Hearing loss — causes, diagnosis, treatment
Hearing loss can develop gradually (over years) or appear suddenly — the causes differ, and so does the approach to treatment. Many patients delay an evaluation because they “still hear” — but early diagnosis significantly eases rehabilitation and preserves quality of life.
Types of hearing loss
- Conductive — a problem in the external or middle ear (cerumen, eardrum perforation, otosclerosis, otitis media). Often reversible.
- Sensorineural — a problem in the inner ear (cochlea) or auditory nerve. Most often permanent but can be rehabilitated.
- Mixed — a combination of both
Most common causes
Presbycusis (age-related hearing loss)
Gradual hearing decline over the years. The patient first loses high frequencies, which makes speech comprehension difficult (especially in noise). Rehabilitation with hearing aids — earlier is better (the brain adapts more easily).
Acoustic trauma
Sudden (explosion) or chronic (working in noise, loud music) noise exposure. A characteristic “notch” appears in the audiogram around 4000 Hz. Prevention is the key — protecting your hearing is permanent.
Otosclerosis
A hereditary disease in which the middle-ear ossicles calcify. Characteristic gradual hearing loss in women between 20 and 40. Treatment is surgical (stapedectomy) or hearing aids.
Chronic otitis media
Long-standing inflammation of the middle ear with or without eardrum perforation. Treatment is conservative + surgical (tympanoplasty).
Earwax (cerumen)
The most common easily resolved cause. With otomicroscopic removal, hearing returns within seconds.
Sudden sensorineural hearing loss
A neurological emergency. The patient wakes up with significantly reduced hearing in one ear. It is essential to start corticosteroid therapy as early as possible (ideally within the first 72 h) — any delay reduces the chances of recovery.
Other causes
- Acoustic neuroma (benign tumor of the auditory nerve)
- Ménière’s disease
- Ototoxic medications (aminoglycosides, chemotherapy agents)
- Genetic causes (in children and young adults)
- Congenital (from birth, detected by newborn hearing screening)
⚠️ Sudden hearing loss — an emergency
If hearing worsens significantly over a short period (hours to days), see an ENT specialist the same or next day. Sudden sensorineural hearing loss (SSNHL) is an emergency — earlier corticosteroid therapy means better recovery. After 2 weeks, the chances are significantly lower.
Diagnostics
- Detailed history — how it developed, sudden or gradual, accompanying symptoms (tinnitus, vertigo)
- Otomicroscopy — magnified view of the external and middle ear
- Pure-tone audiometry — measures hearing thresholds across different frequencies; the foundation of every hearing assessment
- Speech audiometry — measures speech understanding
- Tympanometry — middle-ear function
- OAE (otoacoustic emissions) — cochlear hair-cell function (and the basis of newborn hearing screening)
- MRI if acoustic neuroma is suspected
Treatment
Conservative
Cerumen removal, treatment of middle-ear infections, corticosteroids for sudden sensorineural loss.
Surgical
- Tympanoplasty — repair of a perforated eardrum
- Stapedectomy — for otosclerosis
- Mastoidectomy — for chronic otitis
- Ventilation tubes — for recurrent otitis in children
Rehabilitation
- Hearing aids — modern devices are small, discreet, with excellent sound quality
- Implantable hearing devices (for specific indications)
- Cochlear implants (for severe or total loss)
- Speech therapy and lip-reading training
💡 What you can do
- Hearing protection — always wear earplugs in noise (concerts, lawnmower)
- Lower the volume in headphones
- Regular hearing checks after age 50
- Don’t delay the exam — the earlier, the easier the adaptation to a hearing aid
- For sudden loss — urgent evaluation
Related topics
👂 Ear & hearing (hub)
🔊 Tinnitus
🌀 Vertigo
🔍 All symptoms
Hearing not what it used to be?
Audiometry at ELITE clinic is a complete hearing assessment. We often find treatable causes the patient never expected.