Hearing Impairment And Hearing Loss
Hearing Impairment And Hearing Loss
Jason Hamilton (Facial Plastic & Reconstructive Surgeon) gives expert video advice on: What should I do if I suffer a sudden hearing loss?; How does excessive noise affect my hearing?; Which diseases or illnesses can cause hearing impairment? and more...
What is "hearing impairment"?
Hearing impairment generally means that, for one reason or another, your ability to understand sound and voice is decreased. It could be from a problem in the outer ear, the middle ear or the inner ear. When you see the otolaryngologist, they're experts at defining where the problem is. It could be as simple as something as having wax in your ear, or there is something wrong with the nerve, or there is a tumor in the brain that's affecting your hearing.
What are the different forms of hearing impairment?
There are two main forms of hearing loss. One is sensory, meaning that the nerve does not efficiently transmit the sound that is given to it to the brain. The other form of hearing impairment is conductive, which means that there is some kind of obstruction in the system or amplifier that regulates sound. Those two main differences are made because if you have a sensory neuro loss, those are harder to treat, and patients need hearing aids because the nerve is involved. If you have a conductive hearing loss, then you usually have a mechanical problem; you either have wax or there is something wrong with the ossicles, and traditionally they can be treated with surgery. Hearing loss can also be divided into congenital, which means that a child is born with a hearing loss either from a developmental abnormality or a genetic abnormality in the brain, acquired hearing loss - probably the largest group - which is hearing loss from aging. Other things, like trauma and infections, can cause hearing loss as well. Those are what we typically call acquired hearing loss.
What should I do if I suffer a sudden hearing loss?
Sudden hearing loss is a medical emergency and you should immediately head to the emergency room or to your audiologists to be evaluated. Many times if you're seen quickly you can be treated and preserve your hearing. If you delay, sometimes the hearing loss is irreversible and can't be improved. Sudden hearing loss is a very difficult diagnosis to make. Patients are often curious as to why they've had this hearing loss and they are usually worried that they have a tumor or something dramatic happening to them. Most commonly the hearing loss is idiopathic, which means that there's no real answer to why the hearing loss occurred. Theories on why patients have sudden hearing loss is that there's a vascular abnormality, or similar to a stroke for the brain but the ear its self is affected where an artery may become blocked or go into spasm and cause a lack of oxygen in the ear its self, and the hearing is lost in that manner. The other common theory is that there's some kind of viral infection. Just like a viral infection affects a nose, that it affects the ear primarily and that the hearing is lost in that manner. So making a differentiation in between the two is important. Seeing a physician immediately will help to preserve your hearing
What causes hearing impairment?
Usually, hearing loss is caused by two systems. It could be a sensory hearing loss, meaning there's a problem with the nerve or that system. The inner ear has special hair cells that transmit sound to the nerves, and when you age those cells become less effective in transmiting sound and you lose hearing. The other most common reason for hearing loss is a conductive loss, meaning the bones or the ear drum itself are affected by age and they become stiff, loosing their ability to amplify sound. That commonly can be treated with a surgical procedure to kind of amplifie the sound, either with putting a prothesis in, or removing the ear drum and replacing it with a new one. Another cause of hearing loss is found in trauma patients who have been in accidents. Even though you don't suffer any blunt or direct trauma to the head, just a sudden motion, especially in car accidents, sort of like whiplash, the ear can suffer whiplash as well. The ear has special fluid filled chambers that help to monitor your balance and help keep you in alignment, and often in accidents that fluid is shaken up or the membranes that house the fluid are torn and that can cause problems with the hearing or dizziness as well.
Can I do anything while I'm pregnant to help prevent congenital hearing impairment in my baby?
Congenital hearing loss, in many cases, can be prevented. Often, problems that affect the fetus are due to a maternal infection, such as measles, mumps, syphilis or tuberculosis. Getting routine screening exams and following up with your gynecologist will help prevent you from getting these or spreading these infections to your child. Alcohol has also been shown to cause hearing loss as well. There's something called fetal alcohol syndrome, and often those children are born with hearing loss because of the alcohol's effect on the baby.
How does excessive noise affect my hearing?
Excessive noise can be dangerous in long periods of exposure. Usually OSHA mandates your noise level be under 85 decibels, or you need some protective hearing device, meaning earphones or earplugs. Hearing thresholds: which are the level where the sound becomes painful to the ears. For example if you're at a rock concert and you feel when you leave that you have ringing in your ears, or you have to shout to be understood, or communicate with someone who's sitting right next to you, you're probably in an environment where the sound is too loud. If you're exposed over a short period of time you will actually suffer some hearing loss but it's temporarily and over the next day or two your hearing will come back. If you're constantly exposed to that loud noise you can permanently lose your hearing. It's usually in the high frequencies that you would lose your hearing. Another cause of hearing loss is patients who are either in the military or police and they are around weapons and the gunfire is a very common cause of hearing loss as well, so at the range you see the people wearing protective ear coverings as well to help prevent them from getting hearing loss.
Which diseases or illnesses can cause hearing impairment?
The most common diseases that cause hearing impairment are infections. A simple otitis media can cause deafness if it's gone untreated. Also, common things that are immunized against now, like measles, mumps and rubella, can cause infection in the ear that lead to hearing loss. Tuberculosis can cause hearing loss, and syphilis is usually associated with hearing loss over a longer period of time. Nevertheless, those are common causes of hearing loss.
What kind of trauma can cause hearing impairment?
The most common trauma that causes hearing loss is usually from a Q-tip. Q-tips placed in the ear that actually make contact with the eardrum can dislocate the ossicles, which are the bones of hearing. Many patients come in with a perforation of the eardrum from use of Q-tips that causes hearing loss. Another trauma that can cause hearing loss could be a car accident or a blunt injury to the head that causes a fracture in the bone that houses the ear and the nerve to the ear. However, by far the most common cause of hearing loss from trauma is a Q-tip. Most people don't want to hear that.
What is "ear wax"?
Ear wax is made of two components. It's made of sebum, which is secreted by the sebaceous glands in the ear canal, and cerumen, which is secreted by cerumen glands in the ear canal. This material mixes together and it helps to lubricate the ear as well as keep the pH in the ear at an acidic level. That acidic level helps prevent bacteria from growing, and prevents infection. When Q-tips are used they actually remove the wax and effectively remove some of the protection from the ear, so that if patients that swim or wash their hair and there's water left in the ear, many times they'll get an outer ear infection, simply from their chronic use of Q-tips. Q-tips are dangerous. Otolaryngolists actually have a saying that anything smaller than your elbow shouldn't go in your ear, which pretty much means nothing should go in your ear.
What happens to ear wax if I don't clean it out with a cotton swab?
The ear actually has a self-cleaning cycle where the wax is circulated from the eardrum to the outer ear. Over time, all the wax in the ear kind of works its way out. When you use a Q-tip, you push the wax that's trying to come out back into the ear. Many patients who do use Q-tips are the ones who come in that need to get wax dis-impacted from the ear. We're specialists in the ear, so patients come in who have a hole in their eardrum, and they lose their hearing. We ask, “How did that hole get there?” Most commonly it's from a Q-tip. Another way to get a perforation in the eardrum is if someone slaps someone with an open hand on the ear. That can rupture the eardrum and cause hearing loss.
What is "Presbycusis"?
Presbycusis is hearing loss that's associated with aging. Most patients lose some hearing as they age, as they lose their vision as well. The hearing loss is usually in the high frequencies, so men usually complain less of hearing loss than women because they are usually speaking to their friends, who speak in lower tones with other men. But, they do have problems hearing their wives. Some of them don't mind that actually, they come in later. But, Presbycusis in general is hearing loss with aging.
Can hearing impairment be reversed?
Hearing impairment can usually be treated if its offset, and onset, it can be treated with steroids. If hearing impairment is caused by an infection, it can be treated with antibiotics. Hearing loss that comes from aging or from general disorders is usually non reversible, but it can be treated with hearing aids or with impairment equipment.
What are "cochlear implants"?
The success of cochlear implants depends largely on 1) when the patient became deaf and 2) Their language and speech skills when they became deaf. The most successful cochlear implantations are done on either children who are less than one years old or adults who have lost their hearing, either from some trauma or infection. The adults do very well because they've heard before in their lifetime and their speech is well developed so they don't have to relearn or regain those things. Children who have learned sign language and then they received implants, maybe in elementary school or middle school level usually have alot of problems assimilating the sounds and learning language because they have adapted ianother system already. In the hearing impaired community, cochlear implants are a touchy subject because alot of deaf parents don't necessarily feel that their children should have to hear because they don't necessarily see it as a handicap. They feel that the medical society is looking at them like they have a handicap and they are able to communicate, as far as they are concerned, with sign language or other methods.
Can hearing impairment be prevented?
Hearing impairment can be prevented. Most commonly, antibiotics to treat ear infections can help prevent permanent hearing loss. And immunizations for measles, the mumps and rubella can help prevent hearing loss as well. With patients who use headphones for music become adjusted to the volume of that sound. So you continue to turn the sound up and up, louder and louder, so you don't really appreciate how loud you're really listening to the music. The interesting thing on most portable listening devices is if you turn them over, they have a loudness control that helps protect you from turning the volume up past a comfortable level, so that you protect your ears in that way.
What are "hearing aids"?
Hearing aids are devices that help to amplify sound and transmit it to the ear. Usually, hearing aids are composed of a microphone and an amplifier, and they're commonly used by patients who have some form of deafness that was acquired in their life. Most patients who are congenitally deaf use sign language to communicate.
What is an "audiologist"?
An audiologist is someone who's trained at doing hearing exams. They differ from otolaryngologists in that they study the principles of physics of hearing. Audiologists do an audiometric exam which kind of measures the level that you hear and the level of hearing loss. They are equivalent to an optometrist in the eye field.
What should I do if I think my hearing is becoming impaired?
If you think your hearing is becoming impaired, you should see your primary care physician. He'll examine your ears. If they feel you need to be referred to a specialist, you'll see an otolaryngologist, who will also perform an exam and send you for a hearing screen, to find out if you truly have hearing loss or you need a hearing aid to improve your hearing.