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Do you remove yourself from conversations or social situations because it is difficult to hear what is being said?
One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. A ringing in the ears, called tinnitus, commonly occurs after noise exposure, and it often becomes permanent. Habitual exposure to noise above 85 dB will cause a gradual hearing loss in a significant number of individuals, and louder noises will accelerate this damage. The Occupational Safety and Health Administration, in its Hearing Conservation Amendment of 1983, requires hearing conservation programs in noisy work places. When noise measurements indicate that hearing protectors are needed, the employer must offer at least one type of earplug and one type of earmuff without cost to employees.
Gun muzzle blast, jet engine; noise causes pain and even brief exposure injures unprotected ears. Earmuffs fit over the entire outer ear to form an air seal so the entire circumference of the ear canal is blocked, and they are held in place by an adjustable band.
Just as sunglasses help vision in very bright light, so do hearing protectors enhance speech understanding in very noisy places.
If you have any of these symptoms, you may have nothing more serious than impacted wax or an ear infection, which might be simply corrected. Reprinted with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2006. Central California Ear, Nose & Throat Medical Group (CCENT) announces our new minimally invasive surgical treatment for chronic sinusitis Balloon Sinuplasty. Central California ENT Medical Group Receives CT Accreditation by the IAC Click here to download and read full article! A team of professionals providing a full range of otolaryngology services to the residents of the Central San Joaquin Valley . Otolaryngology Medical Web Site Design & Medical Website Marketing by Vital Element, Inc.
These graphs, created over 15 years ago in the USA, show the the incidence of hearing loss (in green) compared to other neural and sensory pathologies, representing around 10% of the American population. Sensorineural hearing loss (or perceptual hearing loss) is due to the dysfunction of the inner ear (cochlea) and generally manifest as lesions at the level of the hair cells or auditory nerve.Rare cases of central hearing loss also exist.
Mouse over to see the two most common cochlear problems that cause sensorineural hearing loss. Mixed hearing lossConductive and sensorineural hearing losses can be combined in the same ear, causing a mixed hearing loss: for example, a problem in the middle ear (such as advanced otosclerosis) can have repercussions on the inner ear and cause mixed hearing loss.
Genetic and acquired hearing lossHearing loss can have a genetic cause, or occur because of pathology (acoustic trauma, infection, ototoxicity, age).
Profound deafness at birthFor every 1000 births, there are 1-1.5 children that are born with severe or profound hearing loss.
Childhood deafnessThe large majority of hearing loss originates in the middle ear (em), such as otitis media. Adult-onset hearing lossThe factors causing acquired hearing loss are always increasing, and now represent the vast majority of hearing loss. University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a national leader in medical research and education and consistently ranked among the top research medical schools in the country by U.S. Many unanswered questions remain about the causes, diagnosis, clinical course and treatment of patients with EVA. A vestibular aqueduct is a small, bony canal with the temporal bone of the skull (behind the ear) that connects the inner ear to a nearby balloon-shaped structure called the endolymphatic sac. Credit: Photo courtesy of the National Institutes of Health, Department of Health and Human Services.

Most children with EVA will develop some degree of hearing loss, although the timing and severity of any hearing loss can be variable depending on the patient. EVA may be a component of Pendred syndrome which is characterized by hearing loss due to EVA and thyroid disease, among other things.
Given the close anatomic relationship between the hearing and balance centers in the inner ear and their connection to the endolymphatic sac through the vestibular aqueduct, it is no surprise that children with hearing loss associated with EVA may also have problems with their balance. Investigation into a suspected hearing loss typically involves confirmatory hearing testing, often with age-appropriate audiometry and, possibly auditory brainstem response (ABR) testing.
Unfortunately, there are no consistently documented medical or surgical treatments for EVA.
Surgical considerations such as surgical procedures to drain liquid out of the endolymphatic duct and sac or to remove the endolymphatic duct and sac are not only ineffective in treating EVA, it can be harmful. Certain activities have been demonstrated to precipitate a decrease in an EVA patient’s hearing and include contact sports where the participant could sustain a head injury, and activities where barotrauma is more likely. Identifying hearing loss as early as possible is the best way to reduce EVA’s impact. These funnel through the ear opening, down the ear canal, and strike your eardrum, causing it to vibrate. Evidence suggests that loud rock music along with increased use of portable radios with earphones may be responsible for this phenomenon. Some people react to loud noise with anxiety and irritability, an increase in pulse rate and blood pressure, or an increase in stomach acid. For unprotected ears, the allowed exposure time decreases by one-half for each 5 dB increase in the average noise level. Our physicians bring the best in care through our expert centers - The ENT Facial Surgery Center, Physicians Hearing Services, and the Aesthetic Plastic Surgery Pavilion. It can also be acquired due to a genetic predisposition: some people are more affected by infection or trauma than others. Chronic otitis of the middle ear (me) represent around 20% of these factors, fewer than Meniere's disease (M), which also affects the vesitbular system (causing dizziness).Acoustic trauma (t) is caused by overstimulation by sound and represents the largest factor in adult-onset deafness. Information is available through our Health Library or with the following diagrams and more detailed EVA information to give a greater understanding of how EVA occurs and what may trigger EVA. The inner ear structures consist of separate hearing and balance organs, known as the cochlea and vestibular apparatus, respectively. The enlarged vestibular aqueduct (EVA) may be a sign of corresponding enlargement of the endolymphatic duct (which runs through the vestibular aqueduct) and the endolymphatic sac. Children who are diagnosed with sensorineural hearing loss and who go on to have imaging studies as part of their workup will have EVA 5-15 percent of the time.
According to a study by the National Institute on Deafness and Other Communication Disorders (NICDC), approximately a quarter of people with EVA and hearing loss have Pendred syndrome.
Fortunately, the brain is very adept at compensating for such an abnormality so these balance difficulties are typically transient and mild. The most well-known cause of EVA and hearing loss is a gene mutation, known as SLC26A4 (previously known as the PDS gene). Once a sensorineural hearing loss has been confirmed, imaging is often obtained to evaluate the anatomy of the inner ear. There is some anecdotal evidence that a course of steroids may be helpful at restoring some hearing in the setting of a sudden sensorineural hearing loss in patients with EVA.
Activities such as contact sports, cycling, or skiing should be undertaken with protective headgear or avoided altogether. The earlier hearing loss is identified in children, the sooner they can develop skills that will help them learn and communicate with others.
The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear.

This means that as decibel intensity increases by units of 10, each increase is 10 times the lower figure.
What you might notice is a ringing or other sound in your ear (called tinnitus), which could be the result of long-term exposure to noise that has damaged the hearing nerve. Other factors (in blue) complete the picture - mainly drugs that are toxic to the ear and sudden deafness.Genetic deafness (g) only account for a small percentage in this age bracket, but it is important to note that in numerous cases (acoustic trauma, ototoxicity, Meniere's), there is probably also a genetic factor accentuating or accelerating the acquisition of the hearing loss. Through their faculty appointments at Case Western Reserve University School of Medicine, physicians at UH Case Medical Center are advancing medical care through innovative research and discovery that bring the latest treatment options to patients.
The cochlea, vestibular organ and nerves that send signals to the brain are responsible for processing sound transmission and contributing to the body’s sense of balance. Abnormalities in these structures contribute to sensorineural hearing loss by a mechanism that is not entirely understood. The hearing loss associated with Pendred syndrome is more likely to be progressive, meaning there is a reasonable likelihood the hearing loss may progress and become more severe, perhaps even resulting in deafness.
If balance disturbances are more problematic, specific vestibular testing with focused vestibular rehabilitation may be required. Two mutations in the SLC26A4 gene can result in Pendred syndrome and other factors, genetic or environmental, may also lead to EVA. This is perhaps more important in the setting of unilateral or sudden hearing loss and would consist of magnetic resonance imaging (MRI), computed tomography (CT) scanning, or both.
More research on this topic needs to be completed to determine if such treatment is effective. Any situations that can lead to barotrauma or rapid changes in air pressure such as scuba diving or hyperbaric oxygen treatments should be carefully avoided because of their risk of sudden worsening of hearing loss. Children with permanent and progressive hearing loss, which often is linked with EVA, will benefit from learning other forms of communication, such as sign language or cued speech, or using assistive devices, such as a hearing aid or cochlear implant. They are available in a variety of shapes and sizes to fit individual ear canals and can be custom made.
Or, you may have trouble understanding what people say; they may seem to be mumbling, especially when you are in a noisy place such as in a crowd or at a party.
A few rare central causes of hearing loss (involving the brain) exist, but the vast majority are caused by issues in the ear. Anatomic abnormalities of these structures may contribute to hearing loss, balance disturbances, or both. The fluids within the endolymphatic duct and sac must remain in careful balance such that any changes, however subtle, may precipitate a hearing loss.
The identification of EVA can be an important clue to understand the actual cause of the hearing loss.
Although most imaging studies in this setting are normal, the most common finding on an abnormal CT is EVA. In addition, added pressure changes with air travel have also been reported to cause hearing loss in EVA patients. But even cap guns and firecrackers can damage your hearing if the explosion is close to your ear. Conductive hearing loss is caused at the level of the outer and middle ear, whereas sensorineural hearing loss (also known as perceptual hearing loss) occurs in the inner ear. This is a rare event in commercial aircraft with pressurized cabins and this risk may be minimized by preemptively taking a nasal decongestant, particularly if there is sinus or nasal congestion.

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