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Hearing Loss
Hearing Loss Hearing loss, whether mild or severe, can get in the way of your ability to enjoy life and cause strains in relationship.

Do you have trouble following conversations in a noisy environment or over the phone? Do your friends, co-workers, or family complain that you purposely ignore them when they are talking to you? Do you get frustrated and upset because you frequently cannot understand or misinterpret what others are saying? If your answer is yes, then you may be among the 32.5 million Americans affected by hearing loss. Among older adults, hearing loss is one of the most common medical conditions. Roughly one-third of Americans 65 to 74 years of age and 47 percent of those 75 and older have hearing loss. Hearing loss, whether mild or severe, can get in the way of your ability to enjoy life and cause strains in relationship. It can also be dangerous when you cannot hear sirens and other warning signals or alarms.

What Causes Hearing Loss?
Hearing loss can have many different causes, including the aging process, earwax buildup, exposure to loud noises, viral or bacterial infections, certain medications, head trauma, tumors, and heredity. Given the large number of possible causes of hearing loss, we will only focus on the most common ones affecting adults.

In order to understand hearing loss, it is important to get a quick lesson on how normal hearing takes place. Sound travels as waves through the air in the ear canal, strikes the eardrum, and causes it to vibrate. The vibration of the eardrum is then transmitted via three small bones in the middle ear to the fluid in the inner ear. The resulting fluid movement inside the inner ear is sensed by specialized hair cells. These cells stimulate different parts of the hearing (auditory) nerve, sending electrical impulses to the brain resulting in the perception of sounds in different pitches and loudness.

Getting used to a hearing aid takes time. The sound you hear is different because it is amplified. Thus, hearing loss can occur because of problems with sound conduction (conductive hearing loss), sound perception (sensorineural hearing loss), or combination of both (mixed hearing loss). Conductive hearing loss can occur at the level of the ear canal due to blockage by ear wax, cotton from Q-tips, and such. Mechanical problems such as a punctured eardrum or scarring of the eardrum (tympanosclerosis) can also lead to conductive hearing loss. Finally, conductive hearing loss can occur due to impaired movement of the three bones inside the middle ear because of loose connections between the bones, stiff connection between one of the bones (stapes), and inner ear window (otosclerosis), or presence of fluid in the middle ear. Sensorineural hearing loss can occur due to damage to the hair cells or hearing nerve resulting from loud noise exposure, certain medications, head trauma, viral infection, tumor, pressure trauma from diving, and aging. Presbycusis is the term used to describe age-related hearing loss, which can develop at different rates in different individuals. The hearing loss is mostly sensorineural and results from the wear and tear on the ears and damage to inner ear from years of noise exposure.

Sudden Hearing Loss: A Medical Emergency
In most cases, hearing loss is a gradual phenomenon, which takes place over many years. A sudden loss of hearing that occurs over a period of a few hours or a few days can be a cause for concern and requires emergent medical attention because early initiation of treatment may prevent permanent hearing loss. In most cases, despite extensive testing, the cause of this sudden hearing loss is unknown . Viral infection may be the most common cause of this sudden hearing loss. Early treatment with steroids and anti-viral medication may lead to recovery of hearing in some cases.

Asymmetric Sensorineural Hearing Loss: Ruling out Acoustic Neuroma
Typically, sensorineural hearing loss should affect both ears to the same degree because both ears are equally exposed to damage effects from noise, infection, medications, etc. In some cases, the degree of sensorineural hearing loss may be different between the two ears due to different degree of noise exposure. For example, a right-handed hunter would typically tuck his/her right ear into the right shoulder when shooting and thus have more hearing loss in the left ear. However, a unilateral disease process, such as a tumor arising from the balance or hearing nerve (acoustic neuroma), can also cause sensorineural hearing loss on one side but not the other. Thus, in the presence of asymmetric sensorineural hearing loss, a diagnostic test such as MRI may be needed to rule out the presence of tumor.

Hearing Aid
Hearing aids come in variety of shapes, sizes, and styles. Some hearing aids fit inside the ear canal, while others fit behind the ear. Hearing aids can help some kinds of hearing loss by making sounds louder. However, they sometimes pick up background noises such as traffic noise in the street or people talking in a crowded restaurant. This can affect how well you hear in certain situations. Getting used to a hearing aid takes time. The sound you hear is different because it is amplified. You may need to try more than one device to find one that works well for you.

Assistive Listening Devices
Many products can help you improve your hearing in certain situations. They can be used with or without hearing aids. At home, you can use telephone amplifying devices and TV and radio listening systems to help you hear. Captioning on TV also provide great benefit. Assistive listening devices that send sound directly to your ears may also be available in some public places such as auditoriums, movie theaters, churches, synagogues, and meeting places. Other assistive technology that can benefit people with hearing loss includes alerting devices, such as special smoke detectors, doorbells, telephone ring signalers, and alarm clocks, which produce loud signals, visual signals, or tactile signals. For example, a flashing light could let you know someone is at the door or that the phone is ringing.

Cochlear Implants
If your deafness is severe, your doctor may suggest cochlear implants. This treatment involves the implantation of a small electronic device under the skin behind the ear. The device picks up sounds, changing them to electrical signals, and sends them past the non-working part of the inner ear to stimulate the hearing nerve directly. A cochlear implant does not restore or create normal hearing. Instead, it can help people who are deaf or who have a severe hearing loss be more aware of their surroundings and understand speech.

What can be done to Prevent Hearing Loss?
Although you cannot change your genetic make-up, you do have the power to control environmental factors that may contribute to your hearing loss. One of the most important things to do is protect yourself from noise. Wear earplugs and earmuffs when you are exposed to any loud noise at work, recreation (hunting), or home (mowing the lawn). Turn down the volume when listening to music or watching TV. You should also be aware of certain medications that can cause damage to hearing.

Hearing loss can result from both hereditary and environmental causes such as noise exposure, infection, medication, trauma, and tumor. Treatment for hearing loss is available and can result in improved quality of life. Protection from noise exposure is the most important thing that you can do to prevent hearing loss.

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"Hearing Loss"
   authored by:
Ho-Sheng Lin, MD is an Assistant Professor at the Department of Otolaryngology - Head and Neck Surgery at Wayne State University School of Medicine and a staff physician at the John D. Dingell VA Medical Center. He received his medical degree from Y...

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