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HEARING LOSS

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WHAT IS HEARING LOSS?

Hearing loss happens when something affects your hearing system. If you have hearing loss, you may have trouble understanding, following or participating in conversations. It may be hard for you to hear telephone conversations, to take part in online meetings or follow dialogue when you’re watching television.

Hearing loss can affect your ability to work, communicate with others and generally enjoy life. Most often, hearing loss can’t be reversed. But audiologists — healthcare providers who specialize in diagnosing and treating hearing loss — can help. They can recommend treatments like hearing aids or cochlear implants that reduce hearing loss.

Is hearing loss common?

Yes, it is. More than 1 in 10 people in the United States have some degree of hearing loss:

  • An estimated 60,000 people have hearing loss in one ear (unilateral hearing loss).
  • About 1 in 3 adults over 65 and nearly half adults 75 and older have age-related hearing loss.
  • About 2 in 1,000 babies are born with some type of hearing loss.

Types of hearing loss

There are three types of hearing loss:

  • Conductive hearing loss: In this hearing loss, something keeps sound from passing through your outer ear (ear canal) or your middle ear.
    • Image of conductive hearing loss

    Conductive hearing loss refers to a hearing problem caused by physical damage or the presence of obstruction along the outer ear and/or middle ear.

    With this type of hearing loss, the hearing receptors, called hair cells, are intact and normal. The reason for the hearing loss is inefficient transmission of sound, from the environment, due to a physical problem. You can simulate this by simply putting your fingers in your ears.

    A true conductive hearing loss can usually be remedied medically or surgically, depending on the case. In cases wherein the medical doctor cannot fully address the hearing loss, hearing aids may be recommended. The most common causes of conductive hearing loss are:

    • ear wax impaction
    • fluid in the middle part of the ear
    • physical damage to the eardrum
  • Sensorineural hearing loss: This hearing loss happens when something damages your inner ear over time. Rarely, sensorineural hearing loss happens very quickly. This is sudden sensorineural hearing loss (SSHL), or sudden deafness. SSHL may happen all at once or over a few days.
    • Image showing Sensorineural hearing loss

    Unlike conductive hearing loss, there are no physical damages or obstructions on the external ear or middle ear; rather, the problem lies in the hearing receptors themselves. There are different causes of sensorineural hearing loss.

    Unlike conductive hearing loss, there are no physical damages or obstructions on the external ear or middle ear; rather, the problem lies in the hearing receptors themselves. There are different causes of sensorineural hearing loss.

    Sensorineural hearing loss is the most common type of hearing loss and is caused by the deterioration of our hearing receptors (the hair cells) found in the inner ear.

    The most common causes of sensorineural hearing loss is wear-and-tear of our sense of hearing through external noise. Our ears, unlike our eyes, can never be shut off.

    They constantly pick up sounds around us. You can think of the hearing portion of the inner ear as a set of guitar strings. The sound vibrations that reach the inner ear cause those strings to be strummed all the time. Over time, those strings may break, leading to an inability to hear the notes they should play.

    The natural wear-and-tear of our hearing receptors make sensorineural hearing loss very common, especially in older populations.

    In some cases, sensorineural hearing losses can be a byproduct of a viral illness, which causes some virus particles to reach the inner ear, introducing damage to the nerves. In still other cases, sensorineural hearing loss may be hereditary.

    This type of hearing loss cannot be addressed medically/surgically. The most common treatment is the usage of hearing aids.

    Important note on sudden hearing loss - Sudden hearing losses can occur in some individuals and require immediate medical attention. You can wake up one day and notice that you just do not hear from one side, or you can be walking into the mall and suddenly lose your hearing. Should these happen, it is crucial to consult a physician right away to preserve long term hearing health.

  • Mixed: This happens when you have issues in your middle or outer ear (conductive hearing loss) and your inner ear (sensorineural hearing loss).

    • Combining both conductive and sensorineural hearing loss leads to the third type, mixed hearing loss.

    In this type, there is an element of physical damage/obstruction to the outer and/or middle ear, in combination with a deterioration of the hair cells found in the inner ear.

    A physician can treat the conductive part of the hearing loss and may prescribe hearing aids once the obstruction is clear.

Symptoms and Causes

What are hearing loss symptoms?

Most people lose their hearing gradually. They may not even notice that it’s happening. In general, you may be developing hearing loss if:

  • You often ask people to repeat themselves.
  • You have trouble following a conversation, especially when you’re talking on the telephone or in a noisy environment like a restaurant.
  • You think people are mumbling.
  • You can’t hear certain high-pitched sounds, like birds singing.
  • You need to turn up the volume on your television, computer or tablet.
  • You have tinnitus (ringing in your ears).
  • Your ear hurts (earache).
  • You feel as if there’s pressure or fluid inside your ear.
  • You have balance problems or dizziness.

What are symptoms of hearing loss in babies and children?

Babies with hearing loss may seem to hear some sounds but not others. They may:

  • Not startle to loud noises.
  • Not turn to the source of a sound after 6 months of age.
  • Not say single words like “mama” or “dada” by age 1.
  • Not react when you say their name.

Older children with hearing loss may:

  • Say “huh” a lot.
  • Be slower to learn to speak than other children their age.
  • Have unclear speech.
  • Not follow directions.
  • Turn up the volume on television or tablets.

What usually causes hearing loss?

Many things can cause hearing loss. For example, short-term or sudden exposure to very loud noise — like attending a loud concert — can affect your hearing.

Conductive hearing loss causes include:

  • Earwax that’s built up in your ear.
  • Fluid in your middle ear from colds or allergies.
  • Middle ear infection (
  • Swimmers’ ear (otitis externa).
  • Eustachian tube issues that traps fluid in your middle ear.
  • Ruptured eardrum.
  • Ear tumors.
  • Something stuck in your ear. For example, your child, faced with a side dish of peas, may decide to put one in their ear.
  • Congenital conditions (conditions present at birth) that affect how babies’ middle or outer ears are formed.

Sensorineural hearing loss causes include:

  • Aging.
  • Illnesses like coronary artery disease (heart disease), high blood pressure (hypertension), strokes or diabetes.
  • Ototoxicity.
  • Certain genetic (inherited) conditions.
  • Being hit in the head.
  • Noise-induced hearing loss. Long-term exposure to loud noise, like working in a very noisy environment like factories and construction sites.
  • Congenital infections like cytomegalovirus (CMV).

Mixed hearing loss in a combination of conductive and sensorineural hearing loss. That means it affects your outer and middle ear as well as your inner ear. For example, if you take medications that affect your inner ear and you accidentally rupture your eardrum in your middle ear, you have mixed hearing loss.

What are the complications of hearing loss?

Having hearing loss can make you feel disconnected from the world around you. You may become frustrated, irritable or angry. People with severe hearing loss can become anxious or depressed. Children with hearing loss may struggle in school and get poor grades. Studies also show a link between hearing loss in older adults and dementia.

Diagnosis and Tests

How is hearing loss diagnosed?

Several different aspects of hearing are tested during a comprehensive hearing evaluation. The combination of these tests will be able to identify the type and severity of hearing loss an individual has, which provides the audiologist with the information to make the best recommendation for treatment. 

Here are many of the tests audiologists will commonly administer during a comprehensive hearing evaluation.

Otoscopy: This is when an audiologist looks into your ears with a tool called an otoscope in order to evaluate the health of your outer ear and eardrum. It also makes it possible to visually identify whether there may be middle ear conditions present, as well as if there is any cerumen or foreign objects that need to be removed before further testing can be completed.

Tympanometry: Tympanometry uses small changes in air pressure in your ear canal to assess the mobility and function of your eardrum and middle ear system. It can help detect the presence of many middle ear disorders.

Acoustic Reflex Thresholds: This is a test which is sometimes performed in conjunction with tympanometry, which tests the integrity of your middle ear reflex response to loud noises. It is often conducted to determine if the hearing loss is conductive, cochlear, or stems from a nerve pathway in the brain, such as when there is a tumor.

Air Conduction Testing: Air conduction testing is what you most likely picture when you think of a hearing test, where you raise your hand or press a button whenever you hear a beep through a set of headphones. It tests the hearing thresholds of the entire system working together. These thresholds are typically indicated by the X’s and O’s on an audiogram.

Bone Conduction Testing: Bone conduction testing uses a bone oscillator to stimulate the cochlea directly by vibrating the bones of the skull. The audiologist will compare these thresholds with your air conduction thresholds to determine whether the hearing loss is conductive or sensorineural. These thresholds are indicated by angle or square brackets on your audiogram.

Speech Reception Thresholds: This test determines the quietest level that you are able to understand speech, and is used as a cross check to confirm the accuracy of your air conduction hearing thresholds.

Word Recognition Scores: This is a test of your ability to understand speech when it is amplified loud enough to be comfortably audible. This is indicated on your audiogram by a percentage, which represents the percent of speech that will be able to make it to your brain when amplified enough to overcome your hearing loss. A low score on this test indicates lower functional ability and may mean that even with well-fit hearing aids, you may still struggle to understand speech. A higher score indicates that when speech is amplified loud enough, you will likely perform very well.

Speech-in-Noise Testing: This test measures how well you are able to understand speech in the presence of background noise. The results of this test are on a scale of 0 to 24, where a 0 indicates you can understand very well in background noise, while a 24 would mean that if you turned on a fan it would be very difficult for you to pick out speech. Audiologists use the results of this test to make the best recommendations for treatment in terms of hearing aid style and technology so you can hear your absolute best. They may also use this score to recommend whether you would benefit from assistive technology such as remote microphones.

Uncomfortable Levels (UCLs): This test determines the level at which sound becomes uncomfortably loud so that when your audiologist programs your hearing aids, they can customize the output so it never is loud enough to hurt your ears.

Most Comfortable Levels (MCL): This test determines the most comfortable volume that is the sweet spot between too soft and too loud.

A combination of these diagnostic tests paint a comprehensive picture of your hearing loss and what treatment would be most appropriate, whether it be hearing aids, a cochlear implant, or a bone anchored hearing aid.  It can also indicate whether you should be referred to a physician such as an otologist or otolaryngologist (ENT) for medical treatment.

The accuracy of testing is critical for the correct diagnosis and treatment of hearing loss.  It is recommended you only go to a licensed hearing care professional for testing, such as an Audiologist or Hearing Instrument Specialist.  Online hearing tests may be convenient, but they are not reliable or accurate enough to make a treatment recommendation or to treat hearing loss. Additionally, they run a high risk of not identifying serious medical conditions that would be caught during a comprehensive auditory evaluation by a licensed hearing care professional.

What are stages of hearing loss?

If you have a hearing test, your audiologist will share test results and explain what they mean. Often, hearing loss is classified as the degree of loss. The degree of loss is how loud sounds need to be for you to hear them. According to the American Speech-Language-Hearing Association, the degrees of loss are:

  • Normal.
  • Slight.
  • Mild.
  • Moderate.
  • Moderately severe.
  • Severe.
  • Profound.

Management and Treatment

What are hearing loss treatments?

Treatments are different depending on the type of hearing loss you have.

Conductive hearing loss

  • Medications, like antibiotics, to treat ear infections.
  • Surgeries, including tympanoplasty, to repair a ruptured eardrum, tympanostomy to insert ear tubes or surgery to remove tumors.
  • Procedures to remove earwax or other objects in your ear canal.

Sensorineural hearing loss

  • Medications, like corticosteroids, to reduce swelling in your cochlea hair cells. (You can damage your cochlea hair cells if you’re exposed to loud noise.)
  • Management like hearing aids and cochlear implants.

Mixed hearing loss

  • Treatments vary based on the specific issues affecting your outer, middle and inner ear.

Treatment side effects

Side effects vary, but surgeries likely have the most significant side effects:

  • Tympanoplasty complications include graft failure, when surgery doesn’t fix your ruptured eardrum.
  • Tympanostomy side effects may include tympanosclerosis (scarring of eardrum), repeated ear infections or otorrhea (fluid continuously draining from your ear).
  • Ear tumor treatments may cause hearing loss, balance issues and facial weakness.
  • Cochlear implant surgery may affect your sense of balance or affect residual hearing, which is hearing you have despite having severe or profound hearing loss. Rarely, cochlear implant surgery causes nerve damage or cerebrospinal leaks.

Prevention

How can I prevent hearing loss?

There are some types of hearing loss you can’t prevent. For example, many people develop hearing loss as they grow older. That said, noise is the most common cause of hearing loss. You can help prevent noise-induced hearing loss by avoiding situations and environments where you’re bound to encounter very loud noise. If you can’t avoid noisy situations, protect your hearing by:

  • Use hearing protection (earplugs or earmuffs) during loud activities like concerts, riding motorcycles or snowmobiles, or working with loud machinery.
  • Lower the volume. When listening to music through headphones or earbuds, keep the volume level low enough that you can hear people speaking around you. Another good rule is not to exceed 80% of volume level for more than 90 minutes a day.
  • Don’t stick anything into your ear canal, including cotton swabs or hairpins. These objects could become lodged in your ear canal or cause an eardrum rupture.
  • Avoid smoking, which can impair circulation and affect your hearing.
  • Get regular exercise to help prevent health issues that can cause hearing problems, like diabetes or high blood pressure.
  • Manage any chronic illnesses to prevent further damage.

Outlook / Prognosis

What can I expect if I have hearing loss?

That depends on your situation. Some hearing loss is temporary, like hearing loss that happens because you have a cold, swimmer’s ear, or there’s something stuck in your ear. Sensorineural and age-related hearing loss is usually permanent, but hearing aids or cochlear implants may restore most of your hearing.

Living With

How do I take care of myself?

It can be challenging to live with hearing loss, even if you’re already receiving treatment like using hearing aids or cochlear implant surgery.

There may be times when you can’t hear as well as you’d like. If that’s your situation, you may want to let people know you have hearing loss.

Hearing loss can affect your emotional health. Even with treatment, you may feel depressed or anxious. If you do, consider sharing your feelings with a healthcare provider.

When should I see my healthcare provider?

Contact your healthcare provider if you think your hearing loss is getting worse. You may need a different kind of hearing support.

What questions should I ask my healthcare provider?

If hearing tests show you have hearing loss, you may want to ask your provider the following questions:

  • What’s causing my hearing loss?
  • What can I do to improve my hearing?
  • Will my hearing loss get worse?
  • Should I consider cochlear implant surgery?

Additional Common Questions

What’s the difference between hearing loss and deafness?

The difference is someone with hearing loss still hears sounds well enough to take part in conversations. They can improve their hearing ability through hearing aids or other treatments. Someone who’s deaf can hear very little or nothing at all. Hearing aids and devices don’t help. A person who’s deaf may use sign language to communicate.

Is hearing loss a disability?

The Americans with Disabilities Act (ADA) protects people with disabilities from discrimination. The ADA considers certain medical conditions to be disabilities if the conditions limit people’s abilities to do everyday activities. Hearing loss is one such medical condition, but the level of hearing loss factors into whether it’s a disability under federal law.