Hearing Loss Overview

To understand hearing loss it is important to understand how normal hearing takes place. There are 2 different pathways by which sound waves produce the sensationof hearing: air conduction and bone conduction. In air conduction, sound waves move through the air in the external auditory canal (the "ear canal" between the outside air and your eardrum). The sound waves hit the tympanic membrane (eardrum) and cause the tympanicmembrane to move. The bones in the middle ear are connected to the tympanic membrane. When the tympanic membrane moves, this movement is transmitted to the bones. These 3 bones are called the malleus, the incus, and the stapes. Movement of the stapes causes pressure waves in the fluid-filled inner ear. The cochlea is an inner ear structure surrounded by fluid. It contains multiple small hairs. Pressure waves in the fluid cause the hairs to move. This movement stimulates the auditory nerve. Different frequencies of noises stimulate different hairs on the cochlea, which translate to the sensation of sounds of different pitch. Hearing by bone conduction occurs when a sound wave or other source of vibration causes the bones of the skull to vibrate. These vibrations are transmitted to the fluid surrounding the cochlea and hearing results.

Hearing Loss Causes

There are 2 basic types of hearing loss, which are called conductive and sensorineural. Conductive causes: Conductive hearing losses result from physical problems with the movement of the sound wave through the ear. A simple example is blockage of the ear canal. o Obstructed external ear canal - Cerumen (wax) build-up, hematoma(blood collection), or foreign body in the ear canal. This is one of the most common causes of hearing loss and the easiest to fix. Perforated tympanic membrane - Caused by direct trauma such as a finger or cotton swab, middle-ear infections (otitis media), or explosions (blast injury) Dislocated ossicle (malleus, incus, or stapes) - Usually from trauma to the ear Otitis media - Middle ear infection Otitis externa - Infection of the ear canal that causes it to swell

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Sensorineural causes: Sensorineural causes are from damage to the hair cells or nerves that sense sound waves. o Acoustic trauma - Prolonged exposure to loud noises causes the hair cells on the cochlea to become less sensitive. Barotrauma (pressure trauma) or ear squeeze - Usually in divers Head trauma - A fracture of the temporal bone can disrupt the nerves of the auditory system Ototoxic drugs - Certain drugs can affect hearing by damaging the nerves involved in hearing. Usually this occurs when large or toxic doses are used but may also occur with lower doses. Antibiotics including aminoglycosides (gentamicin, vancomycin), erythromycins, and minocycline Diuretics including furosemide and ethacrynic acid Salicylates (aspirin) and nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen Antineoplastics (cancer drugs)

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Vascular diseases (problems with blood vessels) include sickle cell disease, diabetes, leukemia, polycythemia, and diseases in which excessive blood clotting occurs. Children and adults with kidney problems are more susceptible to sensorineural hearing loss. Mnire disease - A disease that affects hearing and balance. It is usually associated with tinnitus (ringing in the ears). It has a gradualonset and often progresses to deafness and severe vertigo. The cause is unknown. Acoustic neuroma - A tumor in the auditory nerve. Usually associated with ringing in the ears. Infections Mumps Measles Influenza

Herpes simplex Herpes zoster Mononucleosis Syphilis Meningitis

Aging (presbycusis)

Hearing Loss Symptoms

Hearing loss may be gradual or sudden. Hearing loss may be very mild, resulting in minor difficulties with conversation, or as severe as complete deafness. The speed with which hearing loss occurs may give clues as to the cause. If hearing loss is sudden, it may be from trauma or a problem with blood circulation. A gradual onset is suggestive of other causes such as aging or a tumor. If you also have other associatedneurological problems, such as tinnitus (ringing in the ears) or vertigo (spinning sensation), it may indicate a problem with the nerves in the ear or brain. Hearing loss may be unilateral (only 1 ear) or bilateral (both ears). Unilateral hearing loss is most often associated with conductive causes, trauma, and acoustic neuromas. Pain in the ear is associated with ear infections, trauma, and obstruction in the canal. Ear infections may also cause afever.

Why do we get ear wax in our ears? Ear wax is produced by glands. Ear wax is a self cleaning process that prevents bugs, dirt, and bacteria from gaining entrance into the internal ear. It also helps maintain the acid balance in the ear and gives protection from infection. This self-cleaning protection mechanism works well most of the time.

When too much ear wax is produced it can become hardened in the ear or coat the ear drum with a layer of wax. When this occurs, it prevents sound waves from reaching the inner ear or sound is not heard properly. Hearing is then muffled so that speech is partially or completely missed. The impaction of ear wax may cause dizziness, loss of balance, pain, and discomfort including ringing. Impacted ear wax may cause you to cough. It's the body's way to help you to expel it.

Exams and Tests

In most medical offices or in the emergency department, doctors do not have access to equipment to directly test your hearing (an audiometer). In these settings the doctor will most likely evaluate your hearing with a tuning fork. The examination may include the following: Each ear will be tested separately to see if you can hear the sound coming from a tuning fork. The ear canal and tympanic membrane will be inspected with an otoscope (a special instrument with a light and a tip to look into the ear canal). The nose, nasopharynx (the part of yourthroat that your ears drain into, located just above your soft palate), and upperrespiratory tract usually will be carefully examined. A general neurologic exam, which includes tests of the nerves that control movement, sensation, and reflexes, will be done. If a process inside the brain (such as an acoustic neuroma) is suspected, a CT scanof the brain may be performed. If an infection, vascular problem, or drug interaction is suspected, blood tests may be performed. Tympanometry may be indicated if a problem with the tympanic membrane (eardrum) is suspected. This test evaluates the middle ears ability to receive sound waves. Ototoxicity is damage to the ear (oto-), specifically the cochlea or auditory nerve and sometimes the vestibular system, by a toxin. It is commonly medication-induced; ototoxic drugs include antibiotics such as the aminoglycoside gentamicin, loop diuretics such as furosemide, and platinum-basedchemotherapy agents such as cisplatin. A number of nonsteroidal antiinflammatory drugs (NSAIDS) such as Meloxicam have also been shown to be ototoxic. This can result in sensorineural hearing loss, dysequilibrium, or both. Either may be reversible and temporary, or irreversible and permanent

Exposure to ototoxic chemicals

Main article: Ototoxicity In addition to medications, hearing loss can also result from specific drugs; metals, such [12] [12] as lead; solvents, such as toluene (found in crude oil, gasoline and automobile exhaust, for [13] example); and asphyxiants. Combined with noise, these ototoxic chemicals have an additive [13] effect on a persons hearing loss. Hearing loss due to chemicals starts in the high frequency range and is irreversible. It damages the cochlea with lesions and degrades central portions of [13] [14] the auditory system. For some ototoxic chemical exposures, particularly styrene, the risk of hearing loss can be higher than being exposed to noise alone. Controlling noise and using hearing protectors are insufficient for preventing hearing loss from these chemicals. [14] However, taking antioxidants helps prevent ototoxic hearing loss, at least to a degree. The [13][14] following list provides an accurate catalogue of ototoxic chemicals:

Drugs antimalarial, antibiotics, anti-inflammatory (non-steroidal), antineoplastic, diuretics

Solvents toluene, styrene, xylene, n-hexane, ethyl benzene, white spirits/Stoddard, carbon disulfide, fuels, perchloroethylene, trichloroethylene, p-xylene

Asphyxiants carbon monoxide, hydrogen cyanide

Metals lead, mercury, organotins (trimethyltin)

Pesticides/Herbicides paraquat, organophosphates