Hearing Loss and Tinnitus
Causes of Hearing Loss
Many different occurrences can result in hearing loss. The ear is composed of interrelated and highly sensitive parts that put it at higher likelihood of damage from illnesses, diseases, or injuries than other body parts. Although hearing loss is often the result of aging, young people should also be made aware of potential risk factors to their hearing. This page provides the most common causes of hearing loss and suggests preventative measures so you can stay informed and keep your ears safe for years to come.
It should be noted that while this list contains a great deal of information, it is not exhaustive. Before you self-diagnose and begin any sort of treatment, schedule an appointment with a hearing care professional to determine the true cause of your symptoms specifically.
As the most common cause of hearing loss worldwide, noise can do serious damage to your hearing. All it takes is one extremely loud sound greater than 100 decibels (dB) or exposure over time to noises of more than 85 dB. The physical trauma from these immediate or consistent sounds is enough to bend and break vital hair cells in the ear that cannot be repaired. A hearing test can determine whether your ears have been damaged by noise exposure, though early warning signs like muffled speech and tinnitus can be recognized without a professional. The best treatment? Prevention.
Injury of the outer ear
Your outer ear consists of the pinna or auricle (the visible part on the side of your head and the entrance to the ear canal). The pinna catches sound from the air and funnels it further into the ear. Any injury that damages your outer ear, such as a severe burn that requires amputation of the pinna, is likely to affect sound intake. Take care of your outer ear by avoiding exposure to intense heat or cold, and keeping any piercings clean to prevent infection.
Sports are among the primary causes of external injury to the ear. Subperichondrial hematoma or auricular hematoma, more commonly known as “cauliflower ear,” is widespread among wrestlers, boxers, and other athletes who participate in contact sports. Regular impact can damage the three layers of soft tissue that compose the ear, including a structure of cartilage, the perichondrium, and an external layer of skin. Because of the lack of blood flow in the ear, burst blood vessels will often remain swollen. These hematomas are pockets of blood that have formed in the ear that can compromise hearing, and may cause the ear to look swollen and closed.
Cosmetic deformation is often permanent, so if you have experienced trauma to the external ear you should seek treatment right away. A doctor specializing in ear, nose, and throat treatment (ENT) can help treat cases of auricular hematoma. With a slight incision, they can drain accumulated blood from the ear. Lacerations in the outer ear should also be kept clean in order to prevent outer ear infections, which can be treated with antibiotic eardrops.
In addition to being disfiguring, cauliflower ear can lead to other hearing complications. If injury repeats or goes untreated, sound will have a very difficult time entering the ear canal and further trauma may damage the inner parts of the ear.
You can prevent cauliflower ear and other external injuries simply by wearing the proper protective head gear. Many sporting goods stores sell products designed to keep your head safe during athletic events without impairing mobility or performance. Headgear should be checked regularly for durability and fit to ensure that it is keeping your head safe from heavy blows, especially the pieces shielding your ears.
Blockage of the ear canal
Hearing loss is not always the result of some bodily trauma. Foreign objects, such as food particles, insects, and dirt as well as excess cerumen (earwax), can block the ear canal and prevent sound from passing smoothly. If you have a blocked ear canal, you may sense that your ear is clogged and perceive sounds as more muffled than usual. Whether or not you know what object is stuck in your ear, it is essential that you do not try to dislodge it using a cotton swab or similar device. Seek help from a medical or hearing care professional to avoid compressing the blockage further or puncturing your eardrum.
Infections of the outer or middle ear
Most people can remember the throbbing pain of a childhood ear infection like it was only yesterday. For parents, a child complaining of ear pain can be particularly alarming and should be treated immediately to prevent any long-term damage. Chronic ear infections could be a sign of a Patulous Eustachian Tube, which can lead to hearing loss.
More children visit the doctor for an ear infection than any other ailment, and roughly five out of six children will experience at least one in their first three years of life. Still, your ears do not become immune to bacteria after puberty—in fact, adults make up about 20 percent of all patients needing treatment for ear infections. With the proper knowledge and care, you can recognize the warning signs of an infection and take the right steps toward healing.
Outer or middle ear infections are particularly common in babies who nurse from bottles lying flat on their backs. Milk or formula can seep into the Eustachian tube and enter the middle ear. Bacteria and fluid then accumulate inside the ear, causing infection. Most people first notice a mild pulsing pain in the ear accompanied by other symptoms, such as:
- Persistent pressure
- Fluid discharge or drainage
- Hearing loss
Because the narrow Eustachian tube responds to slight shifts in pressure, altitude and climate changes can also contribute to ear infections. If possible, avoid contact with cigarette smoke and other sinus irritants. Allergies, colds, and sinus issues can also lead to your Eustachian tube closing, leading to a potentially harmful increase in pressure and fluid in your inner ears, so be sure to follow up with a medical professional even after your symptoms have cleared to determine whether everything is functioning properly again.
Treatment for an ear infection is often highly effective and can reduce the pain associated with your illness. Placing a warm cloth on the affected ear while taking pain medications and decongestants can alleviate the ache that comes with an infection. In addition to prescribing antibiotics to speed up the healing process, a health care professional can examine your ear to make sure there is no additional damage.
This condition is often mistaken for an ear infection, though the causes and symptoms are slightly different. When fluid develops behind the eardrum, it can thicken and prevent sound from moving correctly through the ear. This fluid, which is not a bacterial infection, eventually clears up after a couple of months but could lead to language developmental delays and partial hearing loss if unaddressed. If your child routinely needs statements repeated or asks for the volume on certain devices to be turned up louder than should be necessary, it’s time for a visit to a hearing care professional to determine what is interfering with their hearing.
Perforation of the eardrum
The tympanic membrane (eardrum) is a major component of your hearing system. It vibrates in response to sounds caught in the pinna and conducted down the ear canal. You can think of the tympanic membrane the way you would an actual drum—cut a hole in the skin stretched over the top and the sound goes nowhere when struck. Similarly, a punctured eardrum cannot properly transmit sounds to the auditory nerves, resulting in a loss of hearing.
The eardrum is not as deeply set as you may think—depending on the person, it can sit anywhere from 2.5-3 centimeters inside the ear canal. For this reason, the use of objects like cotton swabs to clean out earwax is never recommended. Not only is a certain level of wax healthy for the hearing system, but regular self-cleaning of the ear canal can lead to permanent damage. Instead, use any one of these strategies to safely clean your ears if a buildup of wax is causing you discomfort:
- Hydrogen peroxide — All it takes is a few drops in the ear for 10-15 minutes to soften and dissolve wax. Drain into a bowl and dry with a paper towel.
- Olive oil — Like hydrogen peroxide, 2-3 drops of olive oil can also help clear blocked wax.
- Earwax drops — Available in pharmacy stores and online, these drops are a safe and portable alternative to other methods.
- Visit a hearing care professional — While these solutions can be used to clean the ear, there is always a risk of harm or ineffectiveness when employed by a non-professional. A hearing care professional like an audiologist or ENT can tell you if the wax in your ear is excessive and will use professional tools to remove the blockage.
A perforated eardrum can be painful, though some people go weeks or months before they recognize the symptoms. An easy way to tell if there is a significant tear in the tympanic membrane is to pinch your nose shut with two fingers and attempt to blow air through your nostrils. Pressure in the nasal cavity will extend through the Eustachian tube and inflate your inner ear. The sound of air escaping from one or both ears is a sign that the eardrum has been torn and needs medical attention. Other symptoms include:
- Partial or total hearing loss
- Pulsing, sudden ear pain
- Ear drainage
- Ear infections
- Dizziness and fatigue
Don’t let the sensation of a clean ear cost you your hearing—perforated eardrums are among the most common causes of hearing loss, but they are also the most easily preventable. If left untreated, a perforated eardrum can allow bacteria, dirt, hair, and more to become trapped deep inside the ear and lead to further complications. In many cases, minor ruptures will heal within a couple of months, but it is important to check in with a medical professional to determine whether any symptoms could worsen. Severe cases may require surgery when a medical patch is not enough to restore hearing, which could have permanent implications for your future hearing health.
When an organ fails to develop in the womb, the child is diagnosed with agenesis. Those with major ear agenesis are born without ears, resulting in total deafness. Microtia, or minor agenesis, refers to an underdeveloped ear that is still visible and functioning, although in many cases hearing will be somewhat compromised.
Other auditory delays can result from complications during birth. Children with auditory processing disorders and other neurological delays may struggle to comprehend speech due to interference in the brain. Auditory processing disorders can prevent the brain from understanding and interpreting sound streams as distinct from one another, forming a blurred and indistinct wall of noise. Those with APDs often confuse words with similar phonetic structures, a disability which is sometimes considered a type of hearing loss.
Birth injuries and hereditary conditions
In more than 50 percent of cases where hearing loss is present at birth, the cause is likely a genetic condition like Down syndrome, Usher syndrome, or Waardenburg syndrome. These hereditary abnormalities can pose problems during pregnancy that prevent auditory systems from developing normally. Non-genetic factors, such as premature birth, low birth weight, smoking or drinking while pregnant, and diabetes in the mother can also lead to congenital hearing loss.
Linguists have long noted that infants are able to discriminate phonetic sounds at a rate far higher than adolescents and adults. This allows them to recognize the contours of their native language as distinct from environmental sounds, accelerating communication and listening skills. Since the first few years play a crucial role in developing these linguistic and auditory skills, it is important to treat any congenital hearing condition immediately. Left untreated, the child may be unable to communicate properly once this critical period of auditory conditioning has passed. In cases of severe or profound sensorineural hearing loss, it is recommended that children develop a non-verbal communication method, such as lip reading or sign language. Other cases of congenital hearing loss have been improved using a cochlear implant.
Hearing aids have been known to help infants as young as four weeks of age hear a broader range of sounds, allowing them to acquire early language skills. If your child has congenital hearing loss, a hearing care professional will help you select a hearing aid that is safe for children in addition to providing information on options for speech and language therapy.
Related medical conditions
Hearing loss is often a symptom or outcome of other potentially life-threatening conditions. Diseases that affect multiple body systems, such as meningitis, rubella (German measles), and other viruses can wreak havoc on your hearing, or if you are sick while pregnant, your unborn baby’s developing ears. Hearing loss may also be symptomatic of a tumor. Another less common cause of hearing loss is injury, such as traumatic brain injury (TBI).
The following are a sampling of other diseases and conditions linked to hearing loss. Regular visits to a hearing care professional can help prevent injuries and illnesses from affecting the ear. A hearing care professional can also recommend the right specialist for any health concerns affecting more than your hearing.
In this image, vestibular schwannoma (or acoustic neuroma) has developed on the auditory nerves behind the cochlea. This benign tumor can be removed with precision surgery or radiation therapy.
Up until very recently, removing a tumor in the ear almost always led to facial paralysis, total hearing loss, and other neurological complications due to its position near several critical nerves. Developments in radiation technology and microscopic surgical devices today have drastically lowered the risk of treatment for acoustic neuromas.
An acoustic neuroma usually affects the Schwann cells of the inferior vestibular nerve, which is responsible for hearing and balance. Unfortunately, these kinds of tumors often form an inseparable bond with the facial and auditory nerves, preventing their electrical signal from reaching the brain. While most patients still experience some type of facial numbness or hearing loss after surgery, there are a wider number of auditory and physical therapy options available than in the past, including hearing aids and cochlear implants that can help speed up recovery.
In more than nine out of ten sufferers, hearing loss is among the first signs of an acoustic neuroma. Those affected may notice a poor sense of balance in addition to a number of motor-related deficiencies in the face, such as twitches and weakness. A medical professional can perform tests to determine the size and severity of an acoustic neuroma once symptoms appear.
While benign, these tumors can cause permanent damage to facial and hearing systems, so it is best to address any symptoms as early as possible with a hearing care professional. If you or someone you know has been diagnosed with an acoustic neuroma, consider making a contribution to the American Hearing Research Foundation. Your donation will help medical professionals continue the fight against hearing and balance related disorders, and you will join a community of people dedicated to raising awareness about hearing health.
The number one cause of death in the United States—heart disease—is known to affect hearing. Conversely, loss of hearing is considered a warning sign of this potentially fatal condition. Because of this link, a thorough medical examination by both a cardiologist and a hearing care professional is recommended should you experience symptoms of either.
When a heart is not pumping blood efficiently through the body, lack of adequate blood flow to the tiny vessels in the ear often results in damage to fragile hearing nerves and a decline in hearing ability. In relation to other parts of the body, sensitivity of the inner ear makes it especially vulnerable to variations in blood flow.
Cardiovascular diseases kill over 17 million people per year and can develop suddenly. Take control of your heart health by visiting the American Heart Association today so you can know the early warning signs of heart disease and stroke. Additionally, anyone diagnosed with heart disease should make an appointment with a hearing care professional to check for signs of hearing loss.
Alzheimer’s disease and dementia
Recent studies confirm what has long been suspected—an association between hearing loss and dementia. While most people don’t typically associate hearing with cognitive health, the ability to listen to your environment and articulated speech plays a large role in shaping your conscious awareness of the world. When this capacity is lost, the mental exhaustion that results from straining to hear can weaken neural pathways in the brain responsible for memory and cognition.
People with hearing loss may experience an earlier onset of dementia. While experts still don’t know exactly how hearing loss weakens the mind, it is well-documented that people who don’t hear well tend to isolate themselves. Because effective communication with others requires critical thinking and listening skills, a lack of regular interaction is a known contributor to developing dementia. In this way, cognition operates on a “use-it-or-lose-it” principle, and sudden reductions in meaningful human contact as a result of hearing loss can drastically weaken mental acuity.
The side effects of hearing loss are extensive. In addition to social isolation, hearing loss can also lead to:
- Increased aggression, fatigue, depression, anxiety, and irritability
- Difficulty learning new tasks
- Lowered attentiveness and concentration
Hearing aids are designed to increase the range of audible, intelligible sounds, both in speech and in the environment. In our world, it is impossible to understate how sound keeps us safe from potential dangers and allows us to feel connected to the people we love. Loss of brain function is a tragic and sometimes unavoidable part of the aging process, but there are preventative measures to help you keep your mind sharp well beyond your retirement years.
While only one-sixth of the world’s population has partial or total hearing loss, one in three people with diabetes will experience diminished hearing as a result of their condition. According to a 2011 study, this makes diabetics twice as likely to develop hearing problems than those without either Type 1 or Type 2 diabetes.
Diabetes refers to a group of diseases associated with high blood glucose levels caused by an inability to produce or use insulin properly. Nearly 26 million U.S. citizens have a form of diabetes, yet most don’t realize that hearing loss is a common symptom of the disease. When insulin is low and blood in the body thickens, it has a difficult time moving through the capillaries and other vessels of the inner ear. This form of auditory neuropathy is aggravated by high levels of glucose in the blood, which cause deterioration of auditory nerves and blood vessels over time.
Dietary changes, medication, or insulin injections are the usual treatments for Type 1 and Type 2 diabetes. Unfortunately, damage to the peripheral nervous system is often irreversible, though some patients have been known to regenerate nerves through regular therapy and treatment. Your physician can refer you to a hearing care professional for help finding the right hearing aids to improve any hearing loss you may experience after your diabetes diagnosis.
Most people know that Beethoven became deaf in his later life, but not why. That would be otosclerosis, a condition that affects the ossicles and is characterized by abnormal bone growth in the inner ear. This extra bone density blocks the stapes from sending vibrations to the nervous system, which can dampen hearing. Often a hereditary condition, otosclerosis can affect both ears over a long period. Unlike most illnesses that damage the ear, otosclerosis tends to weaken the ability to hear low frequencies as opposed to high. Symptoms are minor and can often go unnoticed, including tinnitus, vertigo, and lack of balance. In most cases, surgery is required to remove the bone growth, and in cases of partial hearing loss, a hearing aid may be prescribed.
The vestibular system is responsible for maintaining your body’s sense of equilibrium and spatial awareness. The fluid-filled semicircular canals of the inner ear transmit electrical impulses to the brain regarding movements of the head, which help orient your balance. Intense dizziness or sensory disorientation could be the result of Ménière’s disease, which usually develops between the ages of 40 and 60. Because it compromises the inner ear, this disease can lead to partial hearing loss and tinnitus.
Another possible consequence of Ménière’s disease is Autoimmune Inner Ear Disease (AIED), which occurs in nearly 15 percent of cases. Treatment options for Ménière’s disease include medications intended to treat dizziness, diuretics, dietary accommodations, and antibiotic injections. Speak with a doctor to be sure that certain medications don’t pose an additional risk to your hearing health.
Viral infections—measles, rubella, mumps and chickenpox
Once commonly acquired during childhood, vaccinations now offer protection for potentially fatal illnesses such as rubella, mumps, and measles. Because of the low incidence rate of these viral infections today, their connection to hearing loss is often ignored. Knowing how to protect your ears in case of contact with these viruses can mean the difference between a full recovery and a recovery accompanied by partial hearing loss. A physician or other health care professional can examine your ears to determine if a virus has compromised your hearing system, and will likely refer you to an audiologist or otolaryngologist (ENT doctor) for further treatment.
Measles is a very contagious virus that can be fatal if left untreated. While measles was officially declared eliminated in the United States in 2000, limited access to vaccinations around the world and a U.S. resurgence due to some parents choosing not to vaccinate their children means measles is a serious threat again. The most common symptoms of measles are high fever, cough, runny nose, and red eyes. A few days after these appear, a rash forms and spreads throughout the body. If the measles virus reaches the ears, it can cause moderate to severe bilateral (in both ears) sensorineural hearing loss. In this case, the Eustachian tube becomes blocked, causing a collapse of the walls in the middle ear that cuts off airflow from the throat. Once this damage is done, the only way to restore some hearing is through use of hearing aids and regular visits to a hearing care professional. Older adults should talk to their primary care physician about getting their immunity levels tested, as you may require a booster to ensure continued protection.
Rubella can affect a child in utero if their mother contracts the virus while pregnant, causing a number of congenital complications like blindness, heart problems, and hearing loss. The early symptoms are similar to measles, and infants may also develop a notably blue rash. Because the virus attacks the internal systems of the body, the most common type of hearing loss infants develop is sensorineural. This virus has also been nearly erased from the U.S. for years, but still exists widely around the world. Early vaccination between the ages of 12 months to 6 years can prevent this disease from affecting you and your children.
The onset of mumps is usually mistaken for the flu, but left untreated it can lead to severe sensorineural hearing loss and other serious complications, including encephalitis. Because mumps affects the salivary glands, it often leads to a tender jaw and swollen cheeks. Vaccinations are widely available, but outbreaks still occur in the modern world, such as the 2005 epidemic in the United Kingdom that infected nearly 60,000 people who had not received the proper immunization shots. While most people recover in a few weeks, severe cases can cause unilateral (in one ear) sensorineural hearing loss. Again, ask your general practitioner for a blood test to confirm your immunity, and if needed get your booster shot.
The varicella zoster virus (more commonly known as chickenpox) is very contagious and once was an inevitable, if dreaded, childhood event. Since the 1970s, the chickenpox vaccine has saved countless children from weeks of itchy bumps and an aching fever. Still, the high contagiousness of this virus means that outbreaks still occur. It is important to know the warning signs of chickenpox to prevent any permanent hearing loss. Though rare, chickenpox can compromise the hearing system and lead to an ear infection or a rash in the ear that damages the eardrum. Receiving vaccinations prior to pregnancy is the best way to protect a developing child from being affected by chickenpox and other viruses in utero.
Hearing loss is an unfortunate side effect of certain prescription and over-the-counter medications. Ototoxic medications are toxic to the auditory system and can cause hearing loss, tinnitus (ringing in the ears), balance problems, and other disruptions that may be temporary or permanent. When taken in high doses, NSAIDs like aspirin and ibuprofen have been known to cause hearing loss, particularly in adult men. Chemotherapy, certain antibiotics used to treat kidney disease and similar conditions, and diuretics have also been linked to an increased risk of hearing loss. If you are beginning a new medication or are already taking a prescription regularly, please consult a medical professional about the potential for ototoxicity and how to protect your hearing.
The term presbycusis began to appear in medical textbooks in the late 1800s and is derived from the Greek words presbys (“elder”) and akousis (“hearing”), the latter of which also forms the root of the English word “acoustic.” Among those 65 or older, 30-40 percent have some form of age-related hearing loss. As you age, the brain becomes unable to process sounds of higher frequencies. The contours of conversational speech are not monotone, and words can seem garbled when you lose the ability to hear the higher pitches. For this reason, elderly people often complain that while their perception of volume is the same as ever they only hear mumbling when listening to another person. The loss of stereocilia (hair cells) in the cochlea over a lifetime can reduce your sensitivity to sound. Hearing aids that enhance speech and reduce background noise are the most common treatment option prescribed by hearing care professionals to treat presbycusis. Scheduling an appointment for a hearing test as you begin to approach retirement age is the easiest way to identify any hearing issues and address them before they worsen.
Prevent hearing loss with help from a hearing care professional
Taking reasonable precautions to protect your child’s or your own hearing can help you avoid many causes of hearing loss. However, if you have already suffered enough damage to cause ringing in your ears, find it difficult to hear someone talking a few feet away, or struggle to understand conversations, don’t hesitate to contact a hearing care professional. One visit could give you a lifetime of tools to safeguard against losing more—or all—of your hearing.