Category Archives: Hearing-loss in adult

Hearing Loss Linked to other Health Conditions

Studies Show that Hearing Loss is Connected to Other Health Conditions.

Once upon a time, before people knew any better, they thought that hearing loss was simply a part of growing older—something not worth doing much about.

They were wrong.

Turns out, hearing loss isn’t fussy about age. More than half of us with hearing loss are still in the workforce. And hearing loss is a much bigger deal than we ever imagined. We need to take it seriously.

Hearing loss affects baby boomers, Gen Xers and every other age group. And, when left unaddressed, hearing loss affects just about every aspect of a person’s life.

The big surprise is that hearing loss has been linked to other health conditions.

hearing Loss related problems

Hearing loss can have unwelcome companions—like heart disease; diabetes; chronic kidney disease; depression; cognitive decline, dementia or Alzheimer’s disease; increased risk of falling; increased hospitalizations.

The very best thing to do for hearing loss is to find out if you have it as soon as possible. Then take it seriously. If deemed appropriate by a qualified hearing health care professional, treat it.  Hearing aids can benefit the vast majority of people with hearing loss.

Most doctors don’t include hearing health as a routine part of annual exams. So ask to have your hearing tested. Once you reach middle-age, it makes sense to include hearing tests as part of your routine annual care.

It seems that the “hearing bone” may be connected to more than we originally thought.

For more information visit http://www.betterhearing.org/news/hearing-bones-connected-what

Diabetics have More Chances of Hearing Loss

Most common causes of Hearing Loss are Aging, Heredity, loud noises and ototoxic medicines but studies suggest that diabetes also makes more prone for hearing loss.

Patients with diabetes routinely receive blood exams, kidney function evaluations, feet examination and eye exams, but routine ear and hearing examination is hardly known thing.

On “World Diabetes Day” we recommend hearing tests should be norm for diabetics.

 Reason for hearing loss in diabetics:

There are changes in the nerves themselves and it hypothesized that hearing loss in diabetics is because of damage to nerves and blood vessels in the inner ear.

Sign and symptoms of Hearing loss:

Self hearing Check  at neoalta.com

  • Often turn up the volume of T.V. or radio.
  • Find it difficult to follow a conversation in a noisy area or crowded room.
  • Feel people are mumbling or not speaking clearly.
  • Misunderstand what others are saying and respond inappropriately.
  • Ask others to speak up or to repeat themselves.
  • Sometimes miss birds chirping, doorbell or telephone ringing

How Hearing Loss is diagnosed ?

ENT consultation and hearing tests (Audiometry) by audiologist can diagnose hearing problem. DP OAE (distortion product otoacoustic emissions-test used for newborn hearing screening) can detect early hearing loss in diabetic patients.

Read in detail about Tests of Hearing

What is the treatment of hearing loss?

Treatment will depend on the type of hearing loss. Diabetics usually have sensorineural Hearing Loss which cannot be cured. However, most cases of sensorineural hearing loss can be treated with hearing aids.

Read more about treatment of Hearing Loss.

Protection of Hearing in diabetics:

  • Control of diabetes, Hb A1c should be kept under 7%, diet and exercise are vital
  • Protect your sensitive ears from noise and ototoxic medicine
  • Regular Ear and Hearing Screening : along with your eyes, feet, and kidneys, your ears need regular screening.

If you or a loved one has diabetes, we recommend to  visit hearing clinic to take a hearing test,

visit Audicco.com  ENT and hearing center at Vashi Navi Mumbai to know more.

You Can Permanently Lose Your Hearing From Exposure to Diwali Noise

Any sound above 85 dB has the potential to harm our ears. The noise levels in most urban areas are very high which further goes up to dangerously high levels during Diwali- Fireworks and fireworks,  music systems… soon it may end up with visit to ENT and Audiology clinics.
Serious effects of Noise
Hearing loss
Ringing in the ears (Tinnitus)
Raised blood pressure
Irritability and disturbed Sleep

Levels of noise by American Academy of Audiology

Everywhere talks and campaigns are going on to stay safe in Diwali  —

-Top ten tips for a healthy Diwali on mdhil.com which says to make sure to protect ear from loud noises .

-Top Ten Tips for safe and Healthy Diwali on MeDIndia .

– Visvesvaraya Technological University (VTU), Belgaum will be organizing ‘Campaign’ to create awareness on
the ill-effects of air and noise pollution due to bursting of crackers.

Despite several campaigns being organised to raise awareness about the hazards of firecracker-induced noise pollution, expect a noisy Diwali this year too, as reported By Akshay Deshmane mumbai DNA  Diwali 2012: Noise campaigns fall on deaf ears

So big question remains “Are we really celebrating Diwali? asks Gayatri sankar on Zeenews.com

 

E.N.T. Care and Cure

A teenage girl visited ENT clinic with her mother with ringing in the ear and felt like cotton in the ear. Previous night,  Diwali Night she had spent several hours setting off the fire crackers.

Her ear were normal on video otoscopy and Audiogram showed  35 db at 4000 and 8000 hertz, Several days later, her hearing had returned to normal.

This patient is an example of a “temporary threshold shift.” Or Reversible Hearing Loss by exposure to an intense “impulse” sound such as fireworks or loud rock concert.

If sound is too loud or duration of exposure is long enough, such as noise generated in a woodworking shop it may lead to permanent threshold shift.  This condition is called Noise Induced Hearing Loss which has no cure.

Acoustic trauma occurs when excessive sound energy strikes inner ear. When we are exposed sounds that are too loud or…

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Single Sided Hearing Loss Can Seriously Impact Lifestyle and Work…

 

 

I sleep through bed side alarm because I happen to be lying with my hearing ear to the pillow. I have Single Sided Deafness (hearing loss in one ear) …But I am able to  manage my life…But…

 

What are Symptoms of Single sided deafness?

  •  Inability to hear sound from affected side of the ea
  • Inability to locate the direction of where the sound is coming from.
  • Understanding speech in background noise, sounds all blur into one flat mono channel
  • May turn their head to hear with their “good ear.”

I can manage my life with one ear but is there some psychosocial impact?

Yes…

It affects social, work and home interactions due to the reduced ability to localize sounds and to discriminate speech in background noise.

  • Irritability and fatigue due to more effort needed to listen
  • Frequent headaches, stress
  • Social isolation
  • Blamed for “not paying attention.”
  • Avoids group situations because the noise overwhelms them,
  • Can hear only half of the components of the music, e.g., bass or piano, but not both

 

How one sided hearing loss is diagnosed?

ENT evaluation and Hearing test (audiometry) can detect hearing loss in one ear. Further tests may be required to know the cause.

It can be conductive, sensor neural or mixed in nature.

Conductive hearing loss may be due to problem in the ear canal, such as earwax, ear drum injury or infections.

Senorineural hearing loss can be either congenital or present at or just after birth due to malformation of the inner ear or a dysfunction/absence of the auditory nerve. It can also be acquired later on in life as the result of various causes such as ototoxic drugs, immunological diseases and infections.

 What is the treatment for one sided hearing loss?

Medicines and surgery may help in conductive hearing loss. Hearing aid help for sensorineural hearing loss

For permanent total one sided hearing loss even normal hearing aid does not help and aim is to restore the sensation of hearing by sending a signal to the better hearing side. It can be achieved by following two options-

Surgical: (BAHA)

BAHA (bone anchored hearing aid), are surgically placed into the temporal bone of the unaidable ear. A sound processor transmits sound waves to the implanted fixture, which in turn causes sound to travel via bone conduction to the cochlea of the better ear.

Image courtesy:cochlear

Non-surgical: CROS Hearing aid 

Sound is picked up by a microphone worn on the unaidable ear and wirelessly transmitted to a hearing aid, which is worn on the better ear. The sound signal is typically transferred either by a wire connecting each device or wireless.

Image courtesy:Phonak

Unilateral Hearing Loss in Children:

Did you KNOW …?

SCHOOLCHILDREN with UNTREATED unilateral hearing loss are LIKELY TO FAIL one or more grades despite normal cognitive abilities?

Most of the time child with hearing loss in one ear is  MISSED till he grows sufficiently older to tell parents about his hearing problem. Child may be labelled as not paying attention in school

They can greatly benefit from fitting of hearing aid or sound field system (desk top or ear level FM system) to ensure the child can hear the teacher’s voice. Children with profound one sided hearing loss may benefit from CROS hearing aid designed to transfer sound from hear with hearing loss to the FM Technology.

Helping child with a unilateral hearing loss

Keep background noise to a minimum as much as possible.

Get child’s attention before speaking to them.

Position yourself so that you are on their side with good hearing.

Make the teacher aware that child has a unilateral hearing loss.

Ask for child to be seated as near to the teacher as possible

What is the Phonak CROS System?

The Phonak CROS/Bi CROS wireless system allows sounds to be transmitted from the dead ear to the normal /damaged ear. It is also the smallest solution on the market and is even available in a waterproof version, specially designed for active people.

Noise Induced Hearing Loss

A teenage girl visited ENT clinic with her mother with ringing in the ear and felt like cotton in the ear. Previous night,  Diwali Night she had spent several hours setting off the fire crackers.

Her ear were normal on video otoscopy and Audiogram showed  35 db at 4000 and 8000 hertz, Several days later, her hearing had returned to normal.

This patient is an example of a “temporary threshold shift.” Or Reversible Hearing Loss by exposure to an intense “impulse” sound such as fireworks or loud rock concert.

If sound is too loud or duration of exposure is long enough, such as noise generated in a woodworking shop it may lead to permanent threshold shift.  This condition is called Noise Induced Hearing Loss which has no cure.

Acoustic trauma occurs when excessive sound energy strikes inner ear. When we are exposed sounds that are too loud or loud sounds that last a long time—small sensitive structures in our inner ear, called hair cells, can be damaged, Hair cells convert sound energy into electrical signals that travel to the brain. The louder the sound, the shorter the time period before NIHL can occur.

Sound is measured in units called decibels. Continual exposure to more than 85 decibels (dB) is dangerous to the ears. Firecrackers emit sounds from 120 to 160 decibels. Sound with 140dB can cause ear ache. A very high intensity sound (above 160 dB) may also damage the ear drum and can cause dislocation of middle ear ossicles.

An even higher intensity may cause leakage of inner ear fluid leading to permanent hearing loss associated with dizziness.

Symptoms

  • Hearing loss
  • Sense of fullness  the ear
  • Noises, ringing in the ear
  • Earache
  • Bleeding from the are
  • Dizziness,

Signs and tests

Acoustic trauma is suspected if hearing loss occurs after noise exposure. Audiometry may determine how much hearing has been lost. Audiogram has typical “notch” at 4000 hz, with better hearing at both lower and higher frequencies. Otoacoustic Emisson (OAE) testing is very sensitive to noise induced hearing loss.

Treatment

The hearing loss may not be treatable. The goal of treatment is to protect the ear from further damage. Hearing aid is prescribed for communication needs. If ear Drum is ruptured, surgery to repair ear drum may be needed.

Ear protection using noise protector ear plugs or ear muffs may prevent the hearing loss from getting worse.

Noise exposure, whether occupational or recreational, is the leading preventable cause of hearing loss. It can be prevented by avoiding “too loud” or “too long” Noise exposure and use of hearing protection when necessary.

****

It’s a Noisy Planet. Protect Their Hearing campaign, a program of the National Institute on Deafness and Other Communication Disorders (NIDCD).
NIDCD

Helping hearing impaired: Hear better…

Sensorineural hearing loss may be shocking news to patient and his relatives. Understanding is required to help accept the fact, Talk with your doctor, friends, family and person with same problem to support you.

Most patients are benefited by hearing aids but there is limitation of sound-quality and back ground noise that means it works well in quiet environment but some users have trouble enjoying music and listening in a crowded room.

Hearing impaired person takes time to get used to hearing aid. Assistive listening devices, loop system, FM system, and telephone and mobile amplifying devices help in clarity of sound and music.

Working together to hear better may be tough on everyone. It will take time for hearing impaired person to get used to watching people as they talk and for people to get used to speaking louder and clear.

Be patient and continue to work together.

Treatment and devices for hearing loss

Train your new way of hearing (getting used to hearing aid)

Help from family and friends


What treatments and devices can help?

  • Hearing aids are tiny instruments which make sounds louder.

Quality of hearing aid is of utmost importance and it takes few days to adjust but eventually initial chaotic sound disappear and person is able to appreciate the difference.

  • Personal listening systems help you hear what you want to hear while eliminating other noises around you. Auditory training systems and loop systems make it easier to hear in a crowded room. FM systems and personal amplifiers are better for one-on-one conversations. Improving FM (frequency modulation) boosts the performance of hearing aid.
  • TV listening systems help you listen to the television or the radio without being disturbed by other noises around you. These systems can be used with or without hearing aids.

  • Direct audio input hearing aids are hearing aids that can be plugged into TVs, stereos, microphones, auditory trainers, and personal FM systems to help you hear better.
  • Telephone and mobile amplifying devices. If your hearing aid has a “T” switch, you can use a phone with an amplifying coil (T-coil) or mobile phone with a loop set.  It allows you to listen at a comfortable volume and helps lessen background noise. Special type of telephone receiver and other devices are also available to make sounds louder on the phone.
  • Assistive listening systems. Many auditoriums, movie theaters, churches, synagogues, and other public places are equipped with special sound systems for people with hearing loss. These systems send sounds directly to your ears to help you hear better.
  • Lip reading or speech reading is another option.

How to train your new way of hearing (getting used to hearing aid)

Hearing aid is not same as natural hearing but with few weeks of regular use person usually adapt to it. A period of adjustment is required as the brain gets used to this new way of dealing with sound.

I. At first, wear the hearing aids in your home environment.

  • Wear the hearing aids only as long as you are comfortable wearing them.
  • Read something aloud to yourself. Try to listen to soft noises, such as rustling paper, tape water, jingling your keys, etc.
  • Make a brief phone call
  • Have a conversation with a friend or relative in calm, quiet surroundings.
  • Watch a television show or listen to a radio programme in quiet surroundings.

II. Have a conversation in a loud environment. It may take a few days or a few weeks to adjust.

  • Even people with normal hearing do not hear every word.
  • In loud hearing situations, even people without hearing loss need to make an effort in order to hear what they need to hear and ignore the unwanted noise.

.

III. Gradually increase the hours of wearing hearing aids over 15-20 days.

IV. Gradually extend the number of persons with whom you speak.

V. Be patient and focused.

How friends and family can help the hearing impaired?

  • Know and talk about his hearing loss.
  • Face the person with hearing loss and maintain eye contact when you talk. Your face and expressions may help you to understand them better.
  • Speak louder, but do not shout. Just talk more clearly and slowly.
  • Turn off the TV or the radio if it is not required.
  • Be aware of noise around you that can make his hearing more difficult, like vacuum cleaner, washing machine or loud music Shorten the distance between you and listener in noisy surroundings.
  • Be patient

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Management of sudden sensorineural Hearing Loss

Previous Post:- Causes and evaluation of sudden sensorineural hearing loss

Sudden sensorineural hearing loss is an otologic emergency and challenge to otolaryngologist.

Thorough history, physical examination, appropriate laboratory and radiologic investigations including gadolinium enhanced MRI, and Audiometry tests should be carried out to find out known cause such as: – Infection (bacterial-meningitis/viral-mumps, herpes), Tumor, Trauma, Acoustic trauma, Ototoxic drugs (amino glycoside antibiotics), and Systemic diseases (hypothyroidism, Diabetes mellitus).

If an etiology is apparent, appropriate treatment may be initiated such as antibiotics for infection, withdrawal of ototoxic drugs.

In most cases cause remains unknown (idiopathic) thus existent treatment aims at improving blood flow.

Optimal treatment is still under research and controversies exist but treatment versus non-treatment and early initiation of treatment is proved to give better result.

1. Antivirals– Because of common association with viral infection antiviral medication is prescribed by some clinicians.

2. Steroids- Most widely accepted treatment option studies shows improved recovery rate with use of steroid. It can be given orally, or by injection, or Trans tympanic by means of middle ear instillation or round window micro catheter which is more effective than oral administration.

3. Vasodilator to improve blood flow or oxygenation to inner ear. Clinical studies shows mixed results. Carbogen inhalation, Papaverin, Histamine, Nicotin and Niacin have been used.

4. Immunosuppressant- Wang et al etanercept in experimental animal study improves hearing result.

5. Ginkgo Biloba-

6. General measures-

  • Low salt diet,
  • Avoid caffeine, nicotine and alcohol,
  • Avoid noise exposure,
  • Avoid heavy physical activity,
  • Well balanced diet,
  • Alpha-lipoic Acid, Antioxidants, Co-enzyme Q10.
  • Zinc, Magnesium, Calcium,
  • Vitamin D, B -Complex, Vitamin C

Prognosis of sudden sensorineural hearing loss-

50-65% spontaneous recovery within first 4-6 weeks.

Symptoms of ear blockage or deceased hearing is often considered as wax or middle ear infection and person delays visit to an otolaryngologist. A delay in initiating treatment may decrease the chances of recovery.

Negative factors in prognosis-

  • Age more than 65 years or less than 15 years
  • Severe hearing loss specially affecting high frequency
  • Hearing loss in opposite ear
  • Associated vertigo
  • Elevated ESR

Treatment protocol should be carefully applied and potentially harmful treatment should be avoided. A thorough evaluation to be done on emergency basis and all efforts should be taken to find out known causes. Steroids are most widely accepted treatment options.

Sudden Sensorineural hearing loss

  • It should be regarded as an otologic emergency.
  • Patient should be evaluated by otolaryngologist.
  • A thorough history, physical examination, appropriate laboratory and radiologic investigations including gadolinium enhanced MRI, and Audiometry tests should be carried out to find out known cause.
  • A tapering course of prednisolone/methyle prednisone is prescribed.
  • Antiviral medication may be considered.

Sudden Sensorineural Hearing Loss: Causes and Evaluation

Sudden Sensorineural Hearing Loss (SSNHL) is defined as a hearing reduction greater than 30 db, over at least 3 consecutive frequencies (on pure tone audiogram), occurring over or less than 3 days. It usually affects one ear, there may be mild to sever reduction of hearing, and there may be tinnitus and dizziness.

Most People (30-65%) may have a spontaneous recovery; others may have permanent hearing difficulties.

Causes of sudden sensorineural hearing loss-

There is no conclusive evidence as why it happens but some theories are suggested-

1. Generally 90% cases are idiopathic where cause is not known. Viral diseases appears to be most common cause (about 60% cases) as shown by association with herpes.

2. There may be partial or complete blockage of circulation or vascular spasm to inner ear and nerves of hearing.

3. There may be rupture of delicate inner ear membrane after strong physical activity or sudden change in barometric pressure (flying/scuba diving).

4. Immune theory may ply a role, because of its association with Cogan syndrome, SLE, Lupus and AIDS.

In most cases reason remains unclear.

Diagnosis of SSNHL requires thorough investigation to determine any known causes of sudden hearing loss. Some of the causes are following-

* CONGENITAL –

  • Rubella Syndrome
  • Atresia of the External ear canal
  • Congenital Cytomegalovirus
  • Congenital Perilymphatic Fistula
  • Fetal Methyl Mercury Effects
  • Fetal Iodine Deficiency Effects

* MEDICATIONS (Ototoxic Drugs)-

  • Aminoglycoside Antibiotics-streptomycin, kanamyin, neomycin, amikacin, gentamicin, tobramicin and netilmicin
  • Loop diuretics, ethacrynic acid
  • Antimalarial (quinine, chloroquine),
  • Salicylates
  • NSAIDS
  • Vancomycin
  • Erythromycin
  • Cisplatinum

* INFECTIOUS DISEASES-

Bacterial infection:

  • Otitis media
  • Labyrinthitis
  • Encephalitis
  • Meningitis

Viral infections:

Evidence is circumstantial, with the possible exception of mumps parortitis and herpes zoster, the clinical diagnosis of viral infection is unreliable.

  • Common Colds
  • Adenovirus
  • Cytomegalovirus (Cmv)
  • Infectious Mononucleosis
  • Influenza
  • Parainfluenza
  • Ear Infection (Otitis Media)
  • Mumps
  • Measles
  • Rubella
  • Herpes Simplex Virus Type 1

Others:

Rocky Mountain spotted fever-tick borne infection

Lyme disease- tickborne especially in endemic areas (mostly causes facial palsy)

Syphilis and AIDS

* IMMUNOLOGIC DISEASES-

Immunologic activity within the cochlea may be the cause as suggested by finding of antibodies and response to steroid therapy in many patients. Hearing loss in certain autoimmune diseases is documented.

  • Cogan’s Syndrome
  • Systemic Lupus erythomatosus
  • Fibromyalgia
  • Temporal arteritis

* TRAUMATIC-

Direct trauma (temporal bone fracture) or blunt head injury (concussion to labyrinth) can cause SSNHL.

  • Traumatic ear drum Perforation
  • Head Injuries
  • Skull Fracture (Temporal Bone)

* ACOUSTIC TRAUMA

  • Explosions
  • Fireworks,
  • Gunfire
  • Rock Concerts/Mp3 Players
  • Jets
  • Occupational Work Noise

* BAROTRAUMA and perilymphatic fistula

Barotraumas is caused by unequalized pressure differentials in middle ear and external ear such as in scuba diving, air travellingor blow to ear. If the pressure is severe, eardrum can rupture.

Barotrauma can cause acquired perilymphatic fistula (communication between inner ear and middle ear) leading to SSNHL and vertigo. Other causes of acquired perilymphatic fistula are direct or indirect trauma to temporal bone, heavy lifting or straining and complication of stapes surgery.

* TUMORS-

  • Acoustic Neuroma or Vestibular Schwannoma – SSNHL may be initial manifestation
  • Temporal Bone Metastases
  • Neoplasm of CPA or IAC

* OTHER SYSTEMIC DISEASES-

  • Leukemia
  • Diabetes
  • Hypothyroidism
  • Multiple Sclerosis
  • Ménière’s Disease
  • Syphilis

Evaluation  of sudden sensorineural Hearing loss (searching for cause)-

A thorough and detailed history of associated symptoms, noise exposure, any trauma, fever, medication and family history of hearing loss is necessary to determine the diagnosis.

Ear examination by otoscopy and pneumotoscopy is critical step.

Hearing assessment by Tunning fork test, pure tone audiometry (PTA) and speech audiometry should be done. Tympanometry, Auditory Brainstem Response and Otoacoustic emission may be useful.

Electronystagmogram (ENG)

Radiologic study should be done especially for patients with unilateral sensorineural hearing loss, such as MRI with gadolinium/CT temporal bone to investigate IAC/CPA tumors.

Laboratory investigations-

FTA-antibodies for syphilis

ANA, RA Factor, ESR for autoimmune disease

Coagulation profile

CBC for infection

TH for thyroid function

RBS/PPBS for Diabetes

Cholesterol/triglycerides for hyperlipidemia

Sudden Sensorineural hearing loss-

  • It should be regarded as an otologic emergency.
  • Patient should be evaluated by otolaryngologist.
  • A thorough history, physical examination, appropriate laboratory and radiologic investigations including gadolinium enhanced MRI, and Audiometry tests should be carried out to find out known cause.

Next Post– Management of sudden sensorineural hearing loss

Happy new year and “safe ear”- protect ear from noise

Noise-induced Hearing loss

  • Noise level goes up with new year celebrations, social gatherings, party, music, rock-concert and fire works, and so does people visiting E.N.T. and audiology clinics with hearing problems or ringing in the ear(tinnitus).

· Children and teens listening to loud music are also more prone to develop hearing loss later in life.

· People with occupations involving exposure to noise above 85 decibel over an 8 hour period daily are also at risk. These includes indusries like mining, construction, drilling and agriculture.

  • And now people who love to play golf using latest titanium drivers are at risk of reduced hearing because of noice generated when it strikes the ball. (ref-British medical journal)

How noise causes hearing loss?

Too loud noise damages sensitive nerve endings in inner ear (delicate cells called cillia) and cause sensorineural loss. Sensitivity to sound is different for each person.

Sudden exposure to loud noise may cause temporary sensorineural hearing loss which usually recovers over 24 to 48 hours.

But if sound is too loud, or loud sound is too close or loud sound is exposed over a long period of time(more than 85 db), permanent sensorineural hearing loss can occur.

And 85 decibels is not as loud as you will think. Sound from an ipod shuffle is usually 115 db, and with fireworks it goes at 150 db.

Tinnitus may be presenting complaint for some person.

Protection from noise

Photograph taken from www.visualdictionaryonline.com
Photograph taken from http://www.visualdictionaryonline.com
  • Person working in noise above 85 db should use noise protection devices-ear plugs and ear muffs. It is as simple a concept as using goggles to protect your eyes from UV rays of sun. It is for Musicians also.
  • · People with occupations involving noise exposure should undergo periodic hearing screening(audiometry test).

    · On earliest sign of noise trauma like irritability, buzzing sound in ear or difficulty in hearing visit your physician.

· Turn down the volume of television and MP3 players.

  • Do not stand directly near to the source of noise.

Unfortunately physician can not do much in sensorineural hearing loss except prescribing a hearing aid. So primary aim is prevention and early detection.

Management of hearing loss; Hearing loss is more evident than Hearing-aids

Hearing loss in adult should be evaluated and managed properly taking care of emotional and social impact of condition on patient & his family. Bilateral hearing loss may affect professional life of a person. Aim is to know the treatable cause and manage effectively to prevent further loss. Sensori-neural loss which can not be cured by medicines should be started with rehabilitation by hearing-aids.

Symptoms of hearing loss:

  • Sound may be distorted, quieter and less clear
  • Patients usually have difficulty in hearing in noisy area or while in a group
  • Problem in hearing over telephone
  • Turn up volume of television/Mp3 player
  • Ask people frequently to repeat the sentence/words
  • Patients often misunderstand what others are saying
  • Patients think others are not speaking well

Evaluation of patient:

Thorough medical history(ear infection, giddiness, tinnitus, past medical illness or medication, trauma, exposure to noise-occupational or otherwise if any).

Clinical examination of Ear-Nose and Throat and patient.

Investigation-Audiometry tests to know degree and type of hearing impairment. Depending on clinical clues CT/MRI may be required.

Most common cause of hearing-impairment in adult is wax and after exclusion of wax tympanic membrane perforation is most common cause.

Management of Hearing loss

Management depends on type and cause of hearing loss; loss is of two types conductive and sensori-neural. Sometimes it may be mixed loss.

Conductive hearing loss:

When something hampering conduction of sound from your ear-canal, ear-drum and ear ossicles to reach inner ear or nerves of hearing.

Can be corrected by medicine and/or surgery, like-

  • Wax or foreign body-removal
  • Eustachian tube blockage or fluid in the middle ear -medicines or by procedure of putting small tube (grommet) in ear drum
  • Infection(otitis media)-Medicines
  • Perforation in ear drum-Surgery(Tympanoplasty)
  • Otosclerosis-stapedectomy& piston placement
  • Any cause in nose/throat is managed by medicine/surgery.

Sensorineural hearing loss:

When problem is in inner ear or nerves of hearing (same as one has weak eye-sight).

Causes-

  • Age -hearing loss after age of 65
  • noise-trauma
  • Menieres disease
  • Post viral infections like mumps, measles, influenza, herpes
  • Ototoxic drugs like aminoglycoside antibiotics (neomycin, streptomycin, amikacin, gentamicin, netilmycin), Salycylates, certain diuretics, antimalarial ( quinine & chloroquine), erythromycin and cisplatinum.
  • Hereditary
  • Immune mediated
  • Endocrine& metabolic disorders
  • Vascular or neurogenic
  • tumor

Management of sensorineural hearing loss

Mostly chronic sensori-neural loss can not be cured and person is prescribed to wear hearing-aids. In bilateral severe to profound hearing loss cochlear implant (electronic device, a part is implanted under skin by surgery) may be successful.

Some treatable causes:

If it is sudden loss, spontaneous recovery may be expected assisted by steroids. Underlying etiology present in 10-15 % should be identified & treated.

Immune mediated -steroids

Tumor-surgery

Ototoxicity-Medicine stopped.

Hearing-Aids–

Though hearing aids are not as good as normal ear but if properly met with fitting requirements it can compensate well for hearing loss.

Hearing aids should be fitted and customized to individual after thorough hearing evaluation by by E.N.T. specialist and audiologist.

Most patients are benefited but there is limitation of sound quality and back ground noise that means it works well in quiet environment but some users have trouble enjoying music and listening in a crowded room.Improving FM (frequency modulation) boosts the performance of hearing aid and hearing aids can be optimally set for music.

Quality of hearing aid is of utmost importance and it takes few days to adjust but eventually initial chaotic sound disappear and person is able to appreciate the difference. Usually patients are happy after few weeks of use often coming to tell us that it has improved their quality of life.

Sensori-neural hearing loss may be shocking news to the patient and his relatives. Good doctor-patient relationship and understanding is required to help accept the fact. Talk with your doctor, friends, family and person with same problem to support you.