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Hearing Loss

Hearing loss is when you have a hard time understanding daily conversation, have to make the phone, TV, or radio louder, or have a ringing or buzzing sound in the ear. It happens with age, but can also be caused by noise exposure, infections or wax buildup, or trauma.
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Written by
David Lee, MD.
Clinical Fellow, Pediatric Otolaryngology, Children's Hospital of Philadelphia
Last updated October 16, 2020

Hearing loss questionnaire

Use our free symptom checker to find out what's causing your hearing loss.

Hearing loss questionnaire

Use our free symptom checker to find out what's causing your hearing loss.

Hearing loss symptom checker

Hearing loss is when sounds don’t come through as loud or as clear as they once did. You may have trouble hearing daily conversation; have to turn the phone, TV or radio up; or have a ringing or buzzing sound in the ear. Sometimes this happens in one ear, sometimes in both.

The process of hearing is complicated. Nearly a dozen structures—including the eardrum, ear canal, middle ear bones, and nerves—help you process sound. Problems with any one of these can cause hearing loss. Infections and certain medications can also damage inner ear structures.

There are two categories of hearing loss—bone hearing loss (conductive hearing loss) and nerve hearing loss (sensorineural hearing loss).

It’s important to know how to protect your hearing. A study in the American Journal of Industrial Medicine has shown that noise exposure is responsible for up to 16% of disabling hearing loss. Be sure to talk to your doctor about any hearing loss since it can become permanent if not treated.

Pro Tip

Over the past several decades, the science and technology behind hearing amplification devices (hearing aids) has significantly improved. Many patients with hearing loss are able to fully go about their lives with small, discreet hearing aids. —Dr. David Lee

Causes

1. Middle ear infection

Symptoms

Middle ear infection (otitis media) happens when bacteria or viruses infect the middle ear, causing pain and swelling. It may happen from having a cold, flu, or other respiratory infection.

The back of the throat and nose is connected to the middle ear by a tube called the eustachian tube. It allows germs in the back of your throat and nose to travel to and infect the middle ear.

When fluid builds up in the middle ear, it decreases the sound transmission from the eardrum and middle ear bones to the inner ear. This causes bone hearing loss, often described as ear fullness.

While anyone can get a middle ear infection, these infections are much more common in children.

Treating middle ear infection

Otitis media often gets better on its own, but your doctor may prescribe an antibiotic, especially if the infection is painful or is affecting your hearing.

2. Earwax blockage

Symptoms

Earwax may seem like an annoyance, but it has an important role—keeping your ear canal clean and guarding against bacteria. But earwax can sometimes build up and cause ear pain and affect your hearing.

This buildup of wax can cause hearing loss. It affects the transmission of sound from outside the ear to the eardrum and on to the middle and inner ear.

Treating earwax blockage

Never try to remove earwax with cotton swabs or other objects. You may end up pushing the earwax deeper into the ear canal. Your ear can clear excess earwax on its own, but it won’t be able to do that if you make the wax go too deep.

A doctor can use special ear drops that help the wax come out. Or ask your doctor if it’s safe for you to try hydrogen peroxide solution (people with ear tubes or an eardrum perforation, for example, should not use this).

Hearing loss questionnaire

Use our free symptom checker to find out what's causing your hearing loss.

Hearing loss symptom checker

3. Age-related hearing loss (presbycusis)

Symptoms

  • Hearing loss
  • Difficulty understanding conversation in loud environments
  • Hearing loss that is worse in noisy environments

Most older adults suffering from hearing loss have age-related hearing loss (presbycusis).

Roughly 1 in 3 people over 65 years old have some kind of hearing loss, according to the World Health Organization. That increases to 1 in 2 adults ages 75 and older. It can significantly reduce your quality of life, contribute to loneliness, and make you less active.

Age-related hearing loss happens because of changes in the inner ear, such as in the ear structures or blood flow. It can also be from damage to the tiny cells that help transmit sound to the brain.

Diabetes or smoking can make it worse. Lifetime exposure to loud noise can also increase the risk.

Treating presbycusis

Hearing aids are often enough to improve your hearing and quality of life. There are models that are low-profile and discreet, so no one will know you are wearing one. In severe cases, an implantable hearing device such as a cochlear implant, may help restore your hearing.

Dr. Rx

Many patients with age-related hearing loss may also experience a decrease in mental function. As our brains are less stimulated with less hearing information, the risk for mental decline and development of dementia increases. It is important to be evaluated as soon as the hearing loss is noticed. —Dr. Lee

4. Noise-induced hearing loss

Symptoms

  • Decreased hearing after a loud noise exposure
  • Ear ringing
  • Speaking louder than normal
  • Improves over hours to days

The inner ear structures are very sensitive, and loud noises or sounds can cause temporary hearing loss. This is common after a very loud event, such as a concert, shooting event, or trauma. In some people, ear ringing gets worse at the same time as their hearing decreases.

The US Occupational Safety and Health Administration (OSHA) has defined levels of noise that require hearing protection. Noise at those levels can cause permanent damage.

Treating noise-induced hearing loss

Unfortunately, there isn’t a treatment. The hearing may improve and the ringing may go away, but over time, noise can cause permanent damage.

5. Hole in the eardrum

Symptoms

  • Hearing loss on the affected ear
  • Ear drainage, especially after getting the ear wet

A hole in the eardrum (called tympanic membrane perforation) can cause a type of conductive hearing loss. The holes may be from trauma (such as after a fight), an extreme pressure change, or a foreign object in the canal. Or the holes may be from a burst eardrum, such as following an infection. In some cases, the hole remains after ear surgery.

Treating a hole in the eardrum

Most ear drum holes will close on their own without any treatment. In some cases an outpatient procedure is performed to help close the perforation. Keeping the ear dry is important to prevent ear drainage and infections.

6. Sudden sensorineural hearing loss

Symptoms

This causes an immediate decrease in hearing in one ear. Some people also have ear ringing. The cause of this is generally unknown, though inflammation may cause it in some people.

If you have an abrupt loss of hearing in one ear, it is very important to see an ear, nose, and throat doctor, called an otolaryngologist, for a hearing test.

Treating sudden sensorineural hearing loss

You will need a short course of very high-dose steroids. Your doctor may also recommend imaging tests, such as an MRI, to find the cause of the hearing loss.

Other possible causes

Other conditions that may also cause hearing loss:

Some medications may cause ear ringing or hearing loss. Some types of antibiotics (gentamicin), large amounts of pain medications (like aspirin), or even chemotherapy drugs (like carboplatin or cisplatin) can cause damage to the inner ear. It is important to tell your doctor about other conditions you may have when discussing your hearing.

Hearing loss questionnaire

Use our free symptom checker to find out what's causing your hearing loss.

Hearing loss symptom checker

When to call the doctor

Have your hearing assessed as soon as you or others around you begin to notice symptoms. Even if your doctor can’t identify a specific cause, it is important to start hearing treatments as early as possible.

Should I go to the ER?

Call 911, if you experience any of the following symptoms:

  • Hearing loss after injury to the head
  • Sudden hearing loss, especially in only one ear
  • Slurred speech
  • Difficulty standing
  • Vision problems
  • Severe pain

Pro Tip

One of the newer developments in the treatment of age-related hearing loss are cochlear implants. This involves a surgery where a thin electrode is inserted into the cochlea so it can stimulate the nerve that detects hearing. This procedure may be recommended for adults with severe to profound nerve-type hearing loss. —Dr. Lee

Treatments

  • Your doctor can remove earwax using an oil followed by flushing and suctioning. Do not try to remove ear wax at home.
  • For many types of hearing loss, you will get a hearing aid and have regular check-ins with your doctor or audiologist.
  • Some types of hearing loss, such as a persistent tympanic membrane perforation, may require surgery.
  • In some cases of hearing loss, your otolaryngologist may recommend an implantable hearing device, such as a bone-anchored hearing aid or a cochlear implant.

Prevention

Help prevent hearing loss by doing the following:

  • Don’t use loud earbuds or headphones.
  • Use ear protection when around loud noises.
  • Strictly follow OSHA recommendations for hearing protection in loud work environments.
  • For some causes of hearing loss, such as a tympanic membrane perforation, you may need to keep the affected ear dry when showering or bathing.
  • Avoid using cotton swabs or any other objects in your ear.
  • If you are taking medications that can cause hearing loss symptoms, talk to your doctor about alternative medications.
Share your story
Clinical Fellow, Pediatric Otolaryngology, Children's Hospital of Philadelphia
Dr. Lee is a board-eligible otolaryngologist and medical consultant for Buoy Health. He completed his undergraduate degree in Biochemistry and Spanish at the University of Arkansas (2011) and went on to complete medical school from the University of Arkansas for Medical Sciences (2015). He completed his residency training in Otolaryngology - Head and Neck Surgery at the University of Cincinnati (2...
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