Hearing Problems

the rapid loss of 30 decibels or more of hearing ability, can happen over several hours or days. (A normal conversation is 60 decibels.) In nine out of 10 cases, sudden hearing loss affects only one ear. Though there are about 4,000 new cases of sudden hearing loss a year, the cause can only be found in 10% to 15% of cases.

Symptoms of Hearing Loss

In many cases, hearing fades so slowly, its departure goes unnoticed. You may think that people are mumbling more, your spouse needs to speak up, and the telephone is an inferior communication device. As long as some sound still comes in, you may assume your hearing is fine.

Hearing loss may be gradual or sudden. Hearing loss may be very mild, resulting in minor difficulties with conversation, or as severe as complete deafness. The speed with which hearing loss occurs may give clues as to the cause.

• If hearing loss is sudden, it may be from trauma, acute inflammation, or a problem with blood circulation. A gradual onset is suggestive of other causes such as aging or a tumor.

• If you also have other associated neurological problems, such as tinnitus (ringing in the ears) or vertigo (spinning sensation), it may indicate a problem with the nerves in the ear or brain.

• Hearing loss may be unilateral (only 1 ear) or bilateral (both ears). Unilateral hearing loss is most often associated with conductive causes, trauma, and acoustic neuromas.

• Pain in the ear is associated with ear infections, trauma, and obstruction in the canal. Ear infections may also cause a fever.

At the early stage of hearing loss, high-pitched sounds, such as children’s and female voices, and the sounds “S” and “F” become harder to decipher. Other symptoms of hearing loss include:

• Trouble understanding phone conversations

• Trouble hearing above background noise

• Trouble following a conversation when more than one person speaks at once

• Perception that people are not speaking clearly or mumbling

• Often misunderstanding what people say and responding inappropriately

• Often having to ask people to repeat themselves

• Frequent complaints by others that the TV is too loud

• Ringing, roaring, or hissing sounds in the ears, known as tinnitus.

Types of Hearing Problems

1. You have trouble hearing people in a noisy restaurant

Why it happens: As you age — especially if you’ve been exposed to frequent loud noises — you might have presbycusis, a type of gradual hearing loss caused by the death of hair cells in the cochlea, in your inner ear. Those are the cells that translate sound vibrations into brain signals.

“The cochlea contains only 15,000 of these hair cells, and they don’t regenerate,” says Andrea Boidman, executive director of the Hearing Health Foundation, a research organization in New York. “When they die, it becomes difficult for people to recognize certain sounds or to hear speech clearly.”

Difficulty hearing in noisy places is often one of the first noticeable signs of hearing loss. That’s because filtering out background noise is a fairly complex process that requires precise auditory input from both ears. Quiet conversations aren’t quite so taxing.

How to fix it: Although you can’t repair damaged cells, you can prevent further loss by limiting your exposure to loud noises. Most conversations occur between 40 and 60 decibels; any sound higher than 85 decibels puts you at risk. Common culprits include electronic devices like iPods, music players and sound speakers that can blast out as many as 105 decibels.

“Listening to just one loud song can cause immediate damage to hair cells,” says Monica Okun, M.D., an ear, nose and throat specialist at Lenox Hill Hospital in New York. Her advice: If others can hear your iPod while you’re using earbuds, the music is too loud.

If your hearing loss is starting to affect your everyday activities, talk to your doctor about a hearing aid. And before you balk, consider this: The newest models are so sleek that they’re practically invisible.

“The latest technology effectively reduces background noise while simultaneously enhancing the ability to hear speech more clearly,” says Ellen Finkelstein, chief audiologist at East Side Audiology in New York. “People can also hear voices that would be completely inaudible otherwise.” For severe hearing loss, you may want to consider cochlear implants. Whereas hearing aids amplify sounds so that damaged ears can detect them, cochlear implants bypass damaged parts and directly stimulate the auditory nerve.

Red flags: People with kidney or heart disease have a higher than average risk of developing presbycusis. Researchers think that may be because poor kidney function leads to the accumulation of toxins that can damage nerves in the inner ear. And cardiovascular disease can decrease blood flow to the inner ear. “Improving kidney or cardiac function won’t reverse hearing loss, but it can prevent it from worsening,” says Okun. “I recommend getting a formal hearing test if you have either condition.” The reverse may be true as well; if you have hearing loss, check your kidney and cardiovascular health.

2. You have a feeling of fullness in your ears

Why it happens: Excess mucus from an infection or allergy can block the eustachian tube, the small canal that connects the throat to the middle ear and regulates airflow, particularly when you swallow or yawn. Besides feeling fullness and muffled hearing, you might also experience popping, pain or tinnitus (ringing in the ears) or have difficulty maintaining balance. A buildup of earwax can cause that feeling of fullness, too.

How to fix it: “Most eustachian tube dysfunctions improve when the infection goes away,” says David S. Haynes, M.D., Cochlear Implant Program director at Vanderbilt University Medical Center in Nashville. If not, a doctor can prescribe decongestants and antihistamines to help reduce inflammation. As for earwax, any health care provider can remove it with a suction device, irrigation tool or nasal spray, Haynes says. Don’t try to do it yourself, though, as you can easily damage your eardrum.

Red flags: Hearing loss with fullness that’s accompanied by significant pain could be otitis externa, or swimmer’s ear, an infection of the ear canal that carries sound to the eardrums. The infection is typically caused by water in the ear, which breaks down the skin and provides a breeding ground for bacteria. Otitis externa is usually treated with ear drops that contain an antibiotic.

4. Hearing loss fluctuates and is accompanied by dizziness, nausea or trouble with balance

Why it happens: You may have Meniere’s Disease, an uncommon disorder with no known cause that alters the amount, flow and chemical composition of endolymph, the fluid in the inner ear. According to the Hearing Health Foundation, one in 500 people in the United States has the condition.

How to fix it: Ménière’s can’t be cured, but it can be treated. A low sodium diet and a prescribed diuretic can help reduce fluid in the inner ear. In rare cases, doctors may recommend injecting a steroid into the middle ear to reduce inflammation, or inserting a tube into the ear to drain excess fluid.

Red flags: Dizziness accompanied by fluctuating hearing loss can also signal other medical conditions such as a change in blood pressure, cardiovascular problems, dehydration and anxiety. If you’re experiencing this type of hearing loss, consult your primary care physician or an ear, nose and throat specialist right away.

SYMPTOMS		DIAGNOSIS		SELF-CARE
Begin Here
1. Have you been exposed to loud noises at work, or have you been shooting guns, driving a truck or listening to loud music for long periods of time?	Yes	Loud noises that result from certain types of work or entertainment may damage the inner ear. This kind of hearing loss is called occupational.		Prevent occupational hearing loss by wearing protective ear plugs or earmuffs. Once the hearing loss has occurred it can’t be reversed. If you think you have occupational hearing loss, see your doctor.
No
2. Are you experiencing partial hearing loss, along with earache and a feeling of fullness in the ear?	Yes	Earwax blockage, called CERUMINOSIS, can cause hearing loss in one or both ears.		Use mineral oil, baby oil or an over-the-counter earwax removal kit to soften the wax in your ear. If wax still can’t be removed, see your doctor.
No
3. Has your hearing loss occurred gradually as you have aged?	Yes	You may have PRESBYCUSIS, hearing loss related to aging and other factors.		See your doctor for an ear exam and a hearing test. You may benefit from a hearing aid.
No
4. Are you experiencing gradual hearing loss in one ear only?	Yes	You may have an ACOUSTIC NEUROMA, a noncancerous tumor on the hearing nerve.		See your doctor.
No
5. Do you have bouts of dizziness, nausea or vomiting, ringing in one ear and hearing loss in the same ear?	Yes	You may have Menier’s disease or a more serious TUMOR on the hearing nerve.		See your doctor.
No
6. Are you taking any medicines?	Yes	Certain medicines can cause hearing problems such as ringing in the ears.		See your doctor.
No
7. Do you have pain, reduced hearing, fever, cold symptoms or a “fluid” sensation in your ear?	Yes	This may be due to a cold, flu, allergies or a more chronic condition, SEROUS otitis media, in which fluid builds up in the middle ear.		Use cold medicine for 5 to 7 days. If you don’t feel better or if you have a constant fever or severe pain, see your doctor.
No
For more information, please talk to your doctor. If you think the problem is serious, call your doctor right away.

This tool has been reviewed by doctors and is for general educational purposes only. It is not a substitute for medical advice. The information in this tool should not be relied upon to make decisions about your health. Always consult your family doctor with questions about your individual condition(s) and/or circumstances. Source: American Academy of Family Physicians. Family Health & Medical Guide. Dallas: Word Publishing; 1996.

Hearing Loss Overview

To understand hearing loss it is important to understand how normal hearing takes place. There are 2 different pathways by which sound waves produce the sensation of hearing: air conduction and bone conduction.

• In air conduction, sound waves move through the air in the external auditory canal (the “ear canal” between the outside air and your eardrum). The sound waves hit the tympanic membrane (eardrum) and cause the tympanic membrane to move.

• The bones in the middle ear are connected to the tympanic membrane. When the tympanic membrane moves, this movement is transmitted to the bones. These 3 bones are called the malleus, the incus, and the stapes. Movement of the stapes causes pressure waves in the fluid-filled inner ear.

• The cochlea is an inner ear structure surrounded by fluid. It contains multiple small hairs. Pressure waves in the fluid cause the hairs to move. This movement stimulates the auditory nerve. Different frequencies of noises stimulate different hairs on the cochlea, which translate to the sensation of sounds of different pitch.

• Hearing by bone conduction occurs when a sound wave or other source of vibration causes the bones of the skull to vibrate. These vibrations are transmitted to the fluid surrounding the cochlea and hearing results.

Mixed Hearing Loss

Treatments for Mixed Hearing Loss

Audiologist Mark Ross, Ph.D., recommends taking care of the conductive component first. There have been times when the addition of the conductive component made the person a better hearing aid candidate, by flattening out the audiogram for example, while the underlying sensorineural component presented a high-frequency loss. However, still the emphasis would be on treating medically what can be treated. He says that, generally, you would expect positive results.

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