Overview
What is hearing loss?
Hearing loss is a sudden or
gradual decrease in how well you can hear. Depending on the cause, it can be
mild or severe, temporary or permanent.
Congenital hearing loss
means you are born without hearing. This topic focuses on gradual hearing loss,
which happens over time and can affect people of all ages.
If you have hearing loss, you may not be aware of it,
especially if it has happened over time. Your family members or friends may
notice that you're having trouble understanding what others are saying.
There are ways you can deal with hearing loss. And hearing aids and other
devices can help you hear.
What causes hearing loss?
In adults, the most
common causes of hearing loss are:
- Noise. Noise-induced hearing loss can happen slowly
over time. Being exposed to everyday noises, such as listening to very loud
music or using a lawn mower, can damage the structures of the inner ear, leading to hearing loss over many years. Sudden, loud noises, such as an explosion, can damage your hearing.
- Age. In age-related hearing loss, changes in the
inner ear that happen as you get older cause a slow but steady hearing loss.
The loss may be mild or severe, and it is always permanent.
Other causes of hearing loss include
earwax buildup, an object in the ear, injury to the
ear or head, an ear infection, a
ruptured eardrum, and other conditions that affect the
middle or inner ear.
What are the symptoms?
Common symptoms of hearing
loss include:
- Muffled hearing and a feeling that your ear is plugged.
- Trouble understanding what people are saying, especially when
other people are talking or when there is background noise, such as a radio.
- Listening to the TV or radio at a higher volume than in the past.
- Depression. Many adults may become depressed because of how
hearing loss affects their social lives.
Other symptoms may include:
- A ringing, roaring, hissing, or buzzing in the ear, called
tinnitus.
- Ear pain, itching or irritation of the ear,
or fluid leaking from the ear.
- A feeling that you or your
surroundings are spinning (vertigo).
How is hearing loss diagnosed?
Your doctor will do
a physical exam and ask about your symptoms and past health. He or she also may
look in your ears with a lighted device called an otoscope.
If
your doctor thinks that you have hearing loss, he or she will do hearing tests to
check whether you have hearing loss and find out how severe it is. You may be referred to an audiologist to do the tests. These tests
may include:
- A "whisper" test, which checks how well you hear whispered
speech.
- A tuning fork test, which helps your doctor know which kind
of hearing loss you have.
- Other tests to find out what kind of
hearing loss you have or which part of your ear is affected.
How is it treated?
Noise-induced or age-related
hearing loss can be treated with hearing devices, such as hearing aids. Other
devices can help alert you to sounds around the house like the phone or
doorbell. If hearing aids don't work for you, cochlear implants may be an option.
You also can learn ways to live with reduced hearing,
such as paying attention to people's gestures, facial expressions, posture, and
tone of voice.
In other types of hearing loss, you can treat the
problem that caused the hearing loss. For example, you may remove earwax or
take medicine for an infection to help your hearing come back.
How can you prevent hearing loss?
- Avoid loud noise, such as noise from machines at your
work, power tools, very loud music, and very loud motorcycles.
- Turn down the volume on anything that you listen to through ear buds or headphones, such as mp3 players.
- Wear hearing protection, such as earplugs or earmuffs.
- Avoid putting objects in your ear.
- Blow your nose gently and through both
nostrils.
Frequently Asked Questions
Learning about hearing loss: | |
Being diagnosed: | |
Getting treatment: | |
Living with hearing loss: | |
Cause
In adults, the most common causes of
hearing loss are:
- Noise. Noise-induced hearing loss can affect
people of all ages and most often develops gradually over many years. Over
time, the noise experienced at work, during recreation (such as riding
motorcycles), or even common chores (such as using a power lawn mower) can lead
to hearing loss.
- Age. In
age-related hearing loss (presbycusis), changes in the
nerves and cells of the
inner ear that occur as you get older cause a gradual but steady hearing loss.
The loss may be mild or severe, but it is always permanent.
Other causes of hearing loss include:
- Earwax buildup
or an object in the ear. Hearing loss because of earwax is common and easily
treated.
- Ototoxic medicines (such as certain antibiotics) and
other substances (such as arsenic, mercury, tin, lead, and manganese) that can
damage the ear.
- Injury to the ear or head. Head
injuries can also damage the structures in the ear and cause a sudden hearing
loss.
- Ear infection, such as a middle ear infection (otitis media) or an infection of the ear canal (otitis externa or swimmer's ear).
- Fluid in
the middle ear after a cold or the
flu, or after traveling on an
airplane.
- Otosclerosis, a condition that affects
the bones of the middle ear.
- Acoustic neuroma, a noncancerous tumor on the nerve that helps people
hear.
- Ménière's disease. Ménière's disease
may result in temporary or permanent hearing loss.
- Noncancerous
(benign) growths in the ear canal, such as exostoses, osteomas, and glomus
tumors. Exostoses are bone growths that often develop when the ear canal is
repeatedly exposed to cold water or cold air. Osteomas and glomus tumors are
noncancerous tumors. These all can cause hearing loss if they block the ear
canal. A glomus tumor that occurs elsewhere in the head can also affect
hearing.
Other medical conditions that do not affect the ear
directly may also cause hearing loss.
- An interruption of the blood flow to the inner ear or parts of
the brain that control hearing may lead to hearing loss. This may be caused by
heart disease,
stroke,
high blood pressure, or
diabetes.
- Autoimmune hearing loss can occur in one or both ears and can
come and go or get worse over 3 to 4 months. An
autoimmune disease, such as
rheumatoid arthritis, may be present.
Symptoms
Symptoms of
hearing loss include:
- Muffled hearing.
- Difficulty
understanding what people are saying, especially when there are competing
voices or background noise. You may be able to hear someone speaking, but you
cannot distinguish the specific words.
- Listening to the television
or radio at higher volume than in the past.
- Avoiding conversation
and social interaction. Social situations can be tiring and stressful if you do
not hear well. You may begin to avoid those situations as hearing becomes more
difficult.
- Depression. Many adults may be depressed because of how hearing
loss is affecting their social life.
Other symptoms that may occur with hearing loss
include:
- Ringing, roaring, hissing, or buzzing in the
ear (tinnitus).
- Ear pain, itching, or
irritation.
- Pus or fluid leaking from the ear. This may result from
an injury or infection that is causing hearing loss.
- Vertigo, which can occur with hearing loss caused by
Ménière's disease,
acoustic neuroma, or
labyrinthitis.
People who have hearing loss are sometimes not aware of it. Family members or friends often are
the first to notice the hearing loss. Evaluate your hearing by taking a
hearing loss self-test.
What Happens
We hear sounds when sound energy goes through the ear's three main structures. In hearing loss, one or more of these structures is damaged. These structures are the:
- External ear canal.
- Middle ear, which is separated from the ear canal by the eardrum.
- Inner ear, which contains the cochlea, the main sensory organ of hearing.
Which part of the ear is affected determines the type of hearing loss.
- In conductive hearing loss, sound energy is blocked before it reaches the inner ear. Examples of conductive hearing loss include earwax or a growth blocking sound, such as occurs in otosclerosis.
- In sensorineural hearing loss, sound reaches the inner ear, but a problem in the inner ear or the nerves that allow you to hear (auditory nerves) prevent proper hearing. Examples of sensorineural hearing loss include both noise-induced and age-related hearing loss.
A mixed hearing loss, in which both the conductive and sensorineural systems are affected, can also occur.
Another type of hearing loss is central hearing loss. In this type of hearing loss, the ear works, but the brain has trouble understanding sounds because the parts that control hearing are damaged. It may occur after a head injury or stroke. This type of hearing loss is rare.
Undiagnosed and untreated hearing loss can contribute to depression, social isolation, and loss of independence, especially in older adults.
When to Call a Doctor
Call 911 or other emergency services immediately if:
- Hearing loss occurs with an injury to
the head or ear.
- Hearing loss occurs suddenly with other symptoms
such as:
- Facial droop.
- Numbness or
paralysis on all or one side of the face or body.
- Eye or vision problems, including blurred or double vision or only
being able to see out of one eye.
- Slurred speech, not being able
to speak, or difficulty understanding speech.
- Difficulty standing
or walking (ataxia).
- Severe nausea or vomiting.
Call a doctor immediately if
you:
- Develop sudden, severe hearing loss.
Call your doctor if you:
- Have hearing loss that you think may be caused
by earwax.
- Have hearing loss after taking
medicine.
- Have hearing loss after having cold or flu
symptoms.
- Have hearing loss after traveling on an
airplane.
- Feel your hearing is gradually getting
worse.
- Wonder if you need hearing aids.
- Think your
baby or child may not be hearing well.
If you think you have a hearing problem, you might choose to see an audiologist.
Watchful waiting
Watchful waiting is when you and
your doctor watch symptoms to see if the health problem improves on its own.
Although hearing loss is not usually dangerous, it can affect your personal
safety. It can also reduce how much you can do in the workplace and at home and
limit you socially. It is important that you talk to your doctor or an audiologist about hearing
loss.
Who to see
Hearing loss can be diagnosed by:
If your doctor suspects or diagnoses hearing loss, he or
she may have you see an ear, nose, and throat specialist (otolaryngologist) or an
audiologist.
Exams and Tests
Your doctor will diagnose
hearing loss by asking questions about your symptoms
and past health (medical history) and by doing a physical exam. He or
she may find during a routine visit that you have some hearing loss.
You will also have a
physical exam of the
ears. Your doctor will use a lighted instrument (an
otoscope) and may find problems in the ear canal, eardrum, and middle ear,
including:
- Earwax.
- An object or obstruction in the ear canal.
- An infection or fluid in the ear.
- Injury to the ear.
If your exam, history,
or symptoms suggest a hearing problem, your doctor may refer you to an audiologist to do hearing tests.
Depending on the suspected cause of hearing loss, you
may also have other tests:
- Imaging tests such as a
CT scan or
MRI may be done when an injury or tumor is
suspected.
- Auditory brain stem response (ABR) testing may be used to test nerve pathways in the brain if your doctor
suspects an
acoustic neuroma or another nerve problem. This test
measures how well the nerve that helps you hear is working and how fast sound
travels along this nerve.
Tests for your child
Some hearing problems can delay your child's
speech and language development. Early screening for hearing loss can help
prevent many learning, social, and emotional problems that can be related to
speech and language development.1 The
United States Preventive Services Task Force
recommends that all newborns be screened for hearing loss.2 All 50 states require newborn hearing tests for all babies
born in hospitals. Talk to your doctor about whether your child has been or
should be tested.
Signs of noise-induced hearing loss are
appearing at earlier ages and in children. Be sure your child has
regular hearing exams.
Treatment Overview
Treatment for temporary or
reversible
hearing loss usually depends on the cause of the
hearing loss. Treatment for permanent hearing loss includes using hearing
devices or hearing implants.
Although you and your family may view permanent hearing
loss as part of aging, proper treatment is important. Hearing loss may
contribute to loneliness,
depression, and loss of independence. Treatment cannot
bring back your hearing, but it can make communication, social interaction, and
work and daily activities easier and more enjoyable.
Treatment for reversible hearing loss depends on its cause. It is often treated
successfully. Hearing loss caused by:
- Ototoxic medicines (such as aspirin or
ibuprofen) often improves after you stop taking the medicine.
- An
ear infection, such as a middle ear infection, often clears up on its own,
but you may need antibiotics.
- An
injury to the ear or head may heal on its own, or you
may need surgery.
- Otosclerosis,
acoustic neuroma, or
Ménière's disease may require medicine or
surgery.
- An autoimmune problem may be treated with
corticosteroid medicines, generally prednisone.
- Earwax is treated by removing the wax. Do not use a
cotton swab or a sharp object to try to remove the wax. This may push the wax
even deeper into the ear or may cause injury. For information on how to remove
hardened earwax safely, see the topic
Earwax.
In permanent hearing loss, such as
age-related and
noise-induced hearing loss, hearing devices can often
improve how well you hear and communicate. These devices include:
- Hearing aids. Hearing aids make sounds louder
(amplify). They do not restore your hearing, but they may help you function and
communicate more easily. Having occasional hearing tests can help you know when your hearing aids need adjustment.
Hearing Loss: Should I Get Hearing Aids?
- Implanted hearing devices, such as a cochlear implant. Several types of hearing implants are available, each for specific types of hearing problems. Some implants require devices to be worn outside the ear. Newer implants are contained within the ear.
- Assistive listening devices, alerting devices, and other
communication aids.
Prevention
You can prevent some types of
hearing loss.
Preventing noise-related hearing loss
Being exposed to loud
noise over and over is one of the most common causes of permanent hearing loss.
It usually develops slowly and without pain or other symptoms, and you may not
notice that you have hearing loss until it is severe.
Be sure your child has regular
hearing exams and follows the suggestions below to
prevent hearing loss.
Steps you
can take to lower your risk of
noise-induced hearing loss include the following:
- Be aware of and avoid harmful noise. You can be exposed to harmful noise at work, at home, and in many
other settings. Know what kinds of situations can cause
harmful noise levels. To learn more about hearing protection in workplaces in the United States, contact the Occupational Safety and Health Administration (OSHA).
- Use hearing protectors. If you know you
are going to be around harmful noise, wear
hearing protectors, such as earplugs or earmuffs.
- Control the volume when you can.
Reduce the noise in your life by turning down the volume on the stereo,
TV, or car radio, and especially on personal listening devices with
earphones or ear buds.
- Don't wait to protect yourself. After noise-related damage to the ear
is done, it cannot be reversed. But if you already have some noise-related
hearing loss, it is not too late to prevent further damage and preserve the
hearing that you still have.
Preventing other causes of hearing loss
To lower
your risk of other types of
hearing loss:
- Never stick a cotton swab, hairpin, or other
object in your ear to try to remove earwax or to scratch your ear. The best way to prevent earwax problems is to leave earwax alone. For
information on how to remove hardened wax, see the topic
Earwax.
- Always blow your nose gently and through both
nostrils.
- During air travel, swallow and yawn frequently when the
plane is landing. If you have an
upper respiratory problem (such as a cold, the
flu, or a sinus infection), take a
decongestant a few hours before landing or use a
decongestant spray just before landing.
- Stop smoking. You are more likely to have hearing loss if
you smoke.
Living With Hearing Loss
If you have
hearing loss, you may find that it takes extra effort
and energy to talk with others. Hearing may be especially difficult in settings
where there are many people talking or there is a lot of background noise. The
increased effort it takes to be with other people may cause stress and fatigue,
and you may begin to avoid social activities, feel less independent, and worry
about your safety.
Hearing devices you may want to use
include:
- Hearing aids.Hearing aids make all sounds louder (amplify),
including your own voice. Common background noises, such as rustling
newspapers, magazines, and office papers, may be distracting. When you first
get hearing aids, it may take you several weeks to months to get used to this.
Hearing Loss: Should I Get Hearing Aids?
- Assistive listening devices. These devices make
certain sounds louder by bringing the sound directly to your ear. They shorten
the distance between you and the source of sound and also reduce background
noise. You can use different types of devices for different situations, such as
one-on-one conversations and classroom settings or auditoriums, theaters, or
other large public spaces. Commonly used listening devices include telephone
amplifiers, personal listening systems (such as auditory trainers and personal
FM systems), and hearing aids that you can connect directly to a television,
stereo, radio, or microphone.
- Alerting devices. These devices alert you to a
particular sound (such as the doorbell, a ringing telephone, or a baby monitor)
by using louder sounds, lights, or vibrations to get your attention.
- Television closed-captioning. Television
closed-captioning makes it easier to watch television by showing the words at
the bottom of the screen so that you can read them. Most newer TVs have a
closed-captions option.
- TTY (text telephone). TTYs (also called TDD, or
telecommunication device for the deaf) allow you to type messages back and
forth on the telephone instead of talking or listening. When messages are typed
on the TTY keyboard, the information is sent over the phone line to a receiving
TTY and shown on a monitor. A telecommunications relay service (TRS) makes it
possible to call from a phone to a TTY or vice versa.
Many other communication devices, such as pagers, fax
machines, email, and custom calling features offered by phone companies, can
be helpful. To get more information about selecting and using listening,
alerting, and telecommunicating devices, talk to an audiologist.
For family and friends of people with hearing loss
A person with hearing loss may feel cut off from conversations and social
interaction. The extra effort and stress needed to take part in conversations
can be tiring for all people involved. If you live with someone who has hearing
loss, you may improve your communication by:
- Making sure the person knows you are speaking to him or her.
Use his or her name.
- Speaking to the person at a distance of
3 ft (0.9 m) to
6 ft (1.8 m). Make sure that
the person can see your face, mouth, and gestures. Arrange furniture and
lighting so that everyone in the conversation is completely
visible.
- Not speaking directly into the person's ear. Your facial
expressions and gestures can provide helpful visual clues about what you are
saying.
- Speaking slightly louder than normal, but don't shout.
Speak slowly and clearly. Don't repeat the same word over and over again. If a
particular word or phrase is misunderstood, find another way to say
it.
- Telling the person when the topic of conversation
changes.
- Cutting down on background noise. Turn off the TV
or radio during conversations. Ask for quiet sections in restaurants, and try
to sit away from the door at theaters.
- Including the person in
discussions and conversations. Don't talk about the person as though he or she
isn't there.
Other Places To Get Help
Organizations
American Academy of Otolaryngology—Head and Neck Surgery
(AAO-HNS) |
1650 Diagonal Road |
Alexandria, VA 22314-2857 |
Phone: | (703) 836-4444 |
Web Address: | www.entnet.org |
|
The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders. |
|
American Hearing Research Foundation |
8 South Michigan Avenue |
Suite 1205 |
Chicago, IL 60603-4539 |
Phone: | (312) 726-9670 |
Fax: | (312) 726-9695 |
Web Address: | www.american-hearing.org |
|
The American Hearing Research Foundation helps pay for
research into hearing and balance disorders and also helps to educate the
public about these disorders. On their website you can find general
information on many common ear disorders, including descriptions, causes,
diagnoses, and treatments. References are also included as a source for further
information. The American Hearing Research Foundation also publishes a
newsletter, available by subscription, as well as a number of pamphlets on a
variety of topics. |
|
American Speech-Language-Hearing
Association |
2200 Research Boulevard |
Rockville, MD 20850-3289 |
Phone: | 1-800-638-8255 (301) 296-5700 |
Fax: | (301) 296-8580 |
TDD: | (301) 296-5650 |
Web Address: | www.asha.org/public |
|
The American Speech-Language-Hearing Association (ASHA)
promotes the interests of and provides services for professionals in audiology,
speech-language pathology, and speech and hearing science. ASHA also advocates
for people who have communication disabilities. The website has information on
related health topics, self-help groups, and finding a professional in your
area. |
|
National Institute on Deafness and Other Communication
DisordersNational Institutes of Health
|
31 Center Drive, MSC 2320 |
Bethesda, MD 20892-2320 |
Phone: | 1-800-241-1044 |
TDD: | 1-800-241-1055 |
Fax: | (301) 402-0018 |
Email: | nidcdinfo@nidcd.nih.gov |
Web Address: | www.nidcd.nih.gov |
|
The National Institute on Deafness and Other
Communication Disorders, part of the U.S. National Institutes of Health,
advances research in all aspects of human communication and helps people who
have communication disorders. The website has information about hearing,
balance, smell, taste, voice, speech, and language. |
|
Noise and Hearing Conservation, Occupational Safety and
Health Administration (OSHA), U.S. Department of Labor |
200 Constitution Avenue NW |
Washington, DC 20210 |
Phone: | 1-800-321-OSHA (1-800-321-6742) |
TDD: | 1-877-889-5627 toll-free |
Web Address: | www.osha.gov/SLTC/noisehearingconservation/index.html |
|
The Noise and Hearing Conservation section of the OSHA
Web site provides information on U.S. government noise standards, general
information on noise-induced and work-related hearing loss, and how to protect
your hearing. |
|
References
Citations
- Joint Committee on Infant Hearing, American Academy of Pediatrics (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120(4): 898–921. Also available online: http://pediatrics.aappublications.org/cgi/reprint/120/4/898.
- U.S. Preventive Services Task Force (2008). Universal screening for hearing loss in newborns: Recommendation statement. Available online:
Other Works Consulted
- Agrawal SK, et al. (2008). Occupational hearing loss. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology–Head and Neck Surgery, pp. 732–743. New York: McGraw-Hill.
- American Academy of Pediatrics (2008). Recommendations for preventive pediatric health care. In Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed., p. 591. Elk Grove Village, IL: American Academy of Pediatrics. Also available online: http://brightfutures.aap.org/pdfs/Guidelines_PDF/20-Appendices_PeriodicitySchedule.pdf.
- Centers for Disease Control and Prevention (2010). Risk of bacterial meningitis in children with cochlear implants. Available online: http://www.cdc.gov/ncbddd/hearingloss/meningitis.html.
- Gluth MB, et al. (2008). Cochlear implants. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, pp. 877–887. New York: McGraw-Hill.
- Joint Committee on Infant Hearing, American Academy of Pediatrics (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120(4): 898–921. Also available online: http://pediatrics.aappublications.org/cgi/reprint/120/4/898.
- National Institute on Deafness and Other Communicative Disorders (2010). Ten Ways to Recognize Hearing Loss. Available online: http://www.nidcd.nih.gov/health/hearing/10ways.asp.
- Niparko JN, et al. (2010). Spoken language development in children following cochlear implantation. JAMA, 303(15): 1498–1506.
- Sweetow RW, Cascia T (2008). Aural rehabilitation and hearing aids. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, pp. 705–712. New York: McGraw-Hill.
- U.S. Preventive Services Task Force (2008). Universal screening for hearing loss in newborns: Recommendation statement. Available online:
- Yu KCY, Cheung SW (2008). Implantable middle ear hearing devices. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology–Head and Neck Surgery, pp. 873–876. New York: McGraw-Hill.
Credits
By | Healthwise Staff |
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Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
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Specialist Medical Reviewer | Steven T. Kmucha, MD - Otolaryngology |
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Last Revised | April 13, 2011 |
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