Hearing loss
Hearing loss is evaluated with the Weber and Rinne tuning fork tests to sort conductive from sensorineural loss at the bedside, then confirmed with audiometry; treatment ranges from cerumen removal or hearing aids to urgent oral prednisone and otolaryngology referral for sudden sensorineural loss.
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What this article covers
- Overview
A symptom, not a single disease, requiring classification as conductive, sensorineural, or mixed before workup: conductive loss arises from failure of sound conduction through the external or middle…
- Epidemiology
Presbycusis is the most common cause overall and becomes near-universal with advanced age: hearing loss affects more than 80% of persons by age 80 years.
- Risk factors
Age, the dominant driver of presbycusis and the single most important factor when interpreting a gradual, bilateral, high-frequency-predominant loss.
- Pathophysiology
Conductive loss: a process blocks or dampens sound-wave transmission before it reaches the cochlea, for example cerumen occluding the canal, a middle-ear effusion, tympanic membrane perforation…
- Clinical features
The tempo of the loss is the leading discriminator: sudden (hours to 3 days), progressive, or longstanding; unilateral or bilateral.
- Differential diagnosis
Cerumen impaction: wax fully occludes the canal, with immediate improvement after removal, unlike a fixed sensorineural or ossicular cause.
- Diagnosis
The diagnosis is established by tuning-fork localization followed by audiometric confirmation, not by either test alone: the Weber and Rinne tests classify the loss as conductive, sensorineural, or…
- Management
First, remove or treat any reversible conductive cause identified on otoscopy: irrigation, curettage, or suction removal of impacted cerumen; treatment of the underlying otitis media, effusion, or…
- Complications
Missed diagnosis of vestibular schwannoma when unilateral sensorineural loss is attributed reflexively to presbycusis without confirmatory audiometry and, when indicated, MRI.
- Prognosis
Reversible conductive causes (cerumen impaction, otitis media with effusion, most tympanic membrane perforations) recover hearing fully after treatment of the underlying obstruction or infection.
- Prevention
Avoid or minimize ototoxic drug exposure when alternatives exist, and monitor renal function closely when aminoglycosides are required, since kidney disease compounds ototoxic risk.
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Related articles
- Cerumen impaction
Cerumen impaction is accumulated earwax that occludes the external auditory canal, causing conductive hearing loss, fullness, or itching; management ranges from observation to cerumenolytics, irrigation, or manual/instrument removal, chosen by canal findings and tympanic membrane integrity.
- Otitis media with effusion
Otitis media with effusion is middle-ear fluid persisting without signs of acute infection, most often in young children after an upper respiratory infection or acute otitis media, managed mainly with observation and reserving tympanostomy tubes for persistent hearing loss.
- Otosclerosis
Otosclerosis is a bony overgrowth of the stapes footplate that fixes the ossicular chain and produces slowly progressive, often bilateral conductive hearing loss in young adults, confirmed by a conductive Weber/Rinne pattern and treated with hearing aids or stapes surgery.
- Cholesteatoma
Cholesteatoma is an abnormal growth of keratinizing squamous epithelium in the middle ear that erodes the ossicles, mastoid, and adjacent skull base; it is confirmed on otoscopy, staged by CT, and requires mastoidectomy with tympanoplasty because no medical therapy is curative.
- Chronic suppurative otitis media
Chronic suppurative otitis media is continuous otorrhea through a perforated tympanic membrane for more than six weeks without systemic symptoms. Management starts with topical fluoroquinolone ear drops and aural toilet, escalating to systemic antibiotics or tympanoplasty for refractory disease or cholesteatoma.
- Presbycusis
Presbycusis is age-related, bilateral, symmetric, high-frequency-predominant sensorineural hearing loss from cochlear hair cell loss, diagnosed by pattern recognition and audiometry after excluding other causes, and treated primarily with amplification.
- Sudden sensorineural hearing loss
Sudden sensorineural hearing loss is unilateral hearing loss occurring within 72 hours, most often idiopathic, that is an otologic emergency because delayed treatment worsens recovery.
- Noise-induced hearing loss
Noise-induced hearing loss is a preventable sensorineural hearing loss from cochlear hair-cell injury, either sudden after a single very loud blast (acute acoustic trauma) or gradual from cumulative occupational or recreational exposure (chronic noise-induced hearing loss), with high-frequency loss first and no restorative drug therapy once established.
- Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma is a benign Schwann-cell tumor of CN VIII in the internal auditory canal/cerebellopontine angle that presents with slowly progressive unilateral sensorineural hearing loss and disequilibrium rather than true vertigo. Diagnosis rests on asymmetric audiometry followed by contrast-enhanced MRI, and management is a size- and growth-driven choice among observation, stereotactic radiosurgery, and microsurgical resection.
- Tympanic membrane perforation
A full-thickness defect in the eardrum from trauma or infection, causing sudden ear pain, conductive hearing loss, and otorrhea. Diagnosis is by otoscopy. Most heal spontaneously with dry-ear precautions; a draining ear is treated with ofloxacin otic drops, and a perforation that fails to close by 3 months is referred for myringoplasty or tympanoplasty.
- Otitis externa
Otitis externa is diffuse inflammation of the external auditory canal, usually bacterial (Pseudomonas or Staphylococcus aureus) and diagnosed clinically by tragal tenderness and canal erythema with otorrhea. Uncomplicated disease is treated with topical antibiotic-steroid otic drops for 7 days, while malignant (necrotizing) otitis externa in a diabetic or immunocompromised patient is skull-base osteomyelitis requiring systemic antipseudomonal therapy and urgent otolaryngology referral.