Otology
Hearing Loss
Conductive and sensorineural hearing loss — diagnosis, hearing aids, cochlear implants.
What are the types of hearing loss and modern treatment options?
Hearing loss is classified in three types: (1) conductive — from outer/middle-ear problems (otitis media, otosclerosis, perforation, cerumen); often correctable medically or surgically; (2) sensorineural — inner-ear or auditory-nerve problem (age-related, noise-induced, acoustic neuroma, ototoxic drugs); permanent, managed with hearing aids or cochlear implants; (3) mixed — both. Diagnosis is by audiometry; tympanometry assesses middle-ear function, OAE inner-ear function. Mild-moderate loss: hearing aid; severe-profound sensorineural loss (>70 dB): cochlear implant evaluation. Early treatment is critical for preserving auditory pathways and reducing dementia risk linked to social isolation.
Surgical treatment options
In conductive hearing loss: tympanoplasty for tympanic-membrane perforation (85–90% success); stapedectomy/stapedotomy for otosclerosis (90%+ success); ventilation tubes for persistent middle-ear effusion (especially paediatric); mastoidectomy for cholesteatoma.
In sensorineural loss: cochlear implant in adults and children with severe-profound loss. CROS hearing aid or BAHA (bone-anchored hearing aid) for unilateral deafness. Successful cochlear-implant candidacy requires multidisciplinary evaluation (ENT + audiologist + speech therapist + radiologist).
Frequently Asked Questions
- No — opposite. Appropriate amplification preserves auditory pathways through stimulation. The indirect danger: not using a hearing aid accelerates degeneration of cortical auditory pathways.
- Newborn hearing screening (ABR/OAE) is standard for all babies. Then: turning toward sound at 6 months, simple word comprehension at 12 months, 50+ words at 18–24 months. If in doubt, paediatric audiometry.
- Typically in the 50s in high frequencies. 30% of adults over 65 have clinically meaningful hearing loss. Early hearing-aid use reduces social isolation and dementia risk.
- 2–3 hours under general anaesthesia, 3–4 cm post-auricular incision, 1 hospital night. The device is activated 4 weeks later; rehabilitation (speech therapist) takes 6–12 months.
- Stapes-bone fixation in the middle ear, causing conductive hearing loss. Stapedectomy/stapedotomy (replacing the stapes with a titanium prosthesis) gives 90%+ success.
References
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