Hearing loss is a common condition. If we consider the total population from infants to the elderly, we may assume that on average in the world about ten percent of all people suffer from hearing disorders. Not everyone needs to see a doctor about it, but at least three percent of the total population requires medical treatment.
Causes
Hearing aids come in a variety of designs. The most common models are usually analog behind-the-ear devices. Hearing loss and hearing loss can be compensated with them. They make everyday life much easier for hearing-impaired people. The natural deterioration of hearing already begins in otherwise completely healthy persons shortly before the end of the maturation period. Especially in the hearing organ, whose greatest functional capacity is at about the end of the second decade of life, the age reduction beginning in the third decade of life can be detected very early. Of course, the process of regression varies greatly from individual to individual and also depends on further stresses to which the human being as a whole, but especially the hearing organ, is exposed. By no means is the so-called age-related hearing loss the main cause of all hearing disorders, but all people who reach a high age must one day suffer to a greater or lesser extent from age-related changes in the hearing organ. As is well known, there are very many causes that can cause hearing loss. Beside the already mentioned age degradation must be mentioned here above all: Middle ear inflammations of acute as well as chronic kind, the otosclerosis, accidental damages of different kind in the head area, the noise damage, different infectious diseases, diseases of the upper
airways in infants and young children, ear deformities, damage to the auditory nerves by drugs or other harmful agents, congenital hearing disorders, acute hearing loss in middle age, and various others.
Symptoms, complaints and signs
The first signs of the onset of hearing loss or hearing impairment are often unusual difficulties in conversing. The affected person has problems understanding and therefore has to ask several times. Listeners and interlocutors conversely ask to speak more quietly. Conversations become increasingly tiring. This is especially true during telephone conversations. The symptoms of hearing loss usually develop slowly and insidiously. Quiet sounds that come from nature are hardly perceived anymore. This includes birdsong, the sound of the sea or wind noise. Radio or television have to be turned up louder and louder. Enjoyment of leisure activities such as attending events or watching TV shows is only possible to a limited extent due to the hearing problems. Background noises make conversation more and more difficult. As the disease progresses, noises in the household such as the refrigerator starting up or the doorbell ringing are also perceived less and less often. Even morning waking noises are no longer heard. If the hearing loss is noise-induced, ringing in the ears is a typical symptom. Some sufferers feel as if they have a foreign body in their ear. In the case of a sudden onset of hearing loss, usually only one ear is affected. In the case of a slow-onset otosclerosis, symptoms such as ringing in the ears and cracking noises also only occur in one ear at first. In most cases, these symptoms occur in both ears later on. People who suffer from otitis media in particular require constant medical treatment. The acute and repeated short inflammatory phases are treated conservatively by every doctor, partly by the usual physical therapy, partly ober also with the help of modern medicines, which are counted to the chemotherapy or to the antibiotics. Acute otitis media, which leads to inflammation of the whole mastoid process, used to be treated only surgically.
Complications
As a rule, these complaints have a very negative impact on the quality of life of the affected person. Patients suffer from considerable limitations in their daily lives and, in severe cases, are also dependent on the help of other people. The further course of these diseases depends strongly on their cause, so that a general course cannot be predicted. In children in particular, this can delay development, so that complications and complaints can also arise in adulthood.The diseases do not have to be treated in every case. Nor do they always necessarily mean a health hazard. Direct and causal treatment of these disorders can only be provided in a few cases. Above all, the complaints can be alleviated and limited with the help of technical devices and hearing aids. However, complete hearing loss can usually not be made irreversible. No particular complications occur during the treatment itself. In most cases, the patient’s life expectancy is also not reduced or otherwise affected by these complaints. However, patients often suffer from psychological complaints and therefore require psychological treatment.
When should one go to the doctor?
In case of hearing loss, hearing disorders and otosclerosis, a doctor should always be consulted. There will be no self-healing, so those affected will always need medical treatment from a doctor. At the same time, early diagnosis with early treatment has a positive effect on the further course of the disease and can prevent further complications. A doctor should be consulted in the case of hearing loss, hearing disorders and otosclerosis if hearing complaints occur that do not disappear on their own. This may include buzzing or other annoying noises in the ear, which can significantly reduce the quality of life. In many cases, the feeling of a foreign body in the ear is also an indication of these disorders and should then also be examined by a doctor. Most sufferers also have inflammation in the middle ear. In the case of hearing loss, hearing disorders and otosclerosis, an ENT specialist can be consulted. However, whether this will result in a cure cannot be universally predicted. It may not be possible to cure the disease.
Treatment and therapy
Modern therapeutic approaches of the last 20-30 years have brought a tremendous upheaval in this regard. Unless the mastoid process inflammation is complicated by bone destruction, breakthrough to the outside, inner ear, or cranial cavity, targeted, high-dose antibiotics are now used for treatment after prior pathogen detection, and for more than 80 percent of acute cases, the surgical procedure of simply gouging the mastoid process is no longer needed. The remaining 20 percent of patients who still require surgery are either suffering from pathogens for which the drugs are not effective, or from such wart process destruction that the antibiotics no longer reach the focus of the disease in sufficient concentration. However, if one relies on drug treatment, the specialist must constantly monitor the patient, because in case of improper aftercare, sometimes the intervention that becomes necessary after all is not performed at the right time, or the normal hearing function is not restored despite the healing of the inflammation, because scars formed due to the insufficient treatment and caused a significant hearing impairment. Much more difficult is the treatment of chronic middle ear processes. Today we distinguish three pathologically-anatomically different processes in chronic middle ear inflammation. Only in the case of the so-called simple mucosal suppuration, according to today’s viewpoints, a vigorous conservative treatment with rinses, drops, ointments, powders and the like for several weeks is still appropriate. If there is no significant improvement after at least six weeks of such intensive medical treatment, then surgery must be performed, just as in the case of the other two forms of chronic otitis media, the so-called granulating-polyposis and the malignant cholesteatomatosis. Whereas in earlier decades radical surgery was performed, albeit recently in a more and more gentle form, still according to the current state of microsurgery every ear with chronic suppuration must be operated on primarily with reconstructive intentions. By this is meant that not only the entire destroyed part and all diseased sections of the middle ear must be removed, but immediately from the existing still healthy parts always using the patient’s own body tissue from healthy areas, the middle ear must also be reconstructed to such an extent that better, as optimal as possible hearing is achieved. Any such procedure is commonly called tympanoplasty. There are many forms and types of tympanoplasty.Each operation has to fulfill the two main tasks: to remove the suppuration and to improve the hearing. There are standard types of tympanoplasty, but of these types of operations, almost only the ones that are most gentle on the middle ear and result in the best hearing are used today. Decisive for the success of the operation is the so-called inner ear reserve. If it is still large, then a good result can be achieved even after many years of festering. But it has to be said with all clarity that every continuing middle ear suppuration causes a constantly increasing hearing deterioration. The earlier such suppuration can be brought to a halt, the less the inner ear will be damaged. Tympanoplasty is not successful in the first operation in every case. About one third of the cases, which show particularly unpleasant
Grannulation formations, show poor healing tendencies or are associated with other diseases (diabetes, bleeding tendency, tuberculosis, poor general condition), must also be treated surgically a second time with intensive follow-up. The second time, surgery through the ear canal without external incision is sufficient. In this case, only the reconstructive measures that did not lead to the healing of the tympanum during the first operation are to be performed. Initially, it is only a matter of closing remaining holes in the eardrum or creating a sound transmission chain, which could not be achieved due to insufficient healing tendency in the follow-up treatment. If hearing is to be improved, it is imperative that the tubal function be preserved. In order to achieve this, the specialist has many possibilities today. In most cases, disturbances of tympanic ventilation through the tube are eliminated even before surgery.
Otosclerosis as a cause
Otosclerosis is a non-inflammatory disease that is very common in people in the middle decades of life. It develops gradually and primarily impedes sound transmission to the inner ear. About two percent of all people suffer from this disease. The old surgical procedures and various medications, hormones, vitamins, etc. did not bring any significant improvement. It is only in the last 20 years or so that one can speak of successful surgical treatment of otosclerosis. While 30 years ago archway fenestration with various disadvantages was used as the only operation with permanent success, in the last decade direct surgery on the stapes has become popular. This smallest bone of the human organism can of course only be made sound again with the help of modern surgical microscopes, the finest instruments and the use of the best medications. The operations can be performed even in almost deaf patients, when the diagnosis is confirmed. Today, we distinguish a whole range of different surgeries on the stapes, all of which can be performed through the auditory canal after ventilation of the eardrum. Depending on the degree of changes, sometimes mere mobilizations are sufficient. Sometimes only footplate sections of the stapes have to be removed, but sometimes the entire bone has to be removed and replaced with autologous tissue or modern synthetic materia1. The results of these interventions are very good. It is particularly gratifying that the patient and the physician already know at the end of the relatively short surgical procedure how successful the operation was, because the hearing tests during and after the operation show very well the hearing result.
Accidents and noise damage
Hearing loss is also often caused by traffic accidents. Once the initial severe hours of shock are overcome, hearing tests can already be performed on the patient to determine what damage is present. It is imperative that all accident victims who develop hearing disorders receive care, counseling and, if necessary, surgery from an ear specialist. The earlier help is given, the more certain a good result can be expected. But even minor accidents while diving, water jumping, boxing, throwing snowballs, etc., which can cause ruptures and hearing disorders, especially in the case of already damaged eardrums, must be immediately treated surgically by an ear specialist to avoid inflammation in the middle ear, to achieve primary healing and to prevent permanent hearing damage. Noise damage to the hearing organ is very extensive. Here, only timely recognition of the noise quantity and quality can ensure that as little damage as possible occurs.Noise-generating companies must therefore be examined by appropriate experts and measured in terms of noise levels. People’s sensitivity to noise varies greatly from person to person and also by gender. Women, for example, are much less sensitive to noise than men. Damage often occurs even after a short exposure to noise. On the other hand, no significant changes are noticed even after years. Sensitive persons must be prevented from becoming hard of hearing or even deaf either by using noise protection devices, by taking breaks from exposure to noise, or by changing jobs. Today, there is excellent legislation in Germany in this respect, with noise protection regulations that can reduce the risk of noise exposure and provide appropriate help for those already affected by noise.
Noise affected grant appropriate assistance.
Diseases as a cause
Even though modern medicine has reduced the danger of the infectious diseases measles, scarlet fever, rubella, mumps, tuberculosis, etc., which used to be very widespread, which also affects the sequelae, there are still individual cases of hearing impairment caused by infectious diseases. Here, too, timely detection and early treatment are important in order to prevent permanent damage. The treatment is usually done with medication. In the case of severe disorders that can no longer be reversed, sometimes only a modern hearing aid can help. Many ear diseases and hearing disorders are caused by damage to the upper airways in infancy or childhood. Some oversized adenoids and some constant rhinitis have caused damage to the ears in early childhood, which is difficult to treat and repair later. Therefore, any obstructed nasal breathing, any tendency to inflammation of the upper airways, any prolonged rhinitis belongs to the treatment of the specialist (ear, nose and throat doctor). Then the changes in the upper airway can be corrected in time and damage to the ear can be avoided. Many children with hereditary handicaps also have hearing disorders, which are partly caused by malformed ears, partly also by disorders transmitted from the malformed oropharyngeal region. Depending on the type and location of the changes, surgery must be performed early enough for the child to learn to hear and speak in time. At least until the child enters school, surgery should be performed to ensure that the hearing function enables the child to participate successfully in class. With today’s surgical methods, hearing gains can be achieved that allow sufficient hearing function and thus school attendance even in cases of severe deformities. If the remaining hearing is not sufficient, the child can also use a hearing aid.
Other causes
Modern hearing aids enable even deaf people to perceive sounds in their environment. For centuries, certain drugs and medications have been known in medicine to cause hearing loss, some temporarily and some permanently. Quinine, arsenic, salycilates, but also abuse of stimulants such as alcohol, coffee and tea, and also industrial products such as mercury, lead, benzene, phosphorus, sulfuric acid, carbon monoxide and others can cause severe hearing damage. Unfortunately, even today successfully used modern drugs, for example, antibiotics, are dangerous for the sense of hearing. Therefore, such medications should be taken only under medical supervision, with continuous monitoring of the auditory organ and taking into account international experience. The most important thing is to use the correct dosage. Once ear damage has occurred, there is little that can be done to help and usually only hearing aids can be used. The hereditary damage to the sense of hearing, which was so often mentioned in the past and blamed far too often, is no longer so feared today, since modern diagnostics have cleared up many of the earlier false diagnoses. Nevertheless, the number of congenital hearing disorders should not be ignored. Today, depending on the degree of congenital hearing impairment, since early diagnosis of hearing is possible in the earliest stages of life, rehabilitation can begin in childhood.
Prevention and life
For hearing impaired people, hearing education and training in special kindergarten are among the first measures. Schools for the hearing impaired include the curriculum of a normal school and can educate any child with healthy brain function so that all professions are open to him or her.But also of the deaf children we know today that 60 to 70 percent still have remnants of hearing and with the help of modern hearing aids can also receive a good education, not neglecting the old method of mouth-reading or lip-reading and learning a generally understandable language. Such children, who used to be considered deaf-mutes and not very capable of education, can now study at universities or technical colleges, and with the appropriate intelligence and sufficient diligence, can even learn and use foreign languages. Of course, such successful hard of hearing people today are still isolated cases, but they show the value of the possible measures and the achievable goal.
Aftercare
Hearing loss, hearing disorders and otosclerosis are diseases of the auditory system that require not only professional treatment but also consistent aftercare. This is initiated by hearing care professionals and ENT physicians, but also needs the patient’s cooperation for optimal success. The most important factor in this context is regular examinations of the hearing and the resulting need-based adjustment of hearing aids and other hearing aids to the current situation. In addition, hearing aid acousticians also offer special hearing training, which in some cases can be usefully integrated into the aftercare. The hearing aid itself is also professionally checked for fit and performance during aftercare, as well as serviced or repaired if necessary for the optimal hearing experience. Often, patients diagnosed with hearing loss, hearing impairment or otosclerosis cannot cope psychologically at first. Here it is important to strengthen the ability to act in everyday life and self-confidence as best as possible. A self-help group that is integrated into the aftercare can be enormously helpful in this context through the exchange of experiences and tips from other affected persons. Another visit to a hearing care professional can also make aftercare more profitable. The expert has a whole range of aids for everyday life and work that can improve individual well-being. In the case of some hearing impairments, it is also helpful to improve blood circulation in the head area in the long term by taking in sufficient fluids.
The hearing loss as a cause
As the last of the hearing disorders that is particularly significant, we must mention acute hearing loss – also called sudden
Deafness – called. This very serious disorder occurs suddenly, usually in one ear, and is often diagnosed as deafness. Sometimes it is accompanied by vertigo, sometimes without vertigo. Acute hearing loss mostly affects people in the younger and middle years of life, and especially those who are under a lot of nervous stress. Patients who experience this sudden deafness with dizziness usually lie down in bed and wait for the dizziness to pass. Others, who have become hard of hearing, believe that an earwax plug is the cause and initially postpone seeing a specialist. Both act wrongly. The first priority is to see an ear specialist (ENT) immediately. The cause of acute hearing loss is usually a circumscribed disturbance of the water balance in the inner ear. In our patients who have undergone surgery so far, we have found that hearing is restored only in the first four days.
hearing could be restored only in the first four days. If more time has passed, then surgical help usually comes too late. Not all ear specialists operate on such cases, because they also achieve good results with draining medications and cures or with other treatment methods. In general, the sooner the patient is treated by a specialist, the safer and more complete the restoration of hearing will be. This short summary of different possibilities of hearing disorders and their origin should serve to point out the manifold factors which are capable of damaging our sensitive hearing organ. However, it should also show how modern medicine knows how to help in most cases of the disease and can report gratifying successes.
What you can do yourself
In cases of hearing loss, hearing disorders and otosclerosis, self-help in everyday life is an important factor for the patient’s quality of life. Which measures are the right ones in individual cases is best discussed in cooperation with the ENT physician or hearing aid specialist. It is important to use hearing aids in addition to classic hearing aids in everyday life whenever possible.In cases of severe hearing loss, visual aids such as lights for the telephone or bells should also be considered in order to organize everyday life according to need. People from the environment can often be well integrated into the self-help process. Family and friends are asked to communicate slowly, clearly and sufficiently loudly. People who do not know about the hearing loss must be informed about it so that they do not approach the affected person from behind or too quietly. Hearing aid visits should be made regularly. Firstly, to check the hearing aids accurately for function and fit. For another, because there is modern hearing training that can often significantly improve the ability of people with hearing disorders to act. Those who suffer psychologically from their hearing disorder have two main options. Going to a psychologist can work through the problems in several sessions. Self-help groups have the advantage that here affected people with the same problems can find an exchange among like-minded people and support each other with advice and action.
