Audiology and Hearing Aids

Hearing Loss Overview

You, or someone you love, may be experiencing a mild to profound hearing loss. Sometimes these losses can "come on" gradually, perhaps simply due to the aging process, or quickly, due to infection, disease or accident. Whatever the reason or level of loss, there are steps that can be taken to increase the potential to regain a quality of life in this important arena – the world of sound.

Not sure whether or not you need a hearing test? Ask yourself the following questions:

  • Do I hear, but not understand what is being said to me?
  • Do many people seem to mumble?
  • Do I ask people to repeat themselves?
  • Do others tell me the television or radio is too loud?
  • Do I have problems hearing in groups, such as a business meetings?
  • Do I tend to ask callers to speak up on the phone?
  • Do my family and friends accuse me of not hearing or paying attention to them?
  • Is it difficult for me to hear soft sounds, such as a dripping faucet?

If you answered "yes" to even one of these questions, consider scheduling a hearing exam with an Audiologist or Otolaryngologist (doctors with training in ear and hearing disorders) or an Otologist (a licensed hearing expert). The test will determine if the loss is due to nerve deafness, which can be improved with a hearing aid. In that case, these specialists can help select the aid best suited for your needs.


The information below is NOT intended to replace professional advice or care.

No matter what age you are, you can develop a hearing loss. More than 24 million Americans have some type of hearing problem. Hearing difficulties are often unrecognized by the person involved, but apparent to those around them. Children and teenagers seldom complain about the symptoms of hearing loss, and adults may lose their hearing so gradually that they do not realize it is happening. Generally, the condition takes years to become noticeable to you and you may not even realize that your hearing has begun to deteriorate. It is a good idea to have your hearing checked by an audiologist if you:

  • Have to strain to hear normal conversation.
  • Have to watch other people's faces to follow what they are saying.
  • Need to ask people to repeat what they have said.
  • Often misunderstand what people have said.
  • Turn the volume up on the TV or radio to the point that others complain.
  • Think that people are mumbling or not talking clearly.
  • Have problems with ringing in the ears or head noises (tinnitus).
  • Have repeated ear infections.
  • Have trouble with dizziness or balance problems.
  • Discover that the effort to hear and understand makes you irritated, tired or"cranky".
  • Have trouble understanding over the phone.
  • Any disease or condition that interferes or disrupts the transmission of sound to the hearing centers in the brain causes a hearing loss. The disruption can occur anywhere along the hearing pathway to the brain.


There are four types of hearing loss that are named according to the area of the ear that is affected and they are:

conductive hearing loss, sensory hearing loss, neural or central hearing loss.

Anyone can have a hearing loss. Hearing loss is one of the most common health conditions today, particularly as one ages. Over half of the people over the age of 65 have hearing loss. But keep in mind that hearing loss is not just associated with the normal aging process.

Conductive Hearing Loss

A conductive hearing loss occurs when there is an abnormality in the outer and/or middle ears. Because of the abnormality, sound energy cannot be conducted to the inner ear and then to the brain as it should be. Conductive hearing losses are medically treatable and reversible in most, if not all cases The following are some cases of conductive hearing loss:

I. Disorders of the Outer Ear

Blockage of the External Ear Canal: Obstruction of the external ear canal by either accumulated ear wax (cerumen) or a foreign body can produce a conductive hearing loss, especially in children. If the obstruction is complete, it will prevent sound energy from reaching the ear drum. Accumulated ear wax and/or foreign bodies should be removed by the ENT

Bony Growths in the External Ear Canal: Growths of the bony external ear canal can occur as osteomas, which are protrusions of bone extending from the walls of the external ear canal into the canal itself. An exostosis is a bony growth of the external ear canal and is very hard to the touch. Any bony growth of the ear canal should be removed by the ENT if they are large enough to cause obstruction.

Otitis Externa: Otitis externa can be a bacterial or fungal infection of the external ear canal skin and can cause conductive hearing loss. If there is swelling of the ear canal it can obstruct the pathway of the canal to the ear drum. One form of this condition is called swimmer's ear. Otitis externa should be treated by the ENT

II. Disorders of the Middle Ear

Otitis Media: This is the condition often referred to as Fluid in the Ear. This fluid is not to be confused with the fluid in the inner ear. The fluid in Otitis Media accumulates behind the eardrum in the otic capsule. The fluid arises because of the inability of the eustacian tube to adequately drain the ear. The fluid can be the result of allergies, infection in the throat or other upper repiratory infections. More often than not, when you are told there is an ear infection, it is Otitis Media. This can cause severe earaches and possibly fever. Otitis Media is the most common cause of hearing loss in children and should be treated by the ENT.

Otosclerosis: This is a condition in which the stirrup (stapes) bone of the middle ear begins to grow a "spongy" bone that prevents it from vibrating properly in the oval window. It is the most common cause of conductive hearing loss in adults. Surgery can sometimes improve the hearing loss and therefore the ENT should be consulted in cases of otosclerosis.

Trauma: Damage can occur to the conductive mechanism as a result of trauma to the ear itself or to the side of the head. The damage can manifest itself as injury to the eardrum (perforations) or to any or all of the three middle ear bones. A blow to the auricle with an open palm may result in a traumatic perforation of the ear drum, a hemotympanum (a collection of blood in the otic capsule) or damage to the middle ear bones.

These are only some of the possible causes of conductive hearing loss. For more information, please consult with your ENT or your Audiologist.

Sensory Hearing Loss

A hearing loss that is caused by damage to structures in the inner ear is called a sensory hearing loss. In cases of sensory hearing loss there is no abnormality or damage to the outer and/or middle ears. In general, sensory hearing losses are not reversible through medical or surgical intervention, although there are somes cases where it is. The most common form of treatment for sensory hearing loss is the use of hearing aids.

Disorders of the Inner Ear

Hereditary hearing loss is defined as those cases in which the cause is present in the genetic makeup of the individual. Hereditary hearing loss may be as associated with other signs and/or symptoms such as renal involvement, degenerative diseases of the nervous system, albinism and metabolic disorders. There are many names of syndromes to describe various combinations of abnormalities such as Alport's Syndrome, Waardenburg's Syndrome, and Hurler's Syndrome. The diagnosis of any of these syndromes cannot be made from the results of the hearing tests alone.

Congenital hearing loss, on the other hand, means merely that the hearing loss was present at birth and can include both hereditary as well as acquired causes. The acquired cases have causes that acted while the fetus was developing in the womb, but not contained in the genetic makeup. Examples of congenital hearing loss causes are maternal rubella in the first and second trimesters of pregnancy, and the breakdown of red blood cells with resulting neonatal jaundice, most often the results of erythroblastosis fetalis (Rh incompatibility). In addition, some congenital sensory hearing losses may be due to birth injury often associated with anoxia, drug ingestion by the mother and significant degrees of prematurity.

Post-Birth Acquired Sensory Hearing Loss can be acquired by infants, children or adults. They are usually the results of some disease or toxic agents such as noise or drug usage that damages the structures of the inner ear. The following are some of the causes of infant, childhood or adult aquired sensory hearing loss.

Noise-Induced Hearing Loss is the second most common cause of acquired sensory hearing loss. Noise exposure can cause damage to tiny hair cells in the inner ear. When the hair cells become damaged from exposure to a single noise exposure such as gunfire or to prolonged exposure to loud noises such as machines, motors and other noise producing equipment, they are unable to be stimulated properly by an incoming signal. Once these hair cells have become damaged, they remain so permanently.

Ototoxic Drugs can also cause acquired sensory hearing loss. Several drugs are known to be ototoxic (poison to the ear). These drugs damage the structures of the cochlea and/or semicircular canals. The more common drugs that are particularly toxic to the ear are certain antibiotics, salicylates (drugs containing aspirin), and quinine. Streptomycin, dihydrostreptomycin, gentamicin, viomycin, kanamycin, neomycin and cis-platinum have been shown to be ototoxic. The damage caused by thesse drugs is often dose dependent and is permanent.

Virus-Induced Hearing Loss is caused by specific viruses invading the body. The viruses of measles and mumps are well known causes of sensory hearing loss. The group of viruses that cause respiratory infections may also be carried by blood to the cochlea causing a viral reaction and can produce a sudden hearing loss.

Presbycusis is the sensory loss that is caused by degenerative changes associated with the aging process. Presbycusis is the most common cause of sensory hearing loss in the adult population. Some statistics indicate that as many as 30% of those in the 65-70 age category will suffer from the effects of presbycusis. The percentage increases to 40% of those over 75 years of age.

Sudden Hearing Loss is as its label implies an abrupt loss of hearing. Sudden hearing loss of known causes may be due to drugs, trauma, infection, or disease. There are, however, many instances when no cause can be found. There are two theories as to what happens in these cases: Viral Labrynthitis, which produces damage to the inner ear structures and Vascular Occlusion is the abrupt interference of blood supply to the cochlea. Immediate medical examination is necessary if there is any hope of reversing the hearing loss in these cases.

Central or Neural Hearing Loss

A neural hearing loss is one in which the outer, middle and inner ears are functioning normally and there is an abnormality of theVIIIth N or hearing nerve. Here the patient usually complains of unilateral (one ear) hearing loss, tinnitus (noises or ringing in the ear) and sometimes balance problems. The most common cause of neural hearing loss is the growth of tissue on the hearing nerve itself and is referred to as an Acoustic Neroma. Other causes of neural hearing loss include conditions that cause the covering of nerves to degenerate such as in multiple sclerosis, muscular dystrophy and other demyleniating diseases. A central hearing loss is a loss that comes about due to damage of the auditory structure of the central nervous system such as comes about from strokes, brainstem or brain injury.

Neural and or Central hearing losses do not respond well to hearing aid use.

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