Understanding Hearing Loss

"Hearing loss" refers to a reduced ability to hear sounds, ranging from mild difficulty to profound deafness. It can affect one or both ears and significantly impact communication and quality of life.

Types of Hearing Loss

1. Conductive Hearing Loss (CHL)

What it is: Sound is blocked in the outer or middle ear. Inner ear and nerve function normally.

Sounds like: Muffled, soft; turning up volume helps.

Causes:

Earwax (Cerumen) impaction
Outer/middle ear infections
Perforated eardrum
Otosclerosis
Foreign object in ear
Congenital malformations
Benign tumors

Treatment: Often treatable with medication, surgery, or hearing aids.

2. Sensorineural Hearing Loss (SNHL)

What it is: Damage to the inner ear or auditory nerve.

Sounds like: Softer and distorted, especially in noise. High-pitched sounds are affected first.

Causes:

Aging (Presbycusis)
Noise exposure
Genetics
Ototoxic medications
Head trauma
Viral infections
Ménière's disease
Acoustic neuroma
Autoimmune diseases

Treatment: Usually permanent; managed with hearing aids or cochlear implants.

3. Mixed Hearing Loss

What it is: Combination of conductive and sensorineural causes.

Treatment: Address both components—e.g., surgery and hearing aids.

4. Central Hearing Loss

What it is: Brain's difficulty processing sounds despite normal ear function.

Causes: Neurological conditions, strokes, tumors, head trauma.

Signs and Symptoms

Difficulty understanding speech, especially in noise
Frequently asking people to repeat
Muffled sounds
Increased TV or phone volume
Tinnitus (ringing in the ears)
Social withdrawal or fatigue from listening
Children: delayed speech, poor sound response

Medical Assessment

1. Medical History

Onset and progression
One or both ears affected
Associated symptoms (e.g., pain, tinnitus, vertigo)
History of infections or injuries
Noise exposure
Medications and medical conditions

2. Physical Exam

Otoscopy: examining outer and middle ear
Tuning fork tests: Weber and Rinne

3. Audiological Tests

Pure-tone audiometry
Speech audiometry
Tympanometry
Otoacoustic emissions (OAEs)
Auditory brainstem response (ABR)

These tests help determine the type and severity of hearing loss and guide treatment.

Common Misconceptions About Hearing Loss

"Only older people have hearing loss."
Hearing loss can affect people of all ages, including infants and young adults.

"If you can hear, your hearing is fine."
Many people can hear sound but struggle to understand speech, especially in noise.

"Hearing aids restore normal hearing."
Hearing aids improve hearing but do not fully restore it to normal like glasses for vision.

"Hearing loss is not serious."
Untreated hearing loss can lead to social isolation, depression, and cognitive decline.

"Talking louder helps everyone with hearing loss."
Clear speech, slower pace, and reducing background noise are often more helpful.

"It's easy to tell when someone has hearing loss."
Many people hide their hearing difficulty, and the signs may be subtle.

"Only loud noises cause hearing loss."
Prolonged exposure to moderately loud sounds can also damage hearing over time.