Vivien Williams: …become fewer or don't function well. Hearing aids help to increase volume. For people with profound hearing loss, cochlear implants work by bypassing the hair cells and sending signals directly to the hearing nerve and brain. Once health care professionals figure out your type of hearing loss, they can tailor treatment that's best for you. For the Mayo Clinic News Network, I'm Vivien Williams.
Conductive hearing loss is generally a condition in one ear but can be in both. Depending on the type of conductive loss, treatments may resolve the issue. If the conductive loss is due to earwax, many of our stores can remove this for you. Should the cause be something other than a build-up of earwax, we will refer you to your GP who will assist with a treatment plan.
If your hearing loss is caused by a build-up of earwax, it will need to be removed. You may be able to have this done at your surgery by syringing. Warm water is flushed into your ear canal to remove the wax. But first the wax has to be softened by applying olive oil or almond oil drops, or drops containing sodium bicarbonate, for several days beforehand. You can buy these drops from your local pharmacy. In some cases, you may have to go to a specialist clinic to have wax removed by syringing or with microsuction.
Depending on the cause of your deafness, your doctor may suggest you have a cochlear implant. This device turns sounds into electrical signals and uses them to directly stimulate your auditory nerve, allowing you to hear. One part of the device is put behind your ear on the outside of your head. The other part is surgically implanted in a bone (called the mastoid bone) behind your ear. It will take time and help from a therapist to get used to using a cochlear implant.
Depression is one of the leading causes of morbidity and mortality worldwide. In older adults, the suicide rate is higher than it is for younger adults, and more suicide cases are attributable to depression.[38] Different studies have been done to investigate potential risk factors that can give rise to depression in later life. Some chronic diseases are found to be significantly associated with risk of developing depression, such as coronary heart disease, pulmonary disease, vision loss and hearing loss.[39] Hearing loss can attribute to decrease in health-related quality of life, increase in social isolation and decline in social engagement, which are all risk factors for increased risk of developing depression symptoms.[40]

Conductive hearing loss is sometimes temporary and can be treated with medication or minor surgery, if necessary. However, more major surgery may be required to fix the ear drum or hearing bones. If conventional hearing aids don't work, there are also some implantable devices for this type of hearing loss, such as a Bone Anchored Hearing Aids (BAHAs).

Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of tinnitus, even though they do not express the condition or its effect on their lives.[112][113] Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously.[114] Among those children who do complain of tinnitus, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere's disease or chronic suppurative otitis media.[115] Its reported prevalence varies from 12% to 36% in children with normal hearing thresholds and up to 66% in children with a hearing loss and approximately 3–10% of children have been reported to be troubled by tinnitus.[116]
Your ear consists of three major areas: outer ear, middle ear and inner ear. Sound waves pass through the outer ear and cause vibrations at the eardrum. The eardrum and three small bones of the middle ear amplify the vibrations as they travel to the inner ear. There, the vibrations pass through fluid in a snail-shaped structure in the inner ear (cochlea).
Pure tone audiometry, a standardized hearing test over a set of frequencies from 250 Hz to 8000 Hz, may be conducted by a medical doctor, audiologist or audiometrist, with the result plotted separately for each ear on an audiogram. The shape of the plot reveals the degree and nature of hearing loss, distinguishing conductive hearing loss from other kinds of hearing loss. A conductive hearing loss is characterized by a difference of at least 15 decibels between the air conduction threshold and bone conduction threshold at the same frequency. On an audiogram, the "x" represents responses in the left ear at each frequency, while the "o" represents responses in right ear at each frequency.
Sensorineural causes of hearing loss involve the inner ear or brain and are usually, but not always, permanent. Implants and more invasive procedures may help to restore hearing. Birth defects (prenatal infection, injury during childbirth, and genetic disorders), infections particularly in childhood and age-related degeneration (presbycusis / presbyacusis) are more frequent causes of this type of hearing loss. Sudden, unilateral hearing loss may be related to conditions like a stroke.
Studies have shown that older adults with hearing loss have a greater risk of developing dementia than older adults with normal hearing. Cognitive abilities (including memory and concentration) decline faster in older adults with hearing loss than in older adults with normal hearing. Treating hearing problems may be important for cognitive health. See What’s the Connection Between Hearing and Cognitive Health?

Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise. Those damages may occur even at doses that are not considered ototoxic.[28] More than 260 medications have been reported to cause tinnitus as a side effect.[29] In many cases, however, no underlying cause could be identified.[2]
▶ For most inner ear problems, a sodium-restricted, caffeine-free diet is recommended. Caffeine is a central nervous system stimulant and its intake makes the symptoms of inner ear disorder (especially headache and dizziness) appear more pronounced. Hence, it is advisable to reduce the intake of caffeine as much as possible till the condition is completely treated. Excess sugar in the diet also triggers dizziness.
Tinnitus is sometimes called ‘the sound of silence' because most people, if they are seated in a completely quiet soundproofed room, will hear a type of rushing or hissing sound. Usually this sound is masked by everyday environmental noise. It is when this noise becomes intrusive that it can become irritating and is known as ‘tinnitus'. The more anxious the sufferer gets the worse the tinnitus becomes.
ASD causes a specific and consistent pattern of neurophysiological and psychological symptoms. Initial symptoms include a severe startle reaction, often with a head and neck jerk, and a shock/trauma reaction with symptoms of disorientation, distress, shakiness, crying, headache, fatigue. A severe ASD can lead to Post Traumatic Stress Disorder (PTSD). Other symptoms can include pain/blockage/pressure/tympanic fluttering in the ear; pain/burning/numbness around the ear/jaw/neck; tinnitus, hyperacusis and phonophobia; mild vertigo and nausea; headache; and subjective muffled/distorted hearing. ASD generally does not result in a hearing loss, although if present it tends not to follow the typical high frequency pattern of a noise induced hearing injury but affects low and mid frequency sensorineural hearing (1, 2).
There are three parts to your ear: the outer ear, middle ear and inner ear. The outer ear is the part you can see. It is shaped to focus sound waves into your ear canal, so they travel to your eardrum. The sound waves make your eardrum vibrate. This vibration passes to your middle ear, which contains three small bones (ossicles) called the hammer, anvil and stirrup (named after their shapes). These strengthen the vibrations as they conduct them to your inner ear.
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A 2005 study achieved successful regrowth of cochlea cells in guinea pigs.[119] However, the regrowth of cochlear hair cells does not imply the restoration of hearing sensitivity, as the sensory cells may or may not make connections with neurons that carry the signals from hair cells to the brain. A 2008 study has shown that gene therapy targeting Atoh1 can cause hair cell growth and attract neuronal processes in embryonic mice. Some hope that a similar treatment will one day ameliorate hearing loss in humans.[120]
Biofeedback and stress management. Tinnitus is stressful, and stress can worsen tinnitus. Biofeedback is a relaxation technique that helps control stress by changing bodily responses. Electrodes attached to the skin feed information about physiological processes such as pulse, skin temperature, and muscle tension into a computer, which displays the output on a monitor. Patients learn how to alter these processes and reduce the body's stress response by changing their thoughts and feelings. Mindfulness-based stress reduction techniques may also help.
Frequent, prolonged exposure to loud noise increases the risk of getting tinnitus, or of making it worse, so take care to avoid very loud sounds, or protect your ears against them. Wear proper ear protectors (not cotton wool) when hammering metal, using power tools or when you are near any noisy motors. Ear protection is also important if you watch live music or play in a band or orchestra. Ear protection should not be used if ordinary, everyday sounds are uncomfortable (this may be hyperacusis or oversensitivity to sound). If earplugs are worn for blocking out such sounds, it can actually make hyperacusis worse.
Conductive hearing loss results when there is any problem in delivering sound energy to your cochlea, the hearing part in the inner ear. Common reasons for conductive hearing loss include blockage of your ear canal, a hole in your ear drum, problems with three small bones in your ear, or fluid in the space between your ear drum and cochlea. Fortunately, most cases of conductive hearing loss can be improved.
If your hearing loss is caused by a bacterial infection of the outer ear canal, your doctor may prescribe antibiotic drops. Antibiotics taken by mouth are usually prescribed only for very severe middle ear infections. Ask your pharmacist for advice on your medicine, and always read the patient information leaflet that comes with it. If you keep getting ear infections, your doctor may refer you to a specialist.
We all produce different amounts of ear wax and it is there for a reason. Believe it or not, the ears actually clean themselves. The skins migrates out of the ear canal and carries the wax with it. You should only therefore wipe away any wax that is visible to the naked eye with a tissue. There is a unwritten rule in ENT, "don't put anything smaller than your elbow down your ear". Cotton buds simply push wax down the ear canal and for every small bit you see on the cotton bud much more is pushed down the ear. Over time the wax can become impacted. A little bit of olive oil from time to time can help to keep the wax soft and help it migrate out of the ear canal.
^ Global Burden of Disease Study 2013 Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
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Tinnitus may be perceived in one or both ears. The noise can be described in many different ways but is reported as a noise inside a person's head in the absence of auditory stimulation. It often is described as a ringing noise, but in some people, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging, whistling, ticking, clicking, roaring, beeping, sizzling, a pure steady tone such as that heard during a hearing test, or sounds that slightly resemble human voices, tunes, songs, or animal sounds such as "crickets", "tree frogs", or "locusts (cicadas)".[4] Tinnitus may be intermittent or continuous: in the latter case, it may be the cause of great distress. In some individuals, the intensity may be changed by shoulder, head, tongue, jaw, or eye movements.[7]


There is a progressive loss of ability to hear high frequencies with aging known as presbycusis. For men, this can start as early as 25 and women at 30. Although genetically variable it is a normal concomitant of ageing and is distinct from hearing losses caused by noise exposure, toxins or disease agents.[46] Common conditions that can increase the risk of hearing loss in elderly people are high blood pressure, diabetes, or the use of certain medications harmful to the ear.[47][48] While everyone loses hearing with age, the amount and type of hearing loss is variable.[49]
Very regularly we see people who, after exposure to sudden and loud noise, are bothered by tinnitus, hyperacusis, hearing loss, pressure in the ear, aversion and fear of sounds, depression, etc.. However, a hearing test does not show signs of hearing damage or a noise trauma. This is characteristic of an "Acoustic Shock". Usually the symptoms disappear quite quickly, but when the symptoms persist, they speak of an Acoustic Shock Disorder (ASD).
Boosting your immune system may also stop ringing in your ears. This will help to protect you from infections and diseases that may increase the level of unwanted sound. Also, an improvement in your health can mean an improvement in your tinnitus. Have a healthy lifestyle, which especially includes a healthy diet, proper and regular exercise, and enough sleep at night.

The most important thing you can do if you think you have a hearing problem is to seek professional advice. Your family doctor may be able to diagnose and treat your hearing problem. Or, your doctor may refer you to other experts, like an otolaryngologist (ear, nose, and throat doctor) or an audiologist (health professional who can identify and measure hearing loss).
The Institute for Occupational Safety and Health of the German Social Accident Insurance has created a hearing impairment calculator based on the ISO 1999 model for studying threshold shift in relatively homogeneous groups of people, such as workers with the same type of job. The ISO 1999 model estimates how much hearing impairment in a group can be ascribed to age and noise exposure. The result is calculated via an algebraic equation that uses the A-weighted noise exposure level, how many years the people were exposed to this noise, how old the people are, and their sex. The model’s estimations are only useful for people without hearing loss due to non-job related exposure and can be used for prevention activities.[98]
^ Fuente A, Qiu W, Zhang M, Xie H, Kardous CA, Campo P, Morata TC (March 2018). "Use of the kurtosis statistic in an evaluation of the effects of noise and solvent exposures on the hearing thresholds of workers: An exploratory study" (PDF). The Journal of the Acoustical Society of America. 143 (3): 1704–1710. Bibcode:2018ASAJ..143.1704F. doi:10.1121/1.5028368. PMID 29604694.
There are three parts to your ear: the outer ear, middle ear and inner ear. The outer ear is the part you can see. It is shaped to focus sound waves into your ear canal, so they travel to your eardrum. The sound waves make your eardrum vibrate. This vibration passes to your middle ear, which contains three small bones (ossicles) called the hammer, anvil and stirrup (named after their shapes). These strengthen the vibrations as they conduct them to your inner ear.

The International Organization for Standardization (ISO) developed the ISO 1999 standards for the estimation of hearing thresholds and noise-induced hearing impairment.[104] They used data from two noise and hearing study databases, one presented by Burns and Robinson (Hearing and Noise in Industry, Her Majesty's Stationery Office, London, 1970) and by Passchier-Vermeer (1968).[105] As race are some of the factors that can affect the expected distribution of pure-tone hearing thresholds several other national or regional datasets exist, from Sweden,[106] Norway,[107] South Korea,[108] the United States[109] and Spain.[110]
Atherosclerosis. With age and buildup of cholesterol and other deposits, major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.
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