Hearing loss

Hearing loss refers to a partial or complete inability to detect sounds in one or both ears. It may develop suddenly or gradually and can range from mild to profound. It is a common condition that can affect people of all ages, though it is most prevalent in older adults.

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Types of Hearing Loss

1. Conductive Hearing Loss

   • Caused by obstruction or damage to the outer or middle ear (e.g., earwax buildup, middle ear infection, fluid, eardrum perforation).

   • Often reversible with medical or surgical treatment.

2. Sensorineural Hearing Loss

   • Results from damage to the inner ear (cochlea) or auditory nerve.

   • Common causes include aging (presbycusis), prolonged noise exposure, certain medications (ototoxic drugs), or genetic factors.

   • Usually permanent and may require hearing aids or cochlear implants.

3. Mixed Hearing Loss

   • Combination of conductive and sensorineural components.

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Causes of Hearing Loss

• Age-related (presbycusis) – gradual loss with aging.

• Noise exposure – loud sounds damaging cochlear hair cells.

• Ear infections – recurrent otitis media or chronic otitis externa.

• Impacted cerumen (earwax blockage).

• Eardrum perforation or trauma.

• Meniere’s disease – inner ear disorder causing hearing loss, vertigo, and tinnitus.

• Otosclerosis – abnormal bone growth in the middle ear.

• Autoimmune inner ear disease.

• Head injuries.

• Genetic/hereditary factors.

• Ototoxic medications – aminoglycosides (gentamicin), chemotherapy (cisplatin), loop diuretics (furosemide).

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Symptoms

• Difficulty hearing conversations, especially in noisy environments.

• Frequently asking others to repeat themselves.

• Needing to increase the TV or radio volume.

• Ringing in the ears (tinnitus).

• Trouble understanding speech on the phone.

• Withdrawal from social situations due to communication difficulties.

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Diagnosis

• Otoscopy – check for wax, infection, or eardrum issues.

• Audiometry – measures hearing thresholds across frequencies.

• Tympanometry – assesses middle ear function.

• CT/MRI – may be used for suspected structural or nerve abnormalities.

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Treatment

1. Conductive Hearing Loss

   • Earwax removal: Carbamide peroxide ear drops or manual removal.

   • Infections:

     • Otitis externa – topical antibiotics (ciprofloxacin ear drops).

     • Otitis media – oral antibiotics (amoxicillin).

   • Surgery: Tympanoplasty, stapedectomy, or grommet insertion for chronic fluid.

2. Sensorineural Hearing Loss

   • Corticosteroids (e.g., Prednisone 60 mg daily for 7–14 days, then taper) may help in sudden sensorineural hearing loss if given within 72 hours.

   • Hearing aids – amplify sound for mild to severe cases.

   • Cochlear implants – for severe to profound hearing loss unresponsive to hearing aids.

   • Assistive listening devices (telephone amplifiers, FM systems).

3. General Supportive Measures

   • Avoiding loud noise exposure; use of ear protection.

   • Regular hearing screening in high-risk groups (elderly, occupational noise exposure).

   • Speech therapy and lip-reading classes for communication support.

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Precautions

• Avoid inserting foreign objects (e.g., cotton swabs) into the ear canal.

• Treat ear infections promptly.

• Monitor drug side effects (aminoglycosides, chemotherapy).

• Manage chronic conditions such as diabetes and hypertension, which may impact hearing health.

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Drug Interactions of Concern

• Ototoxic drugs (e.g., aminoglycosides + loop diuretics) increase risk of irreversible hearing damage.

• Chemotherapy agents (cisplatin) with other ototoxic medications exacerbate hearing loss.

• Aspirin and NSAIDs at high doses may cause reversible hearing issues.