Synonyms: Deaf, deafness, hard of hearing, presbyacusis, hypoacusis
Contents
Do I need a doctor?
Conservative measures for new onset hearing loss.
What your doctor needs to know.
What to expect from your doctor.
But what should your doctor do for you?
The differential diagnosis of hearing loss.
Disclaimer: This information is meant to improve the interaction between you and your doctor. It is NOT meant to replace this interaction! There is no substitute for a history and physical examination administered by a competent physician. If you inappropriately use this information to treat yourself, you may be endangering your health.
Any degree of hearing loss severe enough to be noticeable should be reported to a doctor. Aside from the obvious ("I can't hear as well as I used to!") there are a number of less obvious situations in which a doctor may help in the diagnosis of hearing loss. For example:
An infant who does not respond appropriately to loud noises
An infant born to parents who have a family history of deafness at birth
A premature infant who has had a number of medical problems after birth
Note: audiologists have ways of testing an infant's hearing at any age-- even newborn.
A toddler that is having problems learning to speak
A toddler or older child that suffers from repeated ear infections
A person of any age who has difficulty understanding speech in noisy situations
Your primary care physician (pediatrician, family practitioner, internist etc.) will be able to determine whether or not you (or your child) needs to see a specialist. Audiologists are specialists who are trained to test hearing; most are also trained to dispense hearing aids. ENTs (ear, nose and throat specialists) are doctors who are trained in the medical and surgical treatment of ear disease. Otologists are ENTs who subspecialize in the treatment of ear disease.
Danger Signs
As noted above, any degree of hearing loss which you have noticed (or your family and friends have noticed) is cause for concern. There are, however, a few situations in which hearing loss requires more urgent attention. In some cases, this urgency is due to the fact that the hearing loss may be a symptom of a more dangerous health problem which requires urgent treatment. In other cases, the hearing loss itself may be treatable, but only if you begin treatment soon after the onset of the problem.
If any of the following symptoms are also present, you should see a doctor as soon as possible.
Other neurological symptoms are present (for example: facial paralysis; weakness or paralysis of other muscles; skin numbness; dizziness; severe headache; vision changes; new difficulties with speech or swallowing; new problems with balance or coordination.)
Severe ear pain
The hearing loss occurred suddenly (over 24 hours or less) and is severe
High fever (over 101oF)
Neck stiffness and/or sensitivity to light
Painful sores in the ear canal, on the external ear, or on the face
The hearing loss occurred after a blow to the ear or a blow to the head, or after a penetrating injury
The hearing loss occurred after underwater diving
Sudden worsening of hearing following a long history of chronic ear infection
Wondering how to use this information?
Refer to Symptom Guide Help for a bit of advice.
Conservative measures for new onset hearing loss
First, read Do I need a doctor? to determine whether it is a good idea for you to attempt to treat yourself. Pay particular attention to the Danger Signs.
Here are a few situations in which it is safe to "watch" a hearing problem:
Mild hearing loss which occurs when you fly or when you drive through mountains; usually, there is also a mild pain or pressure sensation in the ear, and their may also be some ear noise (often low-pitched, but may also be high-pitched.) If this has happened before, and has cleared spontaneously, then you can safely "wait it out." If it persists for more than one week, see your doctor.
Mild hearing loss which occurs during or after a common cold or flu; again, there is usually mild pain or pressure in the affected ear. If either the pain or hearing loss is more than "mild" you must see a doctor, as there may be a bacterial ear infection.
These two situations refer to a problem known as Eustachian tube dysfunction. For more information on Eustachian tube dysfunction, follow this link.
Hearing loss due to a wax impaction (blockage of the ear canal by ear wax) can SOMETIMES be safely treated with over the counter remedies (but see below.)
Home remedies and over the counter medications for wax impaction.
If you have had problems with ear wax in the past, you can probably recognize this problem when it recurs. The most common situation is this:
A person has a partial wax impaction. In other words, there is a great deal of wax in the ear canal, but there is still a clear "path" through which sound waves can reach the ear drum. At this point, this person may have some ear discomfort, but his hearing may be reasonably normal.
Something happens. He tries to clean the wax out, or someone else tries to clean the wax out, or he gets water in his ear. Suddenly, the partial wax impaction has become a total impaction. Sound waves cannot easily reach the ear drum, so this person notices a sudden loss of hearing.
It must be stressed that the SAFEST course to follow is to see your doctor for help in removing the wax. If you really want to do it yourself, please read the Ear Wax FAQ before you proceed!
What your doctor needs to know.
The questions below are specific to your hearing problem. Your doctor will also need to
know your general medical history. This includes: any problems for which you are
under a doctor's care; problems for which you take medications; a list of all of your
medications, including over the counter drugs, vitamins and herbal remedies; a list of the
operations you have had; whether you are allergic to any medications; whether you drink
alcohol, smoke tobacco, or use other drugs; whether there are any illnesses that run in
your family.
Are you having difficulty hearing from one ear, or are both affected? How long have you had the problem? How rapidly did it develop? Is it getting worse? Does it ever improve, or has it steadily gotten worse?
Are you having any other ear symptoms: pain, liquid draining from the ear, ringing (or other noises) in the ear, dizziness or unsteadiness, a sensation of ear pressure or fullness, distortion of sounds?
Are you having any other neurologic symptoms: facial twitching, facial weakness or paralysis, headache, neck stiffness, new vision problems, problems with balance or coordination, problems with speaking or swallowing?
Have you had much exposure to noise (in the military, in your job, or recreationally?)
Have you flown recently, or gone diving underwater?
Have you had many ear infections during your life? Have you ever had any other serious infections (especially: infections requiring intravenous antibiotics; syphilis; meningitis?) Have you ever suffered any head trauma, particularly a blow to the head that caused you to lose consciousness? Have you ever had an operation on either ear?
Have you ever had chemotherapy for cancer, or have you ever had radiation treatments to your head or neck?
Do you have any nasal symptoms: nasal airway obstruction, postnasal drainage, sneezing, itching, facial pain, "scratchy" throat? Do your eyes tear, are they itchy or red?
Do other members of your family have hearing problems?
Your doctor should take a complete medical and surgical history; this history should cover general medical problems as well as factors that are specific to your hearing loss (see previous section.)
Your doctor should perform a complete head and neck examination. This involves not only an examination of your ears (with an otoscope or operating microscope), but also an examination of your nose, mouth, throat, and neck. A head and neck examination also includes testing of the cranial nerves (for example, the nerves that allow you to see, hear, chew, swallow, and move your facial muscles.)
In addition to a complete head and neck examination, your doctor may need to examine other parts of your body, if this is relevant to your hearing problem.
Unless the problem is very obvious (for example, a wax impaction or an ear infection), your doctor should also test your hearing. This may include tuning fork tests, or more sophisticated tests such as an audiogram (which measures your ability to hear tones that are low-, middle-, and high-pitched) and a tympanogram (which measures the ability of your ear drum to "receive" sound.)
It is impossible to list all of the situations in which it is appropriate for your doctor to refer you to an audiologist or to an ear, nose and throat specialist. It is appropriate for primary care physicians to treat most acute ear infections and some wax impactions. Your doctor's ability to treat other hearing problems depends greatly on his/her training and experience.
If any danger signs are present, your doctor should refer you to an ear, nose and throat specialist at once. Your doctor should also refer you to an ENT if he/she is uncertain as to your diagnosis or is uncomfortable treating your problem.
Your doctor should inform you of your diagnosis, or give you a list of likely diagnoses. He/she should clearly indicate how you will be treated, and what he/she will do if you do not respond to treatment or if your hearing worsens.
In some cases, other studies may be necessary before your doctor can determine your diagnosis. These studies may include an MRI, CT ("CAT scan"), further hearing tests, or blood tests.
Your doctor should be persistent. He/she should investigate your problem until a diagnosis has been determined and treatment has proven effective. (In some cases, the only treatment possible may be a hearing aid; occasionally, hearing loss is so severe that even hearing aids cannot help.)
This list is not intended to fuel the flames of hypochondria. Rather, it is hoped that the material in this section will stimulate discussions between you and your doctor, particularly if your hearing loss has proven difficult to diagnose and treat.
Infection and inflammation: can involve the external ear, the ear canal, the middle ear, or the inner ear; the infection (or inflammatory disease) may be limited to the ear, or may involve other areas of the body.
Mechanical obstruction: wax impaction, foreign body (for example, a child that places a pea in his ear), ear canals that "collapse" (this sometimes occurs with age.)
Trauma: sudden pressure changes (typically, while flying or diving), blows to the head, penetrating injuries to the head (knife wounds, gunshot wounds), burns, Q-tip injuries, noise exposure.
Congenital/hereditary: a variety of problems can cause hearing loss, including malformation of the external ear, the ear canals, middle ear structures, the inner ear, the auditory nerve, or the brain; a family history may or may not be present, as not all such problems are genetic.
Tumors: a variety of growths, both cancerous and benign, can cause hearing loss. The most common tumors involve the external ear, ear canal or middle ear, but tumors of the auditory nerve or of the brain can also lead to hearing loss. Bony growths in the ear canal can also cause hearing loss when they become obstructive.
Iatrogenic (hearing loss due to medical treatment): certain drugs are toxic to the ears; ear surgery can, on occasion, lead to further hearing loss; traumatic wax cleaning can also cause hearing loss.
Degenerative problems: the most common diagnosis in this category is presbycusis (age-related hearing loss.)
Immune system disease, for example: multiple sclerosis, lupus, autoimmune sensorineural hearing loss.
Vascular disease, for example: migraine, cerebellar infarction (stroke), heart surgery involving bypass.
Bone disease, for example: Paget's disease, otosclerosis.
Idiopathic disorders (disorders for which the cause is unknown), for example: sarcoidosis, Meniere's disease; some would group presbycusis (age-related hearing loss) among the idiopathic disorders.