Hearing loss in adult should be evaluated and managed properly taking care of emotional and social impact of condition on patient & his family. Bilateral hearing loss may affect professional life of a person. Aim is to know the treatable cause and manage effectively to prevent further loss. Sensori-neural loss which can not be cured by medicines should be started with rehabilitation by hearing-aids.
Symptoms of hearing loss:
- Sound may be distorted, quieter and less clear
- Patients usually have difficulty in hearing in noisy area or while in a group
- Problem in hearing over telephone
- Turn up volume of television/Mp3 player
- Ask people frequently to repeat the sentence/words
- Patients often misunderstand what others are saying
- Patients think others are not speaking well
Evaluation of patient:
Thorough medical history(ear infection, giddiness, tinnitus, past medical illness or medication, trauma, exposure to noise-occupational or otherwise if any).
Clinical examination of Ear-Nose and Throat and patient.
Investigation-Audiometry tests to know degree and type of hearing impairment. Depending on clinical clues CT/MRI may be required.
Most common cause of hearing-impairment in adult is wax and after exclusion of wax tympanic membrane perforation is most common cause.
Management of Hearing loss
Management depends on type and cause of hearing loss; loss is of two types conductive and sensori-neural. Sometimes it may be mixed loss.
Conductive hearing loss:
When something hampering conduction of sound from your ear-canal, ear-drum and ear ossicles to reach inner ear or nerves of hearing.
Can be corrected by medicine and/or surgery, like-
- Wax or foreign body-removal
- Eustachian tube blockage or fluid in the middle ear -medicines or by procedure of putting small tube (grommet) in ear drum
- Infection(otitis media)-Medicines
- Perforation in ear drum-Surgery(Tympanoplasty)
- Otosclerosis-stapedectomy& piston placement
- Any cause in nose/throat is managed by medicine/surgery.
Sensorineural hearing loss:
When problem is in inner ear or nerves of hearing (same as one has weak eye-sight).
Causes-
- Age -hearing loss after age of 65
- noise-trauma
- Menieres disease
- Post viral infections like mumps, measles, influenza, herpes
- Ototoxic drugs like aminoglycoside antibiotics (neomycin, streptomycin, amikacin, gentamicin, netilmycin), Salycylates, certain diuretics, antimalarial ( quinine & chloroquine), erythromycin and cisplatinum.
- Hereditary
- Immune mediated
- Endocrine& metabolic disorders
- Vascular or neurogenic
- tumor
Management of sensorineural hearing loss
Mostly chronic sensori-neural loss can not be cured and person is prescribed to wear hearing-aids. In bilateral severe to profound hearing loss cochlear implant (electronic device, a part is implanted under skin by surgery) may be successful.
Some treatable causes:
If it is sudden loss, spontaneous recovery may be expected assisted by steroids. Underlying etiology present in 10-15 % should be identified & treated.
Immune mediated -steroids
Tumor-surgery
Ototoxicity-Medicine stopped.
Hearing-Aids--
Though hearing aids are not as good as normal ear but if properly met with fitting requirements it can compensate well for hearing loss.
Hearing aids should be fitted and customized to individual after thorough hearing evaluation by by E.N.T. specialist and audiologist.
Most patients are benefited but there is limitation of sound quality and back ground noise that means it works well in quiet environment but some users have trouble enjoying music and listening in a crowded room.Improving FM (frequency modulation) boosts the performance of hearing aid and hearing aids can be optimally set for music.
Quality of hearing aid is of utmost importance and it takes few days to adjust but eventually initial chaotic sound disappear and person is able to appreciate the difference. Usually patients are happy after few weeks of use often coming to tell us that it has improved their quality of life.
Sensori-neural hearing loss may be shocking news to the patient and his relatives. Good doctor-patient relationship and understanding is required to help accept the fact. Talk with your doctor, friends, family and person with same problem to support you.
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