Mild (26-40 dB HL)
Moderate (41-55 dB HL)
Moderately severe (56-70 dB HL)
Severe (71-90 dB HL)
Profound (91+ dB HL)
dB HL = decibel hearing level
This is how loud the signal had to be in order for the individual to hear it.
Types of Testing
Types of Testing
A hearing evaluation will consist of a series of tests to determine whether hearing loss exists. A hearing test should be conducted by a licensed audiologist, who can interpret the results of each test and develop a treatment plan. After an examination of the ear and a discussion of medical and personal history, the audiologist should perform the following tests:
Tympanometry: a test that assesses middle ear function. It looks at how well the eardrum responds to changes in pressure. It also provides information such as middle ear pressure and ear canal volume. An abnormal result may be due to fluid in the middle ear, a perforated eardrum, excessive earwax, or Eustachian tube dysfunction.
Acoustic Reflex Testing: This test evaluates the acoustic reflex in the middle ear. This reflex is an automatic response where a small muscle contracts when exposed to loud sounds. The purpose is to reduce the amount of sound energy before it reaches the hearing organ. This test also provides information on the pathway of sound traveling through the hearing system- from the outer ear all the way up to the brainstem. An abnormal response could indicate a problem within the auditory system.
Otoacoustic Emissions (OAE's): This test assesses the function of the outer hair cells located in the inner ear. The inner ear houses the cochlea, the hearing organ that contains hair cells. Otoacoustic emissions are sounds that are produced by the outer hair cells. Outer hair cells are responsible for fine-tuning and amplifying sound vibrations. An abnormal result in this test indicates that the outer hair cells have been damaged, which is commonly associated with a sensorineural hearing loss. Damaged hair cells do not regenerate, making this type of hearing loss permanent and irreversible.
Puretone Audiometry: When you think of a hearing test, puretone audiometry is the first thing that might pop into your head. It is conducted with headphones, in which the patient presses a button or raises their hand when they hear a tone. The purpose of the test is to find the softest level that can be detected with 50% probability. Pure-tone audiometry can be performed using air or bone conduction. During air conduction, sound is presented through headphones and travels through the entire hearing system (inner, outer, and middle ear). Bone conduction is assessed through a device that vibrates behind the ear or on your forehead. It bypasses the middle and outer ear, traveling directly to the inner ear via bone vibration. By comparing air- and bone-conduction results, audiologists can determine the type of hearing loss (conductive, sensorineural, or mixed). Pure-tone audiometry will also provide the severity and configuration of the hearing loss.
Speech Testing: Speech testing results will indicate how well the patient hears and understands spoken words. One test will show the softest level at which words can be heard and repeated back to them. Another test will measure how accurately, in percentage terms, the patient can understand and repeat words at a comfortable level. Results will show the patient how the hearing loss affects their ability to understand speech. It may also explain the difficulties they experience in their daily life.
Additional tests:
Auditory Brainstem Response (ABR): This test is conducted by an audiologist when additional information is needed. It is typically done for people who are unable to sit through pure-tone audiometry. It provides information about how well sound travels through the hearing system, from the inner ear to the brainstem.
Management and Treatment
Management and Treatment
The treatment of hearing loss depends on the root cause and severity of the loss. Some types can be treated medically or surgically, while others need management and aural rehabilitation.
Medical Treatment:
Ear wax removal
Medications for ear infections
Surgery for perforated eardrum
Surgery for otosclerosis
Removal of cholesteatoma
Hearing Aids: Hearing aids do not reverse or cure hearing loss, but they do amplify sounds to make speech and environmental sounds easier to hear. They are recommended for individuals with mild to severe hearing loss. Not every hearing aid is compatible with every loss. An audiologist will consider an individual's test battery, lifestyle, and anatomy when recommending a hearing aid. Then, the hearing aid is programmed to fit the individual's hearing loss.
Cochlear Implants: A cochlear implant is an electronic medical device designed for individuals with a severe to profound hearing loss. If hearing aids are not working or providing benefit, cochlear implants are a great option. The cochlear implant will bypass the damaged hair cells in the inner ear and directly stimulate the auditory nerve.
BiCROS/CROS: BiCROS and CROS both route sound from the better hearing ear to the other.
Bimodal Hearing Solution: Using a hearing aid on one ear and a cochlear implant in the other.
Bone Conduction Hearing Devices: Bone conduction hearing devices will transmit sound through the vibration of the skull. They are recommended for individuals with a conductive, mixed, or unilateral loss.
Aural rehabilitation: Aural rehabilitation is a key aspect in treatment and is needed to optimize hearing devices. It includes listening exercises, communication strategies, counseling, and education.
Hearing Aids:
Hearing Aids:
Behind-the-Ear (BTE)
Behind-the-Ear (BTE)
Who may benefit?
Moderate to profoud hearing loss
Individuals who need more durability
People who need more power
Individuals with dexterity issues
Receiver-in-Canal (RIC)
Receiver-in-Canal (RIC)
Who may benefit?
Mild to severe hearing loss
Individuals who want a more discreet look
People who would benefit for modern features like bluetooth connectivity
Custom In-the-Ear (ITE/CIC/ITC)
Custom In-the-Ear (ITE/CIC/ITC)
Who may benefit?
Mild to moderately-severe loss
People who want a more custom fit due to lifestlye or anatomy
Prevention
Prevention
Use ear plugs in noisy situations like concerts
Turn down the volume on personal listening devices
Limit dangerous decibels
Avoid using q-tips or inserting objects into the ear
Get regular screenings
Tinnitus with Hearing Loss
Tinnitus with Hearing Loss
Tinnitus is perception of sound when no external sound is present. It is a common symptom that may occur with hearing loss. It can often be described as a ringing, buzzing, roaring, high-pitched sound, or humming that may be heard in the head or in the ears (either one or both). Tinnitus affects everyone differently, varying in pitch, loudness, and duration. There is currently no cure or exact cause of tinnitus. Studies have shown that there are several aggravating factors such as, caffeine, stress, poor sleep, and loud noise exposure. If you or your loved one are struggling with tinnitus, there are several management strategies that may help. There are certain apps like myNoise that can provide you with background noise in quiet environments or when sleeping. Also, many have noticed that wearing hearing aids seems to manage their tinnitus. The key here with management strategies is to distract your brain with other sounds that will block the tinnitus or make it less noticeable.
FAQ
FAQ
What is hearing loss?
What is hearing loss?
Hearing loss is a decrease in the ability to hear sounds. There are 3 different types of hearing loss: conductive, sensorineural, and mixed. It can range from mild to profound and can affect both ears or only one. Hearing loss makes it difficult to understand speech, especially in noisy environments.
When should I get a hearing test?
When should I get a hearing test?
A hearing test should be done if there are any noticeable changes in hearing perception, such as difficulty understanding speech. If there are any known family members with hearing loss since birth or childhood, a hearing test should be conducted.
Do hearing aids restore my hearing?
Do hearing aids restore my hearing?
No. Hearing aids do not restore hearing back to normal. Instead, they amplify sounds and improve access to speech.
Can loud noise damage my hearing?
Can loud noise damage my hearing?
Yes. Exposure to loud noises for long periods of time can permanently damage the inner ear. Wearing hearing protection can prevent this damage.
What is that ringing in my ear?
What is that ringing in my ear?
The ringing may be tinnitus. It is the perception of sounds in the absence of an external source. Refer to the above tinnitus section for tips and more information.
Does hearing loss affect more than hearing ability?
Does hearing loss affect more than hearing ability?
Yes. Hearing loss can affect relationships with family or friends, work, and overall quality of life. It can also accelerate cognitive decline by diverting mental resources away from memory and thinking and putting it towards listening effort.
Does insurance cover hearing aids?
Does insurance cover hearing aids?
Many insurance companies cover hearing aids but coverage may vary depending on the plan. Contact your insurance to find out if they cover hearing aids.
Do I have to wear my hearing aids all the time?
Do I have to wear my hearing aids all the time?
In order to optimize the benefits of hearing aids, they should be worn daily for 10 to 12 hours. Do not wear them to swim, shower, or sleep. It is important to wear your hearing aids so that the brain can adapt and process sounds and eventually filter out background noise.
How do I clean my ears?
How do I clean my ears?
Your ears should NOT be cleaned with a cotton swab. Using cotton swabs can push the wax deeper into the ear canal and may cause damage or injury. The ear is a self-cleaning system, making cotton swabs unnecessary; however, you may use a warm washcloth to clean your outer ear. Contact your physician or an audiologist if you suspect excessive earwax that is affecting your hearing.
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