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Hearing Loss

Topic Overview

Anatomy of the ear

What is hearing loss?

Hearing loss is a sudden or gradual decrease in how well you can hear. Depending on the cause, it can be mild or severe, temporary or permanent.

Congenital hearing loss means you are born without hearing. This topic focuses on gradual hearing loss, which happens over time and can affect people of all ages.

If you have hearing loss, you may not be aware of it, especially if it has happened over time. Your family members or friends may notice that you're having trouble understanding what others are saying.

There are ways you can deal with hearing loss. And hearing aids and other devices can help you hear.

What causes hearing loss?

In adults, the most common causes of hearing loss are:

  • Noise. Noise-induced hearing loss can happen slowly over time. Being exposed to everyday noises, such as listening to very loud music or using a lawn mower, can damage the structures of the inner ear, leading to hearing loss over many years. Sudden, loud noises, such as an explosion, can damage your hearing.
  • Age. In age-related hearing loss, changes in the inner ear that happen as you get older cause a slow but steady hearing loss. The loss may be mild or severe, and it is always permanent.

Other causes of hearing loss include earwax buildup, an object in the ear, injury to the ear or head, an ear infection, a ruptured eardrum, and other conditions that affect the middle or inner ear.

What are the symptoms?

Common symptoms of hearing loss include:

  • Muffled hearing and a feeling that your ear is plugged.
  • Trouble understanding what people are saying, especially when other people are talking or when there is background noise, such as a radio.
  • Listening to the TV or radio at a higher volume than in the past.

Other symptoms may include:

  • A ringing, roaring, hissing, or buzzing in the ear, called tinnitus.
  • Ear pain, itching or irritation of the ear, or fluid leaking from the ear.
  • A feeling that you or your surroundings are spinning (vertigo).

How is hearing loss diagnosed?

Your doctor will do a physical exam and ask about your symptoms and past health. He or she also may look in your ears with a lighted device called an otoscope.

If your doctor thinks that you have hearing loss, he or she will do hearing tests to check whether you have hearing loss and find out how severe it is. You may be referred to an audiologist to do the tests. These tests may include:

  • A tuning fork test, which helps your doctor know which kind of hearing loss you have.
  • Other tests to find out what kind of hearing loss you have or which part of your ear is affected.

How is it treated?

Your doctor can help you decide on the best treatment. Noise-induced or age-related hearing loss can be treated with hearing devices, such as hearing aids. Other devices can help alert you to sounds around the house like the phone or doorbell. If hearing aids don't work for you, cochlear implants may be an option.

You also can learn ways to live with reduced hearing, such as paying attention to people's gestures, facial expressions, posture, and tone of voice.

In other types of hearing loss, you can treat the problem that caused the hearing loss. For example, you may remove earwax or take medicine for an infection to help your hearing come back.

How can you prevent hearing loss?

  • Avoid loud noise, such as noise from machines at your work, power tools, very loud music, and very loud motorcycles.
  • Turn down the volume on anything that you listen to through ear buds or headphones, such as MP3 players.
  • Wear hearing protection, such as earplugs or earmuffs.
  • Avoid putting objects in your ear.

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Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Hearing Loss: Should I Get Hearing Aids?

Cause

In adults, the most common causes of hearing loss are:

  • Noise. Noise-induced hearing loss can affect people of all ages and most often develops gradually over many years. Over time, the noise experienced at work, during recreation (such as riding motorcycles), or even common chores (such as using a power lawn mower) can lead to hearing loss.
  • Age. In age-related hearing loss (presbycusis), changes in the nerves and cells of the inner ear that occur as you get older cause a gradual but steady hearing loss. The loss may be mild or severe, but it is always permanent.

Other causes of hearing loss include:

  • Earwax buildup or an object in the ear. Hearing loss because of earwax is common and easily treated.
  • Ototoxic medicines (such as certain antibiotics) and other substances (such as arsenic, mercury, tin, lead, and manganese) that can damage the ear.
  • Injury to the ear or head. Head injuries can also damage the structures in the ear and cause a sudden hearing loss.
  • Ear infection, such as a middle ear infection (otitis media) or an infection of the ear canal (otitis externa or swimmer's ear).
  • Fluid in the middle ear after a cold or the flu, or after traveling on an airplane.
  • Otosclerosis, a condition that affects the bones of the middle ear.
  • Acoustic neuroma, a noncancerous tumor on the nerve that helps people hear.
  • Ménière's disease. Ménière's disease may result in temporary or permanent hearing loss.
  • Noncancerous (benign) growths, such as exostoses, osteomas, and glomus tumors. These can cause hearing loss if they block the ear canal. Exostoses are bone growths that often develop when the ear canal is repeatedly exposed to cold water or cold air.

Other medical conditions that do not affect the ear directly may also cause hearing loss.

  • An interruption of the blood flow to the inner ear or parts of the brain that control hearing may lead to hearing loss. This may be caused by heart disease, stroke, high blood pressure, or diabetes.
  • Autoimmune hearing loss can occur in one or both ears and can come and go or get worse over 3 to 4 months. An autoimmune disease, such as rheumatoid arthritis, may be present.

Symptoms

Symptoms of hearing loss include:

  • Muffled hearing.
  • Difficulty understanding what people are saying, especially when there are competing voices or background noise. You may be able to hear someone speaking, but you cannot distinguish the specific words.
  • Listening to the television or radio at a higher volume than in the past.
  • Avoiding conversation and social interaction. Social situations can be tiring and stressful if you do not hear well. You may begin to avoid those situations as hearing becomes more difficult.

Other symptoms that may occur with hearing loss include:

People who have hearing loss are sometimes not aware of it. Family members or friends often are the first to notice the hearing loss. Many adults may be depressed because of how hearing loss is affecting their relationships and social life.

What Happens

We hear sounds when sound energy goes through the ear's three main structures. In hearing loss, one or more of these structures is damaged. These structures are the:

  • External ear canal.
  • Middle ear, which is separated from the ear canal by the eardrum.
  • Inner ear, which contains the cochlea, the main sensory organ of hearing.

Which part of the ear is affected determines the type of hearing loss.

  • In conductive hearing loss, sound energy is blocked before it reaches the inner ear. Examples of conductive hearing loss include earwax or a growth blocking sound, such as occurs in otosclerosis.
  • In sensorineural hearing loss, sound reaches the inner ear, but a problem in the inner ear or the nerves that allow you to hear (auditory nerves) prevents proper hearing. Examples of sensorineural hearing loss include both noise-induced and age-related hearing loss.

A mixed hearing loss, in which both the conductive and sensorineural systems are affected, can also occur.

Another type of hearing loss is central hearing loss. In this type of hearing loss, the ear works, but the brain has trouble understanding sounds because the parts that control hearing are damaged. It may occur after a head injury or stroke. This type of hearing loss is rare.

Undiagnosed and untreated hearing loss can contribute to depression, social isolation, and loss of independence, especially in older adults.

When to Call a Doctor

Call 911 or other emergency services immediately if:

  • Hearing loss occurs with an injury to the head or ear.
  • Hearing loss occurs suddenly with other symptoms such as:
    • Facial droop.
    • Numbness or paralysis on all or one side of the face or body.
    • Eye or vision problems, including blurred or double vision or only being able to see out of one eye.
    • Slurred speech, not being able to speak, or difficulty understanding speech.
    • Difficulty standing or walking (ataxia).
    • Severe nausea or vomiting.

Call a doctor immediately if you:

  • Develop sudden, severe hearing loss.

Call your doctor if you:

  • Have hearing loss that you think may be caused by earwax.
  • Have hearing loss after taking medicine.
  • Have hearing loss after having cold or flu symptoms.
  • Have hearing loss after traveling on an airplane.
  • Feel your hearing is gradually getting worse.
  • Wonder if you need hearing aids.
  • Think your baby or child may not be hearing well.

If you think you have a hearing problem, you might choose to see an audiologist.

Watchful waiting

Watchful waiting is when you and your doctor watch symptoms to see if the health problem improves on its own. Although hearing loss is not usually dangerous, it can affect your personal safety. It can also reduce how much you can do in the workplace and at home and limit you socially. It is important that you talk to your doctor about hearing loss.

Who to see

Hearing loss can be diagnosed by:

If your doctor suspects or diagnoses hearing loss, he or she may have you see an ear, nose, and throat specialist (otolaryngologist) or an audiologist.

Exams and Tests

Your doctor will diagnose hearing loss by asking questions about your symptoms and past health and by doing a physical exam. He or she may find during a routine visit that you have some hearing loss.

You will also have a physical exam of the ears. Your doctor will use a lighted instrument (an otoscope) and may find problems in the ear canal, eardrum, and middle ear, including:

  • Earwax.
  • An object or obstruction in the ear canal.
  • An infection or fluid in the ear.
  • Injury to the ear.

If your exam, history, or symptoms suggest a hearing problem, your doctor may refer you to an audiologist to do hearing tests.

Depending on the suspected cause of hearing loss, you may also have other tests:

  • Imaging tests such as a CT scan or MRI may be done when an injury or tumor is suspected.
  • Auditory brain stem response (ABR) testing may be used to test nerve pathways in the brain if your doctor suspects an acoustic neuroma or another nerve problem. This test measures how well the nerve that helps you hear is working and how fast sound travels along this nerve.

Tests for your child

Some hearing problems can delay your child's speech and language development. Early screening for hearing loss can help prevent many learning, social, and emotional problems that can be related to speech and language development.1 The United States Preventive Services Task Force recommends that all newborns be screened for hearing loss.2 All 50 states require newborn hearing tests for all babies born in hospitals. Talk to your doctor about whether your child has been or should be tested.

Signs of noise-induced hearing loss are appearing at earlier ages and in children. Be sure your child has regular hearing exams.

Treatment Overview

Treatment for temporary or reversible hearing loss usually depends on the cause of the hearing loss. Treatment for permanent hearing loss includes using hearing devices or hearing implants. Your doctor can help you decide on the best treatment.

Although you and your family may view permanent hearing loss as part of aging, proper treatment is important. Hearing loss may contribute to loneliness, depression, and loss of independence. Treatment cannot bring back your hearing, but it can make communication, social interaction, and work and daily activities easier and more enjoyable.

Treatment for reversible hearing loss depends on its cause. It is often treated successfully. Hearing loss caused by:

  • Ototoxic medicines (such as aspirin or ibuprofen) often improves after you stop taking the medicine.
  • An ear infection, such as a middle ear infection, often clears up on its own, but you may need antibiotics.
  • An injury to the ear or head may heal on its own, or you may need surgery.
  • Otosclerosis, acoustic neuroma, or Ménière's disease may require medicine or surgery.
  • An autoimmune problem may be treated with corticosteroid medicines, generally prednisone.
  • Earwax is treated by removing the wax. Do not use a cotton swab or a sharp object to try to remove the wax. This may push the wax even deeper into the ear or may cause injury. For information on how to remove hardened earwax safely, see the topic Earwax.

In permanent hearing loss, such as age-related and noise-induced hearing loss, hearing devices can often improve how well you hear and communicate. These devices include:

  • Hearing aids. Hearing aids make sounds louder (amplify). They do not restore your hearing, but they may help you function and communicate more easily. Having occasional hearing tests can help you know when your hearing aids need adjustment.
    Click here to view a Decision Point. Hearing Loss: Should I Get Hearing Aids?
  • Implanted hearing devices, such as cochlear implants. Several types of hearing implants are available, each for specific types of hearing problems. Some implants require devices to be worn outside the ear. Newer implants may be contained within the ear.
  • Assistive listening devices, alerting devices, and other communication aids.

Prevention

You can prevent some types of hearing loss.

Preventing noise-related hearing loss

Being exposed to loud noise over and over is one of the most common causes of permanent hearing loss. It usually develops slowly and without pain or other symptoms. You may not notice that you have hearing loss until it is severe.

Be sure your child has regular hearing exams and follows the suggestions below to prevent hearing loss.

Steps you can take to lower your risk of noise-induced hearing loss include the following:

  • Be aware of and avoid harmful noise. You can be exposed to harmful noise at work, at home, and in many other settings. Know what kinds of situations can cause harmful noise levels. To learn more about hearing protection in workplaces in the United States, contact the Occupational Safety and Health Administration (OSHA).
  • Use hearing protectors. If you know you are going to be around harmful noise, wear hearing protectors, such as earplugs or earmuffs.
  • Control the volume when you can. Reduce the noise in your life by turning down the volume on the stereo, TV, or car radio, and especially on personal listening devices with earphones or ear buds.
  • Don't wait to protect yourself. After noise-related damage to the ear is done, it cannot be reversed. But if you already have some noise-related hearing loss, it is not too late to prevent further damage and preserve the hearing that you still have.

Preventing other causes of hearing loss

To lower your risk of other types of hearing loss:

  • Never stick a cotton swab, hairpin, or other object in your ear to try to remove earwax or to scratch your ear. The best way to prevent earwax problems is to leave earwax alone. For information on how to remove hardened wax, see the topic Earwax.
  • During air travel, swallow and yawn frequently when the plane is landing. If you have an upper respiratory problem (such as a cold, the flu, or a sinus infection), take a decongestant a few hours before landing or use a decongestant spray just before landing.
  • Stop smoking. You are more likely to have hearing loss if you smoke.
  • Make sure your child receives all the recommended immunizations to protect against pneumococcal disease, meningitis, and other conditions that can cause hearing problems. For more information, see the topic Immunizations.

Living With Hearing Loss

If you have hearing loss, you may find that it takes extra effort and energy to talk with others. Hearing may be especially difficult in settings where there are many people talking or there is a lot of background noise. The increased effort it takes to be with other people may cause stress and fatigue. You may begin to avoid social activities, feel less independent, and worry about your safety.

Hearing devices you may want to use include:

  • Hearing aids. Hearing aids make all sounds louder (amplify), including your own voice. Common background noises, such as rustling newspapers, magazines, and office papers, may be distracting. When you first get hearing aids, it may take you several weeks to months to get used to this.
    Click here to view a Decision Point. Hearing Loss: Should I Get Hearing Aids?
  • Assistive listening devices. These devices make certain sounds louder by bringing the sound directly to your ear. They shorten the distance between you and the source of sound and also reduce background noise. You can use different types of devices for different situations, such as one-on-one conversations and classroom settings or auditoriums, theaters, or other large public spaces. Commonly used listening devices include telephone amplifiers, personal listening systems (such as auditory trainers and personal FM systems), and hearing aids that you can connect directly to a television, stereo, radio, or microphone.
  • Alerting devices. These devices alert you to a particular sound (such as the doorbell, a ringing telephone, or a baby monitor) by using louder sounds, lights, or vibrations to get your attention.
  • Television closed-captioning. Television closed-captioning makes it easier to watch television by showing the words at the bottom of the screen so that you can read them. Most newer TVs have a closed-captions option.
  • Text messaging. You can type messages and send them from your mobile device to someone else's.
  • TTY (text telephone). A TTY (also called TDD, or telecommunication device for the deaf) allows you to type messages back and forth on the telephone instead of talking or listening. When messages are typed on the TTY keyboard, the information is sent over the phone line to a receiving TTY and shown on a monitor. A telecommunications relay service (TRS) makes it possible to call from a phone to a TTY or vice versa.

Many other communication devices, such as pagers, fax machines, email, and custom calling features offered by phone companies, can be helpful. To get more information about selecting and using listening, alerting, and telecommunicating devices, talk to an audiologist.

For family and friends of people with hearing loss

A person with hearing loss may feel cut off from conversations and social interaction. The extra effort and stress needed to take part in conversations can be tiring for all people involved. If you live with someone who has hearing loss, you may improve your communication by:

  • Making sure the person knows you are speaking to him or her. Use his or her name.
  • Speaking to the person at a distance of 3 ft (1 m) to 6 ft (2 m). Make sure that the person can see your face, mouth, and gestures. Arrange furniture and lighting so that everyone in the conversation is completely visible.
  • Not speaking directly into the person's ear. Your facial expressions and gestures can provide helpful visual clues about what you are saying.
  • Speaking slightly louder than normal. But don't shout. Speak slowly and clearly. Don't repeat the same word over and over again. If a particular word or phrase is misunderstood, find another way to say it.
  • Telling the person when the topic of conversation changes.
  • Cutting down on background noise. Turn off the TV or radio during conversations. Ask for quiet sections in restaurants, and try to sit away from the door at theaters.
  • Including the person in discussions and conversations. Don't talk about the person as though he or she isn't there.

Other Places To Get Help

Organizations

American Hearing Research Foundation
Web Address: www.american-hearing.org

National Institute on Deafness and Other Communication Disorders (U.S.)
Web Address: www.nidcd.nih.gov

References

Citations

  1. Joint Committee on Infant Hearing, American Academy of Pediatrics (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120(4): 898–921. Also available online: http://pediatrics.aappublications.org/cgi/reprint/120/4/898.
  2. U.S. Preventive Services Task Force (2008). Universal Screening for Hearing Loss in Newborns: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf08/newbornhear/newbhearrs.htm.

Other Works Consulted

  • American Academy of Pediatrics (2008). Recommendations for preventive pediatric health care. In Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed., p. 591. Elk Grove Village, IL: American Academy of Pediatrics. Also available online: http://brightfutures.aap.org/pdfs/Guidelines_PDF/20-Appendices_PeriodicitySchedule.pdf.
  • Centers for Disease Control and Prevention (2010). Risk of bacterial meningitis in children with cochlear implants. Available online: http://www.cdc.gov/ncbddd/hearingloss/meningitis.html.
  • Gates GA, Clark WW (2012). Occupational hearing loss. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 747–759. New York: McGraw-Hill.
  • Gluth MB, et al. (2012). Cochlear implants. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 850–860. New York: McGraw-Hill.
  • Joint Committee on Infant Hearing, American Academy of Pediatrics (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120(4): 898–921. Also available online: http://pediatrics.aappublications.org/cgi/reprint/120/4/898.
  • National Institute on Deafness and Other Communicative Disorders (2011). Ten Ways to Recognize Hearing Loss. Available online: http://www.nidcd.nih.gov/health/hearing/pages/10ways.aspx.
  • Niparko JN, et al. (2010). Spoken language development in children following cochlear implantation. JAMA, 303(15): 1498–1506.
  • Sweetow RW, Cascia T (2012). Aural rehabilitation and hearing aids. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 721–728. New York: McGraw-Hill.
  • Tsai BS, Cheung SW (2012). Implantable middle ear hearing devices. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 845–849. New York: McGraw-Hill.
  • U.S. Preventive Services Task Force (2008). Universal Screening for Hearing Loss in Newborns: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf08/newbornhear/newbhearrs.htm.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Charles M. Myer, III, MD - Otolaryngology
Current as of March 13, 2014

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