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Deafness & Hearing loss

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Overview

Hearing loss is characterized by a sudden or progressive loss of sound perception. Depending on the cause, hearing loss may range in severity from mild to severe and may be reversible, temporary or permanent. Hearing loss is also known as hearing impairment, including the cases in which hearing loss is present from birth (congenital hearing loss). Next we will refer only to the progressive loss of hearing.
The progressive hearing loss affects all age groups and it is as frequency in the third place of the most common long-term diseases (chronic) in elderly people. This condition is found up to 40% in people over the age of 65 years and up to 80% in people over 85 years. If hearing is lost, the person in question may not be aware of this fact, especially when hearing is gradually diminished. Family members or friends can be the first to notice this. For example they find that the person who has diminished hearing, has difficulty in understanding what people around them talk, especially when several people are talking at the same time or if there is additional noise on the background, like an open radio. Hearing loss also affects the person’s daily activities both at work and at home, as well as the safety of the person in question. Hearing loss can cause the withdrawal of that person, even depression and loss of independence, because the social interaction with others decreases. However, for these people there are different hearing aids and other devices that help to improve hearing.
 

Article Contents:
Overview
Causes
Physiopathogenic mehanism
Symptoms
Consulting a specialist
Watchful waiting
Investigation
Treatment
Prophylaxis
Living with deafness


Causes

In adults, the most common causes of hearing loss are:
- Noise: exposure to loud noise causes hearing loss and can affect people of any age, usually developing progressively with the passage of several years; in time, the noise present at work, at leisure time (riding a bike) or the noise during domestic activities (such as cutting the grass with a motor mower) can lead to hearing loss;
- Age: the gradually reduced auditory acuity due to the aging of the auditory system (presbycusis) is characterized by the degeneration of cells and nerves of the inner ear, which appears along with age and causes the progressive, but irreversible hearing loss; hearing loss may be mild or severe, but it is always permanent.
Other causes of hearing loss:
- Accumulation of earwax in the ear canal (causes the formation of earplug) or the presence of an object in the ear canal; hearing loss due to these causes is very common and can be easily treated;
- Drugs that cause ototoxicity and other substances (such as arsenic, mercury, tin, lead and manganese) can cause hearing loss;
- Ear or head injury: also head injuries can cause damage to the structures in the ear, thus causing the sudden loss of hearing;
- Ear infections such as middle ear infections (otitis media) or external ear canal infections (otitis externa or “swimmer’s ear”);
- Otosclerosis is an impairment of the bones of the middle ear;
- Acoustic neuroma is a benign tumour (non-cancerous) of the nerves that reach the cochlea or of the nerves that leave the cochlea (the part of the inner ear designed to listen – the snail);
- Meniere’s disease (inner ear disorder that manifests through a number of disorders including vertigo, hearing loss and buzz in the ears); this disease cause temporary or permanent hearing loss;
- Benign tumours that develop in the ear canal, such as exostosis, osteoma and glomus tumours. Exostoses are bone growths that often develop when the ear canal is repeatedly exposed to cold water or cold air. Osteomata and glomus tumours are benign. All these can cause hearing loss if the ear canal is clogged. Other glomus tumours localized in the cephalic extremity can also cause hearing loss.
Other medical conditions that do not directly affect the ear, but which can cause hearing loss are:
- Decreased blood flow in the inner ear or in the cortical areas that control hearing may lead to hearing loss; the causes of the decreased blood flow can be heart diseases, hypertension, stroke or diabetes;
- Autoimmune diseases can cause hearing loss in one or both ears, which can be transient or worsen in 3 to 4 months; one of the autoimmune diseases that manifests like this is rheumatoid arthritis.


Physiopathogenic mechanism

Sounds are perceived when sound waves pass through the three main structures of the ear. If hearing loss happens, one or more structures are affected.
These structures are:
- The ear canal;
- Middle ear, which is separated from the ear canal through the eardrum;
- The inner ear containing the cochlea, the main sensory organ of hearing.
Depending on the structures of the ear that are affected, hearing loss can be of several types:
- Hearing loss caused by damage to the sound transmission (transmission deafness): sounds do not reach the inner ear; this situation occurs in the case of earplugs or growths that block sound transmission, such as in otosclerosis;
- Hearing loss caused by a sensorineural cause (sensorineural hearing loss): sounds can reach the inner ear, but its damage or the damage of the auditory nerves prevents proper hearing; examples of sensorineural hearing loss include both hearing loss caused by noise, as well as by age.
More than 90% of the hearing loss cases are represented by sensorineural hearing loss, and in this group the most common is hearing loss due to aging. In some cases, hearing loss may be due to the damage of both sound transmission and sensorineural impairment (mixed deafness). Another category of hearing loss is that caused by a central cause. In this type of disorder, ear structures function normally, but there is a damage to the cortical structures that control hearing, thus preventing sound understanding. This can occur after a head injury or stroke. This type of hearing loss is rare. If hearing loss is not diagnosed and treated in time, it may cause or contribute to depression, social isolation and loss of independence, especially in the elderly.


Symptoms

The smptoms of hearing loss are the following ones:
- Reduced (diminished) hearing;
- Difficulty in understanding what people around you are talking about, especially when in the background you can hear other sounds or voices as well (the affected person can hear another person talking but he can not distinguish the words uttered by that person);
- Listening to a TV or radio louder than before;
- Avoiding conversation and social interaction. Social situations can thus become tiring and stressful in the case of hearing loss; that person will avoid these situations more and more along with hearing loss;
- Depression – many of adults become depressed because hearing loss affects their social life.
Other symptoms that may occur along with hearing loss are:
- Ringing, rattling, whistling, buzzing in the ears (tinnitus);
- Earache;
- Pus or other secretions which drain from the ear; they may be due to injuries or infections that cause hearing loss;
- Vertigo, which can occur at the same time with hearing loss in Meniere’s disease, acoustic neuroma or inflammation of the labyrinth (labyrinthitis).
Depending on the types of hearing loss, the affected person will hear differently in certain situations:
- In case of a blockage of the inner ear sound transmission (transmission deafness) hearing loss will be the same for both low-frequency sounds and those with high frequency; as long as people around are talking loud enough, the affected person will be able to differentiate words with similar sounds (e.g. “two” or “to”) and may perceive sounds with background noise; transmission deafness can occur in the case of earplugs or growths that block sound transmission, such as otosclerosis;
- if the inner ear does not work correctly (sensorineural hearing loss), then high frequency sounds (such as the voice of women or children) will be perceived with more difficulty than low-frequency sounds; in this case the person will hear with difficulty if there is background noise; sensorineural deafness can occur with aging and powerful sounds.
Sometimes, people who lose their hearing are unaware of this, especially when loss is progressive and occurs as a result of persistent noise and aging. Family members and friends are usually the first to notice this. In this case, it is recommended to test your hearing by testing your own hearing acuity.


Consulting a specialist

It is recommended to call an ambulance or other emergency services if:
- Hearing loss occurs after a trauma to the head or ear;
- Hearing loss occurs suddenly and it is accompanied by other symptoms such as:
- Faces without mimic
- Loss of sensation or paralysis of the whole body or of the entire face or only half of the body or face;
- Eye damage or eyesight impairment, including blurred vision or double vision or eyesight loss of only one eye;
- Difficult speech, inability to speak or difficulty in understanding speech;
- Difficulty in maintaining your position or in moving (ataxia);
- Severe nausea or vomiting.
The doctor must be sought immediately, if hearing loss occurs suddenly and is very severe.
The doctor must be called if:
- it is suspected that earplugs caused hearing loss;
- hearing loss occurred after the administration of some drugs;
- the auditory acuity gradually worsens;
- the person believes that he needs hearing aids;
- parents suspect hearing loss in their child.


Watchful waiting

Watchful wait is applied in those cases when the doctor together with the patient observes the symptoms in order to see if this medical problem improves by itself. Although hearing loss is not usually dangerous, it can affect the safety of the person. It can also reduce the efficiency of daily activities, both at work and at home, and can limit a person’s social life. It is therefore very important that the person in question should talk to the doctor about hearing loss.
Recommended medical specialists:
- Family doctors;
- Pediatricians;
- Doctors of internal medicine;
- Resident physicians;
- Nurses.
If your doctor suspects or diagnoses hearing loss, it is recommended that patients consult an ENT (ear, nose and throat) specialist or an audiologist.


Investigation

The doctor will diagnose hearing loss by making a complete case history of the symptoms and diseases present in the family and a complete physical examination. Thus, following a routine medical examination, the doctor can diagnose hearing loss.
If the person has symptoms of hearing loss or the doctor detects a condition that causes hearing loss, then the doctor will ask the patient if he was recently or a long period of time exposed to loud noises, if he has consumed drugs and if he has symptoms such as noises in the ears, ringing or vertigo (dizziness). Depending on the answers to these questions, the doctor will determine the cause of hearing loss.
The doctor will also examine the ears. He will use an instrument equipped with a light source in order to detect the diseases of the ear canal, eardrum and middle ear, including to detect if there are earplugs, objects blocked in the ear canal, infections or secretions or an injury to the ear. If the physical examination, family history or current symptoms suggest an impaired hearing, the doctor may request a standard examination of hearing (audiogram).
The standard examination of hearing (audiogram)
Consists of making one or several of the following tests:
- The whisper test: investigates how well the person hears the whispered words from a short distance and how well that person understands the words;
- The diapason test: investigates how well some sounds are transmitted to the ear;
- The audiometry of simple sounds: checks the way in which a person hears these sounds that reach the inner ear through the ear canal (air duct); the person listens to the sounds through some headphones applied to the ears;
- The test of speech reception and recognition of words: outlines how well the person can hear and understand the conversations around;
- The acoustic test (tympanometry and the acoustic test) measures the amount of sound energy which is reflected from the tympanic membrane to the inner ear bone structures, instead of being transmitted to the inner ear;
- The otoacoustic emission test: measures the response of the inner ear to sounds; otoacoustic emission is represented by sounds produced by the cochlea in response to the sounds from the external environment, such as a sound or a pop, similar to an echo of low intensity. ENT doctors can record and interpret these sounds in order to rule out hearing loss. The otoacoustic emission test is usually used in the screening of newborns to detect hearing disorders.
Additional tests can be made depending on the suspected cause of the onset deafness:
- Imaging tests such as computed tomography (CT scan) or magnetic resonance imaging (MRI) can be used when a tumour is suspected or injury at this level;
- The test of the evoked potentials of the auditory acuity : it is used to test the brain area responsible for hearing acuity, if a doctor thinks there is an acoustic neuroma or other nerve damage. This test measures the response of the cortex to sounds.
Early diagnosis.
The signs of hearing loss after noise exposure, occur at an early age or in childhood. In order to detect the disease early, it is recommended to regularly go to an ENT examination.
 


Treatment

The treatment for temporary or reversible hearing loss, usually depends on the cause of hearing loss. The treatment for permanent hearing loss involves the use of hearing aids. Although sometimes both the family and the person in question believe that the permanent hearing loss is due to aging, it is very important that in these cases an appropriate treatment should be applied. Hearing loss can cause social withdrawal, depression and loss of independence of that person. Although treatment in this case, if done well, can not restore a normal hearing function, it still greatly helps to improve communication, social relationships and also the performance of activities both at work and at home, making them more pleasant.
Initial treatment
In the case of reversible hearing loss, the treatment depends on the cause. In these cases the treatment is effective.
The causes of the reversible hearing loss:
- Ototoxic drugs (such as aspirin or ibuprofen): after stopping taking there drugs, symptoms improve;
- Ear infections such as otitis media: they can heal without treatment, although they sometimes require antibiotics;
- Ear or cephalic extremity traumas: they can heal without treatment, but sometimes they require surgery;
- Otosclerosis, acoustic neuroma or Meniere’s disease: require medication or surgery;
- Autoimmune diseases: are treated with corticosteroid medication, usually with prednisone;
- Earplugs are removed; it is forbidden to use cotton sticks in order to clean ears or sharp objects to remove earplugs, because they can push the wax inside or may cause injury at this level.
In the case of permanent loss of hearing, caused by aging or induced by exposure to noise, hearing aids often improve hearing and communication.
These devices include:
- Hearing aids: they amplify sounds; although hearing aids improve the auditory function and consequently lead to an easier communication, they can not restore normal hearing;
- Devices that enable hearing, alarm devices and other devices that help communication.
Maintenance treatment
Reversible hearing loss, such as that caused by earplugs or ear infections, usually heal after treating the cause. If hearing impairment persists after treatment, you should see a doctor. Sometimes you may need another medication or surgery. In the case of permanent hearing loss, such as that caused by age and exposure to noise, wearing hearing aids probably must continue. The ENT doctor recommends making some hearing tests to see the changes of the auditory acuity after treatment; if there are changes in the auditory acuity, treatment must be adjusted.
Other hearing aids are:
- Devices which improve hearing – these devices increase the intensity of certain sounds by sending them directly to your ear; you can use different types of devices for certain situations, such as in a dialogue with another person and during school hours or cinema; frequently, the use of devices that improve hearing include telephone amplifiers, personal listening systems (such as personal FM systems) and devices that can be connected directly to the TV, stereo, radio or microphone;
- Alarm systems – these systems warn the person about particular sounds (such as the door bell, the sound of the phone or the crying of a child) by using powerful sounds, light or vibration warnings to alert that person;
- Titration of TV programs – this may facilitate the understanding of the transmitted television programs, whatever is spoken on television appears written in the bottom of the screen; most new generation TVs have this option;
- Text phone – it is a device specially adapted for people with deafness, through which messages can be typed on the screen during phone calls; when the message is written on the telephone keypad, the information is sent immediately to the other person, this appearing on the screen . A telecommunication relay allows dialing to any text phone from any station and vice versa.
Treatment if the condition gets worse
Hearing loss due to aging and exposure to noise may worsen, especially if exposure to loud noise is continued. It is necessary to consult your doctor in order to adjust your hearing aid. If there is a severe hearing loss, the cochlear implant represents the only option. This is a small electronic device that allows hearing sounds, in the case of severe or total hearing loss. This replaces the function of damaged or absent nerve cells that normally make hearing possible. In infants with severe hearing impairment or deafness, cochlear implant is sometimes recommended after the initial diagnosis. Some studies have shown that there is a possible link between cochlear implants and meningitis.
Keep in mind!
The worsening of hearing loss can be prevented by avoiding strong noise as much as possible and by using protective ear headphones when the person is in a loud environment, including at work. It is recommended that family members and friends change their behavior when speaking, for example, their face should be directed to the person with hearing loss, so that he can see the facial expression and gestures, and speaking should slow and clear.


Prophylaxis

Some types of hearing loss can be prevented.
Hearing loss caused by exposure to noise.
The most common cause of permanent hearing loss is the prolonged exposure to loud noise. It develops gradually and without pain or other symptoms and can be noticed only when hearing loss is severe.
The ways in which you may decrease the risk of hearing loss caused by exposure to noise are:
- Avoid harmful noise: the person may be exposed to loud noises at work, at home or in many other places; prolonged and repeated exposure to loud noises can damage the ear and cause hearing loss; the noise that is harmful can be produced by commonly used tools such as the lawn mower, chainsaws and other activities such as riding a motorbike; the situations that produce loud noises must be known by people affected by deafness in order to be avoided as much as possible;
- Use of helmets; in situations when people are in an area with loud noises, ear protectors must be worn, such as earplugs or headphones (wool plugs or other material introduced in the ears, does not protect the ears well); when used properly, ear protectors can greatly reduce the intensity of sounds reaching the ear; the lawn mower, the chainsaw, the pneumatic hammer and some appliances affect hearing if ear protection devices are not worn;
- Control volume whenever possible: it is not recommended to purchase noisy toys, devices or tools when there are quieter alternatives; it is recommended to listen to TV, stereo, car radio and especially to the different devices with headphones, at a suitable volume.
Using hearing protectors is not recommended only when the person notices the hearing loss. Once hearing impairment occurs due to noise, it is irreversible. However, if a certain degree of deafness was installed because of noise, it is not too late to prevent the worsening of hearing loss and the keeping of the remained auditory acuity. Preventing other causes that cause hearing loss.
In order to decrease the risk induced by trauma, ototoxic drugs and other causes:
- It is forbidden to introduce ear sticks in the ear, hairpins or other objects to remove earplugs or for ear scratching; generally, the best way to prevent the problems caused by earplugs is to remove them by themselves;
- You must ask both the doctor and the pharmacist about the possible ototoxicity of drugs administered for other purposes; if there appears a new hearing condition while taking drugs, you should consult a doctor immediately;
- It is recommended to clean the nasal cavities by gently bowing them and for both nostrils at the same time;
- While travelling by airplane, it is recommended to frequently ingest and yawn when the plane lands; if a person has an upper airway disease (such as colds, flu or sinusitis), it is recommended to use an oral decongestant a few hours before landing or decongestant spray just before landing;
- When diving, a good knowledge and long practice under the supervision of diving techniques is recommended.
- You must always wear a seatbelt while travelling by vehicles, a crash helmet when riding a bicycle, skiing or while using rollers; these skills can reduce the risk of trauma to the ear and to the cephalic extremity;
- Quit smoking: some studies have shown that adult smokers are more likely to develop hearing loss than nonsmokers, while other studies have not found any association between the two.
The signs of hearing loss caused by noise occur at an early age, in childhood. Children must be consulted regularly by the doctor in order to prevent hearing loss caused by noise. Hearing may be examined by making the hearing tests.


Living with deafness

In the case of hearing loss, the individual will make an extra effort to communicate with the others. Hearing may be difficult especially in situations where several people are talking at the same time or the background noise is very strong. Because it requires an extra effort in order to have a dialogue, the affected person can complain about fatigue and stress, then avoiding social activities, retreating and becoming worried about his personal safety. There are also other communication devices which help affected people, such as pagers, fax, email and the special services offered by phone companies. In order to find out more information about these devices, you can resort to the various associations of persons with hearing impairments or you may require additional information to your doctor. One of the ways in which communication is greatly improved is the technique of understanding language with the help of gestures ( speech reading technique). This technique involves a careful watch of the gestures of the person who is speaking, the facial expression, the posture and the tone of voice. Because of this, the affected individual can more easily understand the speech of others and can easily participate in the dialogue. This involves being in front of the person who is speaking, the face of the speaker being placed in the light so that the affected person can easily read the facial expressions. “Speech reading” is not the same as “lips reading”. Many people can “read speech” without knowing how to “read lips”.
Recommendations for the family and the relatives of people with deafness
A deaf person may feel excluded from the conversation and from the relationships with the others. Extra effort and the stress of a conversation can become tiring for everyone involved in the conversation.
If you cohabit with a deaf person, communication can be improved by:
- Making sure that the deaf person understands the fact that someone is addressing to him; it is recommended to use the name of that person;
- Speaking at a short distance (1 m to 1.8 m), the person with hearing loss must see the face, the mouth and the gestures of the other person; the environment in which that person speaks should be lit, so that the deaf person can see the interlocutors;
- It is not recommended to speak directly into the ear of the deaf person; the facial expression and gestures help much more the understanding of speech;
- You must speak a bit louder than normally, without shouting; also you have to speak more rarely and more clearly; do not repeat the same word several times. If a particular word or phrase is not understood, you must find another way of expressing yourself;
- Person with deafness must always be announced whenever the topic of conversation is changed;
- The background noise should be removed whenever possible; during a conversation, the radio and the television should be turned off; when going to the restaurant, it is recommended to choose quiet places, and when going to the theater or cinema, you should avoid the places near the door;
- Include the person with deafness in discussions and conversations; it is not recommend to talk about the deaf person as if that person were not present.

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