Two different mechanisms on which everything depends
Sound travels a long way: it is collected by the auricle, travels along the ear canal, vibrates the eardrum, is transmitted through the three bones of the middle ear and only then enters the inner ear, the cochlea, where hair cells convert mechanical vibrations into nerve impulses. The signal then travels along the auditory nerve to the brain. A breakdown is possible in any area, and literally everything depends on where exactly it occurred: both prognosis and treatment.
- Conductive hearing loss - the conduction of sound to the cochlea is impaired: cerumen plug, foreign body, otitis media, fluid in the middle ear, perforation of the membrane, otosclerosis. The inner ear is healthy, so such hearing loss is most often reversible, and hearing is restored after treatment or surgery
- Sensorineural hearing loss - damage to the hair cells of the cochlea or the auditory nerve: age, noise, infections, trauma, certain medications. Hair cells in humans are not restored, so such loss is irreversible, and the goal of treatment is compensation using a device or implant
- Mixed form - a combination of both mechanisms, occurs often, especially in older people with a history of chronic otitis media
- Unilateral hearing loss is a separate situation that requires mandatory examination, since the cause may lie in the area of the auditory nerve
- Depending on the degree, hearing loss is classified into mild, moderate, severe and profound; boundaries are determined by audiogram in decibels
Earwax is not hearing loss
A very common situation: a person suddenly stops hearing in one ear after a shower or swimming pool and decides that he has gone deaf. In most of these cases, the culprit is wax plug, which has swollen with water and completely blocked the ear canal. This is not a disease or hearing loss in the proper sense of the word, but a mechanical obstacle that the doctor removes in a few minutes - by washing, aspiration or an instrument under visual control. Hearing returns immediately and completely.
It is much more important to understand why traffic jams form and what exactly should not be done. Sulfur is not dirt, but a protective secretion with antibacterial properties, and the ear canal cleans itself due to the outward movement of the skin. A cotton swab breaks this mechanism: it removes wax at the entrance and at the same time pushes the main mass deeper, closer to the membrane, where the passage is narrow and self-cleaning does not work. This is how most dense ear plugs form, and this is why people who clean their ears with sticks every day suffer from ear plugs more often than others.
- Cotton swabs are intended for anything other than the ear canal: they compact wax, injure the skin and can damage the eardrum
- Ear candles do not work: the wax that is found in them after the procedure belongs to the candle itself, and the risk of burns and paraffin getting into the passage is quite real
- Hairpins, matches, toothpicks are a direct road to membrane injury and otitis externa
- Dissolving drops are used as prescribed by a doctor and are not used for perforation of the eardrum.
- Ear hygiene comes down to washing the outside of the ear; no need to go inside at all
- If you are prone to plugs, it is enough to see an ENT doctor about once every 6-12 months for a preventive ear cleaning
Headphones, noise and hearing that is wasted forever
Hair cells of the inner ear are given to a person once for the rest of his life. They do not divide and are not restored, so each cell that dies is an irretrievably lost part of hearing. Loud sound kills them in two ways: prolonged exposure to moderately high levels and immediate acoustic trauma from an explosion, gunshot or very loud concert. In the first case, the loss accumulates for years and remains unnoticed, in the second it manifests itself immediately as tinnitus and congestion.
- The 60/60 rule is to listen to music with headphones no louder than 60 percent of the maximum volume for no longer than 60 minutes at a time, then take a break.
- The main trap is a noisy environment: in the subway, bus and on the street, a person turns up the volume to block the background, and does not notice that he has reached a dangerous level
- Active noise-canceling headphones and over-ear models are safer than earbuds precisely because they allow you to listen more quietly.
- Signs that the level was too high: ringing or tinnitus after listening, a feeling of fullness, muffled sounds for several hours
- Industrial noise, construction tools, shooting, loud music at concerts and wedding celebrations require protection - earplugs or headphones.
- The first range affected by noise trauma is around 4000 hertz; a person does not notice this because speech lies lower - the loss is detected only on an audiogram
Hence the practical conclusion: hearing should be checked not when it becomes difficult to hear, but when there is regular exposure to noise. An early audiogram records the initial state, and after a few years it shows whether the decline has begun. For people who work in noisy environments or spend hours each day wearing headphones, this is a smart habit comparable to getting an eye test.
Sudden hearing loss: 72 hours that few people know about
A separate and most underestimated condition is sudden sensorineural hearing loss. A person wakes up and discovers that one ear has almost no hearing, or hearing disappears within a few hours. This is often accompanied by noise in the ear and a feeling of stuffiness, which is why people explain what happened as “a blow”, “cerumen blockage”, “water got in” and wait for it to go away on its own. You can’t wait: the earlier treatment is started, the higher the chance of regaining hearing, and the first 72 hours are critical, and a reasonable limit is about two weeks, after which the effectiveness of treatment drops sharply.
- Оцените ситуацию сразу: если слух упал на одно ухо за часы или за одну ночь — это повод обратиться к ЛОР-врачу в тот же день, а не через неделю.
- Простая домашняя проверка: поднесите работающий телефон поочерёдно к каждому уху и сравните громкость; заметная разница — тревожный признак.
- Врач исключает механические причины — пробку, отит, жидкость за перепонкой, — потому что они лечатся иначе и не столь срочно.
- Аудиометрия подтверждает нейросенсорный характер потери и её степень.
- Treatment при подтверждённом диагнозе начинают немедленно, не дожидаясь дополнительных обследований; основой является гормональная терапия, которую назначает врач.
- МРТ головного мозга и внутренних слуховых проходов выполняют планово, чтобы исключить редкие причины односторонней потери слуха, в том числе невриному слухового нерва.
Children: hearing and speech are directly related
In a child, hearing is not only the ability to hear, but also a condition for the development of speech. The speech centers of the brain are formed by processing what they hear, and if the sound arrives in a distorted or weakened form, speech develops with a delay, and pronunciation remains unclear. At the same time, a child with moderate hearing loss behaves quite normally: he reacts to loud sounds, turns around when he hears cotton and gives his parents the complete impression that everything is fine with his hearing. The problem manifests itself when speech is noticeably delayed, and this takes years.
Exudative otitis is especially insidious - the accumulation of thin fluid in the middle ear after a cold or against the background of adenoids. It occurs without pain and without fever, but it reduces hearing in much the same way as if a child constantly walks around with blocked ears. At the same time, the child asks questions, turns up the volume of cartoons, becomes inattentive in class, and parents interpret this as absent-mindedness or stubbornness. This condition is detected by tympanometry in a few minutes and can be treated well, but only if you remember about it.
- Newborn hearing screening is carried out in the first days of life and allows you to identify congenital hearing loss before it affects speech
- Up to 3-4 months, the child shudders from sharp sounds and freezes at the voice; by 6 months turns his head towards the sound source
- By 9-12 months, babbling and a reaction to one’s name appear; the absence of babbling is a reason to have your hearing checked
- After 2 years, poor vocabulary, slurred speech, and the habit of looking at the lips of the speaker are alarming
- At school age - repeated questions, loud TV sound, inattention in class, decreased performance
- Signs of exudative otitis media: congestion without pain, a feeling of fluid transfusion, decreased hearing after a cold.
Hearing aids and the constraint barrier
The most common reason why an elderly person refuses a hearing aid is not the cost or inconvenience, but the reluctance to look old and sick. In this case, a paradoxical thing happens: a person without a device constantly asks again, answers inappropriately, loses the thread of the conversation and looks much more helpless than he would look with a tiny device behind his ear. Modern devices are comparable in size to a bean, and in-ear models are practically invisible from the outside.
- The hearing aid does not damage hearing and is not addictive - it does not affect the condition of the hair cells, but only amplifies the sound in the desired frequencies
- Giving up the device, on the contrary, is harmful: without sound load, the auditory centers of the brain gradually lose the ability to understand speech, and later it becomes more difficult to get used to the device
- The device cannot be purchased ready-made: it is programmed individually according to the audiogram, with amplification of exactly those frequencies that are lost
- Sound amplifiers without tuning, sold as a ready-made solution, amplify everything, including noise, and can cause additional harm
- The period of adaptation takes several weeks: the brain re-learns to filter everyday sounds that a person has not heard for a long time
- For severe hearing loss, when the hearing aid no longer helps, cochlear implantation is used.
- Hearing loss in older adults is associated with social isolation, depression and accelerated memory decline, so hearing correction is important for more than just comfort
It is better to build a conversation with an elderly relative about the device not around medical arguments, but around specific losses: he has stopped understanding what his grandchildren are saying, cannot hear his interlocutor in a cafe, is disconnected from the general conversation at the table and therefore is increasingly silent. It is this, and not the numbers on the audiogram, that usually becomes the decisive factor. It is also useful to go to the selection together and ask to listen to the tuned device right in the office: the difference is felt immediately and convinces better than any explanation.
