Hearing loss

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Most people experience hearing loss at an advanced age. But even at a young age, noise, for example, can damage the ears prematurely. In addition, various diseases such as infections or injuries can impair hearing performance. Read everything you need to know about the causes and treatment of hearing loss here.

Hearing impairment: description

In the course of life, the performance of all senses deteriorates - hearing also decreases. The creeping age-related hearing loss (presbycusis) is a completely natural process that begins in almost everyone from the age of five. The hearing loss is accelerated by noise pollution, diseases such as cardiovascular diseases or diabetes, certain drugs or poisons such as nicotine.

Hearing disorders can be roughly divided into three areas: sound conduction, sound sensation and sound perception deafness. These hearing disorders can also occur in combination.
Conductive hearing loss: With these hearing disorders, sound waves reach the inner ear less or not at all. The cause can be in the ear canal, for example if it is blocked or malformed. However, it can also be located in the area of ​​the middle ear, for example in the event of an infection.

Sensory hearing or inner ear hearing loss: In these types of hearing loss, the eardrum and the chain of the ossicles transmit the sound waves correctly, but the signals are then not properly transmitted and processed. For example, the fine hair cells in the inner ear, which normally amplify sound and convert it into electrical signals, may be damaged.

Sound perception hearing loss: In this type of hearing disorder, the cause of the hearing loss lies in the brain. There, incoming auditory signals are usually identified and given a meaning. In the case of sound perception deafness, the auditory nerve forwards the signals correctly, but they are processed incorrectly in the brain. The result: the person concerned hears the tones, but cannot do anything with them. This can be the case, for example, after a stroke.

Combined hearing loss: Here two or three types of hearing impairment occur at the same time. An example is the explosion trauma: If someone was exposed to extreme noise, for example due to the explosion of a firework right next to the ear, a combined sound conduction and sound sensation hearing loss occurs. The eardrum tears due to the enormous pressure of the sound wave. In addition, the loud bang damages the hair cells in the inner ear.

Hearing impairment: causes and possible diseases

Causes of conductive hearing loss

With these types of hearing loss, the sound waves do not reach the inner ear or only at a reduced rate. The reasons for this can be:

• Clogged ear canal, for example with wax (cerumen) or foreign bodies
• Congenital malformations of the ear canal
• Tumors in the ear canal or middle ear
• Injuries
• Bone growths (e.g. common in swimmers)
• Ventilation disorder and fluid accumulation in the middle ear (tympanic effusion)
• Acute or chronic otitis media
• Inflammation of the air-filled adjoining spaces in the middle ear (mastoiditis)
• Otosclerosis: Here an ossicle, the stapes, has grown together with the bone.
• Eardrum perforation
• Skull base fracture
• Malformations in the middle ear
• Window rupture

Causes of sensorineural or inner ear hearing loss

The causes of these forms of hearing loss are pathological changes in the inner ear or the auditory nerve. In some cases, the auditory nerve does not properly relay the signals it receives to the brain. The main reasons are:

• Age-related hearing loss (presbycusis)
• Noise damage
• Sudden hearing loss
• Meniere's disease
• Poisoning (toxic inner ear hearing loss)
• Skull injuries (e.g., concussion)
• Malformations of the inner ear
• Tumors (e.g. acoustic neuroma, vestibubar schwannoma)
• Nerve injuries (e.B. after skull injuries)
• Inflammation (e.g. meningitis)
• Malformations or lack of application of the auditory nerve
• Malfunction of the connection between the hair cell and the auditory nerve (auditory neuropathy)

Causes of sound perception deafness

In these types of hearing loss, the brain does not process the signals from the ear properly. Possible causes are:

• Encephalitis
• stroke
• Cerebral hemorrhage
• traumatic brain injury
• Malformations

Hearing impairment: when do you need to see a doctor?

If the hearing loss occurs suddenly or is accompanied by pain or fever, you should see a doctor immediately. Even if the hearing loss gradually develops, you should have your hearing tested. Because if the hearing loss lasts longer, the brain forgets how to process the signals on the affected frequencies. Then hearing aids won't help either. One of the first signs of hearing loss, for example, is when you struggle to follow what has been said in larger discussions.

Hearing impairment: what does the doctor do?

Diagnosis

Your first point of contact is an ear, nose and throat doctor (ENT). First he asks for the medical history (anamnesis). This also includes what you do professionally and in your free time. This is followed by a complete ear, nose and throat examination with an otoscopy.

The degree and type of hearing loss can be determined using various hearing tests. These include:

• Hearing range test: The doctor tests the sound perception of both ears by whispering four-syllable numerical words such as "25" or "88" one after the other from different distances.
• Tone threshold audiogram: Tones at different frequencies are played through headphones - first very quietly, then increasingly louder. The volume at which the patient first perceives the sound is known as the hearing threshold.
• Speech audiometry: The patient is played multi-syllable numbers and monosyllabic test words through headphones, which he has to repeat.
• Electrocochleography (ECochG): The procedure is used for severe and sudden hearing loss, for example after a sudden hearing loss. The activity of the sensory cells in the ear is measured.
• Otoacoustic emissions: This method is used to test the function of the inner ear. When sounds hit the ear, the hair cells contract. The resulting noises are called otoacoustic emissions. They can be captured with highly sensitive microphones.
• Brain stem audiometry (BERA): It is used when the cause of the hearing impairment is suspected to be in the area of ​​the auditory nerve and the deeper brain areas. For this purpose, a sound is played to the person examined via headphones. The subsequent reaction of the brain in the form of electrical currents can be determined via electrodes on the head. These are called "acoustic evoked potentials". Based on the intensity and time delay of the brain reaction, conclusions can be drawn about the function of the auditory nerve.
• Cerebral cortex audiometry: This method works in a similar way to brain stem audiometry, only the activity of the cerebral cortex is determined here.

therapy

Hearing aids: If the hearing loss is due to age or noise, hearing cannot be regained. In this case, a hearing aid should be fitted as quickly as possible so that the brain does not forget how to process the sounds. Behind-the-ear devices and in-the-ear devices are suitable. If free linguistic communication (e.g. making a phone call) is no longer possible despite using a hearing aid, an inner ear prosthesis (cochlear implant) should be considered.

Medicines: If the hearing loss is due to an infection of the hearing organ or auditory nerve, the pathogens must be fought. Various drugs are available for bacteria and viruses. Antivirals work against viruses. Acyclovir is most commonly used - the drug of choice for a herpes infection of the inner ear or auditory nerve. Acyclovir is also used when the middle ear is infected with flu viruses.

In the case of bacterial infections (usually otitis media), broad spectrum antibiotics are the most helpful. These kill the most common pathogens (streptococci, staphylococci, Haemophilus influenzae) reliably, or they inhibit the growth of germs. The most common antibiotics for this area of ​​application include penicillin V, amoxicillin, cefuroxime axetil and clarithromycin.

Infusions: In the event of sudden hearing loss or acoustic trauma, an infusion of various medications is usually given. The aim is to alleviate the hearing loss. However, the effectiveness of these procedures has only been poorly proven in studies. Circulatory stimulants are intended to remedy a possible reduced blood flow in the inner ear. Frequently used drugs include hydroxyethyl starch (six percent HAES) and dextrans, but also pentoxifylline. Before the first dextran infusion, a special agent (hapten) is usually administered to prevent an allergic reaction to the active ingredient. Decongestants are used when there is swelling in the inner ear. Common drugs are glucocorticoids such as prednisolone.

Cleaning the ear: If ear wax (cerumen) swells up after bathing, for example, the plug can close the ear canal almost soundproof. If the passage is blocked with cerumen or a foreign body, suction is the method of choice. If this is not possible, the cerumen can be removed using various instruments (hooks, loops, curettes or tongs). The ENT doctor can also remove the sebum with a rinse - but only if the eardrum is intact. First, the doctor pulls the auricle back to straighten the ear canal. He then carefully rinses out the ear canal with water at body temperature. He softens particularly stubborn plugs beforehand with ear drops containing glycerol.

Speech therapy: If the cause of the hearing problem lies in the brain, targeted hearing and speech training is necessary. Under the guidance of a therapist (speech therapist or speech therapist), the affected person learns the meaning of sounds from scratch. The prognosis for a complete healing is unfortunately rather poor - especially at an advanced age or when large parts of the hearing center are affected.

Operations: A defective eardrum can be covered by a surgeon with the body's own muscle or cartilage skin (myringoplasty). If the stapes in the ear no longer function properly, this ossicle can be replaced with a prosthesis made of metal or plastic (stapes prosthesis). In the case of a severe otitis media, it is sometimes necessary to make an incision in the eardrum so that the pus can drain off (paracentesis). In some cases, a so-called ventilation tube made of gold, titanium or plastic is used to ventilate the ear.

Hearing impairment: you can do it yourself

Hearing impairment is still a taboo in our society. People with disabilities are often marginalized and lead a niche existence. A few simple rules and a portion of openness are enough to remove many obstacles. Some tips facilitate the dialogue with a hearing handicap.

• Do not hide your hearing loss, it can quickly lead to unnecessary misunderstandings.
• Ask the person you are speaking to not to speak louder, but more clearly.
• Ask the people you are speaking to to turn towards you as you speak so that you can lip read.
• Do not pretend that you understand something, but ask them to repeat what has been said.
• Have the courage to ask for understanding of your hearing loss.
• When in company, it is best to sit next to someone who speaks clearly. He may be ready to summarize the conversation for you.
• Do not be ashamed of your hearing handicap and do not retire privately or professionally. You have well-known fellow fates: Rudi Carrell, for example, was extremely hard of hearing and still successful. Heinrich Schliemann, who discovered Troy, also had a bad hearing.

Hearing impairment: dealing with those affected

It is seldom clear to those with normal hearing how stressful a conversation can be for someone with hearing loss. The situation is comparable to going to the cinema where a film is shown in a language that you have insufficient command of. In order to understand the context in spite of misunderstood or misunderstood words, a person with a hearing handicap must follow the sentences with extreme concentration and use all of their ability to combine and think.

If you take the following advice to heart, you and the person you are talking to will find it easier to talk to:

• Be patient.
• Speak clearly and calmly.
• Do not yell your message at the other person, because hearing loss does not always have something to do with "hearing too softly". On the contrary: for people who suffer from sensorineural hearing loss, volume levels from 80 decibels are often painful - for people with normal hearing, the pain threshold is around 120 decibels.
• Always turn your face to the person you are speaking to. A hearing-impaired person needs to hear with their eyes: reading their mouths is essential for them.
• Avoid chewing gum and sweets - these prevent you from speaking clearly and make it difficult to understand if you are hard of hearing.

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