Hearing loss

Description
Hearing loss affects more people than any other sensory problem. In the United States, about one-third of people between ages 65 and 74 and roughly half of those age 85 and older are hearing-impaired.
Types of hearing loss include:

Sensorineural loss, which is due to acoustic nerve damage or abnormalities of the cochlear cells. This type includes age-related hearing loss (presbycusis), noise-induced or drug-induced hearing loss, Ménière's disease (an inner ear disorder), acoustic tumor, and infectious and congenital losses (for example, prenatal maternal infections).

Conductive loss, which can be caused either by blockage of the ear canal or a disturbance in the normal functioning process of the tympanic membrane (eardrum) and bones of the middle ear. This type includes otosclerosis (middle ear bone degeneration), developmental defects, foreign body or earwax impaction, otitis media (ear infection), middle ear tumors and perforation of the tympanic membrane.

Hearing loss may also occur as a result of both sensorineural and conductive losses.





Causes/associated factors
Growing older is a risk factor for hearing loss, but it can also be related to various factors, including:
chronic exposure to loud noises
ear infections
medication use (such as erythromycin, vancomycin, nonsteroidal anti-inflammatory drugs, diuretics and certain medications used to treat malaria)
tumors
head injuries
ear trauma
central nervous system infections
certain chronic illnesses
injuries to the cochlear nerve (a nerve in the inner ear necessary for hearing)
excessive wax in the ear canal
For older adults, the most common cause of hearing loss is presbycusis (age-related hearing loss). This condition is gradually progressive and tends to affect both ears equally. Although the rate and extent of hearing loss varies, the impairment is permanent. Men are affected by presbycusis more often and more severely than women. Poor blood circulation, high blood pressure or stroke may also increase the risk of developing this type of hearing loss.


Signs/symptoms
You may strain to understand conversations or think that people mumble. At home, family members or others may complain that you turn up the television too loud. Depending on what causes the hearing loss, you may also have difficulty:
hearing on the telephone
following conversations that involve more than two people
filtering through background noise
hearing the voices of women and children
Dizziness, a feeling of fullness or ringing in the ears, and ear discomfort may accompany hearing loss.


Diagnosis
Hearing loss requires appropriate evaluation. The doctor will ask questions about your medical history, review your symptoms, and do a physical exam. Your family members may also be asked about your symptoms. Next, you may be referred to an otolaryngologist (a doctor who specializes in the ear, nose and throat) or an audiologist (a specialist in hearing disorder testing and treatment) for a more accurate diagnosis. You may need a series of tests to pinpoint the type, cause and extent of your hearing loss. Depending on the results, you may also need computed tomography (CT scan -- a computer-generated, cross-sectional picture of internal body parts) or magnetic resonance imaging (MRI, an imaging technique based on computer analysis of the body's response to a magnetic field). These tests are rarely necessary if you're diagnosed with presbycusis, however.

Treatment
Treatment depends on the underlying cause of the hearing loss.
If the loss is noise-induced, you may need to wear protective ear pieces to prevent further loss.
If medications are to blame, the doctor may adjust your prescription.
Sometimes, hearing loss can be corrected by simply removing earwax.
If the loss is caused by an acute infection, antibiotics may help.
If the loss is related to a structural condition, surgery may be successful.
If you have presbycusis, a hearing aid may be the answer. Behind-the-ear aids last the longest. They can also be easily adjusted and repaired. In-the-ear varieties are less noticeable and often work best for people who have high-frequency hearing loss, which is common with presbycusis. They're harder to adjust and may have more feedback noise, however. To make sure you're satisfied, consider buying your hearing aid from a source that offers a 30-day free trial or guarantee.
Self-help tips
Ask your doctor, audiologist or local phone store about assistive listening devices for the telephone, television or radio. For example, devices are available that can amplify television or radio signals for those who have hearing loss, while other household members listen at a normal volume. Telecaptioning may be another option if you have good vision.

To improve communication, tell family members, friends and others that you have trouble hearing. Ask them to speak to you slowly, clearly and face-to-face. If you don't understand something, ask the person to repeat or rephrase the sentence. Tell the speaker it's not necessary to shout, and reduce background noise whenever possible.


Complications
Hearing loss often leads to depression and isolation. You may be embarrassed and avoid social situations. Others may think you're confused or uncooperative if you respond inappropriately. Unless you inform others about your hearing loss, they may think you're chosing to be a poor listener or purposefully ignoring things that are shared.

Prevention
In most cases, hearing loss is difficult to prevent. Typically, by the time a person becomes aware of hearing loss, the ear damage has already occurred. If you're concerned, see your doctor for a hearing evaluation. If a hearing aid is suggested, give it a try.
To prevent noise-induced hearing loss, avoid exposure to noisy activities, or wear ear protection when such environments are unavoidable. Encourage the young people in your life to do the same.