Health News
Health News
July 17, 2020
Hearing Loss & Vertigo

The human ears are amazing sensory organs that enable us to hear the world around us and communicate with one another.  Our ears treat us to pleasant sounds: music, birds singing, wind rustling the leaves.  They also alert us to danger: an oncoming car or a child crying out in pain.  Hearing is one of the primary ways we receive information – allowing us to learn, laugh and cry.

When something goes wrong with our hearing or our ears, our ability to communicate and overall quality of life can be significantly impacted.  Privia Medical Group North Texas has several Otolaryngologists – also known as Ear, Nose and Throat (ENT) doctors – in its membership.  They are here to help if you or someone in your family should experience ear or hearing problems. 

The Human Ear

To understand hearing loss and some other common conditions that affect the ear, it is helpful to know how the ears and auditory system work. The ear is comprised of three sections:

  • Outer Ear: This is the part we can see on our heads, called the pinna, as well as the ear canal and the ear drum.

  • Middle Ear: The middle ear is composed of the ear drum and three tiny bones called ossicles. When sound reaches the ear drum, it vibrates. The ossicles amplify the vibration and transmit these signals to the inner ear. 

  • Inner Ear: The inner ear is composed of the cochlea, canals that aid our balance and nerves that lead to the brain. The sound vibrations pass through fluid in the cochlea and then into tiny hairs connected to nerve cells. The hairs convert the vibrations into electrical signals that are carried to the brain via the auditory nerve. 

Hearing Loss

Hearing loss can be caused by a variety of factors: sustained exposure to loud noise, heredity, disease and age.  One-third of people between the ages of 65-75 have some level of hearing loss and half of all people age 75 and older have diminished hearing.  

Loss of hearing can be frustrating, especially as it becomes more difficult to communicate with others.  It can also be dangerous, as someone with substantial hearing loss may not be able to hear an alarm, siren or other warning of potential danger.  

“Untreated hearing loss can often lead to the misperception that an older person is confused or does not have all of his or her faculties,” says Dr. Salim Bhaloo, an otolaryngologist.  “This, combined with being unable to communicate effectively with friends and loved ones, can lead to feelings of sadness, frustration and depression.  These are all reasons why it is so important to have hearing loss evaluated and treated.” 

There are several types of hearing loss:

  • Conductive hearing loss: This results from something blocking sound from getting through the outer or middle ear.

  • Sensorineural hearing loss: This is a result of a problem in the inner ear or with the auditory nerve.

  • Mixed hearing loss: This is a combination of conductive and sensorineural hearing loss.

  • Auditory neuropathy spectrum disorder: This type of hearing problem occurs when sound enters the ear as it should, but due to damage to the inner ear or auditory nerve, the sound is not organized in a way the brain can understand it.

Hearing loss is classified as mild, moderate, severe or profound.  Someone with mild hearing loss may have trouble detecting soft sounds.  A person who has suffered profound hearing loss will not be able to hear any speech at all. 

Hearing loss can be present in one or both ears, progress differently in each ear, come on suddenly or gradually, remain constant or fluctuate.   

Hearing Loss Symptoms

The symptoms of hearing loss may seem obvious – one cannot hear as well as in the past.  Often, there are additional, and sometimes subtle, indications:   

  • Speech and sound coming across as muffled

  • Trouble understanding speech and hearing consonants

  • Turning up the volume on the TV or radio in order to hear it

  • Repeatedly asking others to speak up

  • Avoiding or not participating in conversations

Another common condition that can be an early indicator of hearing loss is tinnitus. Tinnitus is often referred to as “ringing in the ears” but it may also sound like hissing, roaring, clicking or buzzing. Tinnitus can be caused by exposure to loud noise, as well as ear and sinus infections, hormonal changes, thyroid disease and cardiovascular problems.  Tinnitus can also be a side effect of various medications.

Hearing Loss Causes & Risk Factors

Some of the specific conditions that may result in hearing loss include:

  • Earwax buildup: Earwax can gradually accumulate in the ear canal and block sound waves from reaching the eardrum, leading to conductive hearing loss. Wax removal, performed by a doctor, may help alleviate this condition.  People should not stick swabs or other objects in their ears to remove wax; this may damage the ear drum. 

  • Inner ear damage: The nerve cells and hairs in and attached to the cochlea may become damaged over time as a result of age or sustained exposure to loud noises. This damage will disrupt the sound signals’ journey to the brain.

  • Ear infection or tumors: These outer ear conditions can disrupt hearing.

  • Ruptured eardrum: Extremely loud noise, a foreign object poking the ear drum, pressure changes or infection can cause a rupture in the eardrum and subsequent hearing loss.    

In addition, the following risk factors may contribute to hearing loss: 

  • Age: Over time, the structure of the inner ear can deteriorate, causing hearing loss. Age is the biggest risk factor for loss of hearing. 

  • Heredity: Some hearing traits can be passed down from parent to child.

  • Medications: Certain medications, including some antibiotics and chemotherapy drugs, can cause hearing loss.

  • Illness: Certain diseases, such as meningitis, may result in permanent hearing loss.

How Much Noise is Too Much?

Exposure to loud noise is a key risk factor for hearing loss. There are two classifications of unhealthy noise:

  • Occupational noise: People who work in jobs that require sustained exposure to loud noise are more susceptible to hearing loss. Common examples include construction jobs and airport workers. 

  • Recreational noises: Even occasional exposure to loud noise, such as attending a rock concert or an auto race, can lead to hearing loss.

Sound is measured in decibels (dB).  When thinking about what level of noise is safe, we have to consider both the volume and the length of time a person is exposed to the noise. When noise levels reach 75 dB, hearing loss becomes possible with sustained exposure.  Here’s a look at a few different common noises and their dB levels:

  • A conversation at a normal volume is about 60 dB

  • A washing machine or dishwasher is around 70dB

  • A lawnmower or leaf blower is about 80-85dB. This noise level can cause hearing loss with about two hours of exposure.

  • A motorcycle engine is 95dB. Hearing loss is possible after just 50 minutes.

  • Cranking your stereo all the way up produces noise in the 105-110dB range. This can cause hearing loss in less than five minutes!

“We all need to protect ourselves from excessive noise exposure.  Use ear plugs or earmuffs when using loud equipment like a lawnmower or leaf blower,” says Dr. Ricardo Cristobal, an otolaryngologist.  “Be mindful of the volume of your television, car stereo and your headphones – any of these at a high volume can damage your hearing.” 

Diagnosing & Treating Hearing Loss

A physical examination can diagnose some causes of hearing loss, such as excess earwax buildup, infection or damage to the ear drum.   Another common tool to diagnose hearing loss is an audiometer test. This is an exam conducted by an audiologist using special equipment that directs sounds and words through earphones to each ear at various levels of volume. 

Surgery

Surgery to place tubes in the ears are a common treatment, especially for children.  Ear tubes are used when a patient develops chronic middle ear infections or experiences a buildup of fluid in the middle ear.  The surgeon makes a tiny incision in the ear drum and then inserts a small plastic tube into the incision.  This allows air flow into the middle ear, reducing the likelihood of infection and fluid buildup. 

Each year, more than 500,000 ear tube procedures are performed on young children.  “When a child gets repeated ear infections, one of the most common ways to help solve the problem is by inserting tubes in the ears,” explains Dr. Andrew Vories, an otolaryngologist.  “Tubes aren’t just for kids though; we also use them for adolescents and adults who experience chronic ear infections. Tubes help prevent ear infections and improve hearing.”

Recovery from this procedure is very quick.  Depending on the type of ear tube used, they may fall out by themselves within six to eighteen months or require removal by the otolaryngologist.

ENTs are often able to surgically repair damaged eardrums or ossicles, as well as remove tumors in the ears. 

Hearing Aids

Hearing aids are a very common treatment for hearing loss caused by deterioration of the inner ear.  Though there are many different styles of hearing aids, they all work by capturing and then amplifying sounds in your ears.  They can be adjusted based on the type and severity of hearing loss the patient is dealing with.  Some hearing aids are designed to sit in the ear canal while some sit partly in the canal and partly outside it. Others rest behind the ear. 

Your doctor and audiologist can discuss the best options for you, as well as the pros and cons of different styles.  No matter what you decide on, there are a few important things to remember with hearing aids. 

First, check with your insurance to see if your plan will cover them.  Some plans do; others do not.  If you have to pay out of pocket, be aware that hearing aids can cost up to a few thousand dollars. 

Regardless of what type of hearing aid you purchase, it is important to stick with it and give yourself a chance to get used to it.  While it will not sound exactly like your natural hearing did, you will get used to it and find that it helps you hear sounds and words you otherwise would not be able to hear.

For people who do not find success with hearing aids, a cochlear implant may be an option.  This is a device that is inserted into the inner ear to directly stimulate the auditory nerve. 

Vertigo

Vertigo is characterized by a feeling of dizziness, a loss of balance, nausea and a feeling that you or your surroundings are spinning.    Different conditions can cause vertigo; the most common is known as benign paroxysmal positional vertigo (BPPV). 

BPPV is usually mild and rarely serious.  Someone with BPPV may have occasional episodes of dizziness, balance issues or feel as though the room is spinning.  The precise triggers for these sensations vary, but the root cause is usually a sudden and specific change in the position of the head.  Standing suddenly, from either a sitting or reclining position, can trigger vertigo. 

These sudden head movements can disrupt the workings of the vestibular labyrinth, a series of canals in the inner ear.  The canals contain fluid and tiny hairs that monitor the head’s rotation. Otolith organs, also located in the inner ear, monitor the head’s movement up and down and right to left.  The otolith organs contain tiny crystals that control the body’s relationship to gravity.  Sudden head movements can cause the crystals to become dislodged, resulting in feelings of dizziness and vertigo. 

BPPV can occur at any age but is more common in people over 50.  While it is usually not serious, if vertigo is accompanied by severe headaches, double or blurred vision or difficulty walking, seek medical attention immediately. 

BPPV that does not go away or causes frequent problems may be treated by an ENT specialist through surgery or a repositioning procedure designed to prevent the crystals from slipping. 

Meniere’s disease is another cause of vertigo, as well as hearing loss and tinnitus.  Meniere’s disease generally affects only one ear.  Its causes are unknown, but it may be influenced by genetics, a viral infection or autoimmune response. 

Protect Your Hearing

Our ears are portals to the world, allowing us to communicate with others.  When something goes wrong with our hearing, our quality of life can be severely impacted.  You can help protect your hearing by limiting exposure to loud noise and using hearing protection when around loud equipment. 

If you are having trouble hearing as well as you once did, or have pain or discomfort in your ears, make an appointment to see your physician and get your hearing and ears checked out. 

This article contains information sourced from:

The U.S. Centers for Disease Control and Prevention

The Mayo Clinic

The National Institute of Deafness and Other Communication Disorders