About Hearing Loss

This is the most common type of hearing loss. It involves damage to the delicate hair cells of your inner ear (cochlea). The area of the inner ear that’s damaged impacts whether you have difficulty with hearing high or low frequency sounds. If the damage is located at the base of the inner ear, this will affect high frequency sounds, whereas hair cell damage away from the base causes difficulties hearing low frequency sounds. When there is damage to the auditory nerve that delivers sounds to the brain, nerve signals are blocked, further impacting loudness and clarity. Comprising 90% of all cases, sensorineural hearing loss generally affects both ears and is permanent. 

Sensorineural hearing loss symptoms

1.  Muffling of speech and other sound
2. Difficulty understanding words, especially in a crowd or with background noise.
3. Trouble hearing specific consonant sounds (e.g. s, sh, th, or f)
4. Needing to frequently ask others to speak slower, more clearly, and louder
5. Needing to turn up the volume on the television, radio, or computer
6. Withdrawing from conversations
7. Avoiding certain social settings

This type of hearing loss is caused by fluid, tissue, or a bony growth that blocks or reduces incoming sound. The blockage can affect your ear canal, middle ear and its bones, or the eardrum. In some cases, conductive hearing loss is temporary and can be reversed once the blockage is remedied.

Conductive hearing loss symptoms

1. Everyday sounds are perceived as softer
2. Better hearing in one ear than the other
3. Difficulty hearing discussions (e.g. on the phone)
4. The quality of sound is less clear or sharp
5. High and low sounds are reduced
6. Feeling of pressure in one or both ears
7. A foul odor coming from the ear canal

This type of hearing loss involves damage to your outer or middle ear and your inner ear or auditory nerve. It’s caused by any combination of issues responsible for sensorineural and conductive hearing loss. For example, temporary fluid in your middle ear from an allergy may block your hearing temporarily when you’re already dealing with permanent hearing loss related to loud noise exposure from all those rock concerts you attended in your youth.

Mixed hearing loss symptoms: If one type of hearing loss is worse than the other, those symptoms will be more obvious. Sounds may be softer in volume and more difficult for you to understand. 

Commonly known as sudden deafness, this is an unexplained, rapid loss of hearing that occurs at once or over a few days. Nine out of 10 people with SSHL experience hearing loss in only one ear. Experts estimate SSHL impacts between one and six people per 5,000 every year, however, the actual number of new cases may be much higher because the condition often goes undiagnosed. While SSHL can affect people of all ages, it’s more common in adults in their late 40s to early 50s. You should seek treatment as soon as possible because this greatly increases the likelihood of recovering a portion of your hearing. If you wait longer than 72 hours to see a medical professional, your window for treatment is lost.

SSHL symptoms

1. Discovering hearing loss upon waking up in the morning
2. A loud, alarming “pop” just before hearing disappears
3. Ear fullness
4. Dizziness
5. Ringing in your ears (tinnitus)
6. Hearing normal speech like whispers

1. Age-related hearing loss: Clinically known as presbycusis, this is generally a slow, progressive hearing loss that impacts both ears equally. In the earlier stages, you’ll experience problems with high frequency sounds like soft speech consonants (e.g. s, sh, th, or f). You might think others are mumbling or not pronouncing words clearly and background noise makes the situation worse. Due to its slow progression, many adults simply view this problem as another side effect of aging and don’t readily admit they have hearing loss. As such, it’s common for family, friends, or caregivers to be the first to recognize and point out the hearing problem.
2. Medication side effects: Medications that cause hearing loss, tinnitus, or balance disorders are called ototoxic. More than 200 medications (prescription and over-the-counter) used to treat pain, serious infections, cancer, heart disease, and kidney disease have been linked to hearing loss, which can be temporary or permanent.
3. Meniere’s disease: While the most obvious symptom is extreme dizziness, this disease can also cause tinnitus, the sensation of blocked or muffled hearing, and a feeling of congestion, fullness, or pressure in the affected ear. If your inner ear fills with excessive fluid, this can damage the delicate hair cells, resulting in permanent hearing loss.
4. Noise-induced hearing loss (NIHL): Hearing loss caused by exposure to loud noise is common, affecting about 10–40 million adults in the U.S. younger than age 70. Excessively loud sounds that occur just once (e.g. gunfire, blasts, and fireworks) or those that happen over an extended period (e.g. occupational-related noise or leisure activities like loud rock concerts) can cause NIHL. This is the only type of hearing loss that is completely preventable.
5. Traumatic head injury (TBI): Due to its sudden and violent nature, traumatic head injury may cause damage to any point within a person’s auditory pathway. This damage can result in conductive and sensorineural hearing loss, central auditory processing deficits, balance issues, and tinnitus. The eardrum, middle ear, and inner ear are the most common sites of peripheral injury because they are often directly in line of the trauma.
6. Viral infections: Many viruses can cause congenital or acquired hearing loss. Most often, this is sensorineural hearing loss. Cytomegalovirus (CMV), a common virus that can infect people of any age, is responsible for up to 40% of all congenitally acquired hearing loss. Other viruses associated with hearing loss include rubella (German measles), measles, mumps, HIV, herpes simplex virus, West Niles virus, and varicella zoster virus. 

Some people recognize they have hearing loss, prompting a doctor’s visit. In other cases, family members realize their loved one is experiencing increasing difficulty understanding conversations or turning up the television volume, suggesting hearing loss. Anyone with hearing loss should undergo a physical exam and in-office hearing tests performed by an audiologist.

These are the five basic hearing tests an audiologist may perform when hearing loss is suspected:

1. Pure-tone audiometry: You sit in a sound-treated room and the audiologist provides instructions through the headphones you wear. This test helps determine the quietest sound you can hear at different pitches or frequencies.
2. Speech test: You’re asked to listen to conversations in both quiet and noisy settings to determine at what threshold you can recognize speech.
3. Middle ear test: During this test, the audiologist pushes air pressure into your ear canal, causing the eardrum to vibrate back and forth. This test helps determine if you have a perforated eardrum or an issue with your ear’s ventilation tubes.
4. Auditory brainstem response: During this test, electrodes are placed on your head that record brainwave activity, providing data about your inner ear and brain pathways involved in hearing.
5. Otoacoustic emissions: A small probe is inserted into your ear canal to measure very soft vibrating sounds produced when the outer hair cells in your inner ear are stimulated. When there is blockage, no sounds are recorded.

Hearing Aids: Although an estimated 28.8 million U.S. adults could benefit from using hearing aids, only 30% in this group ages 70 and older and 16% ages 20 to 69 use them. Research supports the positive effects of hearing aids in older adults. These include reduced negative emotional and psychological symptoms including depression and improved quality of life. Major advances have been made in hearing aid technology, especially during the last few decades. Types of hearing aids include:

1. Receiver-in-Canal (RIC)
2. In-the-Canal (ITC)
3. Completely-in-Canal (CIC)
4. In-the-Ear (ITE)
5. Behind-the-Ear (BTE)
6. Bone-Anchored Hearing Aid (BAHA)

Cochlear implants: This small implanted electronic device is used for cases of severe to profound hearing loss that can’t be treated with hearing aids. An external portion sits behind your ear with a second element surgically placed under the skin. The device works by bypassing damaged hair cells in your inner ear and directly stimulating the auditory nerve to send information to your brain.

Stapedectomy: A procedure called stapedectomy may be an option for people with hearing loss caused by otosclerosis. This condition causes abnormal hardening of the horseshoe-shaped bone tissue called the stapes in your middle ear. During this surgery, all or part of the hardened bone is removed and replaced with a prosthesis.