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  • Writer's pictureDr. Brian James

What Kind of Hearing Loss Do I Have?

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1) Sensorineural Hearing Loss (SNHL) and Presbycusis

By far, the most common type of chronic hearing problem in adults is sensorineural hearing loss or SNHL. According to the NIDCD, about 1 in 8 people in the United States has hearing loss, and men ages 29-69 are almost twice as likely than women to have it. Further, the NIDCD says that 8.5% all adults ages 55-64, one-quarter percent of those ages 65- 74, and half of those who are 75 and older have disabling hearing loss. This is called age-related hearing loss or presbycusis.

You only have about 12,000 hair cells. These are the tiny filaments inside your cochlea that vibrate and send information to your brain about sound. When they’re gone, they don’t grow back. The most common reason for losing these hair cells is that they gradually wear out over time. This is called age-related hearing loss or presbycusis.

However, presbycusis isn’t a very accurate or scientifically useful term. What we really know to be responsible for presbycusis is the accumulated damage you get from a lifetime of loud noises , chemicals and drug exposure , restricted blood flow to the cochlea , and a number of other factors that can damage or kill those hair cells. The word «sensorineural», therefore, refers to the loss of sensory nerve receptors inside the cochlea. In fact, people with high-frequency hearing loss often complain, «I can hear everything you say, I just can’t understand what you’re saying!» That’s because those consonants are «falling out» of their hearing range.

2) Conductive Hearing Loss

Conductive hearing loss pertains to a hearing loss in your middle ear. It’s estimated that probably about 5% of hearing losses are due to conductive losses. A conductive hearing loss can be due to something as simple as a large ball of wax acting like an earplug and blocking sound in your ear canal, to the tiny bones in your middle-ear stiffening and making it more difficult to transmit the sound to the cochlea. It’s possible to puncture your eardrum through pressure or by physical perforation .

People with a conductive loss are always examined with an otoscope to see if it might just be ear wax or something else obstructing the ear canal. There are hearing tests, including bone conduction testing and tympanometry , which lend great insights into how the middle ear is performing. In general, hearing aids can be a good solution for many conductive hearing losses. Additionally, there are bone-conduction hearing aids and bone-anchored hearing solutions which are designed for conductive hearing loss and certain types of single-sided deafness.

3) Mixed Hearing Loss

A mixed hearing loss is usually a combination of SNHL and conductive hearing loss, but can also include APD (see below). 

4) Auditory Neuropathy and Auditory Processing Disorders

In addition to SNHL and conductive hearing loss, the auditory nerve fibers that carry the signals from the cochlea to your brain, as well as the auditory cortex itself, can become damaged. The former is usually called auditory neuropathy, whereas the latter is often referred to central auditory processing disorder . A blanket term for these hearing problems is auditory processing disorder . APD and CAPD are probably much rarer as an «sole» cause of hearing loss and communication problems, but they represent an emerging area of auditory science being researched and sometimes hotly debated.

In truth, aging and cumulative «wear and tear» on our auditory system is probably the cause all adults to experience some degree of APD . If warranted, there are diagnostic tests an audiologist can use to find «breaks» or «lesions» in your auditory nerve pathway to the brain or some other central problem in your auditory cortex, should this type of hearing loss be suspected.

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