There are many different kinds of hearing issues out there, with different causes, symptoms, and treatments. Some people can hear but have a hard time understanding the words spoken, others need sounds to be louder in order to hear properly, some have difficulty distinguishing voices from background noise, and then of course there’s hidden hearing loss. This is because hearing loss involves not only the ears, but the brain too. While the ears are focused on bringing in the sound, the brain is responsible for processing the sounds and making sense of them.
People all function differently depending on the kind of hearing loss they are experiencing. This is why it’s so important to see an audiologist to determine exactly what kind of hearing loss you have to decide on the most effective course of action for you.
Why Do I Hear Background Noise In My Ears?
There is a small but distinct difference between hearing and understanding, which is why background noise can really complicate things if you’re experiencing hearing loss. Everyone hears background noise, but not everybody does well with hearing what they want to hear in comparison to what they don’t want to hear. If you’re having a hard time understanding what is being said to you in a noisy environment (or a quiet one!), there’s a good chance you’re experiencing mild-to-moderate hearing loss. The only way to know exactly why you’re having trouble is to see an audiologist and take a hearing test.
Conductive hearing loss is when there are issues with the ear canal, ear drum, or the middle ear. It is caused by something that stops sound from getting past the outer or middle ear. Causes vary between which part of the ear is affected.
| Outer Ear | Inner Ear |
| A narrowing of the ear canalWax impactionExostoses (bone-like protrusions that can develop inside the ear canal and cause blockages)Swimmer’s earObstructions caused by foreign bodies inserted into the earMicrotia, a deformity of the ear usually present from birth | A breach in the eardrum caused by injury, ear infections, or extreme and rapid air pressure changesEar infection and/or a buildup of fluid in the middle earBlockages in the Eustachian tube, which connects the middle ear to the back of the nose and throatOtosclerosis, which affects the tiny middle ear boneAbnormal growths or tumors that form within the middle ear, such as cholesteatoma or glomus tumorsA break in the connection between the bones of the middle ear, caused by injury or heavy trauma |
If you’re suffering from conductive hearing loss, you will have problems with loudness, not clarity, which means raising the volume on the TV or asking a friend to speak up is a good temporary fix. Conductive hearing loss can usually be treated through medicine or by surgery. But if the hearing loss is severe or permanent, then treatment with hearing aids or bone-anchored implantable devices is best. As always, getting a hearing test from an audiologist is the best way to determine your treatment plan.
Sensorineural Hearing Loss (SNHL), also known as nerve-related hearing loss, is caused by there being a problem in the way the inner ear or hearing nerve works. Damage either to the tiny hair cells in your inner ear, or to the nerve pathways that lead from your inner ear to the brain are usually the reason for SNHL. Inner ear problems associated with SNHL can be caused by:
- Exposure to loud noise
- Aging
- Head trauma
- Virus, disease (tumors)
- Autoimmune inner ear disease
- Heredity
- Malformation of the inner ear
Sensorineural hearing loss affects both the clarity and the loudness of how you hear sounds. It can also impact the range of sound you can hear easily, which means some soft sounds are too difficult to hear, and louder sounds start to feel too loud very quickly.
Sensorineural hearing loss usually develops over time, but there are rare cases of sudden onset SNHL, leading to deafness in one ear. If this happens, it’s important to see a hearing care specialist, an audiologist, right away.
In terms of treatment, simple amplification usually doesn’t work as some sounds might still sound distorted. Depending on the severity, sensorineural hearing loss can be treated with hearing aids. If the hearing loss is severe, then the next best option are cochlear implants. No matter the severity, consulting with an audiologist is your ticket to finding the best solution for your hearing loss.
High-Frequency Hearing Loss
High-frequency hearing loss is when the ear is unable to hear high-pitched sounds. The three most common causes are aging, noise exposure, and varying medical conditions, like:
- Middle ear infections
- Tumors, called acoustic neuromas
- Meniere’s Disease
With high-frequency hearing loss, one of the first symptoms is the inability to hear high pitched sounds, which means that you may be able to hear some words other people say but you can’t hear all of the words in a sentence, or even all of the sounds in a word. If you have trouble hearing what other people say or often feel confused during conversations, it may be a sign of high-frequency hearing loss.
The most common symptoms of High-Frequency hearing loss are:
- Trouble hearing consonants
- Asking others to speak more slowly or clearly often
- Difficulty understanding words, especially in crowds or noisy environments
- Developmental and learning delays (more often in children)
- Insecurity and self-esteem issues
- Tinnitus
If you’re having trouble with your hearing, the first course of action is to see an audiologist to get your hearing tested. You may take a variety of hearing tests to help determine what hearing issue is affecting you. Working with an audiologist is also the best way to figure out the type of treatment you need. More often than not, if you are experiencing high-frequency hearing loss, the suggested and most successful treatment option is the use of hearing aids.
Mixed Hearing loss is caused by both conductive and sensorineural hearing loss. It is usually caused by trauma (exposure to sudden and loud sounds), but in rare cases can happen over time when one hearing loss is compounded by the other. For example, a person with age-related hearing loss may have temporary mixed hearing loss because of a wax impaction. Symptoms for mixed hearing loss are a combination of the symptoms you have with both conductive and sensorineural hearing loss, like:
- Easier time hearing out of one ear than the other
- Pain in one or both ears
- Sensation of pressure in one or both ears
- A feeling that one’s own voice sounds louder or different
- Speech of others may seem slurred or mumbled, or, feeling like you can hear but not understand
- Tinnitus
- Difficulty hearing high-pitched sounds
- Certain speech sounds are difficult to hear during conversations (e.g. the “s” or “th” sound)
- Noises may seem too loud or too quiet (yes, too loud!)
Just like with the symptoms, treatment will change based on what is most responsible for causing the hearing loss. If the loss is mostly due to conductive hearing loss, surgical treatments and medication will be the first line of attack. Conversely, if the causes are more matched with sensorineural hearing loss, then hearing aids or implantable devices will be the better option. A consultation and hearing exam with an audiologist will lead to the right treatment option for you.
Auditory Processing Disorder
Auditory Processing Disorder (APD) affects how clearly one can hear small differences between words. For example, when someone says “What a beautiful dress!” they may hear instead, “What a full test!” APD is a processing disorder and isn’t hearing loss or a learning disorder. Instead, it means your brain doesn’t hear sounds in the typical way.
APD affects people of all ages, and often starts in childhood. Though doctors aren’t certain of the cause for APD, it is thought that it may be linked to:
- Illnesses like chronic ear infections, meningitis, or lead poisoning
- Some people who have multiple sclerosis can also develop APD
- Premature birth or low weight
- Head injury
- Genes (APD may run in families)
According to the American Academy of Audiology, the most common signs of APD are:
- Difficulty hearing speech in noisy environments
- Trouble maintaining attention
- Problems locating the source of a sound
- Frequently asking for information to be repeated
- Inability to detect subtle changes in tone
- Distracted and inattentive behavior
- Difficulty learning to read
APD is considered a chronic disorder, but that doesn’t mean you can’t get help. The sooner it is caught, the better. Treatment for auditory processing disorder include:
- Training or therapy to help reorganize how the brain processes sounds, like:
- Listening to various auditory inputs to help learn how to differentiate between sounds
- Learning to distinguish between similar speech sounds (like the b and p in buy and pie)
- Learning to identify the location and direction of a distant sound
- Workplace or classroom interventions to help with sound intake
If you’re experiencing any of these symptoms, the first step is to see an audiologist for an evaluation. Through a series of hearing tests, an audiologist will be able to determine whether you are experiencing hearing loss, or if it’s APD.
Tinnitus
Tinnitus (ringing in the ears) is when you hear a sound that has no external source. The most common sounds heard by those experiencing tinnitus are ringing, humming, buzzing, screeching, or cricket-like. It varies from person to person, can be constant or intermittent, can be heard in one or both ears, or even in the head. The noise you hear when experiencing tinnitus isn’t caused by an external source, and can only be heard by you. Tinnitus is pretty common, and affects about 15% to 20% of people, and is most common in older adults.
Tinnitus is usually caused by noise-induced hearing loss and can start in the middle ear (behind the eardrum) or in the inner ear (cochlea). Other causes of tinnitus include:
- Sudden exposure to a loud sound resulting in acoustic trauma
- Earwax blocking the canal
- Age-related hearing loss
- Head injury
- Temporomandibular joint disorder (TMJ)
- Stress
- Ototoxic drugs that have been known to damage the eardrum
It’s important to note that tinnitus is usually a symptom, not a disease, so the first step in reducing tinnitus is finding out what the underlying cause is and going from there. As of now, there is no known cure for tinnitus, but some have found success with acupuncture, earwax removal, or the use of hearing aids.
Importance of Proper Testing and Diagnosis
No matter what symptoms you may be feeling, the important thing to do is to take action as soon as you notice something is amiss. Like with most conditions, the longer you wait to do something, the worse it can get. Seeing an audiologist for a proper diagnosis is essential; only testing by an audiologist will tell you if you’re experiencing a hearing loss, or if you have auditory processing disorder.
Audiologists can perform a variety of tests to pinpoint what exactly is going on, like:
- Pure tone testing
- Bone conduction testing
- Acoustic reflex testing
- Speech testing
- Tympanometry
- Auditory brainstem response
- Otoacoustic Emissions
Because hearing and understanding are so closely linked, finding out what is actually happening is the only way you can get on the path to healing your hearing. More importantly, remember that hearing tests are the first step in the process. If you pass a hearing test it doesn’t mean it’s time to give up. Instead, it shows your ears may be fine, and that perhaps your auditory nerve or brain may be having problems processing sounds. Your audiologist will provide you guidance on what to do next!
