Hearing Loss?

Hearing loss is one of the most prevalent chronic conditions in the United States, with more than 19 million Americans age 45 and over having hearing loss. The National Council on the Aging (NCOA) released a groundbreaking study in 1999 that showed the significant impact that untreated hearing loss had on an individual’s emotional and social well-being. Individuals with untreated hearing loss were more likely to report depression, anxiety, irritability, anger and were less likely to participate in organized social activities. Those using hearing instruments reported benefits in many areas of their lives, ranging from their relationships at home to a sense of independence and physical well-being. Family members also noticed these improvements. Other studies have shown that symptoms of untreated hearing loss mimic the outward behavioral characteristics of early onset Alzheimer’s Disease. An individual with even a moderate hearing loss has a total functional impact similar to those exhibited by people with a major medical condition.

Common Signs of Hearing Loss

• You may hear but not understand people
• You may have difficulty understanding radio, television or public address systems
• You need to watch a person’s lips in order to understand
• You find yourself asking people to repeat what they have said
• You may pretend to understand
• You may avoid people and isolate yourself
• You may find it emotionally and physically exhausting to communicate
• It appears that you are the only one who has these difficulties

Type of Hearing Loss

Hearing loss can be categorized by where or what part of the auditory system is damaged. There are three basic types of hearing loss – conductive hearing loss, sensorineural hearing loss and mixed hearing loss.

Conductive Hearing Loss

Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones, or ossicles, of the middle ear. Conductive hearing loss usually involves a reduction in sound level, or the ability to hear faint sounds. This type of hearing loss can often be medically or surgically corrected.

Examples of conditions that may cause a conductive hearing loss include:

• Conditions associated with middle ear pathology such as fluid in the middle ear from colds, allergies (serous otitis media), poor eustachian tube function, ear infection (otitis media), perforated eardrum, benign tumors
• Impacted earwax (cerumen)
• Infection in the ear canal (external otitis)
• Presence of a foreign body
• Absence or malformation of the outer ear, ear canal or middle ear

Sensorineural Hearing Loss

Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear (retrocochlear) to the brain. Sensorineural hearing loss cannot be medically or surgically corrected. It is a permanent loss.

Sensorineural hearing loss not only involves a reduction in sound level, or ability to hear faint sounds, but also affects speech understanding, or ability to hear clearly.

Sensorineural hearing loss can be caused by diseases, birth injury, drugs that are toxic to the auditory system, and genetic syndromes. Sensorineural hearing loss may also occur as a result of noise exposure, viruses, head trauma, aging and tumors.

Mixed Hearing Loss

Sometimes a conductive hearing loss occurs in combination with a sensorineural hearing loss. In other words, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve. When this occurs, the hearing loss is referred to as a mixed hearing loss.

Configuration of Hearing Loss

The configuration or shape of the hearing loss refers to the extent of hearing loss at each frequency and the overall picture of hearing that is created. For example, a hearing loss that only affects the high frequencies would be described as a high-frequency loss. Its configuration would show good hearing in the low frequencies and poor hearing in the high frequencies. On the other hand, if only the low frequencies are affected, the configuration would show poorer hearing for low tones and better hearing for high tones. Some hearing loss configurations are flat, indicating the same amount of hearing loss for low and high tones.

Other descriptors associated with hearing loss are:

• Bilateral versus unilateral. Bilateral hearing loss means both ears are affected. Unilateral hearing loss means only one ear is affected.
• Symmetrical versus asymmetrical. Symmetrical hearing loss means that the degree and configuration of hearing loss are the same in each ear. An asymmetrical hearing loss is one in which the degree and/or configuration of the loss is different for each ear.
• Progressive versus sudden hearing loss. Progressive hearing loss is a hearing loss that becomes increasingly worse over time. A sudden hearing loss is one that has an acute or rapid onset and therefore occurs quickly, requiring immediate medical attention to determine its cause and treatment.
• Fluctuating versus stable hearing loss. Some hearing losses change—sometimes getting better, sometimes getting worse. Fluctuating hearing loss is typically a symptom of conductive hearing loss caused by ear infection and middle ear fluid, but also presents in other conditions such as Meniere's disease.

Dizziness and Balance Disorders

Millions of Americans have disorders of balance they describe as dizziness.   A balance disorder is a disturbance that causes an individual to feel unsteady, giddy, woozy, or have a sensation of movement, spinning or floating. An organ in our inner ear, the labyrinth, is an important part of our vestibular (balance) system. The labyrinth interacts with other systems in the body, such as the visual (eyes) and skeletal (bones and joints) systems, to maintain the body's position. These systems, along with the brain and the nervous system, can be the source of balance problems.

What are the symptoms of a balance disorder?

When balance is impaired, an individual has difficulty maintaining orientation. For example, an individual may experience the “room spinning” and may not be able to walk without staggering, or may not even be able to arise. Some of the symptoms a person with a balance disorder may experience are:

• A sensation of dizziness or vertigo (spinning)
• Falling or a feeling of falling
• Lightheadedness or feeling woozy
• Visual blurring
• Disorientation

Some individuals may also experience nausea and vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, anxiety or panic. Some reactions to the symptoms are fatigue, depression, and decreased concentration. The symptoms may appear and disappear over short time periods or may last for a longer period of time.

What causes a balance disorder?

Infections (viral or bacterial), head injury, disorders of blood circulation affecting the inner ear or brain, certain medications and aging may change our balance system and result in a balance problem. Individuals who have illnesses, brain disorders, or injuries of the visual or skeletal systems, such as eye muscle imbalance and arthritis, may also experience balance difficulties. A conflict of signals to the brain about the sensation of movement can cause motion sickness (for instance, when an individual tries to read while riding in a car). Some symptoms of motion sickness are dizziness, sweating, nausea, vomiting and generalized discomfort. Balance disorders can be due to problems in any of four areas:

• Peripheral vestibular disorder, a disturbance in the labyrinth
• Central vestibular disorder, a problem in the brain or its connecting nerves
• Systemic disorder, a problem of the body other than the head and brain
• Vascular disorder, or blood flow problems

What are some types of balance disorders?

Some of the more common balance disorders are:

Benign Paroxysmal Positional Vertigo (BPPV) – a brief, intense sensation of vertigo that occurs because of a specific positional change of the head. An individual may experience BPPV when rolling over to the left or right upon getting out of bed in the morning, or when looking up for an object on a high shelf. The cause of BPPV is not known, although it may be caused by an inner ear infection, head injury or aging.

Labyrinthitis – an infection or inflammation of the inner ear causing dizziness and loss of balance.

Ménière's disease – an inner ear fluid balance disorder that causes episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears), and the sensation of fullness in the ear. The cause of Ménière's disease is unknown.

Vestibular neuronitis – an infection of the vestibular nerve, generally viral.

Perilymph fistula – a leakage of inner ear fluid to the middle ear. It can occur after head injury, physical exertion or, rarely, without a known cause.

How are balance disorders diagnosed?

Diagnosis of a balance disorder is complicated because there are many kinds of balance disorders and because other medical conditions--including ear infections, blood pressure changes, and some vision problems – and some medications may contribute to a balance disorder.  Your physicians at ENT and Allergy Associates of Florida will obtain a detailed medical history and perform a physical examination to start to sort out possible causes of the balance disorder. The physician may require tests to assess the cause and extent of the disruption of balance. The kinds of tests needed will vary based on the patient’s symptoms and health status and therefore not all patients will require every test.

Some examples of diagnostic tests your physician may request are a hearing examination, blood tests, audiology tests including a videonystagmogram (VNG), vestibular evoked myogenic potential (VEMP), electrochleography and/or imaging studies of the head and brain.

VNG testing is used to determine if a vestibular (inner ear) disease may be causing a balance or dizziness problem, and is one of the only tests available today that can distinguish between a unilateral (one ear) and bilateral (both ears) vestibular loss. VNG testing is a series of tests designed to document a person’s ability to follow visual objects with their eyes and how well the eyes respond to information from the vestibular system.  To monitor the movements of the eyes, infrared goggles are placed around the eyes to record eye movements during testing.  A caloric test may be performed as part of the VNG, in which each ear is irrigated with warm and then cool air, usually one ear at a time; the amount of nystagmus resulting is measured. Weak nystagmus or the absence of nystagmus may indicate an inner ear disorder.

The Vestibular Evoked Myogenic Potential test is recognized as an important tool in the routine vestibular test battery. Whereas traditional ENG/VNG test batteries may be used to assess the semicircular canals, the VEMP test is specifically for assessing the Saccule and associated Inferior Vestibular Nerve function, which may assist in explaining the cause for your dizziness and/or balance disorder.

An additional procedure to assist in obtaining a diagnosis is an electrochleography.  An electrochleography is an inner ear test involving the use of sound stimulation to provide electrical measurements which can be used to assist in the diagnosis of Méniére's disease.

How are balance disorders treated?

There are various options for treating balance disorders. One option includes treatment for a disease or disorder that may be contributing to the balance problem, such as ear infection, stroke, or multiple sclerosis. Individual treatment will vary and will be based upon symptoms, medical history, general health, examination by a physician, and the results of medical and audiological tests.

Another treatment option includes balance retraining exercises (vestibular rehabilitation). The exercises include movements of the head and body specifically developed for the patient. This form of therapy is thought to promote compensation for the disorder. Vestibular retraining programs are administered by professionals with knowledge and understanding of the vestibular system and its relationship with other systems in the body.

For people diagnosed with Ménière's disease, dietary changes such as reducing intake of sodium may help. For some people, reducing alcohol, caffeine, and/or avoiding nicotine may be helpful. Some aminoglycoside antibiotics, such as gentamicin and streptomycin, are used to treat Ménière's disease. Systemic streptomycin (given by injection) and topical gentamicin (given directly to the inner ear) are useful for their ability to affect the hair cells of the balance system. Gentamicin also can affect the hair cells of the cochlea, though, and cause hearing loss. In cases that do not respond to medical management, surgery may be indicated.

For additional information, please do not hesitate to ask your physician or audiologist.