Causes, Treatments, and Community Perspectives on Hearing Loss

Introduction

Many people think of hearing loss as something a person is either born with or develops in old age, but those are far from the only factors that can result in hearing impairment. Whether a person is completely deaf or only has difficulty hearing, a variety of causes must be considered and ruled out before a definitive determination can be made. Additionally, there are several treatments to consider. Which option is best for a given patient depends on the cause of the impairment and other individual factors. Not every option will work for every patient, and doctors must weigh numerous issues before deciding on the most appropriate course of treatment. There are also some people with hearing impairment for whom no treatment options exist.

Since people lose their hearing for various reasons, there are not always ways to help them regain what they have lost. If the loss is gradual, they may be able to adjust to the change and the impairment. A loss that comes on suddenly can make adjustment considerably more difficult. This paper explores the issues behind various types of hearing loss in an effort to determine not only why people lose their hearing, but also whether gradual or sudden losses are more significant from a long-term perspective and how valuable different methods of restoring hearing actually are. While no single treatment will work for all people, improvements are being developed continuously.

When people experience hearing loss, they have either a complete or partial inability to hear (Robinson & Sutton, 1979). There are many reasons why this can occur, and several treatments that can be used to allow them to hear again. Whether full hearing can be restored is an important consideration, but sometimes even restoring partial hearing is significant enough to help a person resume a more normal life (Kral & O'Donoghue, 2010). The level of impairment is measured in decibels using a specialized machine that presents tones for the patient to identify. What the patient indicates he or she can hear provides the technician with information on the severity of the impairment (Kral & O'Donoghue, 2010).

Causes of Hearing Loss

Another important consideration involves the strong opinions held within the deaf community regarding interventions and whether they are always in a person's best interest. Not everyone believes that those who are born deaf should be made to hear, particularly if that requires risky surgery or other invasive methods (Oishi & Schacht, 2011).

The methods used to help people hear have met with limited success. Hearing aids do not restore completely normal hearing, and they can be cumbersome and expensive. Other methods exist, but they are not suitable for everyone (Lieu, 2004). Additionally, some hearing loss cannot be reversed or halted (Lieu, 2004). Outcomes depend on the reason for the loss and the types of treatment to which the individual responds. When hearing cannot be restored, that is an unfortunate reality. However, many people who are born deaf or who lose all or part of their hearing later in life are able to live normal lives with a few modifications (Lieu, 2004). While new advances can be explored for those who wish to hear again, not everyone is eager to attempt to regain their hearing.

Age is one of the primary causes of hearing loss. As people age, they are less likely to hear well because of cumulative damage sustained over their lifetimes (Kral & O'Donoghue, 2010). High frequencies are often what these individuals lose first, although some experience difficulty with lower tones instead (Robinson & Sutton, 1979). The loss of high-frequency hearing is called presbycusis, and it actually begins early in adulthood (Lieu, 2004). Generally, people with this condition do not notice it until much later in life, because it takes until older age for them to realize they can no longer hear conversations properly (Robinson & Sutton, 1979). By the time they reach that point, they may assume the loss is simply due to "old age," when in fact the groundwork for the impairment was laid much earlier. While presbycusis is common, it varies based on genetics and is not related to noise, disease, or toxins (Lieu, 2004).

Nearly half of all cases of hearing loss are attributable to noise, and five percent of people across the globe have some degree of hearing difficulty from noise-related factors (Oishi & Schacht, 2011). Fortunately, noise is one variable that can be avoided to some degree by most of the population. People who live near airports and freeways are exposed to high levels of noise quite frequently (Lieu, 2004). These individuals are at greater risk of hearing loss due to their daily exposure, although noise affects everyone differently (Oishi & Schacht, 2011). Not everyone who lives with significant noise in their environment will sustain hearing damage; they are simply at higher risk of impairment over time (Lieu, 2004). Both the decibel level of the noise and the duration of exposure are important factors when calculating risk.

Diseases can cause hearing loss, especially in children and infants (Kral & O'Donoghue, 2010). Measles, chlamydia, mumps, and meningitis all place people at risk, as does fetal alcohol syndrome in newborns (Lieu, 2004). People living with HIV/AIDS frequently experience hearing difficulties, and being born prematurely, having syphilis, undergoing chemotherapy, or having a brain tumor can also affect a person's hearing (Lieu, 2004). While it is logical that disease could affect many parts of the body including the ears, many people do not think of illness when they consider hearing loss — tending instead to focus on genetics, noise, or old age. However, the range of illnesses that can cause hearing impairment makes it an important etiological factor to consider when pursuing proper treatment (Kral & O'Donoghue, 2010; Lieu, 2004).

Nearly 75 to 80% of genetic hearing loss cases are inherited through recessive genes (Oishi & Schacht, 2011). Another 20 to 25% arise through dominant genes, and the remaining genetic cases of hearing loss involve mitochondrial inheritance or X-linked patterns (Oishi & Schacht, 2011). There are two distinct forms of genetic deafness: syndromic and nonsyndromic (Lieu, 2004). The syndromic form occurs when genetic markers for hearing impairment are coupled with other medical conditions, while the nonsyndromic form involves hearing impairment alone, absent other medical problems (Lieu, 2004). Gene mapping is helping researchers learn more about both forms of deafness, although it is still not possible to determine the precise cause in every case.

Certain medications commonly cause irreversible damage to the ear, such as cisplatin and similar chemotherapy drugs (Lieu, 2004). For this reason, they are used only when necessary, in order to limit permanent hearing damage. Other medications can affect hearing, but their effects tend to be more reversible; these include aspirin, NSAIDs, and diuretics (Lieu, 2004). Women must be particularly cautious about taking NSAIDs and related medications, as they face a greater risk of hearing loss than men (Lieu, 2004). Medications used for erectile dysfunction can also cause hearing loss, which may be permanent (Kral & O'Donoghue, 2010). However, both over-the-counter and prescription medications are not the only concern for those seeking to protect their hearing.

Conclusion

Overall, deafness is considered a serious impairment by many people and not seen as being that serious by others. It just depends on the person who is asked the question — and often whether that person is deaf. People who were born deaf have no experience of hearing, and may not perceive the absence of hearing as a significant loss. Since they cannot experience what they are purportedly "missing," they are likely not missing it in any meaningful sense. Those who have had hearing in the past and have lost it, either partially or completely, may feel very strongly that they are missing something important. They can remember what they once experienced through hearing, and it is logical that they would miss some of that ability.