Alternate Names: Decreased hearing; Deafness; Loss of hearing

Considerations: Prevention of hearing loss is more effective than the treatment.

Minor decreases in hearing, especially of higher frequencies, are normal after age 20. Some nerve deafness (or loss of hearing) affects 1 out of 5 people by age 55. It usually comes on gradually and rarely ends in complete deafness. See hearing loss of aging. Alzheimer’s disease or other neurological problems may sometimes be falsely suspected in older people because they have hearing problems.

Hearing problems may be the reason some children’s speech develops slowly.

There are many causes of hearing loss. They may be grouped in several ways. One way divides causes into 2 categories: conductive loss and nerve loss. Conductive loss occurs when the three tiny bones of the ear (ossicles) fail to conduct sound to the cochlea or when the eardrum fails to vibrate in response to sound because of some mechanical problem such as fluid in the ear or disruption of the ossicles. Nerve loss occurs when the nerve is injured by physical or other means. Conductive loss is often potentially reversible; nerve loss is not.

Common Causes: Genetic:

• osteogenesis imperfecta
• Leopard syndrome (multiple lentigines)
• otosclerosis
• Robinson type ectodermal dysplasia
• Cockayne syndrome
• Bjorn pili torti and deafness syndrome
• Multiple synostosis syndrome
• Hunter syndrome
• Taybi oto-palato-digital syndrome
• hereditary nephritis
• Mohr syndrome
• Hurler syndrome
• Waardenburg syndrome
• Kartagener syndrome
• Fronto-metaphyseal dysplasia syndrome
• Morquio syndrome
• Trisomy 13 S
• Multiple lentigines syndrome
• Treacher Collins syndrome
• Stickler syndrome

• Rubella syndrome
• congenital atresia of the external auditory canal
• Congenital cytomegalovirus
• congenital perilymphatic fistula
• Fetal methyl mercury effects
• Fetal iodine deficiency effects

• meningitis
• mumps
• measles
• otitis media
• scarlet fever
• ossicular discontinuity
• adhesive otitis

• traumatic perforation of the eardrum
• skull fracture (temporal bone)
• acoustic trauma such as from explosions, fireworks, gunfire, rock concerts, and earphones
• barotrauma (differences in pressure)

• aminoglycoside antibiotics
• ethacrynic acid - oral
• aspirin
• chloroquine
• quinidine

• age-related hearing loss (presbycusis)

• Meniere’s disease
• acoustic neuroma

• the build-up of wax in the ear canal(s)
• foreign body lodged in the ear canal
• injury to the head
• allergy
• blocked Eustachian tubes
• scarred or perforated eardrum
• ear infections (otitis externa - chronic, otitis media - chronic, otitis externa; malignant)
• reaction to medication such as aminoglycosides, chloroquine, quinidine

Home Care: Wax build-up can frequently be flushed out of the ear (gently) with ear syringes (available in drug stores) and warm water. Wax softeners (like Cerumenex) may be needed if the wax is hard and impacted.

Care should be taken when removing foreign bodies. Unless it is easily accessible, have your health care provider remove the object. Don’t use sharp instruments to remove foreign bodies.

A hearing aid can be helpful in coping with hearing loss caused by nerve damage.

Call If:

• hearing problems are persistent and unexplained
• hearing problems adversely affect lifestyle
• there is association with other symptoms such as ear pain

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting hearing loss in detail may include:

• distribution
  • Is the hearing loss in both ears (bilateral)?
  • Is it in one ear only (unilateral)?
• quality
  • Is the hearing loss mild or severe?
  • Is all of the hearing lost (inability to hear any sound)?
  • decreased hearing acuity?
  • decreased ability to understand speech?
  • decreased ability to locate the source of a sound?
• time pattern
  • How long has the hearing loss been present?
  • Did it occur before age 30?
• other
  • What other symptoms are also present?
  • Is there tinnitus (ringing or other sounds)?
  • Is there ear pain?

• audiometry (an electronic hearing test)
• auditory response test
• CT scan of the head (if a tumor or fracture is suspected)
• X-ray of the head
• tympanometry
• caloric test
• MRI of the ear (see MRI of the head)