Hearing loss types

Hearing loss types

Learning about hearing loss can help you take the important first step, which is recognizing you have a treatable condition. And if you happen to be one of the millions of people struggling with hearing loss, you don’t have to suffer in silence. A wide array of solutions is available to address this problem. 

Hearing loss is a common issue.
Hearing loss affects about 1 in 3 people ages 65–74 in the US. By age 75, it's nearly half.
So, what does hearing loss feel like? 
  • When hearing loss is mild, you may not hear rustling leaves, normal breathing, whispers, or be able to follow conversations in noisy rooms. 
  • With moderate hearing loss, you’ll find it more challenging to keep up with conversations without hearing aids, even without background noise. 
  • Once hearing loss becomes severe, you may not hear a family member vacuuming or using a hair dryer when you’re in the same room. 
  • When you suffer from profound hearing loss, you won’t be bothered by sounds many people find jarring, like motorcycles, blenders, or lawn mowers.

Hearing loss severity, underlying cause, and impacted part of the ear can vary considerably from person to person. You may notice hearing loss in one or both ears. If both ears are affected, the hearing in one ear may be better than in the other. If hearing loss is gradual, you likely won’t notice it as much as when it happens suddenly. The three primary types of hearing loss are sensorineural, conductive, and mixed. Learning about the three types should help you communicate better with your doctor about your hearing loss, which will guide your treatment.

What is sensorineural hearing loss?

Sensorineural hearing loss, which impacts the cochlea (inner ear), is by far the most common type in adults, comprising 90% of all cases. It is caused by damage to the spiral cavity of the inner ear or the auditory nerve. As a result, sound cannot be converted into electrical signals for the auditory nerve to transmit to your brain. 

What are the causes?

  1. Aging
    If you’re 65 and older, maybe you’ve experienced difficulty having conversations with your friends and family, understanding your doctor’s advice, or hearing the doorbell ring. Perhaps you’re also cranking up the volume on your television or radio. If you’re experiencing difficulty coming to terms with age-related hearing loss, that’s a common reaction and completely understandable. The term for sensorineural hearing loss related to aging is presbycusis. Sensory presbycusis is the most common subtype, with high-frequency hearing loss most often impacting both of your ears equally. This type of hearing loss occurs gradually over time, so you may not even realize you can’t hear well. 

  2. Blood vessel diseases
    Many disorders of the vascular system can impact the blood circulation of your inner ear. This can cause fluctuating or permanent hearing loss. 

  3. Autoimmune diseases 
    Most patients with Sjögren’s syndrome have mucosal dryness, which can result in ear lesions and severe sensorineural hearing loss. Other autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis less commonly cause this problem.

  4. Viral infections
    Hearing loss related to viruses can be congenital or acquired, unilateral (one side), or bilateral (both sides). Most virus-induced hearing loss is sensorineural, although certain viruses may cause conductive and mixed hearing loss. Meningitis, mumps, scarlet fever, measles, rubella, herpes simplex 2, HIV, and West Nile have been linked to hearing loss. Prior to widespread vaccination, measles accounted for 5–10% of profound hearing loss cases in the U.S. With the recent measles outbreak, related hearing loss cases may escalate.

  5. Traumatic brain injuries
    Due to its sudden and violent nature, head trauma may lead to hearing loss as well as vestibular (balance) and central auditory problems. Hearing loss related to a head injury can be sensorineural or conductive.

  6. Noise-induced
    Hearing loss caused by exposure to loud noise is common, affecting about 10–40 million adults in the U.S. younger than age 70. Whether you were exposed to extremely loud noise once or repeatedly over a long period of time, it can damage your sensitive ear structures.

  7. Meniere’s disease
    In addition to extreme dizziness, this disease can cause tinnitus (ringing in your ears), the sensation of blocked or muffled hearing, and a feeling of congestion, fullness, or pressure in the affected ear. If your inner ear fills with excessive fluid, this can damage the delicate hair cells of the inner ear, resulting in permanent hearing loss.

  8. Benign and malignant tumors
    Acoustic neuromas (vestibular schwannomas) are benign tumors of the eighth cranial nerve that can cause hearing loss. An estimated 20% of adults with these tumors experience some hearing loss. Additional tumors that may cause hearing loss include paragangliomas and endolymphatic sac tumors.

  9. A side effect of specific medications
    According to the American Speech-Language-Hearing Association, more than 200 different medications have hearing-related side effects. The most common ones include aspirin in very high doses, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, aminoglycosides, amoxicillin (the most widely prescribed antibiotic), certain chemotherapy drugs, and loop diuretics.

What are the symptoms?

The most common symptoms impact clarity of sound and loudness. Symptoms can be physical and behavioral: 

  • Muffling of speech and other sounds
  • Difficulty understanding words, especially in a crowd or with background noise
  • Trouble hearing specific consonant sounds (e.g. “s” or “th”) 
  • Needing to frequently ask others to speak slower, more clearly, and louder
  • Needing to turn up the volume on the television, radio, or computer
  • Withdrawing from conversations
  • Avoiding certain social settings

How is Sensorineural Hearing Loss treated?

If your hearing loss impacts both ears and worsens over several months or is related to an autoimmune inner ear disease, your doctor will likely prescribe long-term corticosteroids and in some cases, drug therapy. If your hearing loss is related to Meniere’s disease, your doctor may put you on a low-sodium diet and prescribe diuretics and/or corticosteroids. When sensorineural hearing loss cannot be reversed, hearing aids or cochlear implants can improve your hearing and likely your enjoyment of life.

What is conductive hearing loss?

If you have conductive hearing loss, sounds have difficulty passing from your outer ear to your middle ear due to blockage or damage in the outer ear, ear canal, or middle ear. This type of hearing loss is typically mild or moderate, so louder sounds may seem muffled.

What are the causes?

  1. Impaired Eustachian tube function
    If you’re experiencing muffled or reduced hearing, your Eustachian tube may be blocked. The Eustachian tube links the back of your nose to the middle ear. Eustachian dysfunction may occur when the mucosal tube lining swells up or the tube doesn’t open or close properly.

  2. Fluid in the middle ear related to colds or allergies
    Allergies can cause swelling, pressure, and fluid buildup in the tube that runs from your ears to your nose and throat, or even completely block it. When this happens, you may experience reduced hearing temporarily.

  3. Ear infection, or otitis media
    This common inflammation of the middle ear can be sparked by an infection or drainage into your middle ear. If you swim, you’ve probably gotten water in your ears, but luckily, it usually drains out without causing an ear infection. This condition is the most common cause of intermittent, mild-to-moderate acquired hearing loss in infants and young children.

  4. Otosclerosis
    An abnormal growth of the bone of the middle ear, this disorder prevents proper functioning of the structures in your ear.

  5. Ruptured eardrum
    Inflammation or an infection in the middle ear, a blow to the ear, a head injury, or insertion of a cotton swab too far into the ear canal can lead to this condition, medically known as tympanic membrane perforation. However, to put it in simple terms, this literally means you have a hole in your eardrum. If it gets infected, hearing loss can worsen.

  6. Benign tumors
    Although they are nonmalignant, lesions that affect the middle ear can lead to hearing loss. These types of rare tumors are called paraganglioma.

  7. Earwax (cerumen) in the ear canal
    Although it’s a little off-putting, earwax is a highly useful substance because it protects and cleanses your ear canal. But a problem can occur if you produce too much earwax. Excessive wax can prevent sound from traveling from your outer ear to your inner ear. As you get older, earwax can become harder and more prone to building up in your ear canal. You may be tempted to remove earwax from your ears with cotton swabs but doing so can damage your ear canal. It’s important that you consult a doctor for treatment. This involves placing medication in the ear canal to soften the wax, irrigating the ear canal with water, or using special tools to remove the blocked wax.

  8. Infection in the ear canal (external otitis)
    An acute infection of the ear canal skin, this can cause your ear canal to swell up and close, resulting in hearing loss.

  9. Middle ear malformation
    A wide range of birth defects can affect a baby’s ears before birth. When the middle ear is impacted, hearing loss can occur.

What are the symptoms?

These are the symptoms you might experience when you have conductive hearing loss:

  • Everyday sounds are perceived as softer
  • Better hearing in one ear than the other
  • Difficulty hearing discussions (e.g. on the phone)
  • The quality of sound is less clear or sharp
  • High and low sounds are reduced
  • Feeling of pressure in one or both ears
  • A foul odor coming from the ear canal

How is conductive hearing loss treated?

In certain cases, medical treatment can resolve temporary hearing loss. If your hearing loss is permanent, different types of hearing aids can help you hear better by amplifying sounds, enabling you to participate more fully in life again. Some people also benefit from assistive listening devices that also make sounds louder (e.g. amplified telephones or headphones).

What is mixed hearing loss?

Mixed hearing loss refers to hearing loss that is both sensorineural and conductive, the two types already discussed in this article. In simple terms, this means that you have damage in your outer or middle ear and your inner ear or auditory nerve. 

What are the causes?

Mixed hearing loss can be caused by any combination of issues responsible for sensorineural and conductive hearing loss. For example, you may experience temporary fluid in your middle ear from an allergy and already have permanent hearing loss related to loud noise exposure. Or, maybe you have residual hearing loss after being treated for an acoustic neuroma and then experience temporary hearing loss due to wax buildup in your ear canal.

What are the symptoms?

If you have mixed hearing loss, you’ll experience a combination of sensorineural and conductive symptoms. Sounds may be softer in volume and more difficult for you to understand. If one type of hearing loss is worse than the other, those symptoms will be more obvious.

How is mixed hearing loss treated?

Although most cases are treated with hearing aids, medical treatment is required for disorder-related cases of sensorineural hearing loss (e.g. Meniere’s disease). Conductive hearing loss can often be corrected with medical or surgical treatment. Often, treatment involves a combination of medical or surgical treatment plus hearing aids, implants, or assistive devices.

If you think you have hearing loss, schedule an appointment with your primary care doctor as soon as possible. They may be able to diagnose and treat your hearing problem. Your doctor may refer you to an otolaryngologist (ear, nose, and throat doctor) or an audiologist (a health professional who can identify and measure hearing loss). Take this important second step and you’ll discover hearing loss doesn’t have to negatively impact your quality of life!

With you on your journey to better hearing.

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Sources: Hearing Health Foundation, Hearing loss and Tinnitus statistics.

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