What is Hearing Loss?
Hearing loss is a very common health issue that becomes more common and serious as people get older. This problem can affect anyone from newborn babies to elderly people, and it’s almost always found in people over the age of 70. To accurately diagnose and treat hearing loss, different health professionals work together as a team. This team can include your primary care doctor, a ear, nose, throat specialist, a speech therapist, an audiologist who specializes in hearing problems, and a social worker.
To properly manage hearing loss, it’s important to understand the specifics of the person’s hearing loss and the hearing aids or other tools that can help improve their hearing. When it comes to children who have hearing loss, their pediatricians also need to be involved in their care. This ensures that the child’s hearing and language development continue to progress as normally as possible.
What Causes Hearing Loss?
Hearing normally works by sound entering your ear and moving through the ear canal, causing your eardrum to vibrate. This vibration is then passed through tiny bones in your middle ear and sent to your cochlea. Hair cells inside your cochlea then trigger your eighth nerve (related to hearing and balance) to send these signals up to your brain, where it turns these signals into sounds that you understand.
Hearing loss can be caused by several issues. Conductive hearing loss occurs when sound waves are disrupted before they reach your cochlea. There could be many things causing this, such as abnormal ear shape, blockage from earwax or foreign objects, inflammation in the outer ear, problems with the tiny bones in the ear, and fluid in the middle ear. Also, various benign or malignant tumors can cause this kind of hearing loss.
Sensorineural hearing loss (SNHL) occurs when there’s a problem with the signal transfer after the sound reaches the cochlea. This could be linked to damage to the hair cells in your cochlea or a problem with the eighth nerve. The main difference between these two types of hearing loss is that people with conductive hearing loss hear sounds as quieter, while those with SNHL might hear sounds as quieter and distorted.
Mixed hearing loss happens when there are problems both before and after the sound reaches the cochlea.
There are many reasons why people might have hearing loss. In children, genetic issues are often the main cause, making up more than half of all hearing loss cases. Sometimes hearing loss is just one of many symptoms in a genetic syndrome. However, there are also non-syndromic genetic hearing losses where the only symptom is hearing loss. Before a child is born, exposure to certain infections or harmful substances can lead to hearing loss. Causes after birth are less common and mostly related to premature birth, a low APGAR score (a quick test performed on a baby at 1 and 5 minutes after birth), neonatal jaundice, and infections. Hearing loss can also occur later on due to certain infections, head injuries, or repeated middle ear infections.
Older adults often experience hearing loss due to age-related wear and tear on the cochlea, especially the hair cells. This typically results in a gradual decrease in hearing ability and makes it harder to understand speech, especially in noisy environments. Certain conditions such as otosclerosis and cholesteatomas (types of ear growths) are common causes of conductive hearing loss in adults. Another specific condition that can occur is sudden sensorineural hearing loss, where there’s a sudden or rapid loss of hearing in one ear, often after a viral respiratory infection.
Risk Factors and Frequency for Hearing Loss
Hearing loss is a condition that affects around 0.5% to 1% of children in the United States. This condition varies in severity, meaning it can be mild, moderate, or even profound. These figures come from newborn and infant screenings, but the numbers may be higher for school-aged children who come into contact with harmful organisms.
The cause of hearing loss can differ based on age. In newborns and young children, most cases of hearing loss are due to genetic reasons. However, in school-aged kids and teens, it’s typically caused by external factors. As for adults, it’s estimated that almost two thirds of people over the age of 70 experience some degree of hearing loss, although the actual number could be even higher.
Hearing loss is often related to aging, exposure to noise and how long the person has been exposed to it, along with other health complications like high blood pressure, high blood sugar, and smoking habits, which all are recognized as contributing factors to the risk of developing hearing loss.
Signs and Symptoms of Hearing Loss
For children, it’s crucial to understand their medical history to diagnose hearing loss early. This includes details about the mother’s pregnancy, the child’s birth, their early days, and their health and development up to the point when they started showing signs of hearing issues. A family history of hearing loss can also be a clue to a child’s condition. Signs of hearing loss in kids might include lack of response to sounds, behavioral problems, difficulties with speaking or understanding language, struggles at school, and pronouncing words incorrectly.
For adults, diagnosing hearing loss usually involves asking about the person’s symptoms, how severe they are and when they started. The doctor will also ask about vertigo, neurological issues, infections, and other health problems that could relate to their hearing loss. It’s also important to know about the person’s past medical history, family history, and exposure to loud noises at work or elsewhere. These details help the doctor figure out what might be causing the hearing loss and what tests to do next.
The physical exam for hearing loss includes a complete ear, nose, and throat exam. The doctor will look in both ears with a tool called an otoscope to check for anything that could be blocking sound, like earwax, foreign objects, infections, holes in the eardrum, or fluid in the middle ear. Next, the doctor will look for physical signs that could suggest a hearing problem, like facial differences, issues with the ears, neck, or skin, problems with other organs, or balance problems. The Weber and Rinne tests are simple, quick, and used worldwide to tell the difference between sensorineural hearing loss (damage to the inner ear) and conductive hearing loss (problems with the ear canal, eardrum, or middle ear). These test can also help doctors to understand the results of the formal hearing test, called an audiogram.
Testing for Hearing Loss
It’s possible for everyone, no matter their age, to have an accurate hearing test. However, certain age or cognitive factors could make it more complicated to perform the standard hearing measurements. According to the American Academy of Pediatrics and the Joint Committee on Infant Hearing, every baby should get a hearing test to make sure they don’t have any hearing problems. Ideally, this test should happen within a month after birth.
Furthermore, newborns or infants who are suspected of having hearing issues should undergo a detailed examination where their medical and birth record are studied. Their family’s medical history, going back three generations, should also be examined. These guidelines are put forward by the American College of Medical Genetics and Genomics.
The method used to evaluate hearing loss can vary based on the child’s age. For newborns and infants, two main methods are used. The first, called the BAER (brainstem audio-evoked response) test, is reliable for early diagnosis. The second is the otoacoustic emissions test, which is cost-effective and easy to perform but not as reliable as the BAER test.
For older children aged between 4 to 5 or above who can respond to sound commands, audiometry is a better option. There are also specific hearing tests designed for young preverbal children. In these tests, kids are motivated to respond to sound cues through play, which helps assess whether they can hear. While this method of testing only confirms that at least one ear can hear at a tested level, it’s still important because having just one ear with normal hearing is enough for normal language development.
For both adults and children, tympanograms and audiograms can provide information about how well the eardrum, or tympanic membrane, can move. This analysis helps in understanding the overall health of the ear.
Treatment Options for Hearing Loss
Treatment for conductive hearing loss, which is a type of hearing loss caused by blockages or damage in the ear, often focuses on addressing the underlying issue. This might include clearing out things like foreign bodies or excess earwax that are blocking the ear canal. In the case of a condition called otitis media (inflammation of the middle ear), a small surgical procedure to remove fluid build-up might be necessary to let sound waves reach the inner part of the ear. In some persistent cases, doctors may need to insert tiny tubes to ventilate the middle ear. There’s a rare chance that some post-surgery hearing loss might occur due to a condition called tympanosclerosis, where scar-like tissue forms in the ear. If the hearing loss is caused by a cholesteatoma (abnormal skin growth in the middle ear), doctors would need to surgically remove it. The success of hearing restoration in such cases depends on how much damage the cholesteatoma has caused. In chronic or very severe cases of conductive hearing loss that can’t be operated on, doctors might opt for bone-conduction hearing aids or a bone-implanted aid, known as a BAHA, which have proven to yield excellent results.
When it comes to sensorineural hearing loss, caused by damage to the auditory nerve or inner ear, the usual non-surgical treatment involves the use of assistive listening devices and sound amplifiers. Hearing aids are commonly used to improve hearing by up to 40 to 60 dB, although they may be expensive and need customized fitting and venting plans. However, they typically yield very good results. In terms of surgical treatment, babies diagnosed with sensorineural hearing loss might need a cochlear implant. This procedure requires an ear, nose, and throat specialist, and continual monitoring is critical to ensure the baby’s language skills and social development progress normally. For adults who have severe sensorineural hearing loss that won’t improve with other treatments, cochlear implantation could also be an option. However, such a procedure would effectively replace any remaining natural hearing with the device – so it’s a decision to be taken carefully. The outcomes of this procedure have routinely been excellent in cases of severe sensorineural hearing loss.
What else can Hearing Loss be?
Hearing loss can be caused by many different factors, which makes diagnosing it a complex process. This condition has many potential causes, including over 300 genetic syndromes. Other possible causes of hearing loss can result from either problems with the transmission of sound waves in the ear (conductive hearing loss) or issues with interpreting these sound waves (sensory-neural hearing loss). Due to this wide variety of potential causes, a detailed patient history and a thorough physical exam are vital to correctly identify and manage the problem.
The first and crucial step in diagnosing hearing loss involves a physical exam and a comprehensive hearing test, known as an audiogram. These initial assessments can help rule out simple causes of hearing loss, like earwax buildup or issues with the Eustachian tube which connects the middle ear with the back of the nose. These simpler causes must be ruled out before conducting more complicated diagnostic tests.
What to expect with Hearing Loss
The outcome of hearing loss can differ depending on the type. The prediction of sudden hearing loss is influenced by various factors such as the severity of the condition, age, other existing medical conditions, dizziness, and the shape of the audiogram (a graph that shows the results of a hearing test).
As for hearing loss present from birth in children, the most important determining factors of the outcome are the overall condition of the nervous system. Restoring hearing through a cochlear implant is possible, but the overall health of the nervous system, along with the care and speech therapy delivered by family, are crucial to making the most out of the surgery.
Possible Complications When Diagnosed with Hearing Loss
Children with hearing loss can face problems like delayed development of speech skills and difficulties in school performance. A formal hearing check-up becomes necessary for any child experiencing issues with speech development since this is mostly linked to hearing loss.
In adults, particularly the elderly, untreated hearing loss might lead to feelings of loneliness and depression. It’s crucial to properly address and treat hearing loss to aid their mental wellbeing.
Key Consequences:
- Delayed speech development in children
- Difficulties in school performance
- Social isolation in adults
- Depression in adults, especially the elderly
Preventing Hearing Loss
Teaching patients about their conditions is very important, especially with hearing loss in children and adults. For children with hearing loss, parents have a key role to play. They have to learn different ways of talking to their child and make sure that the child grows up with normal language skills and social abilities. It’s also important for parents to know how to check their child’s hearing and learn when they should get professional help.
For adults and older people, learning about their hearing aids – how to use them correctly and when to have a new appointment with their ear doctor – is equally vital. Regular hearing tests and keeping hearing aids clean are key actions for maintaining the best possible hearing over the long run.
