Rao's ENTRao's ENT

Hearing Loss/Deafness

Hearing-loss-deafness-presbyacusis-old age

As per the medical science, doctors classify hearing loss in two broad categories.

  1. Conductive hearing loss
  2. Sensorineural hearing loss

Conductive hearing loss occurs when outer ear and middle ear are not able to conduct sound waves to the inner ear. In contrast, sensorineural hearing loss occurs when the inner ear malfunctions and is unable to convert sounds conducted to it into electrical impulses and send them on to the brain for processing and ‘making us hear’.

However, what happens when hearing loss is partially conductive and partially sensorineural? When that happens, we call it mixed hearing loss. The extent of hearing loss can be scientifically measured in an audiology lab. Depending on how bad it is, doctors grade it as either mild or moderate or severe.

Well, hearing loss does not occur overnight in most cases. Hearing ability fades by and by and most of the time, the patient is not even aware that the deterioration has started. Still, there are some signals that can help you pinpoint the onset of hearing loss:

  • When you regularly feel that people are mostly either mumbling or speaking illegibly.
  • When you often have to ask people to repeat themselves.
  • When you can’t hear the person on the phone line clearly on a regular basis.
  • When you have problem following a conversation where several people speak at once.
  • When you often misunderstand others’ words and give inappropriate responses.
  • When background noise makes you miss the spoken words.
  • When others complain often that your TV viewing volume is too loud.
  • When others ask you to speak softly because you have been talking too loudly.
  • When you get ringing, hissing, or roaring sounds in the ear.

Among Indians, hearing loss in adults usually occurs due to the following conditions:

  • Chronic otitis media (ear discharge)
  • Serous otitis media (bubbles in ear)
  • Otosclerosis (fixed ossicle – stapes)
  • Noise induced hearing loss (especially in factory workers)
  • Old age related hearing loss (Presbyacusis)
  • Ear trauma (slap on the ear, exposure to explosion etc)
  • Outer ear conditions such as ear wax or otomycosis (fungus in ear)

There could also be sudden hearing loss which is an emergency problem requiring immediate medical assistance.

If you feel that your hearing ability is weakening, you should schedule a visit to an ENT specialist to get your ears checked. Post check-up, your doctor may refer you for an audiological test to check what kind of hearing loss you are suffering from – conductive, sensorineural, or mixed i.e. a blend of both. The doctor will then make his diagnosis and begin treatment accordingly.

Your hearing ability has a lot to do with two background mechanisms occurring in your ear. The first of these is conduction of sound. Your ear is divided into three sections – outer ear, middle ear, and inner ear. It is your outer ear and middle ear that conduct sound waves to the inner ear. The second background mechanism at work is the conversion of these sound signals into electrical impulses in the inner ear which are then sent to the brain for hearing to be comprehended.

In the first mechanism, your ear drum and the three small bones located in the middle ear – malleus, incus and stapes, and together called the ossicles – play a key role by vibrating and transferring sound signals. Of these three, the stapes is also the human body’s smallest bone. When this tiny little bone stiffens, the condition is called otosclerosis. A stiffened stapes is not able to vibrate and therefore loses the ability of sound transference onwards to the inner ear. This phenomenon makes itself felt in the patient as hearing loss.

Otosclerosis is a progressive disease. In other words, it worsens over time. The hearing loss occurring due to otosclerosis can be managed in two ways. The first is by installing a hearing aid, and secondly through a surgical procedure called stapedotomy.

Hearing aids amplify sounds around a patient to enable clearer hearing. However if the patient does not prefer to use hearing aids, stapedotomy is an excellent surgical treatment for hearing restoration.

Stapedotomy is a micro-ear surgery. In it, an artificial prosthesis is strategically positioned inside the ear so as to convey the sound vibrations from ear drum to the inner ear without involving the fixed stapes. To do so, the ENT surgeon makes a tiny hole (just 0.8 mm in diameter) called fenestra in the stapes bone using a conventional instrument or a micro-skeeter drill and CO2 laser.

At Dr. Rao’s ENT Super Speciality International Hospital, we use a highly advanced surgical technique called the reverse small fenestra stapedotomy prosthesis operation that delivers excellent results in hearing restoration.

Serous otitis media, also referred to as bubbles in ear or fluid in ear in common language, is a condition more common in children than in adults. In it, the middle ear accumulates fluid due to infection or blockage of the Eustachian tube which hinders ventilation or drainage in it. The manifesting symptoms of this disease are a sense of ear blockage or heaviness or popping sounds in the ear and hearing loss. Children afflicted by serous otitis media suffer from delayed speech development and decreased performance in school.

Children suffer more from this disorder as the Eustachian tube in children does not drain well due to its different shape and fluid accumulates in the middle ear causing serous otitis media. Plus, young children are more prone to upper respiratory tract infections, tonsillitis, and adenoiditis which often lead to fluid accumulation in the region and cause bubbles in ear.

Serous otitis media in adults is usually caused by sinusitis, adenoiditis or mass behind the nose. To make correct diagnosis, the ENT specialist needs to carry out thorough examinations and investigations of the patient’s nose, sinuses, and nasopharynx.

In most such cases, the doctor usually treats the child by facilitating ventilation of middle ear that in turn destroys the underlying infection. The ENT doctor will also treat any allergies the patient may be suffering.

However, if the infection persists or recurs often or if the patient suffers from tonsillitis or adenoiditis, a surgical procedure may become necessary. The preferred surgical treatment in such cases is myringotomy grommet along with adenoidectomy or tonsillectomy, whichever the case merits. In myringotomy grommet, the ear drum is given a small cut and a ventilation tube is placed there to improve middle ear drainage and ventilation which in turn, doesn’t let the fluid accumulate and the problem is resolved.

As we explained in a previous question as well, serous otitis media in adults is usually caused by sinusitis, adenoiditis or mass behind the nose. To make correct diagnosis, the ENT specialist first carries out thorough examination and investigation of patient’s nose, sinuses, and nasopharynx and then prescribes a medical or surgical treatment as required.

A few precautions on your part can certainly help reduce your child’s ear infection risk:

  • No smoking around children – Do you know that your second hand tobacco smoke can up a child’s infection risk by two to three times? Quit smoking now, not just for yourself but also for your children’s health.
  • Breastfeed your baby – Breastfed babies have higher immunity than bottle-fed babies and suffer fewer infections too.
  • Bottle feed your baby in a sitting position – If your baby is taking bottle feed, ensure that it is done with the baby in a sitting position. A child feeding lying down can get milk flowing into his middle ear which can then cause infections.
  • Stay alert towards allergies – Allergic reactions can lead to mucus build up which can then flow to the Eustachian tube, cause blockage and up ear infection risk.

Prevent colds – As recurring colds often lie at the root of ear infections, keep your child warm and snug and teach them to practice good hygiene to reduce cold attacks.

Sudden hearing loss can occur due to trauma, viral infections, blood flow compromises or tumours. It can also happen because of certain medicines. Unfortunately, the most common reason of sudden hearing loss is still idiopathic i.e. unknown to the medical science.

Do note that any sudden loss of hearing is an emergency situation (in ENT terms, it is called an otologic emergency) that requires immediate treatment with no delay whatsoever. Our advice is that you should immediately visit an ENT specialist and start treatment at the earliest. Any delays here can minimize your chances of recovery.

First of all, we must tell you what you should not do. You should not use ear buds to clean your ear. Ear buds just push the wax deeper into the ear and that makes things worse, not better. The deeper the wax goes, the tougher and more painful it becomes to clean out. What you should do is to visit an ENT physician and get your ears cleaned of wax safely and hygienically.


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