Hearing problems - medical conditions

September 2008

Rosie Hayes with help from Antonia Chitty

Conductive Hearing Loss

Conductive hearing loss occurs when sound fails to pass well through the outer or middle ear.  It is due to permanent or temporary damage to the outer or middle ear.  Some people are born with a conductive hearing loss, while others develop it in childhood or adult life.  If sounds are amplified (made louder) speech can be heard more clearly.  Some people may notice that they hear better when there is a lot of background noise as people naturally raise their voices.

Some conductive hearing losses are treated with medication or by surgery.  After some treatments hearing may return to within the usual range.  When the loss is permanent, such as when there is a deformity of the ear, a hearing aid is often supplied.

Sensori-neural Hearing Loss

Sensori-neural hearing loss is a permanent condition and cannot be rectified by surgery.  It is caused where there is damage to the inner ear (cochlea) or the nerve pathways which lead from the inner ear (retrocochlear or behind the cochlea) to the brain.

This type of loss affects the ability to understand speech even when the volume of sound is increased.  This makes it difficult to understand spoken voice in crowded settings and speech can be misheard.

Sensori-neural hearing loss can be caused by diseases, premature birth, drugs that are toxic to the auditory system and genetic syndromes.  It can be acquired through noise exposure, viruses or head trauma at any age.

Many people with sensori-neural hearing loss wear hearing aids.

Mixed Hearing Loss

This is a combination of both a conductive loss with a sensori-neural element to it.  There will be damage to both the outer or/and middle ear and also the inner ear or auditory nerve.

Cauliflower Ear

This is caused by repeated blows to the ear, which damage the connective fibrous tissue that gives the ear its shape (cartilage). 

Wax Impaction

A build up of wax in the ear canal that is difficult to remove.  Some people are prone to making more ear wax than others.  Ear wax production can be stimulated by the overuse of cotton buds to clean the ears, for example.  People with very narrow ear canals can also have problems with wax.

The usual course of treatment is initial softening of the wax with light oil followed by light syringing performed by a nurse or doctor. 

(For information on using olive oil to soften ear wax, read our factsheet on Instructions for using olive oil ear drops.)

Some medical practitioners are reluctant to syringe ears unless absolutely necessary.  Syringing involves squirting water into the person’s ear to remove the wax.  Some people are convinced their tinnitus (sounds heard in the ear) started after ear syringing.  Removal by suction is therefore a preferred method.  This involves a vacuum pump and the soft wax is then ‘hoovered’ up out of the ear canal.  This method of wax removal is essential for people who have had perforated ear-drums or other severe problems as it will help prevent further damage to the ear.

Otitis Externa, Swimmer’s Ear

Otitis externa is an infection of the external ear canal.  A normal ear canal is self cleaning but occasionally it will become infected and will require medical attention.

When water enters the ear it usually drains away naturally.  However, if dirty water remains in the ear canal it can become infected.  Damage to the skin can be caused by small scratches from fingernails, or skin conditions such as eczema and psoriasis.  The swelling causes pain and there will be discharge and the ear may itch.  There will be a blocked feeling and a slight hearing loss due to the blockage.

It is sometimes hard to distinguish between a bacterial and a fungus infection.  If the condition persists a small swab of the infection will be sent to the laboratory for analysis so that the correct medication can be given.

Sometimes the consultant will decide to remove the wax and infected debris using suction apparatus so that the site of the infection can be better treated with drugs which reduce the swelling (anti-inflammatory) and those which fight the infection (antibiotics).

During treatment no water must enter the ear canal, especially during swimming, showering etc.

Foreign Bodies

A foreign body is anything that gets stuck in the ear canal – such as crayons, ’Q’ tips, polystyrene balls, insects, plastic toys, small batteries and so on.  The symptoms may mimic those of otitis externa and discharge may be foul smelling.

If a foreign body is suspected medical attention must be sought.  Never try to remove objects from the ear canal or attempt to wash them out.

Acute Otitis Media

Eardrum, Kevin Kavanagh MD

Acute otitis media is the name given to pain, redness, swelling and infection of the middle ear.  It can start suddenly and may follow a cold.  Symptoms include a raised temperature, pain in the ear and conductive hearing loss.

Sometimes the condition gets better without treatment but antibiotics can be prescribed.

Occasionally the eardrum will develop a perforation if it bursts under the pressure of the inflammation. 

Serous Otitis Media

A build up of thin watery fluid in the middle ear.  This is treated with decongestants in tablet or liquid form.  If it persists, surgical removal of the fluid and insertion of a ventilation tube (grommet) into the eardrum is performed, usually under a general anaesthetic.  Also see Glue Ear.

Glue Ear

Grommet in place, Kevin Kavanagh MD

Glue ear is a middle ear inflammation with thick sticky mucus caused by longstanding Eustachian tube obstruction.

The main symptom of glue ear is hearing loss.  It is important that the middle ear is aerated and a small tube (a grommet) is used for this purpose which is put into place by a surgical procedure.  Glue ear is not common in adults, but people with Down’s syndrome may develop it.

Perforated Eardrum

Perforated eardrum simply means that there is a hole in the eardrum.  It can be due to a middle ear infection or trauma to the eardrum.  The size of the hole will determine whether it can heal itself or whether an operation called a myringoplasty will be needed.  There is often pain when a perforation occurs and a hearing loss may be noticed.

If there is a history of perforations ears should not be syringed for wax removal.  The ears should be kept dry and ear plugs should be worn for swimming.

Cholesteatoma

A destructive cyst which can destroy the bones of the middle ear resulting in hearing loss.  It may progress through the mastoid air cells to the lining of the brain (meninges).  It can occur as a result of untreated middle ear disease.

There is often no pain in the early stages but it can give rise to a variety of conditions such as dizziness and facial pain if treatment is not sought.  It is treated by surgical removal.

Tympanosclerosis

Tympanoscleroses are calcium plaques which appear on the eardrum.  In themselves they are of little significance but their appearance may be due to past repeated infections.

Otosclerosis

A conductive or mixed type deafness which occurs when the usually mobile stapes bone become fixed to the inner ear.  Usually hereditary, otosclerosis occurs more often in females.  It can be triggered by pregnancy and often occurs between the ages of 20 and 40 years.  It may affect one ear or both.  The rate of deterioration is individual.

There are three options for treatment: the fitting of a hearing aid; the placement of a bone anchored hearing aid (BAHA); or surgery to replace the stapes bone with a prosthesis to return functioning to the ossicular chain (stapedectomy).

Bone Anchored Hearing Aid

http://www.cochlearamericas.com/Products/878.asp

Stapedectomy

Presbycusis

A sensori-neural hearing loss caused by the aging process and wear and tear on the hair cells and the auditory nerve. 

Deafness is usually the same in both ears and is mainly in the higher frequencies making consonant sounds difficult to distinguish.

People with this condition say that they can hear adequately if facing the speaker but have difficulty hearing in crowded situations.  Treatment is a combination of hearing aids and training in lipreading skills.  Simple tips to reduce communication difficulties include remembering to always look at the speaker’s face, and keeping glasses clean.

Recruitment

Recruitment means that for a small increase in intensity there is a large perceived increase in loudness.  Put simply, this means that some people find some sounds get too loud too fast when they are amplified.  Sounds then become uncomfortable and can be distressing to listen to.  This can make people reluctant to wear their hearing aids.  Digital hearing aids with compression capability help to increase audibility in the areas needed and it is important that the fitting of a hearing aid matches the particular hearing loss.

Tinnitus

Sounds mainly heard within the ear.  These can be described by many adjectives, whistles, pops, crackling etc.