Hearing loss in both ears can be either conductive, sensorineural, or a mixture of both. It’s best to see an audiologist whenever you think there is a noticeable change in both your ears. They’ll fully assess your ears and perform a number of tests to determine the type of hearing loss you may have, and they’ll be able to recommend the best treatment option to help.
Prolonged exposure to loud sounds is the most common cause of tinnitus. Up to 90% of people with tinnitus have some level of noise-induced hearing loss. The noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. Carpenters, pilots, rock musicians, street-repair workers, and landscapers are among those whose jobs put them at risk, as are people who work with chain saws, guns, or other loud devices or who repeatedly listen to loud music. A single exposure to a sudden extremely loud noise can also cause tinnitus.
Try the skull-thumping trick. If you're coming home from a concert or a club, and your ears won't stop ringing, it's because you've damaged some of the little hairs in your cochlea, which causes inflammation and stimulation of nerves. Your brain interprets this inflammation as constant ringing or buzzing, and this trick can help make that annoying sound go away.
A perforated (ruptured, punctured) eardrum (tympanic membrane) is a hole or tear in the eardrum. The eardrum separates the ear canal and middle ear. Most ruptured eardrums do not cause pain, however, the condition can be uncomfortable. Bacteria, viral, and fungal infections are the most common causes a ruptured eardrum. Earwax removal attempts, changes in air pressure, and trauma are other causes of a ruptured eardrum.
The first major report regarding acoustic shock was published in Denmark5 but this was part of an internal company report and the text not easily accessible. The first widely available publication was from Australia1 and described the clinical features of 103 call centre workers who had been exposed to acoustic incidents. There have been further publications describing acoustic shock from Australia,6 the United Kingdom7,8 and India.9 Although there has been some interest generated regarding this geographical distribution there are unofficial reports of acoustic shock occurring in many other countries. There are also anecdotal reports of acoustic shock symptomatology occurring in people exposed to sudden unexpected sound but not wearing headsets or handsets. In these cases the causative sound is usually generated close to the person and this proximity of the sound source to the ear does seem to be a common feature of the syndrome. There have been reports of acoustic shock occurring in clusters. There is a slight female preponderance of cases of acoustic shock though further work is needed to ascertain whether this gender imbalance is genuine or simply reflects the gender distribution of call centre work.
Hearing loss is categorized by severity, type, and configuration. Furthermore, a hearing loss may exist in only one ear (unilateral) or in both ears (bilateral). Hearing loss can be temporary or permanent, sudden or progressive. The severity of a hearing loss is ranked according to ranges of nominal thresholds in which a sound must be so it can be detected by an individual. It is measured in decibels of hearing loss, or dB HL. There are three main types of hearing loss: conductive hearing loss, sensorineural hearing loss, and mixed hearing loss.[15] An additional problem which is increasingly recognised is auditory processing disorder which is not a hearing loss as such but a difficulty perceiving sound. The shape of an audiogram shows the relative configuration of the hearing loss, such as a Carhart notch for otosclerosis, 'noise' notch for noise-induced damage, high frequency rolloff for presbycusis, or a flat audiogram for conductive hearing loss. In conjunction with speech audiometry, it may indicate central auditory processing disorder, or the presence of a schwannoma or other tumor.
It is estimated that half of cases of hearing loss are preventable.[85] About 60% of hearing loss in children under the age of 15 can be avoided.[2] A number of preventive strategies are effective including: immunization against rubella to prevent congenital rubella syndrome, immunization against H. influenza and S. pneumoniae to reduce cases of meningitis, and avoiding or protecting against excessive noise exposure.[15] The World Health Organization also recommends immunization against measles, mumps, and meningitis, efforts to prevent premature birth, and avoidance of certain medication as prevention.[86] World Hearing Day is a yearly event to promote actions to prevent hearing damage.
Most causes of conductive hearing loss can be identified by examination but if it is important to image the bones of the middle ear or inner ear then a CT scan is required. CT scan is useful in cases of congenital conductive hearing loss, chronic suppurative otitis media or cholesteatoma, ossicular damage or discontinuity, otosclerosis and third window dehiscence. Specific MRI scans can be used to identify cholesteatoma.
Masking. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off. A specialized device isn't always necessary for masking; often, playing music or having a radio, fan, or white-noise machine on in the background is enough. Although there's not enough evidence from randomized trials to draw any conclusions about the effectiveness of masking, hearing experts often recommend a trial of simple masking strategies (such as setting a radio at low volume between stations) before they turn to more expensive options.
Fluctuating sensorineural hearing loss may be from unknown cause or associated with Ménière’s disease. Symptoms of Meniere’s disease are hearing loss, tinnitus (ringing in the ears), and vertigo. Ménière’s disease may be treated medically with a low-sodium diet, diuretics, and corticosteroids. If the vertigo is not medically controlled, then various surgical procedures are used to eliminate the vertigo.
Hearing loss can be inherited. Around 75–80% of all these cases are inherited by recessive genes, 20–25% are inherited by dominant genes, 1–2% are inherited by X-linked patterns, and fewer than 1% are inherited by mitochondrial inheritance.[55] Syndromic deafness occurs when there are other signs or medical problems aside from deafness in an individual,[55] such as Usher syndrome, Stickler syndrome, Waardenburg syndrome, Alport's syndrome, and neurofibromatosis type 2. Nonsyndromic deafness occurs when there are no other signs or medical problems associated with an individual other than deafness.[55]
Tinnitus (pronounced ti-ni-tis), or ringing in the ears, is the sensation of hearing ringing, buzzing, hissing, chirping, whistling, or other sounds. The noise can be intermittent or continuous, and can vary in loudness. It is often worse when background noise is low, so you may be most aware of it at night when you're trying to fall asleep in a quiet room. In rare cases, the sound beats in sync with your heart (pulsatile tinnitus).
It has long been recognised that excessive sound can damage the auditory system. This can happen either by exposure to a single extremely loud sound, typically greater than 120 dB or by chronic exposure to sound at a lesser intensity. For this reason most countries have legislation in place that covers occupational noise exposure, providing both an absolute upper limit and an average daily or weekly sound limit. In the latter part of the 20th century a different pattern of noise damage to the auditory system started to emerge: employees working in call centres reported symptoms following brief exposure to sudden unexpected sounds through their telephone handsets or headsets. They described pain in around the ear, tinnitus, dizziness, hyperacusis, altered hearing and a blocked sensation in the affected ear or ears. For some people the symptoms were short lived but in others the problem persisted and other symptoms developed including hypervigilance, anxiety, depression, insomnia and post-traumatic stress disorder (PTSD). This symptom cluster following unexpected noise exposure through telecommunications equipment became known as acoustic shock injury, acoustic shock disorder, acoustic shock syndrome or simply acoustic shock.1–4 The sounds that triggered acoustic shock were entitled acoustic incidents.
Ginkgo biloba does not appear to be effective.[94][108] The American Academy of Otolaryngology recommends against taking melatonin or zinc supplements to relieve symptoms of tinnitus, and reported that evidence for efficacy of many dietary supplements—lipoflavonoids, garlic, homeopathy, traditional Chinese/Korean herbal medicine, honeybee larvae, other various vitamins and minerals—did not exist.[74] A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.[109]

Hearing loss is associated with Alzheimer's disease and dementia. The risk increases with the hearing loss degree. There are several hypotheses including cognitive resources being redistributed to hearing and social isolation from hearing loss having a negative effect.[27] According to preliminary data, hearing aid usage can slow down the decline in cognitive functions.[28]
Spontaneous otoacoustic emissions (SOAEs), which are faint high-frequency tones that are produced in the inner ear and can be measured in the ear canal with a sensitive microphone, may also cause tinnitus.[6] About 8% of those with SOAEs and tinnitus have SOAE-linked tinnitus,[need quotation to verify] while the percentage of all cases of tinnitus caused by SOAEs is estimated at about 4%.[6]
Sound waves reach the outer ear and are conducted down the ear canal to the eardrum, causing it to vibrate. The vibrations are transferred by the 3 tiny ear bones of the middle ear to the fluid in the inner ear. The fluid moves hair cells (stereocilia), and their movement generates nerve impulses which are then taken to the brain by the cochlear nerve.[75][76] The auditory nerve takes the impulses to the brainstem, which sends the impulses to the midbrain. Finally, the signal goes to the auditory cortex of the temporal lobe to be interpreted as sound.[77]
TTTS was originally described by Dr I. Klockhoff (9-12), and has been proposed by Patuzzi, Milhinch and Doyle (13) and Patuzzi (7) as the neurophysiological mechanism causing most of the persistent ASD symptoms. TTTS is an involuntary condition where the centrally mediated reflex threshold for tensor tympani muscle activity becomes reduced as a result of anxiety and trauma, so it is continually and rhythmically contracting and relaxing, aggravated by intolerable sound exposure1. This appears to initiate a cascade of physiological reactions in and around the ear, which can include: tympanic membrane flutter; alterations in ventilation of the middle ear cavity leading to a sense of blockage or fullness, as well as muffled/echoey/distorted hearing; irritation of the trigeminal nerve innervating the tensor tympani muscle, leading to frequent neuralgic pain; and symptoms consistent with temporomandibular disorder (TMD).

'Acoustic shock' is a term used in connection with incidents involving exposure to short duration, high frequency, high intensity sounds through a telephone headset. Some sources suggest that these incidents are associated with a range of physiological and psychological symptoms that have been reported amongst headset wearers. It has not been established whether the reported symptoms are caused directly by exposure to these unexpected sounds. There is no clear single cause of these incidents, but one cause may be interference on the telephone line. Although call handlers may be shocked or startled by the sounds, exposure to them should not cause hearing damage as assessed by conventional methods.

Prevention involves avoiding exposure to loud noise for longer periods or chronically.[2] If there is an underlying cause, treating it may lead to improvements.[3] Otherwise, typically, management involves psychoeducation or counseling as talk therapy.[5] Sound generators or hearing aids may help some.[2] As of 2013, there were no effective medications.[3] It is common, affecting about 10–15% of people.[5] Most, however, tolerate it well, and it is a significant problem in only 1–2% of people.[5] The word tinnitus comes from the Latin tinnire which means "to ring".[3]
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