Sudden Hearing Loss
A Medical Emergency
"In July last year, I woke up one morning with no hearing in my right ear. It was a feeling similar to having an ear blockage when the cabin pressure changes while flying in an aeroplane and having to adjust the air pressure in the middle ear region through what's called the 'Eustachian tube'.
I put my little finger into the entrance of my ear canal and sort of 'popped' the canal and the ear cleared. The next morning the same thing happened but after trying to 'pop' the ear, I had no success and the ear remained blocked and partially deaf allowing only about only 20% hearing in the right ear."
"Since my mid-fifties I had been having regular free annual hearing tests with one of the National hearing aid franchise companies operating in Australia. My hearing was assessed as good and previously there were no signs of gradual decline through ageing or loud noise exposure."
The Eustachian tube is a canal that connects the middle ear to the nasopharynx, which consists of the upper throat and the back of the nasal cavity. It controls the pressure within the middle ear, making it equal with the air pressure outside the body.
"To cut a long story short, I went to the local GP who thought it may be a Eustachian tube blockage that would clear of its own accord. He recommended I use a steroid-based anti-allergy nasal spray to assist in clearing and opening the Eustachian tube which could take 3 days to 3 weeks."
"After 3 weeks and no success, my GP examined my outer ear again and my ear drum and middle ear with an otoscope. There appeared to be some sort of debris and infection in the middle ear."
An otoscope or auriscope is a medical device which is used to look into the ears.
"I had no success with clearing the infection or restoring my hearing after taking the antibiotics. So I asked to be put on an anti-fungal medication in case I had a middle ear fungal infection which sometimes occurs with children's middle ears. Following this treatment the middle ear infection appeared to have cleared, however, the hearing loss was only marginally improved. After testing with an audiologist, I was assessed as having a 60% (severe) permanent hearing loss."
"The audiologist explained that a permanent hearing loss is associated with damage to the inner ear from an infection or some other trauma. She suggested that I ask my GP to refer me to an Ear Nose Throat (ENT) specialist 'which might take up to 3 months to get an appointment'. She also mentioned that if I had been treated with strong targeted steroids in the first 10 days of the hearing loss, I may have recovered my full hearing."
"The disappointment at waking up with what I thought was a simple Eustachian tube closure related to what appeared to be a mild middle ear infection but in fact turning out to be permanent severe hearing loss caused me distress, anger, confusion and depression. I was especially annoyed that if I had been treated as a medical emergency and offered steroids when my hearing loss first occurred I may have recovered full hearing."
"So many questions: How would my permanent (severe) partial hearing loss impact upon my quality of life? How would it affect my family, social, professional and recreational activities? What could have been done to prevent my hearing loss? What actually caused my permanent hearing loss? What action could I now take to restore my hearing?"
Causes of Hearing Loss
Hearing loss can be congenital (from birth) or occur as a result of a disease or accident. Some of the diseases that affect hearing include Scarlet Fever, Meningitis, Mumps and Measles. Traumatic skull or ear injuries, exposure to loud sounds (such as music or industrial noise) and ear pressure problems incurred while scuba diving can also lead to permanent full or partial hearing loss.
Hearing loss occurs in one of two areas: a conductive hearing loss, which is due to a mechanical problem within the outer or inner ear known as CHL, or sensorineural hearing loss (SNHL), which has to do with the tiny nerve cells in the ear experiencing injury, disease or malfunction.
Noise causes sound waves that make our ear drums vibrate. These vibrations are received by hair cells in the inner ear, which flatten according to the frequency and loudness of the sound and stimulate nerves that pass messages to the brain.
Very loud sounds make the hair cells collapse and flatten temporarily, resulting in temporary deafness. This is referred to as a temporary threshold shift and may last hours or longer depending on the degree of noise exposure.
This temporary hearing loss may also be accompanied by a ringing sensation called tinnitus. If this severe noise exposure is repeated over many years, the hair cells in the inner ear become permanently damaged resulting in permanent hearing loss.
Noise-induced hearing loss occurs gradually over a long period of time and unfortunately, hearing loss is permanent. Historically, noise-induced hearing loss is often due to unsafe industrial practices on construction sites or in factories and the music industry.
Sudden Sensorineural Hearing Loss (SSHL)
Sudden sensorineural (inner ear) hearing loss (SSHL), commonly known as sudden deafness, is an unexplained, rapid loss of hearing either all at once or over a few days.
Sometimes, people with SSHL put off seeing a doctor because they think their hearing loss is due to allergies, a sinus infection, earwax plugging the ear canal, or other common conditions.
Sudden hearing loss in one ear is rare, but when it happens it should be considered a medical emergency and attended to by a hearing medical expert immediately.
Sudden hearing loss can strike at any age, but it is most common in people who have reached their fifties.
If a sudden sensorineural hearing loss is diagnosed and treated within 24-72 hours of onset, the odds of all or some of the hearing returning are best.
Although the hearing loss seems to strike suddenly—as when a patient experiences a sudden pop and hearing is gone—in actuality, as patients look back, some recall ﬂuctuating ear symptoms: tinnitus (noises in the ear), transient hearing loss, or dizziness for a week or two before the SSNHL really hits. Earache is not a common symptom of sudden hearing loss.
Hearing loss, ringing of the ears and dizziness are common complaints. Occasionally, however, these symptoms may be due to a benign tumor that grows between the inner ear and the brain. There is no known cause for these tumors and they are not known to run in families.
Some experts have attributed sudden hearing loss to an impaired blood supply in the cochlea of the inner ear.
Once damaged, the auditory nerve and cilia cannot be repaired. But, depending on the severity of the damage, sensorineural hearing loss has been successfully treated with hearing aids or cochlear implants.
A stroke in the region of the temporal lobe will usually result in a mild hearing loss if the damage is confined to one temporal lobe. Although rare, both temporal lobes can be affected resulting in complete deafness.
While damaged auditory hair cells can be compensated for with the use of hearing aids, there is no replacement or cure for damaged vestibular hair cells. Hair cells do not function in isolation, but need to be connected to the auditory centers of the brain through nerve fibers.
A hearing loss of up to 20 decibels below the hearing threshold is still considered to be normal hearing.
A hearing loss of up to 20 decibels below the hearing threshold is still considered to be normal hearing. More severe hearing loss can be described according to severity, as follows:
- Mild hearing loss: Hearing loss of 20 to 40 decibels.
- Moderate hearing loss: Hearing loss of 41 to 60 decibels.
- Severe hearing loss: Hearing loss of 61 to 80 decibels.
- Profound hearing loss or deafness: Hearing loss of more than 81 decibels.
"After an anxious 3 week wait and much avoidance of social situations where my hearing loss impacted negatively on my attempts to interact and converse with others (supermarkets, coffee shops, restaurants, music and sporting events etc) I was granted a public health appointment with ENT specialists."
"They were sensitive but direct in their assessment that I had a permanent hearing loss in my right ear. However, they did clarify that the restoring of full hearing by prescribing strong steroids has to take place within the first 24-72 hours of the sudden hearing loss and even then, less than 30% of patients get full or partial restoration of their hearing."
"The ENT specialists do not know the specific reasons for an individual's SSHL but it might be related to unknown viruses, stroke or in rare cases, benign tumors attaching themselves to the inner ear."
"To rule out the tumor scenario, I was sent for an MRI. The MRI results revealed that I did not have tumors. In the meantime, my ENT specialists recommended I proceed with being tested for and fitted with a hearing aid."
Hearing Aids and Digital Technology
Digital technology has revolutionised the way hearing devices process sound, providing superior listening comfort, speech clarity, and user control. Most digital hearing devices are programmable to individual requirements. Generally speaking, digital hearing devices are the most sophisticated amplifying devices currently available.
The latest devices have background noise cancellation software and Wi-Fi and Bluetooth technologies that can connect the wearer to the TV, iPhone or Android devices for streaming and calls.
All hearing devices use batteries. Hearing device owners are able to change batteries in most models and some hearing devices function on rechargeable batteries.
There are four types of digital hearing aids to provide different hearing solutions – Behind-the-ear (BTE), Receiver-in-the-ear (RITE, RIC), Invisible-in-the-canal styles (IIC), Canal styles (CIC, ITC, ITE)
"One of my colleagues has been wearing hearing aids for over 30 years and he put me onto an audiologist who, in my colleague's opinion, provided the best service and the best hearing aids prices in Australia."
"Over the years, my colleague had discovered that many of the 'free' audiology testing centres and services provided to the ageing population were tied to a specific hearing aid manufacturer/supplier with a vested financial interest in selling clients the most expensive hearing aids in a limited range of the one or two brands they represented. These brands and models may not always be suitable to the wearer's lifestyle, work or financial circumstances and are often priced much higher than is warranted."
"In a response to the unfair pricing of hearing aids, my colleague set up a website to direct people with hearing losses to more reasonable prices and services."
"Although I am in my mid-sixties, I still live a very active life with my involvement as a martial arts instructor, running, cycling and most importantly in my professional career as an actor. I did not enjoy the prospect of having a visible "behind the ear" hearing aid that could fall off during physical activities or might preclude me from auditioning or being offered acting roles because of its obvious appearance sitting on my ear."
"People with hearing loss in both ears through ageing or gradual loss, usually require two hearing aids and the built-in Wi-Fi, Bluetooth and other technologies allow the hearing aids to "talk to one another" and sort out directionality, volume and sound balance. They can also adjust to the qualities in the variety of sound environments the wearer is exposed too and for using phone handsets."
"Most wearers of two hearing aids use the "behind the ear" or "receiver in the ear" devices, in order to house the software and technologies they require. To the credit of the designers and manufacturers, BTE and RITC aids have become smaller and far less obvious over time."
"I did some research online and was relieved to find that the latest technologies included small in the canal devices that were almost completely hidden in the outer-ear canal and shaped from a mould of the wearer's ear canal to fit firmly and comfortably into the ear. These small hidden devices cannot house all the software and Wi-Fi technology of a pair of 'behind the ear' devices but owing to my SSHL hearing loss in only one ear, I required only one hearing aid."
"In particular the hearing devices of a Canadian company, Unitron, captured my attention"
Founded in 1964, Unitron is headquartered in Canada's innovative Waterloo region, with 20 international offices. It is one of the fastest growing and most successful hearing instrument manufacturers. When Unitron designs hearing instruments, they view every detail through the lens of the patient. Unitron then bundles in industry-first technologies, so you get a highly satisfying listening experience and hearing aids which are comfortable to wear all day, every day. Unitron has a proven track record of developing hearing innovations that provide natural sound with exceptional speech understanding.
Hearing aids are complex digital technologies that should be fitted only by qualified, highly trained hearing healthcare professionals. That's why we choose to partner and sell our hearing aids exclusively through a worldwide network of qualified hearing healthcare professionals and distributors.
We also believe in the critical role hearing healthcare professionals play in helping you achieve the best possible hearing outcomes. Each of our licensed and trained hearing healthcare professionals offers essential, specialized fitting and counselling expertise. In the end, this means a better testing and fitting experience, a better match between you and your hearing aids, and better support from really great people who can show you how to get the most from your investment.
We strongly advise you not to purchase hearing instruments over the Internet, from a catalogue, by mail order or any other indirect means without the direct involvement of a hearing healthcare professional, and without the benefit of face-to-face consultation.
The Hearing Aid Company - My experience
"I attended my appointment with Adrian, the qualified audiologist and owner of The Hearing Aid Company. We discussed my lifestyle, work environments and financial circumstances. I also mentioned the Unitron In-the-canal style of hearing aid that I had researched online."
To my surprise, The Hearing Aid Company prices for the 'entry-level' Unitron IIC hearing aid was $500-1000 cheaper than any online price or other supplier. While Adrian beginning with 'middle price level' devices, I explained that if I was going to be wearing an aid for the rest of my life I wanted to make sure I didn't lose, break or sit-on a more expensive device in my first months of wearing it. I suggested I could move to a higher level of technology and price later if needed and my finances allowed it."
"Adrian gave me a remarkable piece of information about Unitron devices. Where other manufacturers require you to upgrade to an entirely new set of hearing aids if the wearer wanted to move to the newer or better technologies (thus potentially rendering a $4000 pair of hearing aids redundant) and having to purchase a new $7000 pair, Unitron allow for upgrading of the internal software while retaining the existing hearing aid body."
"Therefore, if I wished to upgrade to middle or upper level technologies with my Unitron Hearing Aid I would be paying hundreds of dollars rather than thousands by simply buying and installing the more sophisticated software into the existing hearing aid body. Very few other hearing aid companies provide this flexibility and cost saving."
"I have discovered that no hearing aid can ever replace the quality of sound that a fully functioning human inner ear (cochlear) can provide in conjunction with the human brain; however, our quality of life can be enhanced through the use of hearing aid devices."
"I am much happier now I have my little red Unitron device than over the 6 months that I endured with my unaided hearing loss. The care and maintenance of my Unitron device is simple but I do have to be careful not to leave it on the kitchen bench when I take it out lest it be mistaken for a bird's-eye chili pepper that might end up in my homemade Thai curry."
"Please Remember: Sudden hearing loss in one ear is rare, but when it happens it should be considered a medical emergency and attended to by a hearing medical expert immediately."
Research and Interview conducted by Dr Steven Gration. March 2019.
Many thanks to Robert for his willingness to be interviewed for this article.
Waking up deaf in one ear
ABC Radio National Sept 16th 2019 "Sudden deafness - what's it like to wake up deaf in one ear."
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