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1 Chapter 1 : How to eliminate temporary hearing loss Middle ear infections are a common occurrence in childhood that can cause temporary hearing loss. Also called otitis media, middle ear infections result in inflammation, fluid build-up or a combination of both in the air-filled space behind the eardrum. February 8th, Learn the symptoms and find out when to seek medical help for your child. Also called otitis media, middle ear infections result in inflammation, fluid build-up or a combination of both in the air-filled space behind the eardrum. This build up can reduce the mobility of the eardrum and middle ear bones, leading to decreased hearing ability. If treated properly, the infection will clear and hearing will improve. Pain and tugging on ears can indicate an ear infection. It can be difficult to recognize symptoms for infants and toddlers who cannot verbally express the pain or irritation they might be experiencing. Fever Constant scratching or pulling at the ears Slower to respond to voices and other sounds Irritability For older children, adolescents and adults, these symptoms are common: It is important to act quickly because a middle ear infection can easily be treated and the pain alleviated. Left untreated, the infection can spread to other tissues in the brain, like the mastoid. Treatment Otitis media may be described as acute or chronic. Chronic otitis media can affect the middle ear for a much longer period of time, a month or more, and has a much higher risk of recurrence. It is also more likely to cause long-term conductive hearing loss or damage in the middle ear. Both types of otitis media can be treated with antibiotics, which help destroy the infection. Any fluids in the middle ear space will dissipate gradually over time once the inflammation and swelling are gone and the Eustachian tube can function properly to ventilate the middle ear space. If you suspect a middle ear infection in your child, act quickly to seek medical treatment. Until the fluids have cleared, the ear is susceptible to recurrent infections. It is important for the patient to continue to rest and take the entire prescribed course of antibiotics even though the symptoms may have subsided. Older children may report being able to hear better several days after they have resumed normal activities. This is a sign that the fluid build-up has resolved. For chronic otitis media, an otolaryngologist may recommend a minor surgical procedure to insert pressure-equalization PE tubes into the eardrum. This tube aerates the middle ear space through the ear canal, to allow any trapped fluids to dissipate. Often, the small tube falls out naturally after several months, when the Eustachian tube is functioning again. The eardrum will usually repair itself. Another common cause of recurrent otitis media is a chronic infection of the adenoids or tonsils. These glands are close to the Eustachian tube, so viral or bacterial invaders can easily spread to the middle ear. Often, surgeons will perform a single outpatient surgery to remove the glands and insert PE tubes. Once the surgical areas have healed and the middle ear space is ventilated, otitis media may cease to be a problem for these children. Causes Middle ear infections are more common in infants and toddlers than older children and adults due to the positioning of the Eustachian tube that changes rapidly as we develop. The Eustachian tube, which connects the middle ear with the back of the throat, is more horizontally positioned in infants and toddlers than older children. The area in red is the middle ear space, where fluid and infection can occur. This anatomical positioning, combined with a less-developed immune system, makes the middle ears of infants and toddlers more vulnerable to any infection that affects the respiratory system. This causes inflammation and swelling, which can effectively disable the Eustachian tube, rendering it incapable of equalizing the pressure in the middle ear space. With no ability to equalize, negative pressure builds up in the tiny middle ear space and normal cellular secretions begin to build up. The negative pressure and fluid can cause pain, pressure, dizziness and reduced hearing ability. It is not wise to leave a middle ear infection untreated. In some cases, the eardrum will burst from the pressure that builds up in the middle ear. Although it sounds scary, this is a natural response of the body and the eardrum will usually heal itself within three days. Implications for hearing All types of middle ear infection can cause some degree of temporary hearing loss. However, infants and toddlers who suffer from chronic otitis media experience stretches of mild hearing loss during a crucial learning period for speech and language. This is another reason why it is important to seek medical attention quickly. If you suspect your child may have a middle ear infection, contact a physician right away. Hearing ability will improve after the infection is healed and the fluid is resolved. Read more about Page 1

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3 Chapter 2 : Viral Causes of Hearing Loss: A Review for Hearing Health Professionals It's a Noisy Planet. Protect Their Hearing - A national campaign to prevent noise-induced hearing loss in 8- to year-old children Noisy Planet Teacher Toolkit - Provides easy-to-use resources for fun activities to teach preteens about the causes and prevention of noise-induced hearing loss. Print Overview Hearing loss that occurs gradually as you age presbycusis is common. About 25 percent of people in the United States between the ages of 55 and 64 have some degree of hearing loss. For those older than 65, the number of people with some hearing loss is almost 1 in 2. Aging and chronic exposure to loud noises are significant factors that contribute to hearing loss. Other factors, such as excessive earwax, can temporarily prevent your ears from conducting sounds as well as they should. You and your doctor or a hearing specialist can take steps to improve what you hear. Parts of the ear The ear is made up of three primary parts: Each section is composed of structures that play distinct roles in the process of converting sound waves into signals that go to the brain. Outer ear The outer ear is composed of the visible part of the ear pinna and the ear canal. The cup-shaped pinna PIN-uh gathers sound waves from the environment and directs them into the ear canal. Middle ear The middle ear is an air-filled cavity that holds a chain of three bones: These bones are separated from the outer ear by the eardrum tympanic membrane, which when struck by a sound wave, vibrates. The middle ear is connected to the back of your nose and upper part of your throat by a narrow channel called the auditory tube eustachian tube. The tube opens and closes at the throat end to equalize the pressure in the middle ear with that of the environment and drain fluids. Equal pressure on both sides of the eardrum is important for normal vibration of the eardrum. Bones of the middle ear The middle ear contains three tiny bones: Hammer malleus â attached to eardrum Anvil incus â in the middle of the chain of bones Stirrup stapes â attached to the membrane-covered opening that connects the middle ear with the inner ear oval window The vibration of the eardrum triggers a chain of vibrations through the bones. Because of differences in the size, shape and position of the three bones, the force of the vibration increases by the time it reaches the inner ear. This increase in force is necessary to transfer the energy of the sound wave to the fluid of the inner ear. Inner ear The inner ear contains a group of interconnected, fluid-filled chambers. The snail-shaped chamber, called the cochlea KOK-lee-uh, plays a role in hearing. Sound vibrations from the bones of the middle ear are transferred to the fluids of the cochlea. Tiny sensors hair cells lining the cochlea convert the vibrations into electrical impulses that are transmitted along the auditory nerve to your brain. The other fluid-filled chambers of the inner ear include three tubes called the semicircular canals vestibular labyrinth. Hair cells in the semicircular canals detect the motion of the fluids when you move in any direction. They convert the motion into electrical signals that are transmitted along the vestibular nerve to the brain. This sensory information enables you to maintain your sense of balance. Traveling to the brain Electrical impulses travel along the auditory nerve and pass through several information-processing centers. Signals from the right ear travel to the auditory cortex located in the temporal lobe on the left side of the brain. Signals from the left ear travel to the right auditory cortex. The auditory cortices sort, process, interpret and file information about the sound. The comparison and analysis of all the signals that reach the brain enable you to detect certain sounds and suppress other sounds as background noise. Symptoms Signs and symptoms of hearing loss may include: Muffling of speech and other sounds Difficulty understanding words, especially against background noise or in a crowd of people Trouble hearing consonants Frequently asking others to speak more slowly, clearly and loudly Needing to turn up the volume of the television or radio Withdrawal from conversations Avoidance of some social settings When to see a doctor If you have a sudden loss of hearing, particularly in one ear, seek immediate medical attention. Talk to your doctor if difficulty hearing is interfering with your daily life. Your hearing may have deteriorated if: Page 3

4 Chapter 3 : Causes of Sudden Hearing Loss Infection is a major contributor to loss of hearing. A key problemin addressing this is the general lack of awareness about issuesrelated to deafness and hearing impairment in all parts of societyand the specific lack of awareness regarding the role of infectionin causing it. Continuous pulling on the ear Fever Improper balance The Surgical Procedure The procedure to insert pressure-equalizing tubes is the most common operation for children in the U. It is brief and causes no discomfort. General inhalation anesthesia is used for this procedure. You will also be provided with written descriptions of the procedure and follow-up home care which include what to do if you notice bleeding, if the ear plugs are unsatisfactory or if water gets into the ears. Please contact us at any time with questions or for clarification. At the time of surgery, any fluid in the ear is suctioned out and the tubes are carefully inserted. They will stay in place for about six to eighteen months and then usually come out on their own. The tubes are so small that they may not be detected. The child should experience little or no pain following surgery. They may follow their normal diet when fully awake. Any discomfort should be managed with Tylenol. Ear drops may be prescribed. Drainage may be yellow or pink tinged following surgery. The child may return to school and resume normal activities the day after surgery. As long as there is a tube in the ear, care should be taken to avoid water contamination when bathing, washing hair, etc. Water must be kept out of the ears to prevent infection, so ear plugs must be used when bathing, washing hair, swimming or engaging in similar activities. Ear molds may be necessary for underwater activity. Ear plugs are available in our office. Hearing Aids and Restoration of Hearing Loss It is possible to have a hearing loss but not know it simply because it does not interfere with everyday living. Or you may experience difficulty hearing only in certain situations because of ambient sound. If it is determined that your hearing problem cannot be helped by medical or surgical treatments, a hearing aid might be prescribed. Hearing Aids and Restoration of Hearing Loss The ear hears through three separate parts with three separate functions: These three parts translate sound into signals the brain can interpret and understand. A sound may be distorted or lost anywhere along this path. Head injury or stroke may cause permanent damage. Streptomycin, diuretics, ototoxic drugs and large doses of aspirin can cause damage to the inner ear. Heart or kidney disease, diabetes, smoking, emphysema or stroke can disrupt blood flow to the inner ear, also causing permanent hearing loss. Hearing impairment commonly occurs with age, although it may result from trauma, disease, noisy exposure, medication and heredity. This impairment is defined as any degree of loss for the hearing of loudness or pitch outside the normal range. Some indications of hearing loss are: Inability to hear very quiet sounds Difficulty distinguishing between similar sounding words Listening to the television or radio with abnormally loud volume Trouble distinguishing conversations from surrounding the noise Aiding hearing by increased reliance on sight Loss of very high or very low pitch A feeling of insecurity or isolation Delayed speech The Hearing Aid Function A thorough hearing test must be administered to help pinpoint the exact amount and type of hearing loss. Following examination, you will be presented with hearing aid options â if they are available. It is important to remember that while hearing aids make sound louder, they do not make speech clearer. They also cannot restore hearing; rather, they simply amplify sound to the desirable level. Generally, there are five basic designs for hearing aids. A body type hearing aid is worn on the body with a cord connecting the aid to a receiver that snaps onto the ear mold. A behind-the-ear BTE hearing aid is smaller and requires no connecting cord. It is positioned behind the ear and is connected by clear tubing to the ear mold. An eyeglass hearing aid is a variation of the behind-the-ear model, simply mounted on a pair of glasses. All-in-the-ear hearing aids are ear molds that contain all of the hearing aid mechanisms. Canal hearing aids are actually inserted in the ear canal, making them the smallest type available. Clinical research has indicated that a hearing aid wearer derives the most benefit from hearing aids when wearing two devices. This increases the quantity of sound signals received in both ears. Hearing aids help those who have experienced hearing loss find a way to rediscover some of what they had lost with their hearing. Many people with a hearing problem can be helped with medical treatment, surgery or hearing aids. Page 4

5 Chapter 4 : Hearing Impairment and Deafness Conductive hearing loss is a form of hearing impairment where the transmission of sound from the environment to the inner ear is impaired, usually from an abnormality of the external auditory canal or middle ear. Dedicated To Your Hearing Needs Our friendly team of hearing professionals will provide you with highest quality in hearing healthcare. Our Locations Discover if you may be suffering from hearing loss Deciding if hearing aids are the right choice for you can be a tough decision. Our free online hearing survey can help. Education is the key to better hearing health Make informed decisions on the purchase of your next hearing aid device! We carry the latest in hearing aid technology Todays hearing aid technology are smaller than ever and they produce the clearest, most natural sounds. Ear Infections and Hearing Loss What is an ear infection? Inflammation and fluid buildup behind the eardrum causes pressure and pain for the person. Usually the infection is caused by a cold or flu or allergies causing congestion and inflammation of the throat, Eustachian tubes and nasal passages; in some cases, a person may have a chronic ear infection which can then lead to hearing loss. Hearing loss usually occurs with ear infections, though most of the time they are temporary due to the inflammation and fluid buildup in the ear; however, chronic ear infections can cause permanent hearing damage. Acute otitis media is an ear infection that is short lived and causes by a cold or flu or allergies. There is a buildup of fluid behind the eardrum and some inflammation. The ear aches and a fever is sometimes present, but will go away. If there is a buildup of fluid behind the eardrum from either an ear infection or if it does not drain properly on its own, this is called otitis media with effusion, meaning that the fluid can distort the hearing causing a temporary hearing loss. However, if the fluid remains with increased pressure on the eardrum, the eardrum could burst, which can therefore lead to an infection and a conductive hearing loss in the present or future. Typically an ear infection will cause a conductive hearing loss due to the decreased flexibility of the eardrum from the fluid and pressure behind the ear drum. This can be anywhere from a db loss in hearing depending on the thickness of the fluid, the pressure on the eardrum and the inflammation. For most it will sound as though they are wearing earplugs or are underwater. This usually goes away once the ear infection has cleared; however, if chronic ear infections or a burst eardrum occurs from otitis media with effusion, a more permanent hearing loss can occur. Usually a conductive hearing loss ensues, but depending on the severity of the infection and where the infection occurred, a sensorineural hearing loss or even a mixed hearing loss may occur. If the fluid behind the eardrum is not draining properly, a tympanostomy tube may be placed in the eardrumto help with drainage to decrease the risk of infection, perforation of the eardrum and hearing loss. As with any problem involving the ear, a doctor or hearing health professional should be seem to determine the problem and the proper course of action to fix it. With ear infections, especially chronic ear infections, a health care professional should be seen to help ensure there is not a bigger problem and to reduce the risk of hearing loss as much as possible. Page 5

6 Chapter 5 : Ear Infection and Hearing Loss Ear infection hearing loss is a type of conductive hearing loss Conductive hearing loss affects the outer or middle ear rather than the auditory nerve, the way sensorineural hearing loss does. Conductive hearing loss is commonly caused by an obstruction in the middle ear. Ear Infection and Hearing Loss What is otitis media and ear infection? Otitis media refers to inflammation of the middle ear. This can cause earache and fever. Fluid can remain in the ear for weeks to many months. If not treated, chronic ear infections have potentially serious consequences such as temporary hearing loss. Why do children have more ear infections than adults? To understand earaches and ear infections, you must first know about the Eustachian tube, a narrow channel connecting the inside of the ear to the back of the throat, just above the soft palate and uvula. The tube allows drainage of fluid from the middle ear, which prevents it from building up and bursting the thin ear drum. In a healthy ear, the fluid drains down the tube, assisted by tiny hair cells, and is swallowed. The tube maintains middle ear pressure equal to the air outside the ear, enabling free eardrum movement. Normally, the tube is collapsed most of the time in order to prevent the many germs residing in the nose and mouth from entering the middle ear. Infection occurs when the Eustachian tube fails to do its job. When the tube becomes partially blocked, fluid accumulates in the middle ear, trapping bacteria already present, which then multiply. Additionally, as the air in the middle ear space escapes into the bloodstream, a partial vacuum is formed that absorbs more bacteria from the nose and mouth into the ear. Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. It also makes it harder for the ears to clear the fluid, since it cannot drain with the help of gravity. How does otitis media affect hearing? Most people with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels â equivalent to wearing ear plugs. Twenty-four decibels is about the level of the very softest of whispers. Thicker fluid can cause much more loss, up to 45 decibels the range of conversational speech. Suspect hearing loss if one is unable to understand certain words and speaks louder than normal. Types of hearing loss Conductive hearing loss is a form of hearing impairment where the transmission of sound from the environment to the inner ear is impaired, usually from an abnormality of the external auditory canal or middle ear. This form of hearing loss can be temporary or permanent. Untreated chronic ear infections can lead to conductive hearing loss. If fluid is filling the middle ear, hearing loss can be treated by draining the middle ear and inserting a tympanostomy tube. The other form of hearing loss is sensorineural hearing loss, hearing loss due to abnormalities of the inner ear or the auditory division of the 8th cranial nerve. Historically, this condition can occur at all ages, and is usually permanent. When should a hearing test be performed related to frequent infections or fluid? A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. They include the otoscopy, tympanometer and audiometer. Do people lose their hearing for reasons other than chronic otitis media? Children and adults can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. Cerumen impaction compressed earwax Otitis externa: A mass of horn-shaped squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media. This is a disease of the otic capsule bony labyrinth in the ear, which is more prevalent in adults and characterized by formation of soft, vascular bone leading to progressive conductive hearing loss. It occurs due to fixation of the stapes bones in the ear. Sensorineural hearing loss may result because of involvement of the cochlear duct. A trauma to the ear or head may cause temporary or permanent hearing loss. Page 6

7 Chapter 6 : Can Ear Infections Cause Hearing Loss? Mixed hearing loss is a combination of conductive and sensorineural hearing loss. There may be a problem in the outer or middle ear and in the inner ear or auditory nerve. What is ear infection hearing loss? Got a question about hearing loss or hearing aids? One of our on-staff Starkey audiologists is all ears. Hearing loss can be caused by a number of different factors including aging, injury, noise exposure, infection and heredity. Those factors affect the auditory nerve, causing a sensorineural hearing loss, the most common type of hearing loss. But did you know an ear infection can also cause hearing loss? Hearing loss caused by an ear infection is referred to as a conductive hearing loss. Infection in the middle ear can cause fluid to build up, obstructing the movement of the eardrum and the tiny bones attached to it. Ear infection hearing loss is a type of conductive hearing loss Conductive hearing loss affects the outer or middle ear rather than the auditory nerve, the way sensorineural hearing loss does. Conductive hearing loss is commonly caused by an obstruction in the middle ear. The middle ear moves to send sounds to your auditory nerve. Any obstruction can prevent sounds from passing through the middle ear and cause hearing loss. A buildup of wax, fluid in the middle ear, or a hole in the ear drum can each cause conductive hearing loss. The infection can cause a buildup of fluid, making it difficult for the eardrum and the ossicular chain to work together to move sounds to the auditory nerve. The ossicular chain in the middle ear is made up of the three smallest bones in your body. Called the malleus, incus and stapes, each one is as small as a single grain of rice. Ear infection hearing loss is often temporary Hearing loss caused by an ear infection is usually temporary and subsides after treatment. Your physician may choose to treat your ear infection with antibiotics. If the antibiotics successfully treat the infection, your hearing should return to normal. If you have a history of recurrent ear infections, your physician may insert a tube in your ear drum to help the fluid drain. Eliminating the buildup of fluid relieves the pain and pressure that often accompanies an ear infection and can prevent the eardrum from rupturing. If fluid builds up without resolution, the pressure can cause your eardrum to rupture. A history of recurrent ear infections can also lead to tympanosclerosis, which is the thickening or scarring of the tympanic membrane. A perforated eardrum and tympanosclerosis adversely affect the mobility of the eardrum and reduce hearing acuity. If your hearing does not return to normal following treatment, your physician and hearing professional may recommend hearing aids to treat the unresolved hearing loss. What to do if you think you have hearing loss If you have trouble hearing, it is important to have your hearing tested by a hearing professional, so the degree and type of hearing loss can be identified. Your hearing professional will identify the type of hearing loss you have and discuss the best treatment option with you following your hearing evaluation. Click here to find a hearing professional near you. Page 7

8 Chapter 7 : Hearing loss - Symptoms and causes - Mayo Clinic Hearing loss usually occurs with ear infections, though most of the time they are temporary due to the inflammation and fluid buildup in the ear; however, chronic ear infections can cause permanent hearing damage. The Sinus-Ear Connection A sinus infection is certainly no fun. You may have a sore throat and fever, stuffed-up nasal passages, facial tenderness, and an unbearable pain behind your eyes, cheeks and forehead. These are all symptoms commonly associated with sinus infections sinusitis. You may also be having trouble hearing. But how, exactly, could a sinus infection lead to hearing loss? Simply put, a sinus infection is a swelling, or inflammation, of the para-nasal sinuses known as the sinus cavity. These are the hollow spaces located in the bones, near the nose and between the eyes. When the sinuses become inflamed, the glands in the sinus start secreting more mucus than normal, blocking the nasal passageways and preventing the mucus from draining out of the sinus cavities like it should. A sinus infection may be brought on by an allergic reaction or a bacterial, viral or fungal infection. In some cases, tooth extraction or certain dental procedures may also lead to sinusitis. Because the sinuses are closely located beside the ear canal, when the sinuses are clogged and congested, it can also affect the ears. This blockage in the sinuses can cause the Eustachian tube the channel which connects the middle ear to the throat and regulates ear pressure to become swollen and blocked, sucking fluid into the ear space. This leads to pressure on the eardrum, which can result in pain and hearing loss. At the very least, sounds may seem muffled, as if coming through a long tunnel or being heard underwater. Other times, the hearing loss may be much more severe. The good news is that in most cases this type of hearing loss is temporary: Once the sinus infection is cleared up and the fluids drain away from the nasal passages and the Eustachian tube, typically hearing is restored. If the ear infection is not cured, that can damage the small bones present in the middle ear, which can result in a number of painful or uncomfortable symptoms including tinnitus a ringing in the ears, vertigo a sense of loss of balance, and bleeding or rupturing of the eardrum. The worst-case scenario would be permanent and complete hearing loss. To protect your hearing, it is critical that you seek immediate medical treatment for any type of sudden hearing loss. If the cause of your hearing problems is sinusitis, initial treatment may include medication such as antibiotics along with anti-histamines and analgesics. Steam inhalation may be recommended to relieve nasal congestion. If treated early, the risk of permanent damage to the ear can be effectively reduced. If your sinus problems are chronic or more severe, a surgical treatment may be recommended. Sinus-related hearing loss can be completely avoided by treating the sinus infection before it spreads to the ears. Sinusitis is diagnosed by physical examination of the symptoms and x-ray of the para-nasal cavities. In some cases, a CT scan may be recommended to evaluate the extent of the infection. Your physician may also test the fluid in the ears to detect the type of infection and provide medication accordingly. ENT physicians have the education, training and experience necessary to properly evaluate and treat hearing loss, sinus and ear infections, and even vertigo and balance disorders that often develop as a result of pressure in the Eustachian tube. If you live in the Atlanta area and are experiencing sudden hearing loss, contact the Sinus Institute of Atlanta. Pradeep Sinha and his staff treat all diseases of the ears, nose and throat. Please call today to schedule your appointment, or fill out our online contact form to request a consultation. Page 8

9 Chapter 8 : Ear Infections and Hearing Loss whereas in asymptomatic ccmv children unilateral hearing loss is more common [9].Thus, hearing impairment is the most likely defect to be found in asymptomatic ccmv children. Otitis media refers to inflammation of the middle ear. This can cause earache and fever. Fluid can remain in the ear for weeks to many months. If not treated, chronic ear infections have potentially serious consequences such as temporary hearing loss. Why do children have more ear infections than adults? To understand earaches and ear infections, you must first know about the Eustachian tube, a narrow channel connecting the inside of the ear to the back of the throat, just above the soft palate and uvula. The tube allows drainage of fluid from the middle ear, which prevents it from building up and bursting the thin ear drum. In a healthy ear, the fluid drains down the tube, assisted by tiny hair cells, and is swallowed. The tube maintains middle ear pressure equal to the air outside the ear, enabling free eardrum movement. Normally, the tube is collapsed most of the time in order to prevent the many germs residing in the nose and mouth from entering the middle ear. Infection occurs when the Eustachian tube fails to do its job. When the tube becomes partially blocked, fluid accumulates in the middle ear, trapping bacteria already present, which then multiply. Additionally, as the air in the middle ear space escapes into the bloodstream, a partial vacuum is formed that absorbs more bacteria from the nose and mouth into the ear. Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. It also makes it harder for the ears to clear the fluid, since it cannot drain with the help of gravity. How does otitis media affect hearing? Most people with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels â equivalent to wearing ear plugs. Twenty-four decibels is about the level of the very softest of whispers. Thicker fluid can cause much more loss, up to 45 decibels the range of conversational speech. Suspect hearing loss if one is unable to understand certain words and speaks louder than normal. Types of hearing loss Conductive hearing loss is a form of hearing impairment where the transmission of sound from the environment to the inner ear is impaired, usually from an abnormality of the external auditory canal or middle ear. This form of hearing loss can be temporary or permanent. Untreated chronic ear infections can lead to conductive hearing loss. If fluid is filling the middle ear, hearing loss can be treated by draining the middle ear and inserting a tympanostomy tube. The other form of hearing loss is sensorineural hearing loss, hearing loss due to abnormalities of the inner ear or the auditory division of the 8th cranial nerve. Historically, this condition can occur at all ages, and is usually permanent. When should a hearing test be performed related to frequent infections or fluid? A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. They include the otoscopy, tympanometer and audiometer. Do people lose their hearing for reasons other than chronic otitis media? Children and adults can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. Cerumen impaction compressed earwax Otitis externa: A mass of horn-shaped squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media. This is a disease of the otic capsule bony labyrinth in the ear, which is more prevalent in adults and characterized by formation of soft, vascular bone leading to progressive conductive hearing loss. It occurs due to fixation of the stapes bones in the ear. Sensorineural hearing loss may result because of involvement of the cochlear duct. A trauma to the ear or head may cause temporary or permanent hearing loss. Page 9

10 Chapter 9 : Learn how middle ear infections can affect hearing ability Some causes of hearing loss include damage to the inner ear, a buildup of earwax, infections and a ruptured eardrum. To understand how hearing loss occurs, it can be helpful to understand how you hear. Hearing impairment refers to all degrees of loss, from mild to profound. Deafness refers to more severe-to-profound loss. Hearing impairment can result from tumors, trauma, infection and other disorders. Profound Deafness in Both Ears Hearing loss in children can happen at birth in both ears, and adults can acquire deafness in both ears. When the patient cannot benefit from aggressive hearing aid amplification in both ears, cochlear implant surgery can be offered. Courtesy of Cochlear Americas A cochlear implant has an external part, shown here, and an internal part, implanted surgically. Headphone connection enables the rehabilitationist to hear what the patient hears. We have performed more than cochlear implant surgery procedures yearly, half of them in children. Most cases of hearing loss in children are not severe and allow the child to develop good vocabulary and grow up smoothly in the hearing world after surgery. Many adults who acquire deafness also can use the telephone well and converse in a normal fashion. Implanted hearing device technology is the fastest growing surgical field in otology-neurotology, and the new Center for Implantable Hearing Devices at Hillcrest Hospital offers state-of-the-art surgery and rehabilitation, using Cochlear Nucleus, Med-El and Advanced Bionics implants. In addition, more patients are going for bilateral cochlear implants which significantly helps hearing in real world conditions. Hearing preservation cochlear implant surgery is also being developed. Profound Deafness in One Ear The bone-anchored device consists of an implanted titanium screw A and a removable speech processor B. Implanted Titanium Screw B. Both systems pick up sound on the deaf side and transfer it to the normal side, the CROS aid usually by a wire or radio connection and BAHA by sound vibration traveling directly through the skull. BAHA requires outpatient surgical placement of a titanium screw into the skull. After three months the screw incorporates well into the bone and an external sound processor can be attached and removed as desired. Wound breakdown, bleeding and infection are possible but very uncommon complications of surgery. Otosclerosis The stapes bone is fixed in position by surrounding bone so it cannot vibrate to conduct sound. The eardrum is raised, stapes removed, a small hole drilled, and prosthesis placed. Different prostheses require different techniques. The stapes, a small stirrup-shaped bone in the middle ear, can become fixed to surrounding bone in one or both ears by a benign, progressive, often familial condition called otosclerosis. When hearing loss from otosclerosis interferes with quality of life, the patient can wear a hearing aid or have outpatient surgery through the ear canal to replace the stapes with a small prosthesis of platinum, titanium, Teflon or other material. Although stapes surgery has been well described for more than 40 years, cases are less frequent now and technical demands of surgery require expert care from individuals who frequently perform microscopic ear surgery. While dizziness, change of taste and numbness on the same side of the tongue can occur after surgery, these symptoms usually resolve spontaneously. Other Diseases The malleus, incus and stapes can be fixed or destroyed by other disease such as infection. Such problems are usually repaired when infection is cured. Occasionally the middle ear is explored in outpatient surgery to correct problems with these ossicles, either through the ear canal or through an incision behind the ear. Success varies with extent of disease. Bilateral hearing loss from chronic infection also can be rehabilitated by a bone-anchored hearing device BAHA. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-cleveland Clinic products or services. Page 10