Hearing Loss and Treatment Options

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What is Deafness / Hearing Loss?

Deafness refers to the loss of the ability to hear normally. There are two main types of hearing loss: conductive and sensorineural. These can occur separately or together, in which case it is called mixed loss. Hearing loss can affect one (unilateral) or both ears (bilateral) to varying degrees. Most cases of sensorineural hearing loss do not respond to medical treatment and are typically managed with hearing aids or cochlear implants.

Congenital Hearing Loss

Congenital hearing loss is present at birth. It is now recommended that hearing be tested for every newborn to detect hearing loss early. Early diagnosis and treatment are crucial for the development of normal speech and language functions. If hearing loss is detected late, the brain regions responsible for hearing may adapt to other functions, making surgical outcomes less effective. Newborns are screened using Otoacoustic Emissions (OAE) to ensure early detection.

Causes of Hearing Loss

Hearing loss can either be congenital or acquired. Common causes include:

Congenital causes:

  • Maternal infections
  • Maternal hypothyroidism
  • Certain medications
  • Radiation exposure
  • Birth asphyxia
  • Jaundice at birth
  • Low birth weight
  • Consanguinity (blood relatives marrying)

Acquired causes:

  • Chronic ear infections with discharge
  • Fluid accumulation in the ear due to frequent upper respiratory infections
  • Trauma to the ear
  • Noise trauma from loud sounds or prolonged exposure to noise (e.g., factory workers)
  • Use of ototoxic drugs (e.g., painkillers, anti-malarials, anti-cancer drugs)
  • Age-related hearing loss (typically after 60)
  • Systemic diseases such as diabetes, thyroid disorders, and autoimmune conditions

Signs and Symptoms of Hearing Loss

Mild hearing loss can be hard to detect. Early signs that may indicate hearing loss include:

  • Complaints that people mumble
  • Frequently asking others to repeat themselves
  • Avoiding noisy environments or social gatherings
  • Preferring the television or radio to be louder than normal
  • Difficulty hearing in public settings, such as movies or theaters

Diagnosis of Hearing Loss

Early diagnosis of hearing loss is essential for effective treatment. A thorough examination of the ears and simple hearing tests can identify many common causes. Diagnostic tools include:

  • Audiogram: A graph showing the ability to hear various frequencies
  • Neurological Testing and Imaging: In cases of brain-related hearing loss
  • Diagnostic Audiology Tests:
    • Pure Tone Audiometry (PTA)
    • Impedance Audiometry (Tympanometry, ART, Reflex Decay)
    • Speech Audiometry (SRT, SDS, MCL, UCL, DR)
    • Play Audiometry and Free-Field Audiometry
    • Special Tests (TDT / SISI)
    • Hearing Aid Trials & Fitting
    • Tests for Malingering/Functional Hearing Loss
    • OAE (Otoacoustic Emissions)
    • ABR / BERA (Auditory Brainstem Response Evaluations)
    • ASSR (Auditory Steady State Response)

Newborn Hearing Screening

Every newborn undergoes a hearing screening test before hospital discharge. Infants who do not pass the screening are referred for additional tests like ABR/BAER and ASSR. These tests help identify hearing loss early, ensuring timely intervention.

What is Audiometry?

Audiometry is the technique used to measure hearing ability. During the test, pure tones of controlled intensity are played, and the minimum volume required to hear each tone is recorded. A bone oscillator may also be used to test bone conduction. Audiometry can detect early-stage hearing loss caused by factors like acoustic trauma, chronic infections, or medication-induced hearing loss.

What is Auditory Brainstem Response (ABR or BERA)?

ABR (also called BERA) is a non-invasive test that records the electrical potentials generated by the auditory pathway. Electrodes are placed on the forehead and ears to measure brainstem responses to sound stimuli. This test typically takes 60-120 minutes and is used to diagnose hearing loss and neurological issues.

Treatment Options for Hearing Loss

Treatment depends on the type and cause of hearing loss. Some options include:

  • Hearing Aids: Beneficial for people with irreversible hearing loss. They amplify sound and improve communication.
  • Speech Therapy: A speech therapist helps improve speech intelligibility and language skills, especially for children and those with severe hearing loss.
  • Ear Surgeries: Various surgical interventions include: Removal of ear canal blockages, Grinding excess bone in the ear, Surgical drainage for middle ear infections, Repairing a perforated eardrum with a tiny graft, Surgery for otosclerosis

Benefits of Treatment

Treatment for hearing loss can significantly improve quality of life by:

  • Enhancing communication and family relationships
  • Improving physical health
  • Providing a greater sense of control over life events
  • Potentially increasing earning power and overall independence