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The widespread opinion that hearing impairment is strictly associated with old age, coupled with the notion that such people are no longer fully capable of meeting today's demands, is not really true.
 
Age-related hearing impairment, has indeed very little to do with old age. In fact, already from the age of 40, our hearing slowly but surely begins to deteriorate. One person is afflicted earlier, another somewhat later - but no one is spared.
 
Prolonged exposure to continuous or shock-type noise (on the job, discos, detonations, low-flying airplanes, to name a few examples) can cause irreparable damage to the hair cells of the inner ear even at an earlier age.
 
Another phenomenon is sudden loss of hearing. Together with ringing in the ears or the feeling of pressure, the hearing ability - usually on one side and fully without warning - is suddenly reduced nearly to deafness.
 
This stress-induced disorder occurs mostly in the morning. It is cause to go immediately to an ENT doctor, who can diagnose the problem and initiate measures against it.
 
Causes of sensorinaural hearing loss
Sensoineural hearing loss occurs when there is damage to the inner ear (the cochlea and/or the auditory nerve). In nearly all cases there is no cure, so a sensorineural hearing loss is permanent. The damage to the ear can occur before birth, at birth or after birth depending on the cause.
 
Hereditary Hearing Loss
This type of hearing loss is passed onto the child through the genes from the parents. If the gene is dominant, if one or both of the parents have a hearing loss themselves they may carry a dominant gene. If the parents are normally hearing, they may carry a recessive gene. The most common type of hereditary hearing loss is from a recessive gene, which is why most deaf or hearing impaired children are born to hearing parents.
 
A hereditary hearing loss is usually present at birth but it may not occur until adulthood. Alternatively, a child may be born with normal hearing or just a mild hearing loss that becomes increasingly severe as the child gets older. These hearing losses may affect any of the frequencies and be mild to profound.
 
Hearing Loss before Birth
This may be caused by the mother taking strong medication whilst she is pregnant. There are a few drugs that when taken in large amounts, can prevent the inner ear from developing normally. There are also some infections, such as German measles or cytomegalovirus that can damage the ear if the mother gets them in the early stages of pregnancy.
 
Hearing Loss at Birth
There are many causes of sensorineural hearing loss at birth. If a child is born very early, at about seven months gestation, or has a very low birthweight, there may be a hearing loss. If the birth is difficult and the baby has suffered from lack of oxygen or there has been some injury to the head, there may be a hearing loss. If parents have blood of different Rhesus factor (RH- and RH+), the baby may become very jaundiced at birth. This can also cause a hearing loss.
 
Hearing Loss after Birth
Infection there are many infections that can sometimes damage the cochlea, e.g. mumps, measles, and bacterial meningitis.
 
Injury
Severe head injuries where the skull has been fractured, may also cause damage to the inner ear.
 
Drugs
There are some drugs that are used to treat life threatening diseases that, if taken in large amounts, can cause a sensorineural hearing loss, e.g. streptomycin used in the treatment of tuberculosis.
 
Noise
Exposure to a single very loud noise (such as a nearby explosion) will immediately damage the cochlea. Also continuous exposure to loud noise over a long period of time will also damage the cochlea (such as loud music, working in a noisy factory). This cause effects the high frequencies first and will then spread to the mid and low frequencies.
 
Age
Almost everyone experiences some difficulty with hearing as they get older. It is gradual hearing loss that cannot be prevented and usually the high frequencies that are affected at first. There is no way to predict at what age it will occur and whether the hearing loss will be mild, moderate or severe.
 
It should be remembered that not all the above conditions result in a sensorineural hearing loss. For example, there are many people who get measles who have normal hearing afterwards. It is often very difficult to find out the exact cause of a sensorineural hearing loss because many people do not know exactly when the hearing problem started. This is especially true with very young children, as they do not realise that they cannot hear correctly and a hearing loss is often only identified when spoken language does not develop normally.
 
Causes of conductive hearing loss
Conductive hearing loss is caused by something which prevents the passage of sound through the outer and middle ear. It can often be treated by medication or surgery and in many cases, hearing is restored to normal.
 
Malformations of the outer or middle ear
Sometimes a child may be born without the pinna and/or ear canal. This causes a hearing loss because sound is not transmitted normally to the inner ear. Often when the outer ear is deformed the ossicles are also affected but the inner ear remains normal. The usual treatment is to reshape the pinna and ear canal through surgery.
 
Obstructions in the ear canal
If wax builds up in the ear so that it completely blocks the ear canal a mild conductive hearing loss, mainly at the high frequencies occurs. The usual treatment for this is to first soften the wax with drops (e.g. olive oil) and then remove the wax by syringing the ear with warm water.
 
Other foreign bodies may also block the outer ear. An insect may have crawled into the ear canal or a child may put a bead or other small object into the ear. An ENT Specialist must remove these.
 
Injury
A hole in the eardrum can be caused if someone is hit hard on the ear, or is very near the site of an explosion. If the hole is very small it will heal by itself but if it is a large hole surgery may be needed to help the eardrum to heal. Once the hole has been closed, the hearing usually returns to normal.
 
Ear Infections
The outer and middle ear can become infected, especially in young children. An infection in the outer ear does not cause a hearing loss but should still be treated with antibiotic eardrops. The infection may also cause swelling in the ear canal.
 
The most common cause of conductive hearing loss is due to infected fluid in the middle ear. When the eustachian tube becomes blocked (as often happens in young children) there is a build up of fluid in the middle ear. This fluid can become infected and if not treated quickly with antibiotics can burst through the eardrum. This is very painful and will also cause mild to moderate conductive hearing loss. If a child has repeated ear infections that are not treated, the infection may spread to other parts of the ear. In some cases a sensorineural hearing loss can result.
 
Glue Ear
Glue ear is the name given to the condition when uninfected fluid builds up in the middle ear due to a blockage in the eustachian tube. If the fluid is present in the middle ear it becomes very thick, like glue, and the result is a moderate conductive hearing loss.
 
The usual treatment is to first try medication to unblock the eustachian tube to allow the fluid to drain out of the middle ear. If this is unsuccessful, surgery is needed. The surgeon makes a small hole in the eardrum to drain out the fluid. Often a small plastic tube is inserted into the hole to allow air into the middle ear and to prevent any more fluid building up in the middle ear. If glue ear is successfully treated, the hearing will return to normal.
 
Otosclerosis
This is a condition where one or more of the ossicles (usually the stapes) becomes fixed and does not transmit the sound vibrations to the inner ear. This is a hereditary disorder that often develops in early adulthood and can cause mild to severe conductive hearing loss. It is also more common in women than men. The usual treatment is surgery to replace the stapes, which may considerably improve the hearing.
 
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