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What is Hearing Loss?

The five most common kinds of hearing loss, their typical symptoms and overall prognosis.

If you are one of the more than 40 million people in the United States with hearing loss, or 270 million people worldwide, you might sometimes feel as if life is unfolding all around you, and that you are somehow unable keep up.

Your degree of hearing loss may very well impact that feeling of disconnect. Typically, the more significant the loss, the more challenging it is to communicate with the world around you. However, even mild loss can significantly impact your daily life.

The American Speech-Language-Hearing Association classifies hearing loss into these categories:

  • Slight (16-25 dB)
  • Mild (26-40 dB)
  • Moderate (41-55 dB)
  • Moderately severe (56-70 dB)
  • Severe (71-90 dB)
  • Profound (91+ dB)

Generally speaking, hearing loss is usually addressed by one of several treatment options. The solution that is right for you will depend on a number of factors, starting with the type of hearing loss you have — conductive or sensorineural -- and whether it can be treated medically or with the use of amplification.

Outer Ear

Outer ear

Common problems (conductive losses)
  • Excessive earwax and earwax plugs
  • Ear infections (otitis externa)
  • Foreign bodies
  • Congenital malformations of the ear or canal
What you can do

Consult with your family doctor or an ear, nose and throat (ENT) doctor to talk about treatments. Typically these types of hearing losses may be treated medically or surgically. Hearing loss may resolve or can be effectively treated via hearing instruments.

Middle ear

Common problems
  • Inflammation
  • Middle ear infections known as otitis media (fluid behind the eardrum)
  • Perforations of the eardrum
  • Otosclerosis (a stiffening of the bones in the middle ear)
What you can do

Most outer and middle ear problems can be treated with medication or surgery. Consult with your family doctor ENT to talk about your options. Sometimes the hearing loss is permanent. If this is the case, a hearing aid can usually help.

Inner Ear

Inner ear

Common problems
  • Damage to the fine hair cells, called the cilia
  • Natural aging process
  • Loud noise exposure (instant or over time)
  • Some types of medication
  • Skull fractures
What you can do

Most hearing issues involve damage to the inner ear. This type of hearing loss can usually be corrected with a hearing aid or with cochlear implants.

Conductive Hearing Loss

Conductive hearing loss generally means that something is interfering with the transmission of sound from the outer and middle ear, reducing the overall volume of sound getting to the inner ear

There are many potential causes for this type of hearing loss, including:

  • Fluid in ears from a head cold
  • Ear infections
  • Allergies
  • A broken/perforated eardrum
  • Impacted earwax
  • Foreign matter in ear
  • Damage/malformation of outer ear
  • Congenital abnormalities (i.e. atresia, stenosis, etc)
Symptoms

People with conductive hearing loss often need to turn up the volume on televisions and radios, and ask other people to repeat themselves. They may hear better in one ear than the other. Other symptoms can include ear pain, ear drainage, or the feeling of pressure or blockage in the ears.

Prognosis

A vast majority of conductive hearing loss cases can be treated medically or surgically. Most often, hearing aids are the most effective way to treat this loss.

Sensorineural Hearing Loss (SNHL)

For sensorineural hearing loss, the damage generally lies within the inner ear, the acoustic nerve, or both. Generally, doctors call this condition, “nerve deafness,” which is characterized by the inability to hear faint sounds. The majority of this type of hearing loss is caused by abnormalities in the hair cells within the cochlea.

Included in the potential causes for this type of hearing loss are:

  • Medication side effect
  • Genetics
  • Aging
  • Trauma to the head
  • Illness
  • Exposure to loud noise (instant or over time)
  • Malformation of inner ear
Symptoms

SNHL has a variety of configurations and degrees of loss that can impact each listener differently. Some SNHL can be flat, with the loss relatively the same across all frequencies. Other types of SNHL may be just the low or high pitches, resulting in a variety of outcomes.

For example, babies with more significant levels of SNHL may initially babble until around 6 months, and then suddenly stop as they don’t have the access to sound that reinforces and allows them to play with the phonological structure of their language.

Children and adults who have SNHL impacting the high pitches or frequencies may find the consonants of speech like “s”, “f” and “z“ difficult to hear. They might also struggle with understanding what is said if there is any background noise in the area, as in noisy restaurants, or a room where a TV is playing.

Prognosis

Most often, SNHL hearing loss can be treated successfully with hearing aids or cochlear implants. However, a thorough ear examination and customized treatment plan is vital. There are many different causes for this type of hearing loss, and the severity and configuration of the loss can impact outcomes.

Central Hearing Loss

Issues with the central nervous system of the brain, and a person’s ability to interpret sounds, are common causes of central hearing loss. Usually, this means that the person can “hear” sounds (often these individuals will have normal to near normal hearing ability for typical sounds), but has trouble understanding what they mean.

This type of hearing loss is considered rare, and is often misdiagnosed. If you have central hearing loss, you might find it difficult to read or concentrate when a loud noise like a TV, vacuum or air conditioner is present.

Symptoms

Generally, people with central hearing loss do not have trouble speaking, but they do have difficulty interpreting the meaning of non-verbal or environmental stimuli, like doorbells or telephones. Generally, this type of hearing “loss” comes on suddenly, and is often confused with psychological difficulties like schizophrenia.

Prognosis

Since the issue with central hearing loss is associated with the ability of the brain to interpret sounds and make meaning, rather than to the conducting or sending the signal to the brain, standard solutions like hearing aids and surgery are not considered to be effective treatment options. Instead, treatment focuses on controlling the person’s listening environment, to eliminate as many of the distractions as possible. Since central hearing loss is often associated with higher level brain function and can result from tumors and brain-stem injuries, working with a hearing specialist is critical.

Functional Hearing Loss

Functional hearing loss is a subset of hearing loss categories that involves having normal hearing ability, but the individual appears to show reduced or no response to environment sounds. This type of behavior can be associated with underlying psychological, behavioral or emotional issues rather than having a physical deficit or problem with the auditory system itself.

Symptoms

People suffering from functional hearing loss often show the same signs as those with conductive or central hearing loss, which include lack of response to verbal or other sound-based stimuli.

Prognosis

The most challenging aspect of functional hearing loss is getting it properly recognized and treated. It can be misdiagnosed, resulting in time spent on treatment of an auditory dysfunction rather than actually addressing the actual psychological, behavioral, or emotional issues that are driving these behaviors.

Mixed Hearing Loss

It’s possible for someone to have more than one type of hearing loss. For example, if you have both conductive and sensorineural hearing loss in the same ear, it’s called mixed hearing loss.

Symptoms

Individuals diagnosed with a mixed hearing loss will have a combination of the challenges listed above.

Prognosis

Treatment for mixed hearing loss is a combination of what is usually done for the individual hearing loss types. For example, the conductive loss will be treated medically, and the sensorineural loss will be treated via some form of amplification.

Have Hearing Loss? What Next?

If you’ve found yourself nodding and saying, “That’s exactly what’s happening with me,” the first thing you should do is to see your doctor. A physician can help diagnose the presence of a hearing loss, and refer you to the appropriate specialist.

It never hurts to be prepared, so arm yourself with answers to the typical kinds of questions your family doctor may ask when assessing your hearing loss:

  • When did you first notice a change in your hearing or ability to communicate?
  • In which situations do you notice it the most?
  • Have these difficulties gotten worse? If so, how quickly?
  • Were there any other issues present when the hearing loss started (like illness, exposure to loud noises, or an injury)?
  • Do you have a family history of hearing loss?
  • Have you had ear infections in the past?
  • Do you have any constant ringing or buzzing in your ears?

Your primary physician may then refer you to a hearing specialist, including:

  • Otolaryngologist: Specialists in ear, nose and throat problems. They are often called ENTs.
  • Neurotologist: Surgeons who specialize in the ear, and are specially trained to treat diseases of the inner ear and ear-brain interface.
  • Otoneurologist: Specialists whose background is in neurology and who have a special interest in disorders affecting hearing and balance.
  • Audiologist: Specialists trained to evaluate hearing loss and related disorders, including balance disorders and tinnitus.
Bibliography:

Sudden Deafness resource page. National Institute on Deafness and Other Communication Disorders Web site. http://www.nidcd.nih.gov/health/hearing/pages/sudden.aspx Update March 2003. Accessed January 4, 2012

Hain, T., Ghossaini, S., Sudden Hearing Loss page. American Hearing Research Foundation. http://www.american-hearing.org/disorders/sudden-hearing-loss/ Last modified 8/2007. Accessed January 4, 2012

Discussion

There is 1 comment.

member
eleit1 says: Posted on Feb 20, 2013
My 7 year old son has bilateral mild conductive hearing loss. I am in process of getting second opinion and then fitting him with hearing aids. He is a vert bright first grader and full of questions about what he is experiencing. Do you have any books and material that I could read to him that will assisst him in this?

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