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Hearing loss does not automatically mean only hearing quieter. Hearing impairments occur both gradually and suddenly and do not have to affect both ears. Plugs of earwax or middle ear infections can be the cause if sounds are only perceived muffled. Natural aging processes, noise, or inflammation of the inner ear also cause sound not to be transmitted correctly. Symptoms such as dizziness, nausea, and ringing in the ears (tinnitus) can then occur. Audiometry or otoscopy is used to determine the cause and extent of the hearing loss. Not only hearing aids are available for therapy, but depending on the disorder, surgical restoration of the eardrum or an ankle prosthesis is also used.

Hearing aids

How common is hearing loss?

Hearing loss is one of the most common sensory disorders. It is estimated that almost half a billion people worldwide are affected, approximately 48 million Americans have some degree of hearing loss. However, old age is by no means the only possible cause of hearing loss. It can also be caused by heredity, noise damage, trauma, or hearing loss.

Structure of the ear

The human ear is made up of 3 sections: the outer ear, the middle ear, and the inner ear. Outer ear: The outer ear includes the pinna and the external auditory canal. Middle ear: behind the eardrum, there are 3 successive ossicles of the middle ear, which are located in the tympanic cavity. Inner ear: Finally comes the inner ear, which contains our organ of balance, also the cochlea, so-called hair fibers, and nerve pathways that transmit incoming information to the brain. Now, if a sound is heard in front of the human ear, the outer and middle ear transmits the sound further to the inner ear. Thus, the outer and middle ear serves to conduct sound.

Causes/symptoms/progression of different forms of hearing loss

In principle, three types of hearing loss can be differentiated, each of which is accompanied by different symptoms. There are differences as well as overlaps in the possible causes.

Conductive hearing loss

In conductive hearing loss, the ambient sound cannot be transmitted unimpeded through the outer and middle ear to the inner ear. The sound arrives only muffled or not at all, resulting in hearing loss.

Conductive hearing loss most common causes are:

Hole in the eardrum (eardrum perforation): a hole in the eardrum is caused either by direct injuries, such as from a cotton swab or indirectly by rapid changes in air pressure, such as from an explosion or a blow to the ear. The affected person feels a stabbing pain, sometimes dizziness.

Traces of blood may be visible at the site of the laceration. Genetic causes: in the case of genetic causes, malformations of the auricle or the auditory canal may occur. Damage to the auricle or the external auditory canal: e.g., due to foreign bodies. Interruption of the ossicular chain: If one of the 3 ossicles (hammer, anvil, stirrup) is broken, e.g. after an accident, the affected person hears only muffled, in the worst case not at all.

A damaged bone can be replaced by surgery. Middle ear infection, acute and chronic: Middle ear infections usually occur in connection with an inflammation of the paranasal sinuses, following a cold or a common cold. Affected individuals suffer from stabbing pain and tapping in the ear, and there is also frequent ringing in the ears, headaches, malaise, and fever.

Earwax plug (cerumen): The earwax glands secrete sebum to keep the external ear canal moist and to carry dirt particles out of the ear canal. If too much earwax accumulates or swells during bathing, it can cause hearing loss and a dull feeling in the ears. Cleaning with a cotton swab could harm the ear, so the doctor rinses out the earwax plug with warm water or sucks it in with some air.

Sensorineural hearing loss

In the sensorineural hearing loss, sound vibrations arrive in the middle ear but cannot be processed there and transmitted to the brain.

Sensorineural hearing loss following causes are possible:

Age-related hearing loss: due to aging processes, the auditory nerves and sensory cells increasingly deteriorate and wear out after the age of 50. Affected persons are often first unable to hear high-pitched sounds, and in the later stages, low-pitched sounds as well.

In the old-age hearing loss, individual sounds are missing in a sentence, and those affected often try to follow the conversation from the context of the sentence. Overall, speech comprehension is severely impaired, especially in larger groups. Ringing in the ears often occurs in quiet surroundings. To compensate for the hearing loss, affected persons usually need a hearing aid that amplifies incoming sounds via a microphone.

Hearing loss and diabetes

Hearing loss: for no apparent reason, acute hearing loss occurs suddenly, usually on one side, and there are noises in the ears and a feeling of pressure. The cause of hearing loss has not been scientifically clarified, but circulatory and metabolic disorders, as well as viral infections, are discussed. Unilateral deafness may also occur in this context.

Noise: Acoustic trauma can be caused by sudden or chronic noise. This results in permanent damage to the hair cells. These are the sensory cells that pick up sounds as electrical impulses and transmit them toward the brain. Hearing loss usually occurs on both sides and is often accompanied by ear noise. Chronic noise trauma is said to occur when noise exposure of at least 85 dB is sustained, usually occupationally. Acute trauma occurs when noise exceeds 120 dB for a short period of time (e.g., during a concert or the jets of an airplane).

Inflammatory infections of the inner ear: Inflammations of the inner ear often affect the so-called cochlea and the organ of balance, resulting in dizziness and nausea, sometimes with vomiting. Ear noises are also possible. The cause of the inflammation is usually infection with bacteria or viruses. Congenital or early childhood acquired hearing loss: Congenital deafness often results in a lack of speech development; in this case, it is referred to as deaf-muteness.

Those affected can often be helped with special implants or hearing aids. With speech training and attendance at a special school, those affected can learn to speak. Injuries to the eardrum as well as acoustic trauma and hearing loss occur suddenly, while age-related hearing loss and hearing loss caused by constant noise can worsen over time.

Affected people can then no longer hear certain sound frequencies properly. In many cases, this affects either the high or low tones, but sometimes both frequency ranges. As a result, patients do not miss individual words in a sentence, but rather some sounds can no longer be heard correctly. Sometimes dizziness and nausea occur in addition to hearing loss.


Tinnitus is not in itself a type of hearing loss. Rather, it is a sudden or continuous ringing in the ears that often occurs as an accompanying symptom in other conditions such as sudden hearing loss, inflammation of the ears, age-related hearing loss, or exposure to noise. However, in many of those affected, no clear cause can be identified. The ear noises manifest themselves as hissing, knocking, beeping, or droning in the ears, whereby the acoustic perception is not attributable to an external sound source, and in part impair hearing due to their occurrence and volume.

Therapy for hearing loss

The choice of therapy for hearing loss depends primarily on the cause. If, for example, a medication is identified as the trigger, a change may already be sufficient to remedy the problem. For persistent hearing problems, there are several treatment approaches.

Hearing aid and cochlear implant

To treat sensorineural hearing loss, doctors usually prescribe a hearing aid. If this is no longer sufficient, a so-called cochlear implant is usually the therapy of choice. This small electronic device is inserted by means of a surgical procedure and stimulates the auditory nerve directly. Hesitation is not a good idea when deciding on an implant, according to experts. The sooner one decides on it, the better the decline in hearing ability can be slowed down.

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