Hearing Loss Causes and Treatment

Hearing loss
Hearing loss is a partial or total inability to hear.[5]

Hearing loss
Hearing loss may be present at birth or acquired at any
time afterwards.[6][7] Hearing loss may occur in one or Other names Deaf or Hard of hearing;
both ears.[2] In children, hearing problems can affect anakusis or anacusis is total
the ability to acquire spoken language, and in adults it deafness[1]
can create difficulties with social interaction and at
work.[8] Hearing loss can be temporary or permanent.
Hearing loss related to age usually affects both ears and
is due to cochlear hair cell loss.[9] In some people,
particularly older people, hearing loss can result in
loneliness.[2] Deaf people usually have little to no
hearing.[6]
Hearing loss may be caused by a number of factors,

including: genetics, ageing, exposure to noise, some
infections, birth complications, trauma to the ear, and
certain medications or toxins.[2] A common condition
that results in hearing loss is chronic ear infections.[2]
Certain infections during pregnancy, such as
cytomegalovirus, syphilis and rubella, may also cause
hearing loss in the child.[2][10] Hearing loss is
diagnosed when hearing testing finds that a person is The international symbol of deafness and
unable to hear 25 decibels in at least one ear.[2] Testing
hearing loss
for poor hearing is recommended for all newborns.[8]
Hearing loss can be categorized as mild (25 to 40 dB), Specialty Otorhinolaryngology,
moderate (41 to 55 dB), moderate-severe (56 to audiology
70 dB), severe (71 to 90 dB), or profound (greater than Symptoms Decreased ability to hear
90 dB).[2] There are three main types of hearing loss:
Complications Social isolation,[2] dementia
conductive hearing loss, sensorineural hearing loss, and
mixed hearing loss.[3] Types Conductive, sensorineural,
and mixed hearing loss,
About half of hearing loss globally is preventable central auditory dysfunction[3]
through public health measures.[2] Such practices
Causes Genetics, aging, exposure to
include immunization, proper care around pregnancy,
noise, some infections, birth
avoiding loud noise, and avoiding certain
complications, trauma to the
medications.[2] The World Health Organization
recommends that young people limit exposure to loud ear, certain medications or
sounds and the use of personal audio players to an hour toxins[2]
a day in an effort to limit exposure to noise.[11] Early Diagnostic Hearing tests
identification and support are particularly important in method
children.[2] For many, hearing aids, sign language,
Prevention Immunization, proper care
cochlear implants and subtitles are useful.[2] Lip
around pregnancy, avoiding
reading is another useful skill some develop.[2] Access
to hearing aids, however, is limited in many areas of the loud noise, avoiding certain
world.[2] medications[2]
As of 2013 hearing loss affects about 1.1 billion people Treatment Hearing aids, sign language,
to some degree. [12] It causes disability in about 466 cochlear implants, subtitles[2]
million people (5% of the global population), and Frequency
1.33 billion / 18.5% (2015)[4]
moderate to severe disability in 124 million
people.[2][13][14] Of those with moderate to severe
disability 108 million live in low and middle income countries.[13] Of those with hearing loss, it began
during childhood for 65 million.[15] Those who use sign language and are members of Deaf culture may
see themselves as having a difference rather than a disability.[16] Many members of Deaf culture oppose
attempts to cure deafness[17][18][19] and some within this community view cochlear implants with concern
as they have the potential to eliminate their culture.[20] The terms hearing impairment or hearing loss are
often viewed negatively as emphasizing what people cannot do, although the terms are still regularly used
when referring to deafness in medical contexts.[16][21]
Contents
Definition
Hearing standards
Signs and symptoms
Complications
Cognitive decline
Falls
Depression
Spoken language ability
Causes
Pathophysiology
Diagnosis
Prevention
Workplace noise regulation
Screening
Management
Epidemiology
Social and cultural aspects
Research
Stem cell transplant and gene therapy
Audition
See also
References
External links
Definition
Hearing loss is defined as diminished acuity to sounds
which would otherwise be heard normally.[15] The terms
hearing impaired or hard of hearing are usually reserved
for people who have relative inability to hear sound in
the speech frequencies. The severity of hearing loss is
categorized according to the increase in intensity of
sound above the usual level required for the listener to
detect it.
Deafness is defined as a degree of loss such that a A deaf person using a camera-
person is unable to understand speech, even in the
equipped smartphone to
presence of amplification.[15] In profound deafness, even communicate in sign language
the highest intensity sounds produced by an audiometer
(an instrument used to measure hearing by producing
pure tone sounds through a range of frequencies) may not be detected. In total deafness, no
sounds at all, regardless of amplification or method of production, can be heard.
Speech perception is another aspect of hearing which involves the perceived clarity of a
word rather than the intensity of sound made by the word. In humans, this is usually
measured with speech discrimination tests, which measure not only the ability to detect
sound, but also the ability to understand speech. There are very rare types of hearing loss
that affect speech discrimination alone. One example is auditory neuropathy, a variety of
hearing loss in which the outer hair cells of the cochlea are intact and functioning, but sound
information is not faithfully transmitted by the auditory nerve to the brain.[22]
Use of the terms "hearing impaired", "deaf-mute", or "deaf and dumb" to describe deaf and hard of hearing
people is discouraged by many in the deaf community as well as advocacy organizations, as they are
offensive to many deaf and hard of hearing people.[23][24]
Hearing standards
Human hearing extends in frequency from 20 to 20,000 Hz, and in intensity from 0 dB to 120 dB HL or
more. 0 dB does not represent absence of sound, but rather the softest sound an average unimpaired human
ear can hear; some people can hear down to −5 or even −10 dB. Sound is generally uncomfortably loud
above 90 dB and 115 dB represents the threshold of pain. The ear does not hear all frequencies equally
well: hearing sensitivity peaks around 3,000 Hz. There are many qualities of human hearing besides
frequency range and intensity that cannot easily be measured quantitatively. However, for many practical
purposes, normal hearing is defined by a frequency versus intensity graph, or audiogram, charting
sensitivity thresholds of hearing at defined frequencies. Because of the cumulative impact of age and
exposure to noise and other acoustic insults, 'typical' hearing may not be normal.[25][26]
Signs and symptoms

difficulty using the telephone
loss of sound localization
difficulty understanding speech, especially of children and women whose voices are of a
higher frequency.
difficulty understanding speech in the presence of background noise (cocktail party effect)
sounds or speech sounding dull, muffled or attenuated
need for increased volume on television, radio, music and other audio sources
Hearing loss is sensory, but may have accompanying symptoms:

pain or pressure in the ears
a blocked feeling
There may also be accompanying secondary symptoms:
hyperacusis, heightened sensitivity with accompanying auditory pain to certain intensities

and frequencies of sound, sometimes defined as "auditory recruitment"
tinnitus, ringing, buzzing, hissing or other sounds in the ear when no external sound is
present
vertigo and disequilibrium
tympanophonia, also known as autophonia, abnormal hearing of one's own voice and
respiratory sounds, usually as a result of a patulous (a constantly open) eustachian tube or
dehiscent superior semicircular canals
disturbances of facial movement (indicating a possible tumour or stroke) or in persons with
Bell's palsy
Complications
Hearing loss is associated with Alzheimer's disease and dementia.[27] The risk increases with the hearing
loss degree. There are several hypotheses including cognitive resources being redistributed to hearing and
social isolation from hearing loss having a negative effect.[28] According to preliminary data, hearing aid
usage can slow down the decline in cognitive functions.[29]
Hearing loss is responsible for causing thalamocortical dysrthymia in the brain which is a cause for several
neurological disorders including tinnitus and visual snow syndrome.
Cognitive decline
Hearing loss is an increasing concern especially in aging populations. The prevalence of hearing loss
increases about two-fold for each decade increase in age after age 40.[30] While the secular trend might
decrease individual level risk of developing hearing loss, the prevalence of hearing loss is expected to rise
due to the aging population in the US. Another concern about aging process is cognitive decline, which
may progress to mild cognitive impairment and eventually dementia.[31] The association between hearing
loss and cognitive decline has been studied in various research settings. Despite the variability in study
design and protocols, the majority of these studies have found consistent association between age-related
hearing loss and cognitive decline, cognitive impairment, and dementia.[32] The association between age-
related hearing loss and Alzheimer's disease was found to be nonsignificant, and this finding supports the
hypothesis that hearing loss is associated with dementia independent of Alzheimer pathology.[32] There are
several hypothesis about the underlying causal mechanism for age-related hearing loss and cognitive
decline. One hypothesis is that this association can be explained by common etiology or shared
neurobiological pathology with decline in other physiological system.[33] Another possible cognitive
mechanism emphasize on individual's cognitive load. As people developing hearing loss in the process of
aging, the cognitive load demanded by auditory perception increases, which may lead to change in brain
structure and eventually to dementia.[34] One other hypothesis suggests that the association between
hearing loss and cognitive decline is mediated through various psychosocial factors, such as decrease in
social contact and increase in social isolation.[33] Findings on the association between hearing loss and
dementia have significant public health implication, since about 9% of dementia cases are associated with
hearing loss.[35]
Falls
Falls have important health implications, especially for an aging population where they can lead to
significant morbidity and mortality. Elderly people are particularly vulnerable to the consequences of
injuries caused by falls, since older individuals typically have greater bone fragility and poorer protective
reflexes.[36] Fall-related injury can also lead to burdens on the financial and health care systems.[36] In
literature, age-related hearing loss is found to be significantly associated with incident falls.[37] There is also
a potential dose-response relationship between hearing loss and falls—greater severity of hearing loss is
associated with increased difficulties in postural control and increased prevalence of falls.[38] The
underlying causal link between the association of hearing loss and falls is yet to be elucidated. There are
several hypotheses that indicate that there may be a common process between decline in auditory system
and increase in incident falls, driven by physiological, cognitive, and behavioral factors.[38] This evidence
suggests that treating hearing loss has potential to increase health-related quality of life in older adults.[38]
Depression
Depression is one of the leading causes of morbidity and mortality worldwide. In older adults, the suicide
rate is higher than it is for younger adults, and more suicide cases are attributable to depression.[39]
Different studies have been done to investigate potential risk factors that can give rise to depression in later
life. Some chronic diseases are found to be significantly associated with risk of developing depression, such
as coronary heart disease, pulmonary disease, vision loss and hearing loss.[40] Hearing loss can attribute to
decrease in health-related quality of life, increase in social isolation and decline in social engagement,
which are all risk factors for increased risk of developing depression symptoms.[41]
Spoken language ability
Post-lingual deafness is hearing loss that is sustained after the acquisition of language, which can occur due
to disease, trauma, or as a side-effect of a medicine. Typically, hearing loss is gradual and often detected by
family and friends of affected individuals long before the patients themselves will acknowledge the
disability.[42] Post-lingual deafness is far more common than pre-lingual deafness. Those who lose their
hearing later in life, such as in late adolescence or adulthood, face their own challenges, living with the
adaptations that allow them to live independently.
Prelingual deafness is profound hearing loss that is sustained before the acquisition of language, which can
occur due to a congenital condition or through hearing loss before birth or in early infancy. Prelingual
deafness impairs an individual's ability to acquire a spoken language in children, but deaf children can
acquire spoken language through support from cochlear implants (sometimes combined with hearing
aids).[43][44] Non-signing (hearing) parents of deaf babies (90–95% of cases) usually go with oral approach
without the support of sign language, as these families lack previous experience with sign language and
cannot competently provide it to their children without learning it themselves. Unfortunately, this may in
some cases (late implantation or not sufficient benefit from cochlear implants) bring the risk of language
deprivation for the deaf baby[45] because the deaf baby would not have a sign language if the child is
unable to acquire spoken language successfully. The 5–10% of cases of deaf babies born into signing
families have the potential of age-appropriate development of language due to early exposure to a sign
language by sign-competent parents, thus they have the potential to meet language milestones, in sign
language in lieu of spoken language.[46]
Causes
Hearing loss has multiple causes, including ageing, genetics, perinatal problems and acquired causes like
noise and disease. For some kinds of hearing loss the cause may be classified as of unknown cause.
There is a progressive loss of ability to hear high frequencies with aging known as presbycusis. For men,
this can start as early as 25 and women at 30. Although genetically variable, it is a normal concomitant of
ageing and is distinct from hearing losses caused by noise exposure, toxins or disease agents.[47] Common
conditions that can increase the risk of hearing loss in elderly people are high blood pressure, diabetes, or
the use of certain medications harmful to the ear.[48][49] While everyone loses hearing with age, the amount
and type of hearing loss is variable.[50]
Noise-induced hearing loss (NIHL), also known as acoustic trauma, typically manifests as elevated hearing
thresholds (i.e. less sensitivity or muting). Noise exposure is the cause of approximately half of all cases of
hearing loss, causing some degree of problems in 5% of the population globally.[51] The majority of
hearing loss is not due to age, but due to noise exposure.[52] Various governmental, industry and standards
organizations set noise standards.[53] Many people are unaware of the presence of environmental sound at
damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise
levels include car stereos, children's toys, motor vehicles, crowds, lawn and maintenance equipment, power
tools, gun use, musical instruments, and even hair dryers. Noise damage is cumulative; all sources of
damage must be considered to assess risk. In the US, 12.5% of children aged 6–19 years have permanent
hearing damage from excessive noise exposure.[54] The World Health Organization estimates that half of
those between 12 and 35 are at risk from using personal audio devices that are too loud.[11] Hearing loss in
adolescents may be caused by loud noise from toys, music by headphones, and concerts or events.[55][56]
Hearing loss can be inherited. Around 75–80% of all these cases are inherited by recessive genes, 20–25%
are inherited by dominant genes, 1–2% are inherited by X-linked patterns, and fewer than 1% are inherited
by mitochondrial inheritance.[57] Syndromic deafness occurs when there are other signs or medical
problems aside from deafness in an individual,[57] such as Usher syndrome, Stickler syndrome,
Waardenburg syndrome, Alport's syndrome, and neurofibromatosis type 2. Nonsyndromic deafness occurs
when there are no other signs or medical problems associated with the deafness in an individual.[57]
Fetal alcohol spectrum disorders are reported to cause hearing loss in up to 64% of infants born to alcoholic
mothers, from the ototoxic effect on the developing fetus plus malnutrition during pregnancy from the
excess alcohol intake. Premature birth can be associated with sensorineural hearing loss because of an
increased risk of hypoxia, hyperbilirubinaemia, ototoxic medication and infection as well as noise exposure
in the neonatal units. Also, hearing loss in premature babies is often discovered far later than a similar
hearing loss would be in a full-term baby because normally babies are given a hearing test within 48 hours
of birth, but doctors must wait until the premature baby is medically stable before testing hearing, which
can be months after birth.[58] The risk of hearing loss is greatest for those weighing less than 1500 g at
birth.
Disorders responsible for hearing loss include auditory neuropathy,[59][60] Down syndrome,[61] Charcot–
Marie–Tooth disease variant 1E,[62] autoimmune disease, multiple sclerosis, meningitis, cholesteatoma,
otosclerosis, perilymph fistula, Ménière's disease, recurring ear infections, strokes, superior semicircular
canal dehiscence, Pierre Robin, Treacher-Collins, Usher Syndrome, Pendred Syndrome, and Turner
syndrome, syphilis, vestibular schwannoma, and viral infections such as measles, mumps, congenital
rubella (also called German measles) syndrome, several varieties of herpes viruses,[63][64] HIV/AIDS,[65]
and West Nile virus.
Some medications may reversibly affect hearing. These medications are considered ototoxic. This includes
loop diuretics such as furosemide and bumetanide, non-steroidal anti-inflammatory drugs (NSAIDs) both
over-the-counter (aspirin, ibuprofen, naproxen) as well as prescription (celecoxib, diclofenac, etc.),
paracetamol, quinine, and macrolide antibiotics.[66] Others may cause permanent hearing loss.[67] The most
important group is the aminoglycosides (main member gentamicin) and platinum based chemotherapeutics
such as cisplatin and carboplatin.[68][69]
In addition to medications, hearing loss can also result from specific chemicals in the environment: metals,
such as lead; solvents, such as toluene (found in crude oil, gasoline[70] and automobile exhaust,[70] for
example); and asphyxiants.[71] Combined with noise, these ototoxic chemicals have an additive effect on a
person's hearing loss.[71] Hearing loss due to chemicals starts in the high frequency range and is
irreversible. It damages the cochlea with lesions and degrades central portions of the auditory system.[71]
For some ototoxic chemical exposures, particularly styrene,[72] the risk of hearing loss can be higher than
being exposed to noise alone. The effects is greatest when the combined exposure include impulse
noise.[73][74] A 2018 informational bulletin by the US Occupational Safety and Health Administration
(OSHA) and the National Institute for Occupational Safety and Health (NIOSH) introduces the issue,
provides examples of ototoxic chemicals, lists the industries and occupations at risk and provides
prevention information.[75]
There can be damage either to the ear, whether the external or middle ear, to the cochlea, or to the brain
centers that process the aural information conveyed by the ears. Damage to the middle ear may include
fracture and discontinuity of the ossicular chain. Damage to the inner ear (cochlea) may be caused by
temporal bone fracture. People who sustain head injury are especially vulnerable to hearing loss or tinnitus,
either temporary or permanent.[76][77]
Pathophysiology
Sound waves reach the outer ear and are conducted down
the ear canal to the eardrum, causing it to vibrate. The
vibrations are transferred by the 3 tiny ear bones of the
middle ear to the fluid in the inner ear. The fluid moves
hair cells (stereocilia), and their movement generates nerve
impulses which are then taken to the brain by the cochlear 0:00
nerve.[78][79] The auditory nerve takes the impulses to the
brainstem, which sends the impulses to the midbrain.
Finally, the signal goes to the auditory cortex of the How sounds make their way from the source
temporal lobe to be interpreted as sound.[80] to the brain
Hearing loss is most commonly caused by long-term

exposure to loud noises, from recreation or from work, that damage the hair cells, which do not grow back
on their own.[81][82][9]
Older people may lose their hearing from long exposure to noise, changes in the inner ear, changes in the
middle ear, or from changes along the nerves from the ear to the brain.[83]
Diagnosis
Identification of a hearing loss is usually conducted by a general practitioner medical doctor,
otolaryngologist, certified and licensed audiologist, school or industrial audiometrist, or other audiometric
technician. Diagnosis of the cause of a hearing loss is carried out by a specialist physician (audiovestibular
physician) or otorhinolaryngologist.
Hearing loss is generally measured by playing generated or
recorded sounds, and determining whether the person can hear
them. Hearing sensitivity varies according to the frequency of
sounds. To take this into account, hearing sensitivity can be
measured for a range of frequencies and plotted on an audiogram.
Other method for quantifying hearing loss is a hearing test using a
mobile application or hearing aid application, which includes a
hearing test.[84][85] Hearing diagnosis using mobile application is
similar to the audiometry procedure.[84] Audiograms, obtained An audiologist conducting an
using mobile applications, can be used to adjust hearing aid audiometric hearing test in a sound-
applications.[85] Another method for quantifying hearing loss is a proof testing booth
speech-in-noise test. which gives an indication of how well one can
understand speech in a noisy environment.[86] Otoacoustic
emissions test is an objective hearing test that may be administered to toddlers and children too young to
cooperate in a conventional hearing test. Auditory brainstem response testing is an electrophysiological test
used to test for hearing deficits caused by pathology within the ear, the cochlear nerve and also within the
brainstem.
A case history (usually a written form, with questionnaire) can provide valuable information about the
context of the hearing loss, and indicate what kind of diagnostic procedures to employ. Examinations
include otoscopy, tympanometry, and differential testing with the Weber, Rinne, Bing and Schwabach
tests. In case of infection or inflammation, blood or other body fluids may be submitted for laboratory
analysis. MRI and CT scans can be useful to identify the pathology of many causes of hearing loss.
Hearing loss is categorized by severity, type, and configuration. Furthermore, a hearing loss may exist in
only one ear (unilateral) or in both ears (bilateral). Hearing loss can be temporary or permanent, sudden or
progressive. The severity of a hearing loss is ranked according to ranges of nominal thresholds in which a
sound must be so it can be detected by an individual. It is measured in decibels of hearing loss, or dB HL.
There are three main types of hearing loss: conductive hearing loss, sensorineural hearing loss, and mixed
hearing loss.[15] An additional problem which is increasingly recognised is auditory processing disorder
which is not a hearing loss as such but a difficulty perceiving sound. The shape of an audiogram shows the
relative configuration of the hearing loss, such as a Carhart notch for otosclerosis, 'noise' notch for noise-
induced damage, high frequency rolloff for presbycusis, or a flat audiogram for conductive hearing loss. In
conjunction with speech audiometry, it may indicate central auditory processing disorder, or the presence of
a schwannoma or other tumor.
People with unilateral hearing loss or single-sided deafness (SSD) have difficulty in hearing conversation
on their impaired side, localizing sound, and understanding speech in the presence of background noise.
One reason for the hearing problems these patients often experience is due to the head shadow effect.[87]
Prevention
It is estimated that half of cases of hearing loss are preventable.[88] About 60% of hearing loss in children
under the age of 15 can be avoided.[89][2] There are a number of effective preventative strategies,
including: immunization against rubella to prevent congenital rubella syndrome, immunization against H.
influenza and S. pneumoniae to reduce cases of meningitis, and avoiding or protecting against excessive
noise exposure.[15] The World Health Organization also recommends immunization against measles,
mumps, and meningitis, efforts to prevent premature birth, and avoidance of certain medication as
prevention.[90] World Hearing Day is a yearly event to promote actions to prevent hearing damage.
Noise exposure is the most significant risk factor for noise-induced hearing loss that can be prevented.[91]
Different programs exist for specific populations such as school-age children, adolescents and workers.[92]
Education regarding noise exposure increases the use of hearing protectors.[93] The use of antioxidants is
being studied for the prevention of noise-induced hearing loss, particularly for scenarios in which noise
exposure cannot be reduced, such as during military operations.[94]
Workplace noise regulation
Noise is widely recognized as an occupational hazard. In the United States, the National Institute for
Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA)
work together to provide standards and enforcement on workplace noise levels.[95][96] The hierarchy of
hazard controls demonstrates the different levels of controls to reduce or eliminate exposure to noise and
prevent hearing loss, including engineering controls and personal protective equipment (PPE).[97] Other
programs and initiative have been created to prevent hearing loss in the workplace. For example, the Safe-
in-Sound Award was created to recognize organizations that can demonstrate results of successful noise
control and other interventions.[98] Additionally, the Buy Quiet program was created to encourage
employers to purchase quieter machinery and tools.[99] By purchasing less noisy power tools like those
found on the NIOSH Power Tools Database and limiting exposure to ototoxic chemicals, great strides can
be made in preventing hearing loss.[100]
Companies can also provide personal hearing protector devices tailored to both the worker and type of
employment. Some hearing protectors universally block out all noise, and some allow for certain noises to
be heard. Workers are more likely to wear hearing protector devices when they are properly fitted.[101]
Often interventions to prevent noise-induced hearing loss have many components. A 2017 Cochrane
review found that stricter legislation might reduce noise levels.[102] Providing workers with information on
their sound exposure levels was not shown to decrease exposure to noise. Ear protection, if used correctly,
can reduce noise to safer levels, but often, providing them is not sufficient to prevent hearing loss.
Engineering noise out and other solutions such as proper maintenance of equipment can lead to noise
reduction, but further field studies on resulting noise exposures following such interventions are needed.
Other possible solutions include improved enforcement of existing legislation and better implementation of
well-designed prevention programmes, which have not yet been proven conclusively to be effective. The
conclusion of the Cochrane Review was that further research could modify what is now regarding the
effectiveness of the evaluated interventions.[102]
The Institute for Occupational Safety and Health of the German Social Accident Insurance has created a
hearing impairment calculator based on the ISO 1999 model for studying threshold shift in relatively
homogeneous groups of people, such as workers with the same type of job. The ISO 1999 model estimates
how much hearing impairment in a group can be ascribed to age and noise exposure. The result is
calculated via an algebraic equation that uses the A-weighted sound exposure level, how many years the
people were exposed to this noise, how old the people are, and their sex. The model's estimations are only
useful for people without hearing loss due to non-job related exposure and can be used for prevention
activities.[103]
Screening
The United States Preventive Services Task Force recommends neonatal hearing screening for all
newborns.[8]
The American Academy of Pediatrics advises that children should have their hearing tested several times
throughout their schooling:[54]
When they enter school

At ages 6, 8, and 10
At least once during middle school
At least once during high school
While the American College of Physicians indicated that there is not enough evidence to determine the
utility of screening in adults over 50 years old who do not have any symptoms,[104] the American
Language, Speech Pathology and Hearing Association recommends that adults should be screened at least
every decade through age 50 and at three-year intervals thereafter, to minimize the detrimental effects of the
untreated condition on quality of life.[105] For the same reason, the US Office of Disease Prevention and
Health Promotion included as one of Healthy People 2020 objectives: to increase the proportion of persons
who have had a hearing examination.[106]
Management
Management depends on the specific cause if known as well as the
extent, type and configuration of the hearing loss. Sudden hearing
loss due to an underlying nerve problem may be treated with
corticosteroids.[107]
Most hearing loss, that resulting from age and noise, is progressive
and irreversible, and there are currently no approved or
recommended treatments. A few specific kinds of hearing loss are
amenable to surgical treatment. In other cases, treatment is
addressed to underlying pathologies, but any hearing loss incurred An in-the-canal hearing aid
may be permanent. Some management options include hearing
aids, cochlear implants, middle ear implants, assistive technology,
and closed captioning.[9] This choice depends on the level of hearing loss, type of hearing loss, and
personal preference. Hearing aid applications are one of the options for hearing loss management.[85] For
people with bilateral hearing loss, it is not clear if bilateral hearing aids (hearing aids in both ears) are better
than a unilateral hearing aid (hearing aid in one ear).[9]
Epidemiology
Globally, hearing loss affects about 10% of the population to some degree.[51] It caused moderate to severe
disability in 124.2 million people as of 2004 (107.9 million of whom are in low and middle income
countries).[13] Of these 65 million acquired the condition during childhood.[15] At birth ~3 per 1000 in
developed countries and more than 6 per 1000 in developing countries have hearing problems.[15]
Hearing loss increases with age. In those between 20 and 35 rates of hearing loss are 3% while in those 44
to 55 it is 11% and in those 65 to 85 it is 43%.[8]
A 2017 report by the World Health Organization estimated the costs of unaddressed hearing loss and the
cost-effectiveness of interventions, for the health-care sector, for the education sector and as broad societal
costs.[108] Globally, the annual cost of unaddressed hearing loss was estimated to be in the range of $750–
790 billion international dollars.
The International Organization for Standardization
(ISO) developed the ISO 1999 standards for the
estimation of hearing thresholds and noise-induced
hearing impairment.[109] They used data from two
noise and hearing study databases, one presented by
Burns and Robinson (Hearing and Noise in Industry,
Her Majesty's Stationery Office, London, 1970) and
by Passchier-Vermeer (1968).[110] As race are some
Disability-adjusted life year for hearing loss (adult
of the factors that can affect the expected distribution
onset) per 100,000 inhabitants in 2004.
of pure-tone hearing thresholds several other national
no data 475–520
or regional datasets exist, from Sweden,[111]
Norway,[112] South Korea,[113] the United <250 520–565
States[114] and Spain.[115] 250–295 565–610
295–340 610–655
In the United States hearing is one of the health 340–385 655–700
outcomes measure by the National Health and 385–430 >700
Nutrition Examination Survey (NHANES), a survey 430–475
research program conducted by the National Center
for Health Statistics. It examines health and
nutritional status of adults and children in the United States. Data from the United States in 2011-2012
found that rates of hearing loss has declined among adults aged 20 to 69 years, when compared with the
results from an earlier time period (1999-2004). It also found that adult hearing loss is associated with
increasing age, sex, ethnicity, educational level, and noise exposure.[116] Nearly one in four adults had
audiometric results suggesting noise-induced hearing loss. Almost one in four adults who reported excellent
or good hearing had a similar pattern (5.5% on both sides and 18% on one side). Among people who
reported exposure to loud noise at work, almost one third had such changes.[117]
Social and cultural aspects

People with extreme hearing loss may communicate through sign
languages. Sign languages convey meaning through manual
communication and body language instead of acoustically
conveyed sound patterns. This involves the simultaneous
combination of hand shapes, orientation and movement of the
hands, arms or body, and facial expressions to express a speaker's
thoughts. "Sign languages are based on the idea that vision is the
most useful tool a deaf person has to communicate and receive
information".[118]
The sign for "friend" in American
Deaf culture refers to a tight-knit cultural group of people whose Sign Language
primary language is signed, and who practice social and cultural
norms which are distinct from those of the surrounding hearing
community. This community does not automatically include all those who are clinically or legally deaf, nor
does it exclude every hearing person. According to Baker and Padden, it includes any person or persons
who "identifies him/herself as a member of the Deaf community, and other members accept that person as a
part of the community,"[119] an example being children of deaf adults with normal hearing ability. It
includes the set of social beliefs, behaviors, art, literary traditions, history, values, and shared institutions of
communities that are influenced by deafness and which use sign languages as the main means of
communication.[120][121] Members of the Deaf community tend to view deafness as a difference in human
experience rather than a disability or disease.[122][123] When used as a cultural label especially within the
culture, the word deaf is often written with a capital D and referred to as "big D Deaf" in speech and sign.
When used as a label for the audiological condition, it is written with a lower case d.[120][121]
There also multiple educational institutions for both deaf and Deaf people, that usually use sign language as
the main language of instruction. Famous institutions include Gallaudet University and the National
Technical Institute for the Deaf in the US,[124] and the National University Corporation of Tsukuba
University of Technology in Japan.[125]
Research
Stem cell transplant and gene therapy
A 2005 study achieved successful regrowth of cochlea cells in guinea pigs.[126] However, the regrowth of
cochlear hair cells does not imply the restoration of hearing sensitivity, as the sensory cells may or may not
make connections with neurons that carry the signals from hair cells to the brain. A 2008 study has shown
that gene therapy targeting Atoh1 can cause hair cell growth and attract neuronal processes in embryonic
mice. Some hope that a similar treatment will one day ameliorate hearing loss in humans.[127]
Recent research, reported in 2012 achieved growth of cochlear nerve cells resulting in hearing
improvements in gerbils,[128] using stem cells. Also reported in 2013 was regrowth of hair cells in deaf
adult mice using a drug intervention resulting in hearing improvement.[129] The Hearing Health Foundation
in the US has embarked on a project called the Hearing Restoration Project.[130] Also Action on Hearing
Loss in the UK is also aiming to restore hearing.[131]
Researchers reported in 2015 that genetically deaf mice which were treated with TMC1 gene therapy
recovered some of their hearing.[132][133] In 2017, additional studies were performed to treat Usher
syndrome[134] and here, a recombinant adeno-associated virus seemed to outperform the older
vectors.[135][136]
Audition
Besides research studies seeking to improve hearing, such as the ones listed above, research studies on the
deaf have also been carried out in order to understand more about audition. Pijil and Shwarz (2005)
conducted their study on the deaf who lost their hearing later in life and, hence, used cochlear implants to
hear. They discovered further evidence for rate coding of pitch, a system that codes for information for
frequencies by the rate that neurons fire in the auditory system, especially for lower frequencies as they are
coded by the frequencies that neurons fire from the basilar membrane in a synchronous manner. Their
results showed that the subjects could identify different pitches that were proportional to the frequency
stimulated by a single electrode. The lower frequencies were detected when the basilar membrane was
stimulated, providing even further evidence for rate coding.[137]
See also
Deaf hearing
H.870
Otologics
Safe listening
World Hearing Day
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World Health Organization. 2017. Internet archive (https://web.archive.org/web/2020051208
5900/https://apps.who.int/iris/bitstream/handle/10665/254659/9789241512046-eng.pdf?seq
uence=1) on 12 May 2020.
Deafness and Hearing Loss (https://www.who.int/health-topics/hearing-loss). World Health
Organization. 2022. Internet archive (https://web.archive.org/web/20220609145726/https://w
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efault.html) U.S. Department of Health and Human Services, Centers for Disease Control
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Hearing Loss Causes and Treatment

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Hearing Loss Causes and Treatment

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Hearing loss

Hearing loss is a partial or total inability to hear.[5]

Hearing loss may be caused by a number of factors,

Signs and symptoms

Hearing loss is sensory, but may have accompanying symptoms:

There may also be accompanying secondary symptoms:

hyperacusis, heightened sensitivity with accompanying auditory pain to certain intensities

Spoken language ability

Hearing loss is most commonly caused by long-term

Workplace noise regulation

When they enter school

Social and cultural aspects

Stem cell transplant and gene therapy

Occupational Noise and Hearing Loss Prevention (https://www.cdc.gov/niosh/topics/noise/d

Retrieved from "https://en.wikipedia.org/w/index.php?title=Hearing_loss&oldid=1101669467"

This page was last edited on 1 August 2022, at 06:41 (UTC).

Text is available under the Creative Commons Attribution-ShareAlike License 3.0;

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