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Hearing impairment, deafness, or hearing loss refers to the total or partial inability to hear sounds. There are many causes and types of deafness.

A patient with a mild hearing impairment may have problems understanding speech, especially if there is a lot of noise around, while those with moderate deafness may need a hearing aid.

Some people are severely deaf and rely on lip-reading to communicate with others. People who are profoundly deaf can hear nothing at all and can find themselves totally reliant on lip-reading or sign language.

In the United States, around 15 percent of people over the age of 18 years report some level of hearing loss.

Causes

Hearing loss refers to either partial or total reduction in the ability to hear sounds.

Some diseases or circumstances that can cause deafness include:

• chicken pox
• cytomegalovirus
• mumps
• meningitis
• sickle cell disease
• syphilis
• lyme disease

The inner ear is home to some of the most delicate bones in the body, and damage to the eardrum or middle ear can cause hearing loss and deafness in a range of ways.

Hearing loss vs. deafness

It is important to distinguish between the different levels of hearing loss.

Hearing loss: This is a reduced ability to hear sounds in the same way as other people.

Deafness: This occurs when a person cannot understand speech through hearing, even when sound is amplified.

Profound deafness: This refers to a total lack of hearing. An individual with profound deafness is unable to detect sound at all.

The severity of hearing impairment is categorized by how much louder volumes need to be set at before they can detect a sound.

Some people define profoundly deaf and totally deaf in the same way, while others say that a diagnosis of profound deafness is the end of the hearing spectrum.

How does hearing work?

Sound waves enter the ear, move down the ear or auditory canal, and hit the eardrum, which vibrates. The vibrations from the eardrum pass to three bones known as the ossicles in the middle ear.

These ossicles amplify the vibrations, which are then picked up by small hair-like cells in the cochlea.

These move as the vibrations hit them, and the movement data is sent through the auditory nerve to the brain. The brain processes the data, which a person with functional hearing will interpret as sound.

Types

There are three different types of hearing loss:

1) Conductive hearing loss

This means that the vibrations are not passing through from the outer ear to the inner ear, specifically the cochlea. This type can occur for many reasons, including:

• an excessive build-up of earwax
• glue ear
• an ear infection with inflammation and fluid buildup
• a perforated eardrum
• malfunction of the ossicles
• a defective eardrum

Ear infections can leave scar tissue, which might reduce eardrum function. The ossicles may become impaired as a result of infection, trauma, or fusing together in a condition known as ankylosis.

2) Sensorineural hearing loss

Hearing loss is caused by dysfunction of the inner ear, the cochlea, auditory nerve, or brain damage.

This kind of hearing loss is normally due to damaged hair cells in the cochlea. As humans grow older, hair cells lose some of their function, and hearing deteriorates.

Long-term exposure to loud noises, especially high-frequency sounds, is another common reason for hair cell damage. Damaged hair cells cannot be replaced. Currently, research is looking into using stem cells to grow new hair cells.

Sensorineural total deafness may occur as a result of congenital deformities, inner ear infections, or head trauma.

3) Mixed hearing loss

This is a combination of conductive and sensorineural hearing loss. Long-term ear infections can damage both the eardrum and the ossicles. Sometimes, surgical intervention may restore hearing, but it is not always effective.

Symptoms

The symptoms of hearing impairment depend on its cause. Some people are born without being able to hear, while others suddenly become deaf due to an accident or illness. For most people, symptoms of deafness progress gradually over time.

Some conditions may have hearing loss as a symptom, such as tinnitus or stroke.

Hearing impairment in infants

The following signs may indicate a hearing problem:

• Before the age of 4 months, the baby does not turn their head toward a noise.
• By the age of 12 months, the baby still has not uttered a single word.
• The infant does not appear to be startled by a loud noise.
• The infant responds to you when they can see you, but respond far less or do not respond at all when you are out of sight and call out their name.
• The infant only seems to be aware of certain sounds.

Hearing impairment in toddlers and children

These signs might become more evident in slightly older children:

• The child is behind others the same age in oral communication.
• The child keeps saying “What?” or “Pardon?”
• The child talks in a very loud voice, and tends to produce louder-than-normal noises.
• When the child speaks, their utterances are not clear.

Four levels of deafness

There are four levels of deafness or hearing impairment. These are:

• Mild deafness or mild hearing impairment: The person can only detect sounds between 25 and 29 decibels (dB). They may find it hard to understand the words other people are saying, especially if there is a lot of background noise.
• Moderate deafness or moderate hearing impairment: The person can only detect sounds between 40 and 69 dB. Following a conversation using hearing alone is very difficult without using a hearing aid.
• Severe deafness: The person only hears sounds above 70 to 89 dB. A severely deaf person must either lip-read or use sign language in order to communicate, even if they have a hearing aid.
• Profound deafness: Anybody who cannot hear a sound below 90dB has profound deafness. Some people with profound deafness cannot hear anything at all, at any decibel level. Communication is carried out using sign language, lip-reading, or reading and writing.

Diagnosis

Patients who suspect something is wrong with their hearing will initially go and see their doctor.

The doctor will talk to the patient and ask several questions regarding the symptoms, including when they started, whether or not they have gotten worse, and whether the individual is feeling pain alongside the hearing loss.

Conclusion

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