Hearing Loss And/Or Tinnitus

Hearing loss is divided into two types: conductive and sensorineural. Conductive hearing loss is due to a problem in the outer or middle ear, while sensorineural hearing loss is due to a problem in the inner ear or central nervous system. Tinnitus is the sensation of noise in the ear when no external noise is present. It is often described as ringing in the ears, although the sound may be a low pitched roaring or a high pitched ringing. Occasionally the tinnitus is pulsatile like the heartbeat.

Causes of conductive hearing loss and tinnitus include wax impaction, foreign bodies, tumors or infections of the outer ear, perforations of the eardrum, infections or persistent fluid in the middle ear, abnormalities of the middle ear bones, such as dislocation, erosion, fracture or fixation, cholesteatoma (skin trapped in the middle ear and/or mastoid), and otosclerosis (fixation of the third middle ear bone to the inner ear). All can be treated with medicines or surgery. Wax and foreign bodies are removed. Infections are treated with antibiotics and/or surgery. Tumors and cholesteatoma are excised. Persistent fluid is treated with middle ear ventilation tubes. Perforations, abnormalities of the middle ear bones, and otosclerosis are repaired. In most cases, the conductive hearing loss and tinnitus improve.

Sensorineural hearing loss and tinnitus have many different causes and the work-up is usually quite involved. In a surprising number of cases, the cause is never identified. The goal of the work-up is to eliminate serious causes that may be life-threatening or that may result in other organ system involvement. Whether or not the cause is identified, an attempt is made to treat the hearing loss and tinnitus. The general basic work-up includes a hearing test and several laboratory blood tests. Depending on the results of these initial tests, other tests may be ordered, including more advanced hearing tests and possibly magnetic resonance imaging (MRI).

Metabolic causes of hearing loss and tinnitus include high blood pressure, high cholesterol, diabetes, thyroid disease, anemia, and calcium disorders. Autoimmune causes include rheumatoid arthritis, lupus, sarcoid, and other more rare disorders. Infectious diseases such as syphilis and meningitis may also cause hearing loss and tinnitus. The above causes can often be identified by laboratory testing. Treatment of these conditions may not improve the symptoms.

Acoustic neuroma is a benign tumor that forms on the nerve of hearing or the nerve of balance between the ear and the brain. It can usually be cured with surgery but can be life-threatening if untreated. Hearing tests can identify this tumor but MRI is needed to confirm its presence.

Meniere's disease is a condition where fluid builds up in the inner ear, resulting in episodic vertigo, pressure in the ear, and a fluctuating hearing loss and ringing in the ear. The hearing loss can vary from time to time but generally continues to worsen. There is no one diagnostic test for Meniere's disease, but the history and results of the hearing and balance tests may suggest the diagnosis. The first treatment for Meniere's disease is diuretic therapy with potassium supplementation. If this fails, various surgical procedures to lower inner ear pressure may relieve the vertigo. In most cases, the hearing continues to worsen. Allergies, particularly to foods, may lead to build up of inner ear fluid and to symptoms that mimic Meniere's disease. Identification and treatment of these allergies usually results in an improvement in these symptoms.

Congenital causes of hearing loss result from abnormalities during fetal development. Often CT scanning and specialized laboratory testing are necessary to make the diagnosis. In most cases, hearing aids are the only treatment option, although surgery may help if the hearing loss is conductive.

Noise exposure can lead to hearing loss and tinnitus that may be temporary or permanent. The hearing test usually shows a characteristic pattern and, along with the history, makes the diagnosis. The only treatment available is a hearing aid, if the hearing loss is severe enough.

Presbyacusis is hearing loss and tinnitus due to aging. It affects the high frequencies first and then eventually all frequencies are involved. Again the only treatment available is a hearing aid, if the hearing loss is severe enough.

In some cases of sudden hearing loss, steroids may be of benefit. If tinnitus affects sleeping patterns, antidepressants may help. Niacin, a B-vitamin, has been shown to reduce tinnitus in 50% of patients in clinical trials. Besides amplifying sound and improving hearing, aids may also decrease tinnitus. Tinnitus maskers, such as humidifiers, radios, the Sound Spa, and non-amplifying hearing aids can drown out the offensive ringing with a more pleasant sound.