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When silence isn’t golden

Whether temporary or permanent, hearing loss can be a terrifying experience, but there are cures for many of the causes…

The ability to hear is one of the most important senses that you have, allowing you to communicate with others, entertain yourself through music and keep yourself safe by warning you of dangers, such as approaching road traffic.

However, there are a number of ways your hearing can become impaired, and depending on the type and severity of cause, this hearing loss can be temporary or permanent. Typically, a hearing impediment will result in an earache and/or a constant ringing in the ears, as well as making it difficult for the sufferer to hear conversations in loud places.

We discover why people suffer hearing loss, and what can be done to remedy the situation…


Temporary hearing loss
The hows and whys of non-permanent deafness

Earwax
Most people probably don’t think about much earwax, other than when it needs to be removed, but it serves several useful purposes – it helps to clean and lubricate the ear, as well as trapping dirt and repelling water to protect the lining.

However, when too much earwax builds up, it can cause problems. In addition to the discomfort a blocked ear can bring, you may  also suffer from earache, itching, tinnitus – which is when you hear a constant noise, often a ringing sound – and vertigo, the sensation of spinning when standing still.

Some people naturally produce too much earwax, though excessive build-up can occur if you have narrow or deformed ear canals, have a lot of hair in your ear canals, have benign (non-cancerous) bony growths in the outer part of your ear canal, have hard wax, are elderly or have a history of recurrent impacted earwax.

Removing excess earwax needn’t be complicated – it can be treated with a syringe, ear drops, or ear irrigation, a method that uses a pressurised flow of water to dislodge the build up of wax.

According to the Clear Ear Clinic (www.clearearclinic.com), there is a ‘safer, quicker, neater, better-tolerated, more effective way that does not require pre-treatment with ear drops’ – this method is known as microsuction. In this technique, a binocular operating microscope that allows depth perception and magnification is used to let the practitioner to look straight into  the ear canal. Then, a very fine suction device is used at low pressure to remove the wax.

Exposure to loud sounds
Noise-induced hearing loss is one of the most common types of temporary hearing loss and occurs when exposure to sudden or constant loud sounds causes damage to the sensitive structures in the inner ear. If you’re unable to hear loud speech from a distance of a metre, then it’s likely your ears are exposed to dangerous noise levels. Hearing aids are an appropriate remedy in this case.

Noise-induced hearing loss is accompanied by tinnitus – that ringing sound in the ears. If the exposure is continuous and left unattended, the hearing loss could become untreatable and permanent.

‘Although hearing aids are not yet perfect, digital technology has revolutionised their quality and performance,’ says consultant audiologist Huw Thomas. ‘The correct hearing aid prescription, fitted by a professional to recognised protocols, can transform lives.’

Perforated eardrum
Perforations happen because of a sudden tear or rupture in the eardrum caused by an untreated ear infection, or by prodding something into the ear. It may be accompanied by pain and bloody drainage out of the ear. This condition is known as otitis media with perforation. Around 80% of cases clear up within three days without any treatment, but in some cases it may be necessary to carry out surgery to repair the rupture.

Repairing a perforation can improve hearing, reduce tinnitus  and prevent water entering the ear while showering, bathing or swimming, which may cause an ear infection. It may also prevent the development of cholesteatoma – a skin cyst in the middle ear that can cause chronic infection and destruction of ear structures.

Damage to the sensory structures
Temporary hearing loss may be a result of damage to the sensory structures (hair cells) of the inner ear, auditory nerve pathway or auditory nerve in the brain. These structures may get damaged by infections, drugs, skull injuries or tumours. Infections can be treated with antibiotics and it might be possible to repair any structural damage with surgery. It’s always advisable to seek medical attention as soon as possible to prevent further or permanent damage.

Long-term medication
If you’ve been taking certain medicines, including ibuprofen or aspirin, more than twice a week over a long period of time, you could be putting yourself at risk of temporary hearing loss. This is especially true in men who are under the age of 50.

It’s thought that the drugs reduce blood flow to the cochlea – the small tube in the inner ear that processes sound vibrations. The good news is the condition  is reversible and normal hearing should be resumed once the offending medication is stopped.


Permanent hearing loss
The hows and whys of lifelong deafness

Advancing age
Age-related hearing loss is hands-down the most common type of deafness in the UK, with an estimated three-quarters of men and women over 70 suffering some kind of loss of hearing.

One of the reasons why this occurs is down to the tiny hairs inside the ear that help us hear. The hairs pick up sound waves and change them into the nerve signals that the brain interprets as sound.

However, as we age, some of these hair cells get damaged or die and, since they cannot regrow, the hearing loss is permanent.Hearing loss in older people can also be caused by changes to the inner ear, as well as by genetics.

The eternal culprit smoking is also said to be a contributory factor. According to the Royal National Institute for Deaf People (RNID, www.rnid.org.uk), although nothing can be done to ‘cure’ deafness caused by ageing, modern hearing aids can make a huge difference, making it possible for users to communicate with  less stress and take a full part  in life.

Sudden sensorineural hearing loss (SSHL)
Also known as sudden deafness, SSHL is caused by damage to the pathway between the inner ear and the brain. Although the exact cause of the hearing loss is only unearthed in around 15% of cases, possible reasons include:

  • Circulatory problems: trouble with the flow of blood to the ears can cause SSHL. In fact, a lack of blood to the inner ears can result in permanent hearing loss in less than one minute.
  • Multiple sclerosis: this is a neurological condition that affects the brain and spinal cord.
  • Some cancer treatments: such as chemotherapy and radiation therapy.
  • Certain infections: such as measles, mumps or meningitis, especially in children.
  • Ménière’s disease: this is acondition of the inner ear that causes hearing loss, balance problems and tinnitus.
  • Cholesteatoma: a benign skin growth in the middle ear that can cause deafness and vertigo.
  • Genes: some children are born deaf, sometimes because deafness is in the genes and sometimes due to a complication or illness during pregnancy.

‘Sensorineural hearing loss not only changes our ability to hear quiet sounds, but it also reduces the quality of the sound that is heard, meaning that individuals with this type of hearing loss will often struggle to understand speech,’ says the RNID. ‘Once the cochlea hair cells become damaged, they will remain damaged for the rest of a person’s life. Therefore, sadly, sensorineural hearing loss is irreversible.’

SSHL usually happens over the space of hours, but can occur over a period of up to three days. It’s classed as a medical emergency, so requires immediate attention.

Trauma
Trauma-induced hearing loss is caused by exposure to extremely loud noise – such as an explosion, airbag discharge or a gunshot – or by an injury to the ear or head.

A head injury can cause damage to structures in the ear, the neural pathways that carry sound to the brain, and the hearing centres of the brain. Sudden changes of inner-ear pressure can also cause trauma-induced hearing loss.

Depending on the severity of the injury, the patient may be able to recover some of their hearing with the help of a hearing aid or a cochlear implant – also known as bionic ear – which is a surgically implanted electronic device that stimulates the cochlear nerve.

Otosclerosis
This is the abnormal growth of bone of the middle ear. This bone prevents structures within the ear from working properly, which then causes hearing loss. For some otosclerosis patients, the loss may become severe. The condition can be genetic – if one of your parents has it, you have a 25% chance of getting it; if it’s both parents, the risk goes up to 50%. It’s usually treated through the use of hearing aids or surgery.

Acoustic neuroma
An acoustic neuroma is a benign slow-growing brain tumour. It appears on the acoustic nerve, which helps control hearing and balance. The condition is most likely to be found in middle‑aged adults, especially women. Apart from difficulty in hearing, symptoms include tinnitus and a feeling of fullness in the ear. Sufferers may also have problems when walking and in keeping their balance.

Although radiotherapy or surgery may be used to treat the tumour, some degree of hearing loss in the affected ear may well be permanent. However, a hearing aid to divert sounds from the affected ear to the other ear can be an effective solution.


‘Getting on the right side of me helps me to cope’
Gavin Holroyd, 39, has hearing loss in his left ear. Over 10 years, he’s developed self-help techniques to help him lead a normal life.

‘About 10 years ago, I noticed I was bumping into things a lot, especially in the dark – even when sober! My doctor sent me to have some tests at hospital, which concluded that an earlier infection had caused hearing loss in my left ear. I also discovered that the balance organs inside both ears were badly damaged. They told me there was nothing that could be done about it.

‘My hearing has got considerably worse over the years. If I sleep on my right side and have my left ear up, I can hardly hear a thing, which can be an advantage if I’m somewhere noisy, but is a major issue when my alarm clock goes off!

‘It’s also very difficult to hear people talking to me in a busy pub or restaurant, especially if there’s background music. But I’m getting quite good at positioning myself so I have every chance of hearing better: I try to
sit so everyone is to my right and preferably no intrusive noise on my left.

‘I get fed up with saying “pardon”, and embarrassed at having to ask people to repeat themselves more than once.

‘What’s worse, I’ve found that my loss of hearing could prove fatal. I was in Europe recently, and automatically looked right before stepping out into the road. I don’t hear traffic coming and I’ve had a couple of close shaves!’


Dr Christian says… ‘In terms of earwax, don’t remove it – it comes out by itself. If your ears are really blocked then use some olive oil drops for a week or so to soften the wax and then ask your doctor to syringe your ears clean.’

The above feature was published in at home’s Ask the Doctor with Dr Christian Jessen in March 2011. To read more articles from the mag, just click here or visit at home‘s health section here.

 


Images: Getty, Shutterstock

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