Hearing Care & Optics

Hearing Care & Optics
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What is Hearing loss. A common problem

You know what hearing is, but what is hearing loss? Hearing loss, or hearing impairment (say: im-pare-ment), happens when there is a problem with one or more parts of the ear or ears. Someone who has hearing loss or impairment may be able to hear some sounds or nothing at all. Impairment means something is not working correctly or as well as it should. People also may use the words deaf, deafness, or hard of hearing when they're talking about hearing loss.
About 3 in 1,000 babies are born with hearing impairment, making it the most common birth defect. A hearing problem can also develop later in life. To understand how and why hearing loss happens, it helps to know how the ear works.

How Hearing Works

The ear is made up of three different sections: the outer ear, the middle ear, and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and the waves then travel through the outer ear canal.
When the sound waves hit the eardrum in the middle ear, the eardrum starts to vibrate. When the eardrum vibrates, it moves three tiny bones in your ear. These bones are called the hammer (or malleus), anvil (or incus), and stirrup (or stapes). They help sound move along on its journey into the inner ear.
The vibrations then travel to the cochlea, which is filled with liquid and lined with cells that have thousands of tiny hairs on their surfaces. There are two types of hair cells: the outer and inner cells. The sound vibrations make the tiny hairs move. The outer hair cells take the sound information, amplify it (make it louder), and tune it. The inner hair cells send the sound information to your hearing nerve, which then sends it to your brain, allowing you to hear.
There are more than 500 million people experiencing diminished hearing worldwide. And unfortunately the number is rising. An estimated 60% of these go undetected, and 40% of all cases go untreated – don't be one of the statistics that suffer in silence.

What Problems Can Affect The Inner Ear?

There are many conditions that cause the delicate inner portion of the ear to function abnormally. They include:
  • Otosclerosis
  • Presbycusis
  • Fistula
  • Head injury
  • Meniere's syndrome
  • Noise
  • Infections
  • Sudden deafness
  • Neural problems
Otosclerosis (the hereditary disease in which bone deposits collect around the small bone in the middle ear known as the stirrup) can also affect the cochlea (the coiled tube in the inner ear), and cause hearing loss in some people.
The natural aging process also causes sensorineural hearing loss, in which the damage lies in the inner ear, the hearing nerve, or both. Beginning shortly after birth, we begin to lose hair cells and nerve endings within the cochlea (the region that hears very high frequencies). As this loss pattern progresses over a lifetime, sensorineural hearing loss develops.
There also are other age-related causes of hearing loss, including stiffening of portions of the cochlea and loss of nerve endings in the acoustic nerve.
A fistula (opening) is an abnormal connection between the inner ear and middle ear. The inner ear is filled with fluid, and the middle ear is filled with air. If a fluid leak occurs from the inner ear, hearing loss and dizziness commonly result. This kind of hearing loss often is cured by surgically repairing the fistula. Such leaks are usually caused by trauma. The trauma may be direct, such as a blow to the ear or a head injury in a car accident. However, it may also be the result of air pressure changes in an airplane trip, a forceful sneeze, or lifting a heavy object.
Head injury
Direct head trauma, particularly trauma severe enough to cause unconsciousness, can cause inner ear concussions and hearing loss.
Meniere's syndrome
Meniere's syndrome is a condition characterized by fluctuating hearing loss (usually more prominent in the lower frequencies where we hear speech), dizziness, fluctuating ear pressure, and tinnitus (a noise sensation heard in one or both ears). It is due to a swelling and fluid overload of the middle compartment of the inner ear (a condition known as endolymphatic hydrops).
There are many treatable causes of Meniere's syndrome. When all tests have revealed none of the known causes, the condition is classified as Meniere's disease.
Noise is an important cause of hearing loss. An estimated 7 to 10 million people in American industry have noise-induced hearing loss, virtually all of which was preventable. In addition to industrial noise, recreational noise can damage hearing. Such noise is encountered commonly from gunfire, power tools, snow blowers, motorcycles, loud music (especially with earphones) and other causes.
In some cases, the playing of musical instruments can damage hearing. This has been reported not only with loud, electrical rock and roll instruments, but also with classical music performance such as violin playing and flute playing. One can minimize such problems by using ear protection whenever practical, such as during selected practice sessions.
Infections involving the inner ear and hearing nerve can also produce deafness. Middle ear infections can spread to the inner ear, causing loss of hearing and, usually, dizziness. Infections may also involve the hair cells or acoustic nerve, causing hearing loss and even sudden total deafness.
For more information about middle ear infections, go to Middle Ear Infection.
Sudden deafness
Sudden deafness may be caused by a variety of problems. Treatment is controversial, but there is some evidence to suggest that aggressive treatment may improve the chances for hearing recovery even after a sudden profound loss. Once the condition has been present for more than two or three weeks, even the most aggressive treatments generally do not work.
Neural problems
Neural (nerve-related) problems may also produce hearing loss. Among the more common are:
  • Acoustic neuroma, a common tumor of the acoustic nerve
  • Multiple sclerosis
  • Autoimmune sensorineural hearing loss, in which the body attacks its own ear
  • Ototoxicity, which is hearing loss caused by a substance that gets into the body; most often the substance is a medication, particularly certain antibiotics, but other toxins (such as lead) may also cause hearing loss

Need To Know:
What is an acoustic neuroma?
An acoustic neuroma is a common tumor of the acoustic nerve, the nerve responsible for hearing. It generally starts in the internal auditory canal, the bony channel through which the nerve courses as it goes from the ear to the brain. Acoustic neuromas grow, compressing the brainstem and other structures, including the facial nerve.
Ordinarily, these tumors can be cured with surgery. They are managed best by neurotologists, inner ear subspecialists with particular interest and expertise in treatment of this specific tumor. Neurotologists often work in collaboration with a neurosurgeon. In the majority of cases, it is possible to remove acoustic neuromas without serious injury and without facial paralysis. In some tumors diagnosed early, it is even possible to preserve hearing (despite the fact that the tumor has its roots in the acoustic nerve).

What Other Conditions Can Cause Hearing Loss?

A number of other problems can cause hearing loss, particularly sensorineural hearing loss. Many of them are very common conditions that are not always associated with hearing loss. They include:

Common Childhood Infections

Mumps is the most common cause of one-sided total deafness in the United States. Frequently, the child and family are not aware of the hearing loss until years later. Other childhood infections, such as scarlet fever, may also affect hearing, particularly by destroying the eardrum and damaging the middle ear bones.

Special Infections

Many infections can result in hearing loss, including:
  • Syphilis. It can be acquired at birth or through sexual contact, and a person may have it a long time before hearing symptoms occur (sometimes for 30 or more years). Caught early, this form of hearing loss can be cured. However, if it is not recognized and treated, the hearing loss may progress and even become total.
  • Lyme disease. This increasingly common infection is spread through the bite of a tick. Lyme disease often causes a rash and joint pain, but these may be minor enough to escape notice. A diagnosis of Lyme disease can be made with blood tests. It is treated with antibiotics.
  • Numerous other infections including herpes, cytomegalo virus (CMV), measles, mononucleosis, chickenpox, pneumonia, flu, and fungal diseases may cause hearing problems as well.

Problems With Blood Flow

Insufficient blood flow in the inner ear or related areas of the brain can contribute to hearing loss. This can happen as a result of cardiovascular disease, untreated high blood pressure, and other similar conditions. It also may be present in people whose blood tends to sludge and clot excessively (hypercoagulability), or who have too many blood cells (polycythemia).


Hearing loss is one of the most common consequences of meningitis, especially bacterial or fungal meningitis. Meningitis is an infection of the membranes covering the brain and spinal cord. Anyone who has had meningitis should have a hearing test upon recovery.
For more information about meningitis, go to Meningitis.


AIDS is associated with ear infections and nerve damage. Conductive and sensorineural hearing loss both occur in people with AIDS. AIDS is also associated with tumors in the head and neck that can cause hearing loss.
For more information about AIDS, go to AIDS: What is it?.


Tuberculosis and other similar illnesses have been associated with hearing loss. The problem may be due to the disease itself or to the medications used to treat the disease (such as streptomycin). Despite the availability of vaccines for tuberculosis, it is becoming increasingly common, especially among people with AIDS and those who come in contact with them.


Arthritis (inflammation of joints) and vasculitis (inflammation of blood vessels) commonly are associated with hearing loss. These include conditions such as rheumatoid arthritislupus erythematosus, and others. The hearing problem is probably related to abnormalities in blood vessels from these diseases.


It is well recognized that allergic problems in children cause fluid to collect in the eustachian tubes and middle ear. However, in some cases allergies may also cause inner ear problems such as Meniere's syndrome. Allergy treatments usually resolve the problem.

High Blood Pressure

Some conditions associated with high blood pressure (such as hypolipoproteinemia, which is extremely high cholesterol and triglyceride levels in the blood) are also associated with hearing loss. In general, it appears that people with high blood pressure have a higher incidence of hearing loss. They may also be more prone to noise induced hearing loss than others.
For more information about high blood pressure, go to High Blood Pressure.

Thyroid Problems

Hypothyroidism (underactive thyroid) is commonly linked with hearing loss. About half of people with low thyroid function have hearing losses. Moreover, about 3% of people with Meniere's syndrome have hypothyroidism; and in some, control of the thyroid disease eliminates the symptoms of Meniere's syndrome.
For more information about hypothyroidism, go to Hypothyroidism.

Kidney Disease

Many of the things that damage the kidney also damage the cochlea A hollow tube in the inner ear that is coiled to resemble a snail's shell; it contains thin fluid and the organ of Corti, and it is where sound vibrations picked up by the middle ear are carried in the inner ear. Parts of the kidney and cochlea are quite similar and can be damaged by the same drugs, for example. Hearing loss is not uncommon in people with kidney disease.


Cancers that involve the ear and the brain can cause hearing loss. However, cancers elsewhere may also be related, particularly because many of the treatments for cancer produce hearing loss. Chemotherapy agents can affect the ear. Radiation may also cause hearing loss if the ear is included in the radiation field. Individuals who receive chemotherapy or radiation therapy should have an audiogram (hearing test) before treatment is begun, and usually during and after treatment.


Diabetes is one of the most common diseases in the United States. Although estimates vary from study to study, it appears that about 40 percent of people with diabetes have hearing loss. It usually occurs in both ears and is most severe in the high frequencies. However, Meniere's syndrome may also be caused by diabetes, and sudden deafness can occur.
For more information about diabetes, go to Diabetes In Adults.


The relationship has been controversial, but it is probable that there is a significantly increased incidence of hearing loss in people with glaucoma, a condition in which there is high pressure within the eye. This is especially true for people with a type of glaucoma called narrow-angle glaucoma.
For more information about glaucoma, go to Glaucoma.

Sickle Cell Disease

About seven percent to nine percent of black Americans carry the sickle cell trait. About 1 in 400 has sickle cell disease, and 20 percent to 25 percent of people with sickle cell disease have sensorineural hearing loss. Sudden deafness has also been reported in connection with this condition, although in some cases hearing will return.

Fainting Disorders

A person who has hearing loss (often severe) along with fainting may have a condition called Jervell and Lange-Nielson syndrome. This hereditary condition accounts for approximately 1% of all cases of hereditary deafness. If hearing loss and fainting occur together, a person's heart should be checked immediately. The fainting can be due to heart arrhythmias (irregular heartbeats) that may cause sudden death.

Tinnitus And Dizziness

Tinnitus (ear noises) and dizziness commonly occur in association with hearing loss. In some cases, both of these symptoms can be effectively treated.
For more information about tinnitus, go to Tinnitus.

Hereditary Diseases And Syndromes

There are many hereditary diseases and syndromes that can lead to hearing loss. The syndromes involve defects in virtually any part of the body. Hearing loss is often hereditary.
  • When it runs in families from generation to generation, the hearing loss usually follows a hereditary pattern called "autosomal dominant."
  • However, the absence of a family history does not mean that hearing loss is not genetic. "Autosomal recessive" inheritance is common. It means that neither parent has hearing loss, but both carry a gene that causes it. On the average, the hearing loss will be present in one child out of four.
Support and practical information for new or potential hearing aid users, for friends and family, for kids with hearing problems and for their parents.
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