Hearing Loss

Hearing Loss Hearing loss affects patients of all ages and is one of the most common impairments in the United States. According to the Hearing Loss Association of America, about 48 million Americans have reported some degree of hearing loss. Having trouble hearing can make it difficult to detect, recognize, discriminate, comprehend, and perceive auditory information for speech and language. It is important to identify hearing loss in children as early as possible to prevent them from developing speech, language, and learning delays. Adults with hearing loss may find it difficult to communicate with friends, family, and co-workers, which may cause frustration and embarrassment. Hearing loss affects the quality of life for both children and adults if left undiagnosed and untreated, and may be even become dangerous in environmental situations. Hearing loss is typically evaluated based on type, degree, and shape. Types of hearing loss include conductive, sensorineural, and mixed. Degree of hearing loss refers to the severity of the loss from mild to profound, and is measured in decibels (dB). The shape of hearing loss refers to the degree and pattern across the frequency range. These three categories are illustrated on an audiogram after an evaluation by an audiologist.
Hearing evaluations and screenings are performed by the audiologist after obtaining a thorough case history. The hearing evaluation typically includes pure-tone testing, speech recognition testing, and middle ear testing. Pure-tone testing determines the smallest tone that a person can hear across frequencies from lowest to highest loudness level. Tones are presented to patients in each ear through headphones, and patients usually press a button indicating that they have heard the tone. Speech recognition testing determines the softest speech that a person can hear half of the time. Once a speech recognition threshold (SRT) has been confirmed, the audiologist will find the patient’s most comfortable loudness level to determine the word recognition score (WRS), or the ability to correctly repeat words. Speech recognition testing helps to confirm pure-tone findings. Middle ear testing includes tympanometry, which detects fluid, eardrum perforation, or wax. During tympanometry, the ear drum moves back and forth as a result of pressure created by a tube inserted into the ear canal. Information from this test is recorded on a tympanogram, which shows the characteristics of eardrum mobility. Other middle ear tests include acoustic reflex measures and static acoustic impedance. Additional tests for hearing evaluations include auditory brainstem response and otoacoustic emissions.
Tinnitus is a symptom referred to as ringing in the ears, but can also occur as buzzing, clicking, or hissing in one or both ears. Tinnitus is commonly caused by noise-induced hearing loss, but other health conditions such as sinus infections, brain tumors, Ménière’s disease, head injuries, ear infections, and medication side effects can also cause tinnitus symptoms. Experiencing tinnitus may signal the first sign of hearing loss, but tinnitus can also occur without hearing loss.
Did you know that nearly 10% of adults in the U.S. experience tinnitus?
Otolaryngologists and audiologists will work together to identify the underlying cause responsible for tinnitus. The otolaryngologist will perform a head, neck, and ear exam and decide if additional testing is warranted, such as hearing evaluations or radiologic imaging. The audiologist will perform a complete audiological evaluation in order to assess tinnitus and determine if hearing loss exists with the tinnitus. There is not a cure for tinnitus at this time, but various management devices and techniques exist to address the problem. Forms of tinnitus treatment include hearing aids, biofeedback, tinnitus maskers, habituation therapy, vitamin therapy, and counseling.
Vestibular (balance) disorders can cause impaired balance, making it difficult to maintain orientation. For example, patients may have a “spinning room” feeling. When this happens, they may not be able to walk well or get up if seated or laying down. Symptoms of a person with a balance disorder include sensation of dizziness or vertigo (spinning), lightheadedness or faintness, feeling of falling, blurred vision, disorientation, and nausea or vomiting. Some patients may also experience changes in blood pressure and heart rate, fear, and anxiety. Reactions to balance disorder symptoms include depression, fatigue, and reduced concentration. Symptoms may appear and disappear over short or long periods of time. Some of the more common balance disorders are Benign Paroxysmal Positional Vertigo (BPPV), Ménière’s disease, vestibular neuronitis, labrynthitis, and perilymph fistula.

Causes and Symptoms of Hearing Loss

Generally, hearing loss can be caused by a variety of factors including, diseases, infections passed during birth, hereditary causes, head and ear traumas, ototoxic medications, pressure differences, normal aging, and noise exposure. Noise exposure is a common cause of hearing loss which damages the inner hair cells of the cochlea, the snail-like structure in the inner ear. Noise exposure can lead to permanent hearing loss and, in some cases, tinnitus.Tinnitus is a common symptom of hearing loss that is characterized by intermittent or constant ringing in one or both ears. Causes of hearing loss are typically conductive or sensorineural. Conductive causes of hearing loss include:
  • Earwax build-up in the ear canal
  • Damage to the tiny bones, called ossicles, located behind the eardrum
  • Foreign objects stuck in the ear canal
  • Infectious fluid and scarring in the ear from otitis media
  • Eardrum perforations from ear trauma
Sensorineural causes of hearing loss include:
  • Gradual, age-related hearing loss, also called presbycusis
  • Otosclerosis
  • Meniere’s disease and other dizziness and balance problems
  • History of noise exposure
  • Ototoxic medications
  • Acoustic neuroma
  • Viruses such as meningitis, mumps, scarlet fever, and measles
  • Genetic factors
People with hearing loss may experience any of the following symptoms:
  • Ear pain and pressure
  • Sudden hearing loss
  • Unclear, muffled, or slurred hearing quality
  • Noticeable difference in hearing between both ears
  • Ringing, buzzing, or hissing sound in the ears
  • Loud perception of certain sounds
  • Difficulty understanding speech in groups, crowds, and background noise
  • Trouble hearing the voices of women and children
  • Dizziness or balance issues

Diagnosis and Treatment Hearing Loss

Hearing loss is usually diagnosed by an audiologist. The audiologist will perform a complete audiological evaluation, which will identify the type, degree, and shape of the hearing loss. Tympanometry is performed during the hearing evaluation to assess the movement of the eardrum. Hearing screenings are usually performed in hospitals and schools to identify hearing loss in infants and children. Some cases of hearing loss require additional testing, such as CT or MRI of the head, to identify underlying causes of hearing loss. Many treatment options are available for hearing loss depending on the type, degree, and shape. The audiologist will assess these factors and recommend the most efficient treatment option based on the individual needs of the patient. Hearing aids, assistive listening devices, and aural rehabilitation are non-invasive methods for hearing loss treatment. Some hearing losses require surgical intervention, such as myringotomy, placement of tubes in the eardrum, or tympanoplasty, repair of eardrum perforation. Candidacy for cochlear implantation may also be explored for profound cases of hearing losses.


  • Anne S.

    Kaitlyn is a smart, astute and wonderful clinician. After a year of trying to figure out what was wrong with my ears, ...

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    Dr. Emanuele is wonderful because she really explained everything. She addressed my problems more than any other doctor has.

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    Very satisfied! Dr. Emanuele was great, and the office staff is GREAT too.

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