ENT
Hearing Loss: Types, Causes, Testing and Treatment
Hearing loss may develop gradually or suddenly and may affect one or both ears. The main types are conductive hearing loss, caused by problems in the outer or middle ear; sensorineural hearing loss, caused by damage in the inner ear or hearing nerve; and mixed hearing loss, which combines both.
Conductive causes include earwax blockage, fluid behind the eardrum, ear infection, a perforated eardrum and problems with the small middle-ear bones. Sensorineural causes include ageing, repeated loud-noise exposure, certain medicines, genetic conditions, head injury and inner-ear disorders.
Signs include difficulty following conversation, asking people to repeat themselves, increasing television volume, struggling in noisy places, tinnitus, delayed speech in children or reduced response to sound. Hearing loss that develops suddenly over hours or a few days requires urgent ENT assessment because early treatment may improve the chance of recovery in selected cases.
Evaluation usually includes an ear examination and a formal hearing test performed by an audiologist. Tests help identify the degree and type of hearing loss. Additional tests or imaging may be requested depending on the pattern and associated symptoms.
Treatment depends on the cause. Wax, infection or middle-ear fluid may be managed medically or procedurally. Permanent hearing loss may be supported with hearing aids, assistive devices, communication strategies or implantable hearing devices in selected patients. Children should be assessed promptly because hearing is important for speech, language and learning.
Protecting hearing includes using suitable hearing protection around loud sound, keeping personal audio at safe levels and obtaining testing when changes are noticed.
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Tinnitus: Causes, Evaluation and Ways to Manage Ringing in the Ears
Tinnitus is the perception of sound without an external source. It may be heard as ringing, buzzing, humming, clicking or roaring and can affect one or both ears. It is a symptom rather than a disease.
Common associations include age-related hearing loss, noise exposure, earwax blockage, middle-ear problems and certain medicines. Sometimes no single cause is identified. Pulsatile tinnitus, which seems to beat in time with the pulse, is different and may require additional investigation.
Assessment starts with a medical history, ear examination and usually a hearing test when tinnitus is persistent, one-sided or associated with hearing changes. Imaging is not required for every patient, but may be considered when tinnitus is pulsatile, one-sided with asymmetric hearing loss or accompanied by neurological signs.
Treatment focuses on identifying reversible causes and reducing the effect on daily life. Removing impacted wax or treating an ear condition may help when these are responsible. Hearing aids may reduce tinnitus awareness in people with hearing loss. Background sound, sound therapy, sleep strategies and cognitive behavioural therapy can help some people manage distress. No single medicine or supplement reliably cures tinnitus, and products making guaranteed claims should be viewed cautiously.
Seek prompt assessment for tinnitus with sudden hearing loss, severe dizziness, facial weakness, neurological symptoms or a sound that follows the heartbeat. Persistent tinnitus that affects sleep, concentration, mood or quality of life should also be discussed with an ENT specialist or audiologist.
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BPPV: Why Certain Head Movements Cause Brief Vertigo
Benign paroxysmal positional vertigo, or BPPV, is a common inner-ear cause of vertigo. It produces brief episodes of spinning triggered by changes in head position, such as rolling over in bed, looking upward, bending down or getting up. Episodes usually last seconds to less than a minute, although nausea or unsteadiness may continue longer.
BPPV occurs when tiny calcium crystals that normally sit in one part of the inner ear move into a semicircular canal. Head movement then shifts the crystals and sends an incorrect movement signal to the brain.
Diagnosis is based on the symptom pattern and positional examination. A clinician may perform a test such as the Dix–Hallpike manoeuvre while observing for characteristic eye movements called nystagmus. Brain imaging is not routinely required when the history and examination are typical, but may be needed when symptoms or neurological findings are unusual.
Treatment commonly involves a canalith-repositioning manoeuvre, such as the Epley manoeuvre, performed according to the affected canal and side. These manoeuvres guide the crystals back to an area where they no longer trigger vertigo. Medication may reduce nausea temporarily but does not correct the displaced crystals.
BPPV can recur, and some patients may be taught appropriate home exercises after diagnosis. Seek urgent care if dizziness occurs with weakness, numbness, difficulty speaking, severe new headache, fainting, chest pain, inability to walk, continuous vomiting or sudden hearing loss, as these features are not typical of uncomplicated BPPV.
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