By Georgia Warren
Hearing loss is often considered an ‘old person problem’ with current statistics suggesting over 70% of people aged over 70 have a hearing loss at least of a mild degree. However, the facts are that 1 in 1000 babies is born with significant hearing loss and by the end of their time at secondary school, more than 3 out of 1000 children will have a hearing loss requiring hearing aid or assistive listening device fitting.
The HCIA Hearing for Life – The value of hearing services for vulnerable Australians – March 2020 report found that the number of Australians with hearing loss is 3.95 million people in 2019-20 which is almost 15% of the population (1). Hearing loss often occurs in both ears, but it is also possible to have hearing loss in just one ear.
Hearing loss occurs when any part of the ear is not working effectively to transmit sound waves to the brain to be interpreted into something meaningful. The outer ear consists of the pinna (the part we can see) and the ear canal. The middle ear is the eardrum and middle ear bones (ossicles).
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The inner ear is made up of the cochlea and balance organ. The sound waves travel into the ear via the ear canal, vibrate the eardrum which moves the ossicles transmitting the sound waves into the cochlea. The hair cells in the cochlea respond to different pitches of sound and transmit the signal via the hearing nerve to the brain. All parts of the ear must be working for us to be able to make sense of the sound.
When parts of the ear are not functioning correctly this will lead to hearing loss. The classification of hearing loss is determined as to which part of the ear is not functioning. Conductive hearing loss occurs when the outer or middle ear parts of the ear are preventing the sound from transmitting through to the inner ear. This could occur due to wax build-up, impaired middle ear function due to middle ear fluid, or a damaged eardrum. The hearing loss can occur in one ear or both ears. It is often temporary and can be recovered on its own or with medical intervention.
Conductive hearing loss is more prevalent in children than old people. The hearing loss is often mild affecting some or all of the pitches of speech sounds. This can lead to speech delay, behavioral concerns, and balance issues – especially if the hearing loss is in one ear.
Children often have difficulty hearing in the classroom which can result in learning delays. Luckily, though in most cases the conductive hearing loss is treatable, and hearing can recover to normal. In some cases where the conductive hearing loss is not treatable amplification devices such as hearing aids can be beneficial.
Sensorineural hearing loss occurs when the hair cells responding to sound in the cochlea are damaged. Damage to the hair cells resulting in sensorineural hearing loss can occur due to aging, noise exposure, ototoxic (toxic to the ear) drugs as well as other rarer causes.
The hearing loss can vary in degree from mild which may have a minor impact on the detection of sound to profound where there is little to no detection of sound at all. The hair cells can be damaged for all pitches evenly or only for some pitches. The hearing loss can be in both ears, different degrees in both ears, or hearing loss in one ear only.
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Medical attention is always recommended when hearing loss occurs suddenly or when hearing loss is in one ear. This could be a sign of a viral infection or other more serious medical conditions. You should be referred to an Audiologist who can perform a diagnostic hearing test to determine if there is hearing loss. If a loss is diagnosed further testing is completed to determine the nature of the hearing loss and whether further medical advice is required.
The most common causes of sensorineural hearing loss are old age and noise exposure. In Australia, we have an aging population which is therefore resulting in increasing numbers of people with hearing loss. The most concerning statistic though are the number of young Australians with hearing loss due to loud noise exposure.
This is largely due to the use of personal listening devices. When the ears are exposed to continuous amounts of noise for prolonged periods this can result in damage to the hair cells in the cochlea and therefore a hearing impairment.
Having hearing loss affects the way we hear the sounds around us. As a speech and environmental sounds are made up of different pitches, if we have hearing loss in certain pitches then this will change the way we hear the sound.
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Hearing loss in one ear can result in the individual feeling off-balance or disoriented in their environment. They must be cautious at times where hearing in both ears is crucial such as crossing the road. The hearing loss in one ear can result in the person have increased difficulty listening in a noisy environment and with localizing sound.
Often children born with hearing loss in one ear can adapt to listening in their environment better than adults with an acquired hearing loss in one ear. This is because the brain has adapted to listening to the cues in the environment from birth.
A hearing screening program has been rolled out in all Australian states to assess the baby’s hearing at birth. Hearing loss in children is therefore able to be diagnosed at an earlier age. In past years hearing loss was not often noticed until the child was not developing speech well or if they were having difficulty in the classroom. Hearing loss in one ear was much harder to diagnose in children and was often only noticed when the child had difficulty hearing grandma on the phone in one ear and not the other.
If a newborn baby fails the hearing screening test they are then referred for a full diagnostic hearing assessment. The Audiologist performing the diagnostic hearing assessment can determine first if there is a hearing loss if the hearing loss is in both ears (bilateral) or hearing loss in one ear (unilateral).
The degree and type of hearing loss are then determined. If the hearing loss is conductive and requires treatment, then referrals to a doctor and/or ENT specialist would be arranged. If the hearing loss is permanent, then a referral for hearing aid fitting will be made.
In toddlers and pre-school children, special tests are used to determine whether the child responds to different pitches of sounds. The testing should be performed in a soundproof room. All attempts should be made to perform the testing with headphones so that a hearing loss in one ear can be excluded, however, this may not be possible until the child is over 3 years of age when headphone tolerance is more likely. The same process is followed as with infants in terms of the management of the hearing loss.
In school-age children and old people, testing usually takes place in a soundproof room with headphones and a response button. The Audiologist is determining the individual’s threshold to sound across a range of pitches determined to be the most important for speech discrimination.
The hearing is tested in both ears. Again, the management is determined on the degree, the type, and the configuration of the hearing loss and its potential impact on the individual. Hearing aids are considered if the hearing loss is likely to impact the individual’s listening needs.
Hearing loss is not just an issue for old people. People of any age can have hearing loss with temporary or conductive hearing losses more prevalent in children and permanent or sensorineural hearing losses more common in adults.
With the introduction of universal hearing screening, hearing losses in children are becoming easier to diagnose earlier leading to better outcomes for the child’s future. Hearing loss can vary from individual to individual in degree and type. You can also have hearing loss in one ear or in both ears. If you suspect you may have a hearing loss arrange an appointment with an Audiologist.
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