Hearing loss

Considerations

Symptoms of hearing loss may include:

• Certain sounds seem too loud
• Difficulty following conversations when two or more people are talking
• Difficulty hearing in noisy areas
• Hard to tell high-pitched sounds (such as "s" or "th") from one another
• Less trouble hearing men's voices than women's voices
• Problems hearing when there is background noise
• Voices that sound mumbled or slurred

Other symptoms include:

• Feeling of being off-balance or dizzy (more common with Meniere's disease and acoustic neuroma)
• Pressure in the ear (in fluid behind the eardrum)
• Ringing or buzzing sound in the ears (tinnitus)

Causes

Conductive hearing loss (CHL) occurs because of a mechanical problem in the outer or middle ear.

• The three tiny bones of the ear (ossicles) may not conduct sound properly.
• Or, the eardrum may not vibrate in response to sound.

Causes of conductive hearing loss can often be treated. They include:

• Buildup of wax in the ear canal
• Damage to the very small bones (ossicles) that are right behind the eardrum
• Fluid that stays in the ear after an ear infection
• Foreign object that is stuck in the ear canal
• Hole in the eardrum
• Scar on the eardrum from repeat infections

Sensorineural hearing loss (SNHL) occurs when the tiny hair cells (nerve endings) that detect sound in the ear are injured, diseased, do not work correctly, or have died. This type of hearing loss often cannot be reversed.

Sensorineural hearing loss is commonly caused by:

• Acoustic neuroma
• Age-related hearing loss
• Childhood infections, such as meningitis, mumps, scarlet fever, and measles
• Meniere's disease
• Regular exposure to loud noises (such as from work or recreation)
• Use of certain medicines

Hearing loss may be present at birth (congenital) and can be due to:

• Birth defects that cause changes in the ear structures
• Genetic conditions (more than 400 are known)
• Infections the mother passes to her baby in the womb (such as toxoplasmosis, rubella, or herpes) 

The ear can also be injured by:

• Pressure differences between the inside and outside of the eardrum, often from scuba diving
• Skull fractures (can damage the structures or nerves of the ear)
• Trauma from explosions, fireworks, gunfire, rock concerts, and earphones

Home Care

You can often flush wax buildup out of the ear (gently) with ear syringes (available in drug stores) and warm water. Wax softeners (like Cerumenex) may be needed if the wax is hard and stuck in the ear.

Take care when removing foreign objects from the ear. Unless it is easy to get to, have your health care provider remove the object. Don't use sharp instruments to remove foreign objects.

See your health care provider for any other hearing loss.

When to Contact a Medical Professional

Call your health care provider if:

• Hearing problems interfere with your lifestyle
• Hearing problems do not go away or become worse
• The hearing is worse in one ear than the other
• You have sudden, severe hearing loss or ringing in the ears (tinnitus)
• You have other symptoms, such as ear pain, along with hearing problems
• You have new headaches, weakness, or numbness anywhere on your body

What to Expect at Your Office Visit

The health care provider will take your medical history and do a physical exam.

Tests that may be done include:

• Audiometry (a hearing test used to check the type and amount of hearing loss)
• CT or MRI scan of the head (if a tumor or fracture is suspected)
• Tympanometry

The following surgeries may help some types of hearing loss:

• Eardrum repair
• Placing tubes in the eardrums to remove fluid
• Repair of the small bones in the middle ear (ossiculoplasty)

The following may help with long-term hearing loss:

• Devices for hearing loss
• Hearing aids
• Learning techniques to help you communicate
• Sign language (for those with severe hearing loss)

Cochlear implants are only used in people who have lost too much hearing to benefit from a hearing aid.

Alternative Names

Decreased hearing; Deafness; Loss of hearing; Conductive hearing loss

References

Baloh RW, Jen J. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 430.

Hildebrand MS, Husein M, Smith RJH. Genetic sensorineural hearing loss. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 147.

Arts HA. Sensorineural hearing loss in adults. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 149.

Lonsbury-Martin BL, Martin GK. Noise-induced hearing loss. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 151.

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 156.

El Dib RP, Matthew JL, Martins RHG. Interventions to promote the wearing of hearing protection. Cochrane Database Syst Rev. 2012;4:CD005234.  DOI: 10.1002/14651858. CD005234.pub5.

Update Date: 5/22/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.