Definition

Hearing loss is a decreased ability to hear. There are two types: of hearing loss, conductive and sensorineural. There may also be a mixture of the two.

  • Conductive—when sound cannot get through the outer and middle ear
  • Sensorineural—damage in the inner ear that leads to hearing loss

A person may also have a mix of both types.

Anatomy of the Ear
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Causes

Conductive hearing loss is caused by problems that make it hard for sound to travel from the outer to the middle or inner ear, such as:

Sensorineural hearing loss is caused by damage to the parts of the inner ear that are responsible for hearing. In some people, the cause is not known. In others, it may be due to:

  • The aging process
  • Illnesses, such as Meniere disease or labyrinthitis
  • Certain medicines, such as loop diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), or antibiotics
  • Trauma
  • Problems with the way the inner ear is formed
  • Work or environmental exposure to a lot of noise

Risk Factors

Hearing loss is more common in older adults. Other things that may raise the risk of hearing loss are:

  • Having other family members with hearing loss
  • Genetic problems
  • Work or environmental exposure to a lot of noise
  • Heart diseases that affect blood flow to the ear and brain
  • Taking certain medicines, such as loop diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), or antibiotics
  • Stroke
  • Neurological disorders, such as migraine headaches or multiple sclerosis
  • Obesity
  • Not getting all advised immunizations
  • Autoimmune disorders, such as systemic lupus erythematosus or Cogan syndrome (rare)

Symptoms

Hearing loss may cause a decreased ability to hear:

  • Higher-pitched sounds
  • Lower-pitched sounds
  • Speech when there is background noise
  • All sounds

Hearing loss may also cause:

  • A feeling of spinning when standing still— vertigo
  • Ringing or other sounds in the ears— tinnitus
  • Problems with balance
  • Problems learning to speak in children

When Should I Call My Doctor?

Call the doctor for any problems hearing. You should also call if there is:

  • Ear pain
  • Vertigo
  • Tinnitus
  • Problems with speech or balance
  • Sensitivity to sound

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

An ear exam will be done. It may include:

  • Weber test or Rinne test to find out which type of hearing loss you may have
  • Audiometric tests to test your ability to hear
  • Tympanometry to measure the pressure in the middle ear and how it responds to pressure waves
  • Electrocochleography to test the function of parts of the inner ear that are responsible for hearing

Images may be taken of the ears and surrounding structures. This can be done with:

The electrical response of your brain to sound may be tested. This can be done with brain stem auditory evoked response testing.

Treatment

Treating underlying health problems may improve some forms of hearing loss. Other treatment options are:

Nonsurgical Treatment

Methods that may improve hearing are:

  • Earwax removal
  • Modifying any dietary deficiencies
  • Hearing aids
  • Assisted listening devices
  • Lifestyle changes, such as facing people when talking, turning off background noise, and learning how to lip read

Medications

Medicines that cause hearing loss may be stopped or changed.

Oral or injected corticosteroids may be used to help treat certain types of hearing loss. They are used to:

  • Ease inflammation and promote fluid drainage
  • Suppress the immune system

Surgery

People who are not helped by other methods may need surgery. Some examples are:

  • Stapedectomy to replace the diseased stapes bone with an artificial device
  • Tympanoplasty to repair a ruptured eardrum or correct a defect of the middle ear bones
  • Myringotomy to drain fluid trapped in the ear
  • Cochlear implant to implant a device that stimulates part of the brain to make sounds clearer and easier to hear

Prevention

The risk of hearing loss may be lowered by:

  • Managing chronic health problems
  • Not smoking
  • Getting all advised immunizations
  • Avoiding excess noise
  • Wearing ear protection when around loud noises, such as at work
RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org

American Tinnitus Association
https://www.ata.org

CANADIAN RESOURCES:

Canadian Hearing Society
http://www.chs.ca

Canadian Society of Otolaryngology—Head and Neck Surgery
http://www.entcanada.org

REFERENCES:

Chandrasekhar SS, Tsai Do BS, et al. American Academy of Otolaryngology Head and Neck Surgery Foundation (AAO-HNSF). Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019 Aug;161(1_suppl):S1-S45.

Cochlear implants. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at: https://www.nidcd.nih.gov/health/cochlear-implants. Accessed March 15, 2021.

Sudden sensorineural hearing loss. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/sudden-sensorineural-hearing-loss. Accessed March 15, 2021.

Last reviewed December 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 03/15/2021