A GUIDE TO THE

MECHANISM AND LEVELS

OF HEARING LOSS
 INTRODUCTION

Hearing loss or hearing impairment refers to a reduction in or loss of the ability

to hear sounds. It can occur in one or both of the ears. It is a common
occurrence among the elderly where the power to hear slowly diminishes with
increasing age. Hearing impairment can also be spotted among children at the
time of birth at very low levels. It can be caused due to a variety of reasons and
has specific symptoms by which one can identify the same. It can often be
treated with medications and also be supplemented with hearing aids.
(Information Credit – https://www.theeardepot.com)
 WORKING OF THE EAR

Before getting into the depths of hearing impairment and how it is caused, it is
important to understand the structure of the ear and how it works. The ear
consists of three parts, the outer ear, the middle ear and the inner ear. The
outer ear is comprised of the visible part of the ear, the ear canal and the thin
tissue called the eardrum which separates the outer and the middle ear. The
middle ear is located behind the eardrum comprising of three tiny bones called
ossicles. Lastly, the cochlea and the auditory nerve constitute the inner ear.

The sound waves which enter our ear hit the eardrum which starts vibrating
upon impact. From there, the vibrations pass into the middle of the ear reaching
the three bones called ossicles which amplify them. These vibrations then hit
the small hair-like cells in the cochlea which start moving and send the
movement data to the brain through the auditory nerve. This data is processed
by the brain and interpreted as sound.
 DIFFERENT LEVELS OF HEARING LOSS

Hearing loss can be differentiated based on the severity of the problem. The
different levels of the problem need to be distinguished to facilitate the
diagnosis and treatment of the loss.

 Hearing Loss: This refers to the reduction in the ability of the person to
hear sounds in the same way as others.
 Deafness: In this condition, the person cannot comprehend speech or
other sounds through hearing even at escalated volumes. There are four
distinct levels of deafness:

 Mild level: The person suffering from mild deafness can only detect
sounds between 25 and 29 decibels. They can face problems in
understanding the words people are saying in the presence of loud
background noise.
 Moderate level: People with such a condition can perceive sounds
between 40 and 69 decibels only. It is difficult for them to follow a
conversation using only their natural hearing power. With hearing
aids, they can participate in a conversation easily.
 Severe Deafness: The person can hear only sound above 70 decibels
up to 89 decibels. A severely deaf person has difficulties in
conversing even with a hearing aid. They must lip-read or use sign
language to communicate.
 Profound Deafness: People who cannot hear sounds below 90
decibels are suffering from profound deafness. Some people with
profound deafness cannot hear anything at all. They communicate
using other mediums like lip-reading, sign language and reading and
writing.
 TYPES OF HEARING LOSS

Hearing impairment can be of three types depending on its characteristics and

the part of the ear suffering the loss:

 Conductive Hearing Loss - A conductive hearing loss is where the ear’s

ability to conduct sound from the outer ear into the middle or inner ear is
blocked. This means that the vibrations are not passing into the inner ear,
specifically the cochlea. It occurs due to problems in the eardrum, the ear
canal or the middle ear and its little bones. This type of hearing loss can
occur due to many reasons including:
 Excessive build-up of ear wax
 Malformation of the ear canal, outer ear or middle ear structure.
 Ear infection causing accumulation of fluid in the eardrums or
canals.
 Allergies
 Perforated eardrum
 Soft tumors
 Blockage due to foreign object
 Otoscleorosis or a hereditary disorder in which a bony structure
forms around the small bones in the middle ear preventing it from
vibrating.

 Sensorineural Hearing Loss - This condition arises due to problems in the

inner ear, auditory nerve, the cochlea or brain damage. It is normally
caused by damage to hair cells in the cochlea. Age-related and noise-
induced hearing losses are also types of sensorineural hearing loss. As
humans grow older, the hair cells lose some of their functioning
 deteriorating their hearing capability. Total or profound deafness is also a
kind of nerve-related hearing loss which may occur due to head trauma or
inner ear infections. The causes of sensorineural hearing loss are:
 Exposure to loud noise
 Aging
 Head Trauma
 Severe inner ear disease
 Disease or Virus
 Heredity
 Malformation of ear

 Mixed Hearing Loss - In some cases, there are signs of both sensorineural
and conductive hearing loss. Problems are found with conducting sound
to the inner ear and the hair cells in the cochlea are also damaged
simultaneously. This is known as mixed hearing loss.
 CAUSES OF HEARING LOSS

Hearing loss can occur due to slight or extensive damage to the ear parts.
These damages can occur due to a variety of reasons including:

 Aging: Deterioration of delicate inner ear structures occurs over time. As a

person grows old, the ear loses its ability to function properly. This is why
hearing problems are common among the elderly. Due to aging, damage
can be seen on the nerve cells in the cochlea leading to sensorineural
hearing loss. It can also be caused by changes in blood supply to the ear
due to heart diseases, vascular condition or high blood pressure.

 Noise induction: This is caused by prolonged exposure to amplified sound.

Sudden exposure to loud sounds can damage the cells of your inner ear.
Problems can also arise due to long-term exposure to loud noises or from
exposure to short blast of noise like gunshots. While this is generally
temporary in nature, repeated exposure to loud noise does not give the
ear enough time to recover. The noise causes damage to the hair cells of
the ear, causing hearing loss to increase over time and become
permanent.

 Heredity: Your genetic composition may also play a part in your hearing
loss. People with family histories are more prone to hear loss from ear
damage or from aging. While most hereditary hearing losses are present
at birth itself, some conditions might develop over time.
 Severe illness: There are numerous diseases, disorders and illnesses that
can contribute to hearing loss. These include:
 Otosclerosis: It is a disease in which a bony structure forms around
the bones of the middle ear restricting their movement.
 Meniere’s disease: This disease can result in tinnitus or a ringing
sensation in the ears, hearing loss and a feeling of congestion in the
ear. It generally affects only one ear. It can develop at any age but is
more likely to happen in adults between 40 to 60 years of age.

 Medication: Ototoxic medication – like the ones used in chemotherapy –

can damage the cochlea or the auditory nerve. This leads to sensorineural
hearing loss. Generally, signs of hearing loss are noticed after
consumption of huge amounts of these drugs.

 Tumors and trauma: Tumors in the ear can also cause hearing loss. Tumor
related hearing loss might also cause ringing in the ears and a feeling of
fullness or congestion in the ears. Head trauma can damage inner
structures of the ear causing a temporary or permanent hearing loss.
 SYMPTOMS OF HEARING LOSS

The symptoms of hearing loss vary depending on the cause of hearing loss and
its severity. However, there are some common symptoms of all cases including:

 Muffing of speech and sounds

 Difficulty in comprehending words, especially when there is a lot of
background noise or a huge crowd
 Trouble in hearing consonants
 Frequently requesting others to speak slowly, loudly and clearly in the
middle of a conversation
 Needing to turn up the volume of the radio or the television
 Withdrawing from conversations because it feel tiring
 Avoiding social events involving a lot of communication
 Difficulty in conversing on the phone
 Feeling as if others are mumbling
 Ringing in the ears
 Hissing, roaring, buzzing or whistling noises in the ear

In babies and small children, the symptoms of hearing loss are largely different.
In most cases, such a condition is diagnosed in infants during the tests
conducted a week after the birth. In some cases, the condition might develop
after the test. Alert and caring parents can easily detect the problem through
these symptoms:

 Delay in language and speech development

 Difficulty in identifying the direction from which the sound is coming
 No signs of shock when loud sound is present
 Poor performance in school due to hearing issues
 WHEN TO SEE A DOCTOR?

It is extremely important to visit a doctor if one experiences a sudden loss of

hearing, especially in one ear. It is also advised to see a doctor if someone has
been facing difficulty in hearing soft sounds for a long time. If hearing problems
start interfering with the daily routine, it is a sign that treatment and aid is
required. While deciding whether it is required to seek medical attention
immediately or not, one should consider the following:

 Is it difficult to understand what is said in a conversation, especially when

there is a lot of noise?
 Does sound feel muffed?
 Are people always complaining that the radio or television volume is too
high?
 PREVENTION OF HEARING LOSS

The natural causes of hearing loss such as age and heredity are beyond human
control. However, other factors like noise and ototoxic drugs can be monitored
to prevent hearing loss.

Noise Induced Hearing loss -

Noise exposure is a major cause of hearing loss which damages the tiny hair
cells in the ear. Once damaged, these cells cannot be replaced. It is important to
note that loud noise rarely affects the hearing ability of a person in a single
instance, rather the impact adds up over a lifetime. To limit this impact, one
should try to limit exposure to sounds above 100 decibels to not more than 15
minutes, and sounds above 110 decibels to not more than 1 minute. The
following points should be followed to prevent sound exposure:

 Wear earmuffs or earplugs that block noise in noisy areas such as building
sites.
 Avoid places with loud noises unless utmost necessary.
 Turn down the volume of the television, radio and other gadgets.

Ototoxic Drugs -
Certain drugs are toxic to the ears and can cause hearing loss and other related
diseases like tinnitus. These are known as ototoxic drugs. It is advisable to
always enquire about the side-effects of the medicines one takes. If hearing loss
is a possible side-effect, one should opt for substitutes that work just as well
without the side effect. Examples of ototoxic drugs include some antibiotics,
certain anti-inflammatory drugs, some chemotherapy drugs and some daily
drugs in high doses.

Hearing loss due to ototoxic drugs can be easily identified by the following signs.
If one is aware of these, the medicine can be changed and the condition can be
treated at the early stages itself. The signs of ototoxicity include-

 Development of a ringing sensation in one or both of the ears

 Intensification of existing tinnitus or appearance of new sound
 Fullness in the ear
 Hearing loss progression
 Development of vertigo which may or may not be accompanied by
nausea
 CONCLUSION

Tracking hearing ability is important. One should always take hearing tests at
regular intervals. In case there are any probable signs of hearing impairment, it
is sensible to consult a hearing expert immediately. It is always beneficial to stay
aware of the noise levels in the immediate environment. Hearing loss is not the
end of the world. It can often be treated with hearing aids and other
procedures. Hearing problems, no matter how small, should never be ignored
and treated at the core level, before they grow into something bigger (that can
no longer be reversed or resolved).