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Hearing Loss

Some things you should know about hearing loss

All about Hearing Loss

Hearing loss or hearing impairment is becoming ever more prevalent in our noisy world. It is on the increase across the world and it is believed that the onset of hearing loss is happening at a younger and younger age. Let's look at hearing loss, what it is, how it happens and what the symptoms are.

Hearing Problems, Hearing Impairment, Hearing Loss?

Hearing loss can be temporary or permanent. It can happen at birth but generally, it comes on gradually as you get older, however, sometimes it can happen suddenly. If you suffer any type of sudden hearing loss, you should treat it as a medical emergency until you know better. You can read more about sudden hearing loss here.

First of all a hearing loss does not immediately equate to a hearing impairment, a mild hearing loss or hearing outside of the parameters we call normal may not actually cause an impairment. When I first qualified as a hearing professional it was generally felt that we should not treat a mild hearing loss. The accepted thought at the time was that even if a person had a mild hearing loss, if it was not past a certain degree it probably would not be classed as an impairment.

However, that belief is beginning to change, with recent study findings in relation to the connection between hearing loss and neurocognitive disorders such as dementia. The evidence at present is correlative, which means there is a correlation between the two, correlative evidence does not mean that they are connected without doubt or that one causes the other. The weight of study evidence is gathering though and the opinion of the profession is starting to become that all hearing losses should be treated as early as is possible. 

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What is the definition of hearing impairment?

A hearing impairment is any hearing loss that prevents someone from receiving all of the sounds they normally would through the ear. If the loss is mild, the person may have difficulty hearing faint or distant speech. If the loss is moderate, a person may have difficulty hearing speech in complex sound situations. If the loss is severe, a person may have difficulty hearing speech clearly. If a loss is profound, a person may have difficulty hearing speech at all. 

What are the three types of hearing loss? 

Hearing loss can be caused by many different causes, a few of which can be successfully treated with medicine or surgery, depending on the disease process. Most forms of hearing loss cannot be treated other than with hearing aids. There are generally three types of hearing loss that are discussed here. 

  • Conductive Hearing Loss: A conductive loss is caused by diseases or obstructions in the outer or middle ear that usually affect all frequencies of hearing.  Some conductive hearing losses are temporary, some are chronic or long term. Conductive loss can often be medically treated sometimes with surgery, temporary conductive losses (usually caused by mid-ear infections) are often treated with medication. For a conductive hearing loss of a more chronic nature, a hearing aid is generally a fantastic solution delivering real benefit.
  • Sensorineural Hearing Loss: A sensorineural loss results from some damage to the inner ear (cochlea). Sometimes referred to as a nerve-related hearing loss or nerve deafness. The loss can range from mild to profound and often affects certain frequencies more than others. The only treatment for sensorineural hearing loss at present is hearing aids.
  • Mixed Hearing Loss: A mixed loss is as it sounds a mix of both conductive and sensorineural hearing losses that occur in both the inner and outer or middle ear. A mixed hearing loss tends to be pretty rare. 

Let's look at those a little closer

What can cause a conductive hearing loss?

A conductive hearing loss is caused by anything that interferes with the transmission of sound from the outer to the inner ear. That could be a malformation of the outer ear, ear canal, or middle ear structures, or a perforated eardrum all of which will cause a conductive hearing loss (this may be corrected surgically). Fluid buildup in the middle ear caused by colds or upper respiratory tract infections will cause a temporary hearing loss (temporary, should pass with the condition that caused it). Ear infection formally called otitis media, (an infection of the middle ear that causes an accumulation of fluid) will interfere with the movement of the eardrum and ossicles (this can be temporary, but chronic ongoing otitis media can cause permanent damage). so the causes of a conductive hearing loss can be classified as:

  • Middle ear infections (otitis media).
  • Collection of fluid in the middle ear (“glue ear” in children).
  • Blockage of the outer ear, most commonly by wax.
  • Otosclerosis, a condition in which the ossicles of the middle ear harden and become less mobile.
  • Damage to the ossicles, for example by a serious infection or head injury.
  • Perforated (pierced) eardrum, which can be caused by an untreated ear infection, head injury or a blow to the ear, or from poking something in your ear.

 

What is the cause of sensorineural hearing loss?

A sensorineural hearing loss is due to damage to the pathway that sound impulses take from the hair cells of the inner ear to the auditory nerve and the brain. So sensorineural hearing loss happens when there is damage to the structures of the inner ear (cochlea), it can be caused by age, disease, noise or genetic causes. Or damage to the nerve that runs from the inner ear to the brain (auditory nerve), can be caused by disease, tumour or genetic causes. Or finally, damage to the auditory centre of the brain, varying causes such as disease or stroke. Generally speaking, the causes of sensorineural hearing loss tend to be the following:

  • Age-related hearing loss (presbyacusis). This is the natural decline in hearing that many people experience as they get older. It’s partly due to the loss of hair cells in the cochlea.
  • Acoustic trauma (injury caused by loud noise) can damage hair cells.
  • Certain viral or bacterial infections such as mumps or meningitis can lead to loss of hair cells or other damage to the auditory nerve.
  • Ménière’s disease, which causes dizziness, tinnitus, and hearing loss.
  • Certain drugs, such as some powerful antibiotics, can cause permanent hearing loss. At high doses, aspirin is thought to cause temporary tinnitus – a persistent ringing in the ears. The antimalarial drug quinine can also cause tinnitus, but it’s not thought to cause permanent damage.
  • Acoustic neuroma. This is a benign (non-cancerous) tumour affecting the auditory nerve. It needs to be observed and is sometimes treated with surgery.
  • Other neurological (affecting the brain or nervous system) conditions such as multiple sclerosis, stroke, or a brain tumour.

A mixed loss is generally a mixture of both conditions and causes

There are further subcategories of hearing loss, such as sudden hearing loss and single-sided deafness

Do you have a hearing problem?

Most hearing loss occurs gradually, so the symptoms are often difficult to recognise. It may take something specific for you to realise that your hearing has deteriorated, such as a someone telling you that they think you have a problem; it may take people a long time to let you know, they may not want to hurt your feelings by suggesting you are going deaf. Or, it may be that you failed to hear something that resulted in an accident or some kind of undesirable event; a window-cleaner shouting from atop his ladder to warn you of his falling bucket, for example.

Many people may come to the realisation that there is something wrong with their hearing but will refuse to accept it and try to make up excuses so that they can ignore the problem.

Recognising Hearing Loss

The list below shows some common symptoms of hearing loss:

  • People seem to be mumbling
  • You have to strain to hear when someone talks or whispers
  • You have difficulty hearing someone call from behind or in another room
  • You need to watch a speaker’s lips more closely to follow conversation
  • Following a conversation is difficult when you are in a group of people
  • You have to turn up the volume on the TV or radio
  • You have problems hearing clearly on the telephone
  • You have difficulty hearing at the theatre, cinema or other venues
  • You find it hard to hear in noisy restaurants or in the car
  • Family or friends mention that they often have to repeat themselves

If you are experiencing one or more of the problems listed above, you should get your hearing checked by a professional. Some types of hearing loss are reversible, you may be suffering needlessly.

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