Treatment of Hearing loss
There are different treatments designed to cure or improve the effects of hearing loss or deafness. Their application depends on the origin, causes and characteristics of the lesion causing the deafness or loss of hearing.
Non-drug therapy
Artificial hearing devices
Hearing aids. Their main purpose is to amplify sound and render speech more audible without creating user discomfort. All types of hypoacusis require a greater level of stimulation to improve the patient’s hearing. Besides increasing its strength, the auditory signal must also be customised and adapted to each patient depending on their specific hearing impairment. Hearing aids are designed to give sounds these quantitative and qualitative properties and therefore produce an audible result. They are recommended for mild to severe cases of hearing loss. There are two types available:
- Air conduction. The amplified signal is transmitted to the external ear canal.
- Bone conduction. The amplified signal is transmitted to the inner ear by means of the mastoid bone.
Implantable devices. These devices are designed to mitigate hearing loss. They are either partially or fully implanted by means of a surgical intervention.
- Bone conduction implant. These implants are anchored to the parietal bone. They are equipped with a sound processor that converts sound into vibrations before transmitting them through the skull and directly to the inner ear.
- Cochlear implant. These devices replace the function of the cochlea (inner ear) by transforming sound, which is captured by an external processor, into electrical impulses that are sent directly to the auditory nerve through an array of electrodes implanted within the cochlea. Cochlear implants are only prescribed in cases of severe or profound hearing loss.
The most common types of hearing aid
Depending on the degree of impairment measured during each patient’s audiometry test, the hearing aid specialist will decide on the most appropriate type of hearing aid for the given hearing loss.
Behind-the-ear (BTE) hearing aids
- With an earphone placed in the ear. Sound is transmitted along a very discreet, hair-like wire to an earphone positioned in the ear canal and close to the eardrum. A small ear mould holds the earphone in place.
- With a sound tube. Sound is sent down a tube to a mould or adapter that fits perfectly inside the ear. These devices have a larger battery than those with earphones and can produce greater amplification, so they are more powerful and ideal for people with severe hearing loss.
In-the-ear (ITE) hearing aids
Hearing aids placed within the ear canal are customised (made-to-measure) according to the shape of the wearer’s canal. They are ideal for mild to moderate hearing loss but cannot be used for more severe cases. The size and shape of each patient’s ear canal determines whether they can use an ITE hearing aid and how visible it will be.
- Completely-in-the-canal (CIC) hearing aids. These are positioned in the deepest part of the ear canal.
- In-the-canal (ITC) hearing aids. These are placed in the outermost portion of the external ear canal.
Hearing aid technology has advanced rapidly in recent years and the devices can now achieve a lot more than a few years ago.
Drug therapy
The use of medications depends on the location of the lesion causing the hearing loss.
The drug-based treatment of presbycusis (age-related hearing loss) includes the use of vitamin preparations combining vitamins A, E and some from the B-complex family, as the dietary incorporation of antioxidants can help preserve hearing cells in the elderly population.
In the case of sudden deafness, patients are prescribed corticosteroids, or the ENT specialist will administer them via an intratympanic (inside the eardrum) injection, due to their anti-inflammatory and immunosuppressive effect.
When the hearing loss is caused by otosclerosis (fixation of the ossicular chain preventing normal bone vibration), the only pharmaceutical treatment available is based on the long-term administration of sodium fluoride – which inhibits osteoclast activity, the cells responsible for bone remodelling.
In the case of chronic otitis where there is a clinical association between the ear inflammation and a nasopharyngeal disease, the success of any drug therapy will depend on whether good nasal breathing can be achieved through a specific treatment. Once the nasopharyngeal factors have been resolved, antibiotics are administered to eliminate the germs in the middle ear.
The first thing to do in cases of otitis media (middle ear inflammation) caused by Eustachian tube obstruction (which allows the middle ear to “breathe”) is to re-establish correct tube function. Patients are therefore prescribed anti-inflammatories, antihistamines and corticosteroids.
Surgical treatment
The surgical treatment for hearing loss depends on the location of the underlying lesion.
- In the case of otitis media where the discharged pus remains in the middle ear, and without producing spontaneous perforation and otorrhoea, a myringotomy (incision in the eardrum) may be indicated to allow the pus to discharge.
- When otitis media is caused by Eustachian tube dysfunction, an incision is made in the tympanic membrane, or eardrum, and a drain (or transtympanic ventilation tubes) inserted through the hole. This procedure communicates the middle ear with the outer ear, thus replacing the dysfunctioning Eustachian tube.
- The surgical treatment for otosclerosis (limited mobility of the ossicle bones in the middle ear due to calcification) consists of replacing the stirrup with a prosthesis using a technique known as a stapedectomy, thereby delaying the ossicular fixation process.
- Tympanoplasty is a surgical procedure conducted to repair alterations in the eardrum (particularly perforations), the ossicular chain or both.
- A mastoidectomy is a set of surgical interventions used to treat chronic otitis by removing any damaged areas in the different cavities of the middle ear and mastoid bone.
- If the hearing loss is due to a benign tumour located in the upper portion of the auditory vestibular nerve, which is otherwise known as an acoustic nerve neuroma, then it may need to be removed via a surgical intervention.
Complementary therapies
- Aural rehabilitation. Evidence shows that aural rehabilitation programmes implemented to complement the use of hearing aids bring about significant improvements in patients’ perception of their hearing impairment in comparison with the use of hearing aids alone.
- Individual auditory training. Analytical auditory training programmes break speech down into its basic parts (consonants and vowels) to improve the patient’s ability to distinguish between them and recognise them. The primary aim of a synthetic approach is to improve their listening skills by using key points associated with linguistic and contextual redundancy.
- Group aural rehabilitation programmes (communication strategies). In contrast to individual courses, these provide guidance and communication strategies to help patients cope better with any deficits in their social participation.
- Active Communication Education (ACE) programme. The ACE programme was created in Australia by Louise Hicks, Linda Worrall and Nerina Scarinci. The training course focuses on older adults with hearing loss and is based around problem-solving strategies. It contains six modules about daily communication activities that have proven difficult for older adults with hearing loss and their closest relatives, such as using the telephone, watching television, eating in a restaurant and holding a conversation during dinner. The specific modules covered throughout the sessions depend on the communication needs identified by the participants during their first session.
Treatment complications
The complications associated with drug therapies are those inherent to the use of antibiotics, antihistamines, anti-inflammatories and corticosteroids.
Complications involved with surgical treatments depend on the site of the lesion causing the hearing loss as well as the operation required to resolve the problem. These complications include:
- Tympanic membrane perforation (ruptured eardrum).
- Damage to the chorda tympani nerve, which could result in an altered sense of taste.
- Damage to the facial nerve causing paralysis of facial muscles.
- Dizziness.
- Infections, including meningitis.
- Partial or total deafness.
Complications associated with the use of artificial hearing devices are:
- In the case of hearing aids or non-implantable prostheses, the most common complication is that the patient is unable to adapt to the device. The hearing aid specialist will take care of adjusting the device’s fit so the patient finds it easier to adapt.
- In the case of implantable devices, besides the patient finding it hard to adapt to them, which would require optimum adjustment by the specialist, surgical complications may also occur, e.g., infection, facial paralysis, cerebrospinal fluid (CSF) leak or meningitis.
Substantiated information by:
Published: 18 May 2018
Updated: 18 May 2018
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