Hearing loss treatment options
Receiving a new diagnosis can be scary and confusing. Let us help you understand hearing loss treatment options and how to get professional help.
Treatment options for hearing loss
The 3 key takeaways
- There are three types of hearing loss — A hearing test can determine whether you are suffering sensorineural hearing loss, conductive hearing loss, or mixed hearing loss.
- There is no one-size-fits-all when it comes to treatment— Hearing loss treatment is individual to you, but all types of hearing loss can be treated!
- Conductive and mixed hearing losses need a medical evaluation with an Ear, Nose, and Throat provider— This is necessary to rule out other medical disorders and see if you are a candidate for medical treatment such as surgery.
Whether you suspected hearing loss or were shocked to get a diagnosis, you are not alone. According to the World Health Organization, hearing loss affects approximately 1.5 billion people worldwide.
But just because something is common does not mean you have to live with it and allow it to impact your quality of life.
You might feel that there is nothing you can do about hearing loss, but in truth, hearing loss treatment is available for all types and degrees of hearing loss.
Causes of hearing loss
We typically think of hearing loss as a problem limited to older adults; however, hearing loss can present at any age. Hearing loss has many causes, and the loss is unique to each individual.
To pinpoint the cause of hearing loss, you should start with a hearing test performed by a licensed audiologist. Although a hearing evaluation will tell you the type of hearing loss and the parts of the ear affected, it is not always possible to diagnose the exact cause.
Causes of hearing loss include genetic conditions, viral infections, noise exposure, aging, anatomical differences, and even certain medications.
How is hearing loss diagnosed?
An audiologist will diagnose hearing loss through a hearing test. During a hearing test, the audiologist will perform a battery of tests that evaluate all parts of the ear.
After taking a case history and answering preliminary questions, the audiologist will move on to the exam. The steps listed below are some parts of a hearing test.
The audiologist may perform additional tests based on your individual needs.
- Otoscopy. This is an exam of the outer ear. The audiologist will use an otoscope to examine your ears and rule out ear wax (also called cerumen) or foreign bodies in the ear canal. They will also inspect your ear drums (also known as the tympanic membrane) for abnormalities. Audiologists also pay attention to the shape of the outer ear and may even look for signs of skin problems.
- Tympanometry. This exam assesses how the middle ear functions. Tympanometry uses a probe tip in the ear canal to change pressure and measure how well the eardrum moves. Although it is not always routinely performed, it does play an essential role in determining the causes of hearing loss when middle ear issues are present.
- Air conduction testing. This measures how well a patient can hear sounds played through headphones or, in cases of very young children, sound field speakers. This testing helps determine the softest thresholds heard at different frequencies.
- Speech testing. This assesses how well one perceives speech. Words or sentences are given to the patient to repeat, and a score is calculated based on how many they heard correctly. The audiologist may present this test in silence or in the presence of noise.
- Bone conduction testing. This test measures your thresholds at different pitches while a bone vibrator sits behind your ear. This piece sends the sounds directly to the inner ear, skipping the middle ear. Bone conduction testing is a crucial step in determining the type of hearing loss.
Types of hearing loss
There are three types of hearing loss: sensorineural, conductive, and mixed. Diagnosing the type of hearing loss is essential in determining hearing loss treatment and follow-up care.
Sensorineural hearing loss
Sensorineural hearing loss occurs when there is damage to the inner ear or auditory nerve. Sensorineural hearing loss can be congenital or acquired.
Acquired sensorineural hearing loss most often occurs slowly over time, but in some cases, it can be sudden. Most sensorineural hearing losses are permanent and most often affect both ears equally.
Causes of sensorineural hearing loss
Different causes of sensorineural hearing loss are listed below. You are probably familiar with many of the causes – but others may surprise you!
Aging. Gradual hearing loss due to aging is called presbycusis. Overuse of inner ear hair cells over time can lead to hearing loss. Presbycusis is the most common cause of hearing loss.
Viral infections. Cytomegalovirus (CMV), COVID-19, rubella, measles, mumps, and Varicella-zoster are just some viruses that can cause hearing loss. Viruses could attack the auditory nerve, trigger an immune response that attacks the inner ear, or interfere with blood flow to the ear, resulting in hearing loss.
Viral infections often cause permanent hearing loss, but there can be some recovery in some cases. If the hearing loss occurs suddenly, seek immediate help from your provider and insist on getting a hearing test.
Ototoxic medications. Did you know that high doses of NSAIDs (non-steroidal anti-inflammatory drugs) can cause hearing loss and tinnitus?
Although this can sometimes be reversible, many other medications can cause permanent damage to the inner ear or auditory nerve. These include but are not limited to aminoglycoside antibiotics, antimalarials, or certain chemotherapy drugs.
Requesting a baseline hearing test before beginning these medications is always good. Talk to your provider if you have concerns about any of your medications being ototoxic.
Genetics.Research has discovered many genes linked to hearing loss. Some genetic differences can cause hearing loss at birth (referred to as congenital hearing loss), or they can be responsible for hearing loss developed later in life (acquired hearing loss).
Genetically-linked hearing loss can be syndromic, in which the gene can also affect other body parts, or non-syndromic, in which the gene does not affect other areas.
Noise exposure. Loud noise exposure, whether long-term or short-term, can damage the inner ear hair cells, causing permanent hearing loss.
The louder the sound is, the shorter the time you can safely be exposed!
Vestibular schwannoma (acoustic neuroma). This benign but rare tumor can grow on the auditory-vestibular nerve and cause hearing loss in the ear affected and even balance problems.
Vestibular schwannomas are almost always in only one ear; a patient may be referred for an MRI or to an audiologist for auditory brainstem response (ABR) testing, one of the most sensitive tests for identifying acoustic neuromas.
Treatment for sensorineural hearing loss
Your audiologist should discuss hearing loss treatment with you. They will give you appropriate options and resources based on the severity of the hearing loss and its possible origins.
Hearing aids. These can amplify sounds based on residual hearing loss, giving the patient better access to speech sounds.
Since there are many types of hearing aids, an audiologist can help you narrow down your options.
Cochlear implants. Patients with severe hearing loss and poor speech understanding may no longer benefit from hearing aids. A cochlear implant is an implantable device that bypasses the heavily-damaged cochlea (inner ear) and sends electrical impulses directly to the auditory nerve.
Since getting a cochlear implant is a more complex process involving surgery, you would undergo a more rigorous evaluation to determine if you are a candidate.
Your audiologist can help you decide whether you might be a possible candidate.
Assistive listening devices. These devices help make sounds more audible to a person with hearing loss. Assistive listening devices (ALDs) include personal amplifiers, amplified telephones, and TV listening sets.
ALDs can help people with all varieties of hearing loss.
Conductive hearing loss
Anything that prevents sound from reaching the inner ear is considered conductive. In cases of conductive hearing loss, the inner ear has no permanent damage. Conductive hearing loss can occur in one or both ears.
Conductive hearing loss can be acquired, though some anatomical differences or genetic syndromes present at birth can also cause conductive losses.
Causes of conductive hearing loss
Many causes of conductive hearing loss are treatable, reversing a hearing loss, while others are chronic.
Ear wax impaction. An earwax blockage in the ear canal can prevent sound from passing through the eardrum. It can cause temporary hearing loss.
Middle ear dysfunction. Frequent ear infections coupled with fluid can fill up the middle ear space, preventing sound from transmitting correctly to the inner ear.
This occurs most commonly in children under three but can affect anyone at any age. Dysfunction of the eustachian tube, which equalizes pressure in the middle ear, is usually the culprit.
Chronic middle ear issues generally cause temporary hearing loss, but left untreated, may cause permanent damage.
Otosclerosis. This disorder occurs when one of the middle ear bones, the stapes, is prevented from moving properly due to abnormal bone growth around it.
It can affect one or both ears. Otosclerosis can be hereditary and is most commonly found in middle-aged women.
Differences in anatomy. Some people are born with their pinna (the visible outer ear) absent, smaller, or missing essential landmarks. They might also have a limited or absent ear canal.
Since the outer ear is crucial in capturing sound, abnormalities will cause hearing loss.
Tympanic membrane perforation. A hole in the tympanic membrane (eardrum) will cause conductive hearing loss because sounds will have difficulty transmitting through the middle ear space. It can also leave you vulnerable to infection.
Perforations often heal on their own, but they can sometimes be chronic. Physical trauma to the ear or ear infections can cause a perforation.
Treatment for conductive hearing loss
The treatment for conductive hearing loss will depend on what structures are affected. The audiologist could remove a simple earwax impaction or foreign body in the ear; however, most conductive hearing losses require a referral to an ear, nose, and throat physician.
Some ways they might treat conductive hearing losses include:
Surgery. For otosclerosis, the surgeon might replace the damaged stapes with a prosthesis. The surgeon might need to patch a perforated eardrum in surgery.
Ventilation tubes. Also called PE (pressure equalization) tubes, these are inserted into the tympanic membrane to help drain out middle ear fluid in cases of chronic infections.
An ear, nose, and throat physician might advise against surgery or medical interventions and recommend you return to your audiologist. Treatment of conductive hearing loss might also include the following:
Hearing aids. These can amplify sounds based on residual hearing loss, giving the patient better access to speech sounds.
Assistive listening devices. The same types of devices that can help a person with sensorineural hearing loss can help someone with conductive hearing loss.
These include personal amplifiers which are worn to make speech louder in certain settings, amplified telephones, and TV listening sets. These devices might be used alone or to supplement other treatment options.
Bone Conduction hearing aids. Instead of traditional hearing aids that use air conduction, these transfer sound directly to the inner ear, bypassing the middle ear. Bone conduction hearing aids can be implanted surgically, worn on a band, or attached with an adhesive.
Mixed hearing loss
Mixed hearing loss is a combination of both sensorineural and conductive hearing loss. Both poor sound transfer to the inner ear and permanent damage in the inner ear exist.
An ear, nose, and throat physician should evaluate your mixed hearing loss after your initial hearing test.
Causes of mixed hearing loss
The same factors that cause sensorineural and conductive hearing loss also cause mixed hearing loss.
Treatment for mixed hearing loss
Treatment options for sensorineural and conductive hearing loss are also used for mixed hearing loss. Sometimes, a combination of medical intervention and hearing devices like hearing aids and implants are necessary.
I’ve been diagnosed with hearing loss…now what?
After you have been diagnosed with hearing loss, your audiologist will help you determine your next steps. Suppose you do not have any hearing loss that warrants a medical evaluation with an ear, nose, and throat physician.
In that case, you can begin to discuss your options for hearing aids and other assistive listening devices. It is always a good idea to check with your insurance to find out if they might cover the cost of hearing aids before you make any final decisions.
When referred to an ear, nose, and throat physician, you must take this next step to evaluate your hearing loss further and determine if there are any medical treatment options before getting hearing devices.