Hearing loss

1) Disease description (causes and pathophysiology, main symptoms)

• Definition: Hearing loss is a condition in which the ability to hear speech and sounds is reduced. Depending on the cause, it is divided into conductive hearing loss (a transmission problem involving the outer or middle ear) and sensorineural hearing loss (a problem involving the cochlea, auditory nerve, or central nervous system).
• Summary of pathophysiology:
  • Conductive hearing loss: Sound cannot be transmitted to the cochlea because of problems such as an external auditory canal obstruction (earwax or blockage), eardrum perforation, otitis media, middle-ear effusion, or ossicular abnormalities.
  • Sensorineural hearing loss: Damage to the hair cells in the cochlea, damage to the auditory nerve, or abnormalities in the brain’s auditory processing. Causes include aging (presbycusis), noise exposure, medications (ototoxicity), infection or inflammation, sudden hearing loss, and tumors.
• Main symptoms:
  • Sounds seem quiet, or speech is difficult to understand
  • Reduced hearing in one or both ears, with sudden or gradual progression
  • Tinnitus (ringing in the ears), difficulty determining the direction of sounds, and sometimes accompanying dizziness, ear pain, or discharge
• Emergency findings: Prompt evaluation is needed if hearing in one ear suddenly decreases significantly (over several hours to several days) or if severe dizziness and vomiting occur (suspected sudden hearing loss).

2) Treatment methods, precautions, complications, and self-management

• Treatment principles after diagnosis: Treatment according to the cause (conductive vs. sensorineural) → correction of reversible causes, medication, surgery, hearing aids/prostheses and rehabilitation, etc.
• Medication treatment (examples):
  • Acute sensorineural (sudden) hearing loss: High-dose oral steroids or intratympanic steroid injections are standard initial treatments (early treatment after onset is favorable for the prognosis).
  • Infectious conductive hearing loss, such as otitis media: Appropriate antibiotics and anti-inflammatory drugs, with drops or oral treatment if needed.
  • If exposed to ototoxic medications, consider discontinuing or replacing the medication (consult a doctor).
• Procedures/surgery:
  • Acute or chronic otitis media: Tympanostomy tube insertion (for middle-ear effusion); if it becomes chronic, mastoidectomy, tympanoplasty, and other procedures may be performed.
  • Conductive causes (e.g., otosclerosis): Adhesion-release surgery such as stapedotomy may be possible.
  • Severe bilateral sensorineural hearing loss: Hearing aids (various types) → if hearing aids are ineffective or the hearing loss is severe to profound, a cochlear implant may be considered.
  • Bone-conduction devices (bone-conduction hearing aids and bone-anchored hearing aids) may be selected in specific situations.
• Rehabilitation and lifestyle management:
  • Hearing-aid adaptation education and auditory rehabilitation (speech therapy and listening training).
  • Avoid noise exposure (to prevent noise-induced hearing loss) and wear hearing protection (earmuffs and earplugs).
  • Take care not to allow water to enter the ears (if there is a history of otitis media).
• Precautions and complications:
  • Some medications (such as aminoglycosides and cisplatin) are toxic to the cochlea and may cause hearing loss with long-term use.
  • Noise-induced hearing loss is irreversible with repeated exposure and may cause tinnitus and social isolation.
  • Delayed early treatment for sudden hearing loss may lead to permanent hearing loss.
  • Infection after surgery, facial nerve damage (very rare), and residual or recurrent hearing loss may occur.
• Emergency recommendation: If sudden hearing loss occurs (especially in one ear), an otolaryngology consultation is recommended as soon as possible (the treatment window affects the prognosis).

3) Checklist before an outpatient visit (including items to bring, records, and example questions)

• Items to prepare/bring:
  • A list of all medications currently being taken (including prescription drugs, over-the-counter medications, herbal medicines, and supplements)
  • Previous hearing test results (audiogram) and otolaryngology or internal medicine examination records (including CT/MRI reports, if available)
  • Notes on when the symptoms began and how they have progressed (when, sudden or gradual, one-sided or bilateral, aggravating factors)
  • Records of accompanying symptoms such as tinnitus, dizziness, ear discharge, and pain
  • History of noise exposure (occupation and leisure activities) and medication exposure (such as antibiotics and anticancer drugs)
• Materials to show the doctor during the consultation:
  • If there is a sound coming from the ear (tinnitus), an example of the symptom through a recent cellphone recording
  • The impact of reduced hearing on daily life (difficulty during conversations, inconvenience during telephone calls, etc.)
• Example questions (items patients can prepare and ask themselves):
  • "How do you distinguish whether this symptom is conductive or sensorineural hearing loss?"
  • "What additional tests do I need (hearing test, TITPER/tinnitus test, MRI)?"
  • "What is the treatment window and what effects can be expected?"

4) Examples of general questions to ask the doctor

• What are the expected effects and possible side effects of this medication (e.g., steroids)?
• What do you think is causing my hearing loss? What is the possibility of recovery (prognosis)?
• Could hearing aids help? Which type would be suitable (facial type, in-the-ear type, bone-conduction type, etc.)?
• Do I meet the indications for a cochlear implant? To what extent can hearing function be expected after surgery?
• What actions must I avoid or precautions must I take in daily life?

5) Examples of disease-specific questions (1–2 tailored to the characteristics of this disease)

• If sudden hearing loss is suspected: "If this is sudden hearing loss, by when is the treatment window for starting treatment (within how many weeks), and how does the prognosis change after that?"
• If a noise-related cause is suspected (noise-induced hearing loss): "What tests and evaluations are needed to determine whether the damage was caused by occupational or recreational noise exposure, and what protective equipment do you recommend to preserve my hearing?"

(Note: The information above is intended to supplement medical care and consultation. Accurate diagnosis and treatment are determined based on an otolaryngology specialist’s examination and test results.)