CHRONIC HEARING LOSS

Definition of hearing loss

Deafness (hypacusis) is a reduction in hearing that can range from mild hearing loss to complete deafness.
Hearing impairment is a widespread condition that occurs in both young people and more often in old people. In Germany around six percent of the population is affected by hearing loss. It is noticeable that the age at which hearing loss occurs is decreasing. Naturally, however, the hearing loss only progresses with increasing age.

One only becomes aware of a decrease in hearing when familiar noises, sounds and voices are suddenly no longer perceived or understood. The hearing loss usually occurs gradually and can be perceived as a significant disability if the damage has already occurred.

The focus is not so much on the therapy of hearing loss, but rather on prevention at a young age. There are many preventive measures that can be taken to preserve our hearing. There are legal regulations in the workplace, according to which you are not allowed to expose yourself to a volume of more than 85 decibels (dB) without hearing protection, but this limit is reached especially in leisure time. Discos, rock concerts, loud music through headphones, car races, etc. generate such noise that can in the long term damage your hearing inexorably.

Causes of chronic hearing loss

As with the acute, the chronic hearing loss between a sound conduction (cause lies in the outer ear or Middle ear) and a sound sensation disorder (cause lies in Inner ear or the auditory nerve).
There is a clear difference in therapy depending on the location of the disorder.
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Origin and Therapy

How does it come to chronic Conduction disorder and how is it treated?

Ear wax (cerumen)
Ear wax, Dust and bits of skin are natural in the external auditory canal and are usually transported to the outside or washed out when showering.
Excessive accumulation or increased Ear wax formation takes place in narrow ear canals or working in dusty conditions.
Attempting to remove the wax with chopsticks unfortunately leads to that even more towards you eardrum transported and the ear canal is further clogged. Other foreign bodies such as cotton residue can increasingly block the ear canal. Children sometimes run the risk of getting caught in small objects while playing ear stuck without the parents having noticed.
These foreign bodies or earwax can be seen through an otoscope (ear mirror) and can be removed by the family doctor with small instruments.
If mechanical removal is unsuccessful, the Ear wax or the foreign body is washed out with water.

Increased bone growth (exostoses)
In some people, bone growth occurs in old age or with hormonal diseases. When the bone grows in the area of the ear canal, it becomes narrowed. If less sound now reaches the eardrum, one gradually creeps up Hearing loss a. Excess bone tissue can be surgically removed.

Narrowing due to scarring (stenosis)
After every inflammation in the ear canal, be it by one Fungal infection or by a Hair follicle inflammation (boil) there is a small scar. The more inflammation and injury to the ear canal has occurred, the more scar tissue is created and narrows the canal. The increasing constriction leads to progressive hearing loss. Surgical removal can expose the auditory canal again, but this again leads to scarring.

Chronic middle ear infections (otitis media chronica)
At a chronic otitis media the inflammation is permanent. The symptoms are characterized by variable strength Earache and ear runny ears. The inflammation can spread to nearby bones and make the disease worse. Increasing hearing deterioration creeps in and can only be treated with difficulty later.
In therapy, the surgical rehabilitation of the middle ear through the radical removal of purulent and inflammatory tissue is in the foreground. If possible, one tries of course to maintain some residual hearing. Today it is possible to replace the ossicular chain with artificial implants (tympanoplasty).
Further information on this topic is also available at: chronic otitis media

Chronic tube ventilation disorder (chronic middle ear catarrh)
The Eustachian tube (Tuba Eustachii, Tuba auditiva) normally equalizes the pressure differences between the middle ear and the outside world.
Constant infections caused by colds (runny nose, Sinus infection, Tonsillitis), the tube can be permanently closed and its function can be severely impaired. In addition to a latent feeling of pressure in the ear, which cannot be remedied by swallowing and yawning, a hearing loss creeps in. The permanent closure also promotes fluid accumulation (Serotympanum) or inflammation-related accumulation of mucus in the middle ear (Mucotympanum).
If the liquid also presses on the eardrum from the inside, its vibration is impaired and worsens the already existing hearing loss. If not soon therapy (see Polyps, Tonsillitis), the lining of the middle ear changes (Tympanosclerosis) and severe hearing loss occurs.
Chronic middle ear catarrh is mostly due to enlarged tonsils, which should be removed in the event of recurring infections.
In the event of non-healing, ventilation of the middle ear is ensured through a small incision (paracentesis) and insertion of a tube (tympanic drainage) into the eardrum. The tube can be removed after it has healed. The defect in the eardrum heals after a while.

Otosclerosis
In otosclerosis there is one Stiffening of the ossicular chain in the area of the stapes. This attaches to the inner ear and ossifies there with the oval window, making it immobile and unable to transmit sound. This fixation restricts the mobility of the entire ossicular chain and greatly reduces sound transmission. The hereditary disease occurs more often in women than in men and peaks between the ages of 20 and 40.
The disease process can be accelerated during pregnancy. The special feature of the resulting hearing loss is that patients can hear their conversation partner better than usual when there is a lot of noise (Parakusis willisisii).
In addition to hearing loss, there is also ringing in the ears (Tinnitus) on. Otosclerosis can be prevented by surgical therapy (Stapes plastic) be treated. The function of the stapes is replaced by a prosthesis made of titanium or platinum.

Tumor, tumors
Cancerous tumors can also occur in the ear area (see also tumor) occur. They can be benign or malignant. What they all have in common is that they increasingly worsen hearing and produce a feeling of pressure with occasional ringing in the ears (tinnitus).
They are found in all areas of the ear, from the external auditory canal to the middle ear and the inner ear. Fortunately, ear tumors are relatively rare and can be easily removed using microsurgical procedures.

Chronic sensation disorder

How does it come to chronic Sensory sensation disorder and how is it treated?

Permanent noise pollution
Noise makes you sick! First and foremost, the ear itself is affected before psychological reactions occur. A daily noise exposure of six hours with a volume of 75 dB or more can cause considerable inner ear damage after years. Factory workers, flight floor personnel, disk jockeys and even regular visitors to noisy discos run the risk of permanent inner ear hearing loss.
The occupational health and safety laws absolutely provide for noise protection measures with appropriate hearing protection for occupations with high noise exposure.

Age-related hearing loss (presbycusis)
With aging, hearing deterioration is still normal to a certain extent. Various aging processes such as circulatory disorders, medication intake, high blood pressure, diabetes and lifelong exposure to noise contribute to hearing impairment.
The bilateral hearing loss can begin from the age of 50 and initially only affects the higher frequencies. For example, insects and birdsong can no longer be heard. With louder background noises such as At a birthday party, where there are usually lively conversations and maybe music is played, speech understanding can be restricted. Nowadays, hearing loss can be compensated with the most modern hearing aids.

Tumor of the auditory nerve (acoustic neuroma)
The acoustic neuroma is a benign and slowly growing tumor on the auditory and equilibrium nerves (vestibulocochlear nerve), which usually only occurs from the age of 50. In addition to hearing loss, early symptoms also include impaired balance, dizziness and ringing in the ears (tinnitus). Surgical removal can stop the increasing hearing loss.

Central damage
Since hearing not only takes place in the ear and its structures, but is ultimately perceived in the brain, damage to the central auditory pathways can result in hearing loss or even complete loss.
A stroke (apoplexy) caused by bleeding or arteriosclerosis can be the cause of central hearing damage. Most of the time, other neurological symptoms also appear and the hearing loss fades into the background.