Hearing loss, or deafness, is the partial or total loss in one or both ears of the ability to transform sound vibrations into the electrical energy understood by the brain. Despite the ear’s delicate nature, it is remarkably resilient. Still factors such as aging, illness and injury can impair your ability to hear properly.

More than 28 million Americans have a hearing loss. And roughly 50 percent of American seniors have a hearing loss by age 65. Unfortunately, many patients avoid confronting the problem, and there is usually a delay of 5-7 years between a loss of hearing and a professional diagnosis. Given the ever-improving technology in amplification, this represents a great deal of lost time with poor hearing.

In hearing, sound is gathered by the outer ear, amplified by the eardrum and three tiny bones in the middle ear and transduced into an electrical nerve signal by the inner ear. This signal is sent via the hearing nerve to the brain. When the impulse reaches the auditory cortex of the brain, we experience the sensation of hearing.

Injury or disease at any point in the anatomy results in hearing loss. Thus, there are four basic types of hearing loss:

Conductive Hearing Loss
Conductive hearing loss (CHL) refers to a mechanical failure to move sound vibration from the outside world through the outer and middle ear to the inner ear. The simplest example is the plugging of your ear canal. Wax impaction in the ear canal and fluid build-up in the middle ear are perhaps the most common examples of dampening the transmission of sound through the ear. Otosclerosis is a less common, often inherited disease resulting in conductive loss.

CHL affects the lower frequencies and makes it especially difficult to hear vowel sounds. Since vowels contain the “power of speech” the person perceives speech and other sounds as being much “quieter” than normal. If the sound is loud enough, a person with a CHL can hear and understand clearly. Conductive hearing losses can often be treated.

Sensorineural Hearing Loss
Sensorineural hearing loss (SNHL) is the most common type of hearing loss and is caused by damage to the inner ear and/or the auditory nerve. Noise exposure, diseases, certain medications and aging can destroy parts of the inner ear and cause permanent hearing loss. Once damaged, the inner ear cannot be repaired. A “cochlear implant” is available for some who have a profound hearing loss and do not gain benefit from conventional hearing aids. Sometimes, SNHL is accompanied by intolerance to loud sounds.

In contrast to conductive hearing losses, SNHL hearing loss usually affects high frequencies the most, which impairs a person’s ability to perceive consonant sounds.

Mixed Hearing Loss

A mixed hearing loss occurs when you have both CHL and SNHL. For example, if a child who has permanent SNHL gets a middle ear infection, he or she will experience both a conductive and a sensorineural hearing loss.

Retro-Cochlear Hearing Loss

Retro-cochlear hearing loss is caused by problems of the hearing nerve or the part of the brain that receives signals from the hearing nerve. With retro-cochlear hearing loss, you may have poorer ability to recognize speech than might be suspected based on your ability to hear pure tones. An acoustic tumor may be involved and may lie on the auditory nerve, brainstem or in the brain.

The diagnosis of a hearing loss is made by taking a careful history, performing an accurate exam, and thoughtfully utilizing diagnostic testing, including audiometry (a hearing test), computed tomography (CT) and magnetic resonance imaging (MRI). At MOSA, we have on-site audiologist who is dedicated to aiding in the diagnosis and treatment of hearing loss, including fitting and dispensing hearing aids.

Ear infection is one of the most common reasons people are seen by ENT doctors. Ear infections can involve multiple parts of the ear. The three parts of the ear are the outer ear, middle ear and inner ear. When the ear canal is infected it is called otitis externa, which is more commonly known as “swimmer’s ear.” The ear will be painful and very tender to the touch. This condition will typically respond with antibiotic ear drops.  The most common area of infection is in the middle ear and is called otitis media. It is most often seen in children because the Eustachian tube is still developing and will often become blocked leading to infection.  Symptoms of ear infections include pain in the ear, drainage, hearing loss, ringing, fever, or runny nose. If it is happening in a small child or baby they may only show signs of being irritable, fever and tugging the ear.

When patients have recurrent ear infections it is often necessary for them to receive ear tubes. Placing tubes in the ear or “myringotomy” is a minor procedure which can be done in the office in adults or under anesthesia in children. It is the most common surgery done for children in the country. The tubes are made of plastic and sit in the ear drum for about 1 year before the ear drum pushes them out. Their purpose is to ventilate the middle ear and allow infected fluid to drain out. If you or your child has recurring ear infections speak with your primary doctor for a referral to see if tubes are necessary.

Mastoiditis refers to an infection in the mastoid bone which is located behind the ear.  The mastoid bone is a honey comb of air pockets which are connected , through a passage, with the middle ear.  Mastoiditis is frequently caused by a middle ear infection which spreads to the mastoid bone, fills the air pockets with infected material and then broke down.  Symptoms include fever, hearing loss, pain, redness and swelling behind the ear.  Untreated mastoiditis can lead to meningitis, brain abscess and permanent hearing loss.  The condition is not common in children.  Before antibiotics, mastoiditis was one of the most common causes of death in children.   Today the condition is less common and much less dangerous.  Treatment today usually involves antibiotics, occasionally draining the middle ear (myringotomy), and rarely cleaning out the mastoid bone (mastoidectomy).

Dizziness is a general term used to describe a sense of feeling faint, lightheaded, woozy or unsteady. When dizziness has a false sense of spinning or moving it is called vertigo. Dizziness can range from being a slight nuisance to completely incapacitating. Dizziness is rarely a life threatening condition but it is important to see a doctor urgently if the dizziness is associated with severe headache, uncontrolled vomiting, changes in speech, vision or hearing, fainting, chest pain, numbness or weakness, high fevers or recent head injury. Not all patients with dizziness need to see an ENT doctor but it may be helpful in the following situations: if the dizziness has spinning or “vertigo,” feeling of ear plugging or pressure, ringing in the ears, hearing loss, pain in the ears, recurrent ear infections, drainage from the ears, or dizziness that comes about with changes in body position. It is always wise to discuss your symptoms with your primary care doctor as well since dizziness may have many other causes not related to the ears.

Tinnitus is a ringing, roaring, swishing, hissing, buzzing or other type of noise originating in the ear or head. In many cases it is not a serious problem but rather a nuisance that eventually resolves. Tinnitus is not a single disease, but a symptom of an underlying condition. In almost all cases, only the patient can hear the noise.

Tinnitus can arise in the outer, middle or inner ear or by abnormalities in the brain. Some tinnitus or head noise is normal. Anything, such as earwax or a foreign body in the external ear, can cause us to be more aware of our own head sounds. Fluid, infection or disease of the middle ear bones or eardrum (tympanic membrane) can also cause tinnitus. One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, consequently causing chronic tinnitus. 

Loud noise is a common cause of tinnitus, and it can damage hearing as well. Some medication and other diseases of the inner ear, like Meniere’s syndrome, can cause tinnitus. Tinnitus can in very rare situations be a symptom of such serious problems as a brain aneurysm or a brain tumor, such as an acoustic neuroma. 

Treatment of tinnitus relies on exploring the patient’s global health issues, as well as the patient’s hearing. In many cases, there is no specific treatment for tinnitus because it may simply go away on its own, or it may be a permanent disability you learn to “live with.” Occasionally adjusting medications, diet or lifestyle can be helpful. In other cases, amplifying ambient sound with a hearing aid can significantly reduce the annoyance of tinnitus.

A comprehensive medical history, physical examination and a series of diagnostic tests can help determine where the tinnitus is originating. If you experience persisting, unexplained tinnitus, you’ll need a hearing test (audiogram). Reviewing the patterns of your hearing loss may lead to the diagnosis. However, other tests, such as a brainstem auditory evoked response (BAEP), which is a computerized test of the hearing nerves and brain pathways; a computer tomography scan (CT) scan; or magnetic resonance imaging (MRI) scan may be needed to rule out a tumor occurring on the hearing or balance nerve. All of these diagnostic studies can be performed within one of MOSA’s technologically advanced locations.

Hearing aids are an effective tool to improve hearing and quality of life. Hearing aids come in a variety of shapes, sizes, colors, and with different technological features. Prescriptive hearing aids are fine-tuned to your hearing loss. Your audiologist can make best recommendations and guild your journey as you navigate the process to better hearing.

MOSA works with most major hearing aid brands, of which there are several. We also work with most private insurances. Some insurances help cover hearing aids, some do not. We do our best to determine coverage information prior to your decision to proceed.

We also offer bone anchored hearing aids for patients with single sided deafness. The new Cochlear corporation subcutaneous device makes this technology much more convenient than the early model which required a titanium anchor post that poised maintenance issues with some patients