Hearing Loss

There are three main types of hearing loss classified by which part of the hearing (auditory) system is damaged.

Conductive Hearing Loss is caused when sound is not transmitted efficiently through the outer ear to the eardrum (tympanic membrane) and the three bones (ossicles) of the middle ear. This type of hearing loss can usually be corrected medically or surgically and is potentially reversible.

Some common causes of conductive hearing loss include:

• Fluid in the middle ear from a cold
• Ear infection in the middle ear (otitis media) and outer ear (swimmer’s ear, called otitis externa)
• Cholesteatom or abnormal skin within the middle ear and mastoid
• Wax buildup or impacted wax (see below)
• Allergies
• Problems with the eustachian tube
• An eardrum rupture or perforation
• A foreign body in the ear
• Otosclerosis or fixation of the stapes bone

Sensorineural Hearing Loss results from damage to the cochlear (inner ear), the hearing nerve or the pathway from the inner ear to the brain. If hearing loss is severe, a cochlear implant might be indicated.

Some common causes of sensorineural hearing loss include:

• Aging or age-related hearing loss (also called presbycusis)
• Noise-induced due to loud and constant exposure to loud noise
• Fractures of the head
• Illnesses and infections
• Certain antibiotics and certain diuretics
• Genetic or hereditary: this type runs in members of the family

Mixed Hearing Loss refers to the combination of conductive hearing loss and sensorineural hearing loss. In other words, there may be injury to the outer or middle ear (causing the conductive component) and to the inner ear (cochlea and nerve).

Surgical Treatment

The Division of Otolaryngology offers surgical procedures to address issues of hearing problems and loss.

• Tympanoplasty is the surgical repair and reconstruction of a perforated eardrum (tympanic membrane).
• Mastoidectomy refers to the surgical removal of disease from the mastoid (hollow space behind the ear that might harbor infection).
• Ossiculoplasty is the surgical repair or reconstruction of the bones of the middle ear (called malleus, incus and stapes). This reconstruction is usually performed at the same time as a tympanoplasty.
• Stapedectomy or stapedotomy is the surgical replacement of the stapes bone, usually damaged by otosclerosis.
• BAHA (or bone-anchored hearing aid) is a hearing aid which is placed surgically. The device is primarily suited for people who have conductive hearing losses, unilateral hearing loss, single-sided deafness and people with mixed hearing losses who cannot otherwise wear “in the ear” or “behind the ear” hearing aids.

Medical Treatment

Medical treatment for hearing loss include intratympanic steroid injection for sudden sensorineural hearing loss as well as hearing rehabilitation including hearing aids.

Earwax, also called cerumen, is naturally produced by the outer part of the ear canal to keep the ear clean. It does this by trapping dust and sand particles before they reach the eardrum. Wax also coats the fragile skin of the ear canal and acts as a water repellent and as an antibiotic. Accumulated wax usually migrates to the ear opening, dries up, and falls out.

If ear wax accumulates excessively, it can result in a blocked ear canal often causing temporary hearing loss (cerumen impaction). This can also be referred to as ceruminosis.

Predisposing risk factors for developing impacted ear wax:

• Cotton tip or swab use inside the ear canal
• Narrowed ear canals
• Hearing aid use (in the ear-ITE)
• Bony growths from cold water exposure (exostosis or osteomas)
• Frequent use of earplugs

A Brigham and Women’s Hospital otolaryngologist should be consulted to remove the ear wax by:

• An irrigation of the ear canal to wash out the wax
• A vacuuming of the ear canal to remove the wax
• The use of a special instrument(s) to remove the wax
• Prescription eardrops or mineral oil to soften the wax

Learn more about ear wax buildup.

Another condition that affects the ear is when fluid doesn’t drain properly and causes air pressure problems on both sides of the eardrum. This ear drainage problem is most often seen in children and can be corrected by a tympanostomy procedure, or the insertion of drainage tubes into the ear. During surgery, the doctor removes the fluid from the middle ear and places a tiny tube in the eardrum. This tube creates a very small tunnel between the outer ear canal and the middle ear. This tunnel balances air pressure on both sides of the eardrum and prevents fluid buildup.

The Audiology Program at Brigham and Women’s Faulkner Hospital and Brigham and Women's Hospital provides comprehensive diagnostic and rehabilitative services to patients of all ages experiencing issues with hearing.

Learn more about the Audiology Program at Brigham and Women’s Faulkner Hospital.

Hearing aids can help improve hearing and speech especially in persons with sensorineural hearing loss (hearing loss in the inner ear). Our Hearing Technology Center is a fully operational hearing aid center staffed by experienced audiologists certified by the American Speech and Hearing Association and the American Academy of Audiology. We offer a full range of hearing aid products including the latest digital technology.

We provide a wide range of services related to hearing aids and assistive listening devices for patients of all ages. While at your appointment for a hearing aid evaluation, the type, style and size of amplification will be matched to your specific needs. Ear impressions will also be taken. Typically, you will return in approximately two weeks for a fitting. A 30-day adjustment trial period follows to ensure that you achieve the maximum amplification benefit.

Specialized ear mold services include:

• Custom and Standard Swim Molds
• Noise Protection/Musician Earplugs Repeated exposure to loud sounds can result in permanent damage to hearing. A wide variety of standard and customized ear protection devices are available. For example, specialized devices are available for musicians to ensure that an earplug will not dramatically alter the quality of sound.

Learn more about hearing aids.

You will receive a thorough diagnostic examination to evaluate if you have hearing loss and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by otolaryngologist, anesthesiologists and nurses who specialize in surgery for patients with hearing loss. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by experienced surgical and nursing staff.

Brigham and Women’s Faulkner Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to Brigham and Women's Hospital's world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.