Hearing Loss Explained

Let it be known: hearing loss is a complicated issue. Despite many people’s conception that hearing loss simply acts as a slider between fully hearing and fully deaf, there are many different ways that we can lose our hearing.

If you are experiencing hearing loss, however, it can be hard to get a grasp on what’s happening. Much like the eyes, the mechanisms and systems behind hearing are extremely precise and delicate.

In this comprehensive guide, we will:

1. Dissect every kind of hearing loss
2. Look at potential causes
3. Give you some tips or help for how you can address each kind

According to our research, 62.9% of our site visitors are seeking a hearing aid, either for themselves or for someone else. At the very least, this means 62.9% of our visitors have hearing loss (or know someone with hearing loss) sufficient enough to look into hearing aids.

The thing about hearing loss is that you might not even know you’re experiencing it. As serious as it is, it’s certainly one of the more subtle health conditions. Without hearing tests, you wouldn’t notice hearing loss until it was fairly progressed. In our survey of 379 Clear Living users, 9% said they had never had a hearing test, with an additional 26.6% only having had their hearing tested more than a year ago.

As we age, we get more and more susceptible to hearing loss, so periodic check ups are crucial when it comes to taking care of your ears. If you find yourself turning up the TV, asking people to repeat themselves, or hearing a ringing in your ears, you may be experiencing hearing loss.

How do the ears work?

If you’ve come to this article, you’re most likely looking for breakdowns of different hearing types and wondering how they’re all treated. But to answer that, we need to talk about how the ear actually works.

As you may know, sound is made up of vibrations. These vibrations travel through the air and trigger the sensation of sound upon reaching your ears. These vibrations are funneled into the ear by the intricacies of the curves and crevices of your visible ear and travel through the air in your ear canal. They then stimulate the eardrum, which vibrates three small bones. These bones then move the fluid inside your inner ear. This fluid bends thousands of tiny hair cells, and this movement creates electrical pulses that are sent to your brain to be translated into the sound you hear.

If you think this sounds complicated, keep in mind that this process is constant. Sound is constantly entering your ears, with every click of your mouse, every step you take, and even when you breathe. The bones and fluid in your ear are constantly whirring and sending signals back to your brain.

So let’s go on a journey into the ear, starting from the outside going in, and take a step by step look at the various problems you can have with your hearing. We’ll look at what causes these problems, the science behind them, and how they can be treated.

The causes will be marked as exogenous or endogenous. Exogenous forms of hearing loss come from an external environmental factor, while endogenous forms are caused by an internal factor.

Types of hearing loss

In this extended section, we’ll go over the different kinds of hearing loss, causes of hearing loss, and the hearing loss treatment associated with each of them.

Conductive hearing loss and treatment

This type of hearing loss is the easiest to grasp. Inflicted mostly on the outer ear, but often in the middle ear as well, this tends to be more related to the mechanical side of hearing.

This occurs when there’s a physical reason that your ears struggle to pick up on sound, as opposed to a problem within the nerves or inner ear. As with all rules, there are exceptions, but conductive hearing loss can usually be fully cured with surgery or simple procedures.

Blockage

Cause – Endogenous

The easiest cause of conductive hearing loss to understand is simply something being in the way of the sound receptors. Whether it’s a buildup of wax, or even a foreign object like the top of a cotton swab, too much in your ear canal can block sound, making it quiet or muffled.

Treatment

Since it’s the simplest form of hearing loss, it’s also the most easily fixed. A simple professional cleaning procedure will be able to remove any excess wax or foreign objects from the ear.

Bone damage

Cause – Endogenous or exogenous

Like we mentioned earlier, there are three bones within the ear. These auditory ossicles, colloquially known as the hammer, anvil, and stirrup, vibrate with each other in a chain reaction to get the sound to the inner ear. Since they’re so small and precise, even the tiniest fault in these bones would lead to hearing problems.

If these bones are somehow broken or suffer some kind of damage, sound can be distorted or even lost entirely. There is also a condition known as “otosclerosis,” where the three bones become fused and cannot vibrate separately.

Treatment

In the case of otosclerosis, surgery can be performed to undo the fusing. In the case of other damage to these bones, however, things get a bit more complicated. It’s possible to repair the bones with surgery, but another option has recently seen a surge in interest.

3D printing is a technology that has been around since the ‘80s, but has seen a rapid rise in the past few years. With a 3D printer, a computer can design any kind of shape it wants and have it printed as a 3D object. This has led to big steps in developing prosthetics, machine parts – in our case – auditory ossicles.

Broken ossicles can be surgically removed from the ear and replaced with a brand new 3D printed version. These 3D printed replacements are made of plastic but still work exactly like the bone it’s replacing. This procedure has yet to fully take the audiology world by storm, but has received a lot of praise and looks promising for the future.

Growths

Cause – Endogenous

There are various growths that can impede hearing. Cholesteatoma is a condition where tumors grow in the ear canal or middle ear, which can disrupt the auditory system. Similarly, bone spurs (which is when part of a bone grows into a contusion) can also arise and cause substantial hearing problems. This condition is known as exostosis. There are various kinds of growths that can occur within the ear, but these two are the most common.

Tumors, as always, are dictated heavily by your lifestyle. Healthy diet, sleep, and activity can all help prevent tumors, but in the end even the healthiest people can be unfortunate enough to develop tumors, as it always comes down to chance.

Ear canal exostosis is also known as “surfer’s ear.” This is because these bone growths develop after extended exposure to wind and cold water.

Finally, if an ear infection is bad enough, it can swell to the point of having the same effect on the ear as a tumor or an exostosis.

Treatment

With both tumors and exostosis, surgery is the best way of removing the blockage. Of course, success rates and safety vary based on the size and location of the blockage, but endoscopic ear surgeries have a negligible rate of complications or failures.

Ear infections, like other infections, can be cured over a week or two with a course of antibiotics. Swelling should be reduced in a matter of days and hearing will most likely be restored. But remember, even if the infection goes away, always finish a course of antibiotics to stop it from resurfacing.

Chronic ear infections can also be treated by inserting a pressure equalizer tube (PE tube) into the eardrum.

While these are the biggest offenders for conductive hearing loss, there are dozens of smaller, more specific reasons that you might be suffering from conductive hearing loss.

Sensory hearing loss and treatment

Sensorineural hearing loss comprises two different types of hearing loss: sensory hearing loss, which we’ll discuss here, and neural hearing loss, discussed below. Sensory hearing loss occurs when, for whatever reason, there is a problem with the cochlea, an important part of the inner ear.

The cochlea houses all of the tiny hair cells we mentioned above. Known as stereocilia, these cells are essential when it comes to being able to hear, so any problems with the cochlea that houses them would obviously be an impediment on your hearing as a whole.

Exposure to loud sound

Causes – Exogenous

This is exactly what it sounds like. Go to enough concerts without ear protection, have your headphones up too loud, or even mow your lawn too frequently, and you could risk inflicting serious damage onto your ears.

Another cause could be acoustic trauma, which is caused by one intense sound, like an explosion or eruption, rather than extended exposure. A famous example of this is the eruption of Mt Krakatoa, during which a captain of a sea vessel located 40 miles from the volcano claimed that his crew suffered immediate and permanent hearing loss.

Treatment/prevention

The issue with sensory hearing loss is that it is mostly permanent and irreversible. Most cases of sensory hearing loss can only be remedied with a hearing aid or other hearing technology.

The best “cure” for sound-induced sensory hearing loss is foresight. Make sure to always protect your ears in loud situations, and be aware of the amount of sound your ears are taking on.

Aging/presbycusis

Causes – Endogenous

The scientific word “presbycusis” comes from combining the Greek word for old, “presbys,” and the word for hearing, “akousis.” Often hand in hand with loud noise, age is an inevitable factor in your hearing loss. Even if you were to take perfect care of your hearing, if you lived long enough you would experience some hearing loss – it’s just a fact of life.

Short of isolating yourself in a soundproof box, there is no avoiding the slow wear and tear that a lifetime of sound will have on your ear. However, it can be slowed down, with awareness of your sound environment and a conscious avoidance of loud noise.

Treatment/prevention

Once you find a cure for aging, let us know. Until then, you can’t undo any of the effects that aging or sound do to your ears. As mentioned before, the only solution here is more than likely going to be a hearing aid or a similar piece of technology.

Ototoxicity/Drug-induced hearing loss

Causes – Endogenous or Exogenous

Ototoxicity is a property that means “toxic to your ears.” Ototoxic chemicals are included in many kinds of antibiotics and chemotherapy agents, as well as the nicotine in cigarettes.

Treatment/prevention

Like all sensory hearing loss, prevention is the name of the game when it comes to ototoxic damage to your ears. But the thousands of different complicated chemicals on medication bottles can be overwhelming and – if we’re being honest – pretty scary-looking.

That is why, whenever you’re receiving a prescription from a doctor, you should inquire about whether or not the drug is ototoxic. If it is, it would be worth requesting an alternate medication or a lowered dosage.

We do respect, however, that hearing is not the most important part of your health. If you’re experiencing a serious health issue that requires the use of ototoxic medication and there is no alternative, it would be irresponsible to suggest that you not take it. 

What we will suggest, however, is the strict avoidance of cigarettes.  Smoking has a few harshly ototoxic effects on your hearing, and should be avoided entirely.

Disease or fever

Causes – Endogenous or exogenous

As we’re sure you can tell by now, these little hair cells are simultaneously important and frail. It doesn’t take much to kill one of these, and – while they number in the many thousands – the damage adds up over a lifetime, as they cannot regenerate.

One thing that can damage these hair cells on a massive scale is a high fever. A massive increase in heat within your head can essentially fry these cells. These fevers can come from all kinds of diseases, like jaundice, meningitis, and mumps.

Treatment/prevention

The trick here is really to avoid falling to these diseases in the first place. Keeping up your vaccinations, staying out of potential infection areas, and keeping good health (diet, exercise, stress) are all great ways to avoid fevers that could damage your ears.

If you do fall ill with one of these diseases then make sure to take care of yourself. Take any medications or treatments suggested by your doctor, and don’t overexert yourself.

Genetic disposition

Causes – Endogenous

Natural variation is a cornerstone of the development of life. Everyone’s body has different traits, pros and cons. Some people are taller, some have bigger lungs, and some have ears that are more susceptible to damage.

Sometimes it’s just unavoidable that individuals are born with hearing loss. As much of a shame as it is, it happens purely because of genetic luck. Some specific problems may be an underdeveloped cochlea, prenatal exposure to a fever-inducing virus like rubella, or an issue with a chromosome.

Treatment/prevention

We don’t live in the universe of Brave New World, so we can’t prevent any genetic problems while babies are developing. However, like all sensory hearing loss, hearing aids are a reliable and effective method of treating this hearing loss. And as before, vaccinations for fever-inducing diseases are always a good idea.

Neural hearing loss

While this type of hearing loss falls under sensorineural hearing loss, it bears some discussion on its own. Neural hearing loss refers to an issue with the nerves and parts of the brain (the auditory cortex) responsible for hearing. Where conductive hearing loss has cures and treatments, and sensory hearing loss has preventative measures, sadly there is no known way to cure, treat, or prevent neural hearing loss, even with hearing aids.

This type of hearing loss is mostly sustained from birth, as it is generally caused by developmental problems within the womb. It can also possibly be sustained by brain damage throughout the course of a life, like damage inflicted by alcohol or smoking.

Faults in the auditory cortex are usually responsible for hearing problems that aren’t just being unable to hear. For example, auditory processing disorder is a hearing disorder in which the person has difficulty deriving meaning from – or interpreting – sound.

A broader example of neural hearing loss is Auditory Neuropathy Spectrum Disorder (ANSD). This is when there is an impairment in the system that transports sound from the inner ear to the auditory nerve. At its least severe, a person may be unable to discriminate some words in a sentence. At its worst, the person may completely miss the meaning of a sentence.

Mixed hearing loss

There is no specific “type” of mixed hearing loss, as it is, by its very nature, a combination of other types. For example, you may have conductive hearing loss due to a damaged bone in your ear, on top of some sensorineural hearing loss due to a fever killing off several hair cells in the cochlea.

If this was the case, you would need surgery to repair/remove the bone, and then potentially a hearing aid to make up for the damaged hearing cells.

Since there are a couple of layers to it, mixed hearing loss can be trickier to diagnose. It will take a qualified hearing healthcare professional to accurately assess the severity and type of hearing loss that you’re undergoing.

Other kinds of hearing loss

While the kinds of hearing loss we’ve listed so far make up a large majority of hearing loss, there are some that don’t fit too well within these classifications.

Functional hearing loss

Functional hearing loss, or non-organic hearing loss, is a hearing loss that can not be explained by analyzing the auditory system. It can be described as a “psychological” hearing loss in which the patient believes they have a hearing loss when there is no problem with the auditory system itself.

Idiopathic hearing loss

An idiopathic hearing loss is a hearing loss that occurs for an unknown reason. Even after further examination to search for a possible pathology, the cause of the hearing loss is unknown.

A sudden sensorineural hearing loss is the most common idiopathic hearing loss, in which no infection, systemic abnormality, or other pathology can explain the loss of hearing. In some cases, the hearing will return just as spontaneously as it went, often within the first few days.

It’s important to note that if you do experience sudden hearing loss, time is of the essence when it comes to treatment. The sooner you address your hearing loss with a professional, the sooner you can get it treated.

Degrees of hearing loss

Like we mentioned earlier, these kinds of hearing loss can all come in different degrees. From mild to profound, you can miss the odd word here or there, or you may barely be able to hear anything.

Mild hearing loss

A person with mild hearing loss has difficulty hearing soft sounds. Mild hearing loss is generally classified in the 20-40 dB hearing threshold range, which means this person can only start hearing noise once it rises above 20-40 decibels. A person with a mild hearing loss might benefit from wearing hearing aids.

Moderate hearing loss

A person with moderate hearing loss has difficulty hearing normal conversation, especially amidst background noise. It is classified in the 41-55 dB hearing threshold range. A person with a moderate hearing loss could also benefit from wearing hearing aids.

Moderately-severe hearing loss

A person with moderately-severe hearing loss will have difficulty hearing normal conversational speech. A moderately-severe hearing loss is classified in the 56-70 dB hearing threshold range. A person with a moderately-severe hearing loss could benefit from wearing hearing aids but may also need additional assistive listening devices.

Severe hearing loss

Severe hearing loss describes the severity of hearing loss in which a person has difficulty hearing most sounds in the environment and can not hear normal conversational speech. A severe hearing loss is classified in the 71 to 90 dB range. A person with a severe hearing loss may benefit from hearing aids, but hearing aids alone may not be enough. Assistive listening devices and/or a cochlear implant may be necessary to improve communication.

Profound hearing loss

A profound hearing loss describes the severity of hearing loss in which a person can not hear most sounds. A profound hearing loss is classified above the 90 decibel range. It is considered deaf or deafness. A person with a profound hearing loss will probably not be able to benefit from traditional hearing aids, and may be a candidate for a cochlear implant.

Unilateral/bilateral hearing loss

A final categorization of hearing loss, unilateral and bilateral hearing loss refer to hearing loss in one or both ears, respectively. Bilateral hearing loss is typically the same degree in both ears, but not always. This can be any kind of hearing loss, with any intensity, but the causes are generally age, genetics, and noise exposure.

What other hearing problems come with hearing loss?

You might not be too concerned about hearing loss as an isolated issue. It just happens as we age and there isn’t much to be done about it. If this is the case, you should know that hearing loss can come with some unfortunate side effects.

For example, you may know that the ears are crucial in your sense of balance. When a person has a hearing problem it might be a symptom of a bigger issue with their ears or head. These issues could lead to health conditions like vertigo, a feeling of dizziness, or a lack of balance.

Other negative side effects of hearing loss can include social reclusion, mental fatigue, depression, or even dementia.

Am I going deaf?

As much as we do know about hearing and ears, we can’t tell you if you’re going deaf. The only way you’ll know for sure is by seeing a qualified hearing professional. Our own research has shown that a massive 77.2% of hearing aid owners purchased them from a hearing specialist. As shown in our article on why you shouldn’t buy hearing aids online, purchasing from a specialist is the best way to go about spending your money effectively.

Looking to the future, the hearing loss treatment field looks bright. The aforementioned 3D-printing looks promising, hearing aid technology is progressing at a breakneck pace, and countless audiologists are working on a way to revive the inner ear hair cells. Keep an eye on the evolution of hearing loss treatment, as there's plenty more to come.