HEARING LOSS

How the Ear Works

The Outer Ear

The auricle (pinna) is the visible portion of the outer ear. It collects sound waves and channels them into the ear canal (external auditory meatus), where the sound is amplified.

The sound waves then travel toward a flexible, oval membrane at the end of the ear canal called the eardrum, or tympanic membrane. Sound waves cause the eardrum to vibrate.

The Middle Ear:

The vibrations from the eardrum set the ossicles into motion. The ossicles are tiny bones — the smallest in the human body. The three bones are named after their shapes: the malleus (hammer), incus (anvil) and stapes (stirrup). The ossicles further amplify the sound.

The tiny stapes bone attaches to the oval window that connects the middle ear to the inner ear. The Eustachian tube, which opens into the middle ear, is responsible for equalizing the pressure between the air outside the ear and that within the middle ear.

The Inner Ear:

The sound waves enter the inner ear and then into the cochlea, a snail-shaped organ. The cochlea is filled with a fluid that moves in response to the vibrations from the oval window. As the fluid moves, 25,000 nerve endings are set into motion. These nerve endings transform the vibrations into electrical impulses that then travel along the eighth cranial nerve (auditory nerve) to the brain. The brain then interprets these signals, and this is how we hear. The inner ear also contains the vestibular organ that is responsible for balance.

Types of hearing loss

The type of hearing loss you have determines which treatments will work best for you.

A conductive hearing loss happens when sounds cannot get through the outer and middle ear. It may be hard to hear soft sounds. Louder sounds may be muffled.

Medicine or surgery can often fix this type of hearing loss.

Causes of Conductive Hearing Loss

This type of hearing loss can be caused by the following:

Fluid in your middle ear from colds or allergies.
Ear infection, or otitis media. Otitis is a term used to mean ear infection, and media means middle.
Poor Eustachian tube function. The Eustachian tube connects your middle ear and your nose. Fluid in the middle ear can drain out through this tube. Fluid can stay in the middle ear if the tube does not work correctly.
A hole in your eardrum.
Benign tumors. These tumors are not cancer but can block the outer or middle ear.
Earwax, or cerumen, stuck in your ear canal.
Infection in the ear canal, called external otitis. You may hear this called swimmer’s ear.
An object stuck in your outer ear. An example might be if your child put a pebble in his ear when playing outside.
A problem with how the outer or middle ear is formed. Some people are born without an outer ear. Some may have a deformed ear canal or have a problem with the bones in their middle ear.

Boy being bullied in elementary school class

About Sensorineural Hearing Loss

A sensorineural hearing loss happens when there is damage in your inner ear.

Sensorineural hearing loss, or SNHL, happens after inner ear damage. Problems with the nerve pathways from your inner ear to your brain can also cause SNHL. Soft sounds may be hard to hear. Even louder sounds may be unclear or may sound muffled.

This is the most common type of permanent hearing loss. Most of the time, medicine or surgery cannot fix SNHL. Hearing aids may help you hear.

Causes of Sensorineural Hearing Loss

This type of hearing loss can be caused by the following things:

- Illnesses.
- Drugs that are toxicto hearing.
- Hearing loss that runs in the family.
- Aging.
- A blow to the head.
- A problem in the way the inner ear is formed.
- Listening to loud noises or explosions.

Mixed Hearing Loss

A mixed hearing loss is a problem in your outer or middle ear and in your inner ear. Audiologists can help you if you have a mixed hearing loss.

Sometimes, a conductive hearing losshappens at the same time as a sensorineural hearing loss, or SNHL. This means that there may be damage in the outer or middle ear and in the inner ear or nerve pathway to the brain. This is a mixed hearing loss.

Causes of Mixed Hearing Loss

Anything that causes a conductive hearing loss or SNHL can lead to a mixed hearing loss. An example would be if you have a hearing loss because you work around loud noises and you have fluid in your middle ear. The two together might make your hearing worse than it would be with only one problem.

General symptoms of hearing loss

For adults with any kind of hearing loss, these are all good indicators that you may not be hearing as well as you used to. You may experience all or just a few of these scenarios:

Friends or family say you turn the television or radio up too loud
• You struggle to understand speech, especially in noisy environments
• You have difficulty hearing people on the phone
• A feeling that you can hear, but not understand
• You are not sure where sound is coming from, known as localization
• You often ask people to repeat themselves
• You’re dependent on a spouse or a loved one to help you hear
• You find yourself avoiding social situations
• You feel exhaustion after attending social events
• You notice tinnitus, or ringing in the ears
• Paradoxically, some sounds seem too loud, known as “recruitment“

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