La Hearing loss It's much more than just hearing less clearly: it affects how we interact with others, our daily safety, and our emotional well-being. Many people notice it gradually, while others experience it suddenly, but in all cases, it's crucial to understand what causes it, what symptoms it produces, and what treatment options are available.
Although it is usually associated only with older people, the Hearing loss can occur at any age.From the prenatal period to old age. The good news is that a significant number of cases can be prevented or slowed down, and that today we have hearing aids, implants, and rehabilitation programs that greatly improve quality of life when intervention occurs early.
What is hearing loss and how does the ear work?
When we talk about hearing loss, we are referring to a decreased ability to hear sounds with respect to what is considered normal hearing (better threshold of 20 dB). This loss can be mild, moderate, severe or profound, and affect one or both ears, with very noticeable differences between people.
To understand why hearing loss occurs, it helps to review, even briefly, how the ear works. The ear is divided into outer, middle and inner earSound enters through the outer ear, travels through the ear canal, and makes the eardrum vibrate. These vibrations are transmitted through three small bones in the middle ear to the cochlea in the inner ear.
The cochlea is a snail-shaped structure filled with fluid, lined with thousands of very delicate hair cellsThese cells transform mechanical vibrations into electrical impulses that travel through the auditory nerve to the brain, where they are interpreted as sounds that we can understand.
If transmission is disrupted at any of these steps (by blockage, injury, inflammation, or death of nerve cells), it occurs hearing loss of different types and degreesSometimes the cause can be corrected (for example, a wax plug) and other times the damage is permanent.
Types of hearing loss
Depending on the affected area of the ear, three main types are distinguished hearing loss or hypoacusiswhich determine both the symptoms and the most appropriate treatment.
La Sensorineural hearing loss It occurs when the hair cells of the cochlea or the auditory nerve itself are damaged. It is the most common type, especially in older people, and is usually irreversible. Aging, prolonged exposure to loud noises, certain medications, and illnesses such as meningitis are among its main causes.
In conductive hearing lossThe problem lies in the outer or middle ear: the sound does not reach the inner ear correctly due to obstructions (earwax, foreign bodies), infections, fluid in the middle ear, eardrum perforations, or alterations of the small bones that transmit vibrations.
We talk about mixed hearing loss When both mechanisms are combined, there is a neurosensory component (inner ear/nerve) and a conductive component (outer or middle ear). It is relatively common for an older person with cochlear damage to also accumulate earwax or have had repeated infections.
Beyond these types, hearing loss can be classified into unilateral or bilateral (whether it affects one or both ears), sudden or gradual, and ranging from mild to profound. Each combination results in different needs in terms of aids and rehabilitation.
Symptoms of hearing loss
The symptoms of hearing loss can be very clear or go largely unnoticed at first, especially when the loss is slow. A typical sign is noticing a feeling that voices and noises sound muffled or distant, as if heard behind a wall.
Many people notice that they find it especially difficult understand speech when there is background noiseIn restaurants, family gatherings, social events, or crowded places. It's not that the sound doesn't reach us, but rather that the brain has more difficulty separating the main voice from the other sounds.
People with hearing loss often have trouble to perceive high-pitched sounds and certain consonants, such as “s”, “f”, “sh” or “th”. This makes it harder for them to understand words, especially those of women and children, and causes sentences to reach them incomplete or distorted.
Another very common indicator is the need to turn up the volume on the TV, radio or mobile phone to levels that are annoying to everyone else. At the same time, they often ask others to repeat what they've said, to speak more slowly, or to enunciate better.
In many cases they also appear buzzing, ringing, or noises in the ears Without an external source, this is known as tinnitus. It can be continuous or intermittent, more or less intense, and is often one of the first signs that something is wrong with your hearing.
Other possible symptoms include a feeling of ear full or blockedThe difficulty in locating where a sound is coming from, auditory fatigue (exhaustion from making a constant effort to understand) and, in some cases, dizziness or vertigo if the balance system is also involved.
When to see a doctor for hearing loss
There are situations where waiting isn't advisable. If you notice a sudden loss of hearing in one or both ears If it appears within hours or a few days, it is a medical emergency and you should consult immediately, ideally with an ENT specialist.
It is also recommended to make an appointment if hearing loss, even if gradual, It begins to make daily life difficult.Symptoms include difficulty following conversations, feelings of isolation, the need to turn the volume up significantly, or increased tinnitus. The sooner it is evaluated, the more options there are for treating reversible causes and adapting to hearing aids.
Causes of hearing loss throughout life
The reasons for hearing loss are varied and change depending on the stage of life. Some are present from before birth, while others accumulate over the years. A significant percentage can be prevented with well-applied prevention measures at the opportune moment.
Causes in the prenatal period
Before birth, certain genetic alterations They can cause hereditary hearing loss or hearing loss due to new mutations, with conditions ranging from mild hearing loss to profound deafness. Infections contracted by the mother during pregnancy, such as rubella or cytomegalovirus, can also play a role, affecting the development of the baby's inner ear.
Causes in the perinatal period
Around the time of birth, some serious problems can damage auditory structures. These include: lack of oxygen at birth (perinatal asphyxia)Severe jaundice with high bilirubin levels (hyperbilirubinemia) or extremely low birth weight can also play a role. Other neonatal complications and associated treatments may also be contributing factors.
Causes in childhood and adolescence
During the first years of life, the following are common: middle ear infectionsSome of these infections become chronic and leave permanent fluid or discharge (chronic otitis media). If not treated properly, they can cause significant hearing loss and speech difficulties in children, and sometimes lead to vertigo in children.
They can also occur in childhood. meningitis or other serious infections that damage the cochlea or the auditory nerve. That is why routine vaccination against certain germs reduces both mortality and long-term hearing loss.
Causes in adulthood and old age
In adults, chronic diseases such as diabetes, cardiovascular disorders, or autoimmune diseases They can contribute to the progressive deterioration of the inner ear. Smoking has also been linked to an increased risk of infections and cochlear damage.
Specific pathologies such as otosclerosis (abnormal bone growth in the middle ear), Ménière's disease, or some forms of sudden sensorineural hearing loss cause significant losses that can be partially managed with surgery, medication, or hearing aids.
The so-called presbycusis, that is, the age-related hearing lossThis is one of the most common causes. Over the years, the hair cells of the cochlea and the nerve pathways deteriorate naturally, making it more difficult to hear and, above all, to understand speech in noisy environments.
Factors present throughout life
It can appear at any age. earwax plug blocking the ear canal This earwax can cause a feeling of fullness in the ear and conductive hearing loss. Removal by a professional usually restores the previous hearing level without further consequences.
The blows to the head or direct trauma to the ear They can damage the eardrum, the ossicles of the middle ear or the inner ear, causing anything from moderate hearing loss to profound deafness, sometimes accompanied by intense vertigo.
Exposure to loud noises or sounds It is one of the major preventable culprits. Working for many years in very noisy environments (construction, industry, agriculture, workshops…), using powerful machinery, or listening to very loud music with headphones or at concerts gradually damages hair cells.
Some drugs are considered ototoxicIn other words, they can damage the inner ear. These include certain antibiotics (such as gentamicin), some chemotherapy drugs, strong diuretics, and very high and prolonged doses of salicylates. Certain chemicals used in the workplace can also be harmful.
severe nutritional deficienciesSpecific viral infections and forms of late-onset genetic hearing loss complete the list of factors that act throughout life, often adding to one another.
Relationship between hearing loss, vertigo, and inner ear fluids
The inner ear is not only responsible for hearing, it also houses the vestibular system, responsible for balanceTherefore, many diseases that affect hearing can also cause a sensation of spinning, dizziness, or instability, which greatly complicates daily life.
In pathologies such as Ménière's disease or labyrinthitisThe membranous labyrinth and the fluids that fill it—the endolymph and perilymph—are altered. These fluids must be maintained in a very fine balance of volume and chemical composition for the sensory cells to function correctly.
When endolymph pressure increases too much or an internal membrane ruptures and both fluids mix, a sudden loss of auditory and vestibular functionThe result is crises with intense rotary vertigo, nausea, instability and, often, a sudden decrease in hearing.
Over time, the body can seal the rupture area and readjust the pressure and composition of the endolymph and perilymphThis allows some sensory cells to regain their function. Even so, some degree of hearing loss usually remains, along with a tendency for further episodes if the underlying disease is not controlled.
It should also be taken into account that the anxiety and stress These symptoms can worsen the perception of dizziness and tinnitus, and the hearing loss itself contributes to feelings of instability. All of this leads many patients to seek medical advice. vertigo and deafness as a joint problem.
Risk factors and dangerous noise levels
Not everyone exposed to the same situations experiences hearing loss in the same way, but there are factors that clearly increase the risk. aging It is one of them: the older we get, the more vulnerable the inner ear becomes to other damage.
La exposure to loud noises Repeated or prolonged exposure is another fundamental pillar. It has been proven that noise levels above 70 dB begin to be potentially harmful if sustained over time; the higher the level, the fewer minutes or hours it takes to cause irreversible damage.
As a guideline, a whisper is around 30 dBA refrigerator running produces about 40 dB and a normal conversation about 60 dB, levels considered safe. However, heavy traffic A full school cafeteria can reach levels close to 75-85 dB, and at that point it's important to monitor the duration of exposure.
A motorcycle is positioned around 95 dB, a snowmobile close to 100 dB A chainsaw or a rock concert can reach 110 dB or more. Firecrackers and gunshots easily exceed 140 dB, capable of causing immediate and permanent damage in a matter of seconds.
In the workplace, regulations dictate maximum daily exposure times Without protection: for example, 8 hours at 90 dB, 4 hours at 95 dB, 2 hours at 100 dB, or just 15 minutes at 115 dB. Exceeding these limits without protective measures multiplies the risk of noise-induced hearing loss.
La Genetic heritage It also matters that some people are more susceptible to premature damage to the cells of the cochlea due to aging or noise. Smoking, certain systemic diseases, and some medications complete the list of modifiable and non-modifiable risk factors.
Consequences of untreated hearing loss
Delaying hearing loss has an impact on many areas. First, it leads to communication difficultiesIt is difficult to participate in conversations, follow meetings, or talk on the phone, which can lead to misunderstandings and frequent conflicts.
At a cognitive level, it has been observed that Untreated hearing loss is associated with further deterioration Memory, attention, and other mental functions are affected in older adults. The brain dedicates so many resources to deciphering incomplete sounds that it becomes exhausted more quickly (auditory fatigue) and leaves less room for other processes.
On a social and emotional level, hearing loss facilitates isolation, loneliness, anxiety, and depressionMany people begin to avoid situations where they find it difficult to follow conversations, which weakens their support network and progressively worsens their mood.
There is also a clear increase in risk of falls and accidentsNot hearing a car, an alarm, a doorbell, or someone warning of danger reduces reaction time. In work environments and on public roads, this has a direct impact on safety.
From a social and economic point of view, the untreated hearing loss is related to more years lived with disability, less access to education and employment and a huge cost to health systems and families, with billions of dollars a year globally in direct and indirect expenses.
How is hearing loss diagnosed?
The diagnosis always begins with a good medical history and physical examinationThe professional asks when the hearing loss began, whether it is in one or both ears, if there have been infections, loud noises, blows, previous illnesses or family history, and what medications are being taken.
Then a observation of the ear canal and eardrum An otoscope, which is a type of magnifying light, is used to examine the ear. This allows doctors to see earwax buildup, inflammation, perforations, fluid, or malformations. Sometimes tuning forks are used for simple tests that can indicate conductive or sensorineural hearing loss.
The next step is usually a battery of audiometric tests in a quiet booth, performed by an audiologist. Pure-tone audiometry evaluates at what frequencies and from what intensity one begins to hear, thus creating the particular “audiogram” of each patient.
La speech audiometry It assesses the ability to understand words at different volumes. It allows you to see if there is a significant difference between hearing a sound and understanding it, something typical in presbycusis and other sensorineural hearing loss.
Other useful tests include the bone conduction (which helps to differentiate conductive and neurosensory components), tympanometry and the study of acoustic reflexes to analyze the functioning of the middle ear, and otoacoustic emissions, which measure the response of healthy hair cells.
In selected cases, the following are requested: imaging tests such as magnetic resonance imaging or computed tomography to study in detail the inner ear, the auditory nerve and neighboring structures, ruling out tumors, otosclerosis, congenital malformations or other structural causes.
Treatment of hearing loss
The treatment strategy depends on whether the cause is reversible, the type of hearing loss, and its functional impact. In many cases, a combination of treatments is used. medical, surgical and technological solutions to get the best possible result.
When the loss is conductive and is due, for example, to a earwax buildup or a middle ear infectionRemoving the obstruction or treating the infection is usually enough to restore much of the hearing. In some middle ear problems, such as certain types of otosclerosis or tympanic membrane perforations, surgery may be indicated.
In permanent losses, the basis of treatment consists of the hearing aids or hearing prosthesesThese devices capture sound with a microphone, process it electronically, and amplify it according to the user's hearing profile. They come in multiple formats (in-ear, behind-the-ear, rechargeable, connected to mobile phones, etc.) to suit different lifestyles.
For people with severe or profound sensorineural hearing loss who do not benefit sufficiently from hearing aids, the cochlear implants They are a key option. This is a system surgically implanted in the inner ear that directly stimulates the auditory nerve through electrical impulses, bypassing the damaged hair cells.
In addition to these devices, there are complementary technical aids such as FM systems, magnetic loops, light or vibrating alert devices for doorbells and alarms, and subtitling or sign language interpreters, which facilitate access to sound and communication.
La auditory rehabilitation It is another fundamental pillar. It includes training to make the most of available hearing, lip-reading techniques, communication strategies in noisy environments, and, when necessary, speech therapy to improve speech and language, especially in children with early hearing loss.
In some specific cases they are used drugs (for example, corticosteroids in certain sudden losses, drugs for Ménière's disease or for autoimmune processes) with the aim of slowing the damage or relieving associated symptoms such as vertigo or tinnitus.
Hearing prevention and protection
A very important part of hearing loss can be prevented or delayed by following certain guidelines. sensible prevention measures throughout one's life. It is much easier to protect hearing than to try to recover what has been lost.
In childhood, the key lies in the vaccination and good maternal and child care: control infections during pregnancy, properly address perinatal problems, and treat otitis early in children to prevent it from becoming chronic or leaving lasting effects.
At the population level, they are very useful safe listening campaigns These warnings highlight the dangers of excessive volume in headphones, nightclubs, concerts, and sporting events. Respecting time limits in noisy environments and giving your ears breaks is an investment in your future health.
In the workplace, companies must implement hearing protection programs This includes providing earplugs or earmuffs, measuring noise levels, rotating job duties, and conducting regular hearing tests in high-risk positions. Exposure to ototoxic chemicals must also be monitored.
In the healthcare field, it is essential to prudent use of ototoxic drugsadjusting doses, monitoring hearing during prolonged treatments, and choosing alternatives when possible, especially in already vulnerable individuals.
On an individual level, it is advisable Do not insert objects into the ear canal (cotton swabs, pens, hairpins…), maintain a healthy lifestyle, avoid tobacco, monitor blood pressure and glucose levels, and have regular hearing checks if you belong to a risk group or notice any changes in your hearing.
Tinnitus: the buzzing that warns
Tinnitus, or ringing in the ears, is the perception of buzzing, whistling, whistling, roaring, or hissing in the ear without an external sound source. It affects between 15 and 20% of the population and is often one of the first signs of hearing damage.
The most common cause is exposure to excessive noise that damage the hair cells of the inner ear. When these cells are lost or malfunction, the signals that reach the brain are altered, and the brain "fills in the gaps," generating the sensation of constant noise.
Although it cannot always be completely eliminated, there are strategies to reduce its impactTreatments such as habituation therapy, sound generators, relaxation techniques, and proper hearing aid fitting for those with associated hearing loss are recommended. Seeking timely consultation helps rule out treatable causes and allows individuals to learn to live with the symptom with less discomfort.
Understanding that hearing loss is a complex condition, with multiple causes and consequences, but also with many possibilities for prevention, diagnosis and treatment, allows you to make informed decisions, ask for help early and take care of a sense as basic as hearing throughout your life.
