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In the cochlea the vibrations are translated into electrical signals which are passed on to the brain along the acoustic, or auditory, nerve. A problem of transmission (or conduction) of sound waves through the ear canal and middle ear is referred to as a conductive hearing loss. A conductive hearing loss occurs when there is a failure of the conversion of sound waves into movements by the eardrum and the little bones of the middle ear. There are a great number of causes of conductive hearing loss including blockage by wax, infection, a collection of fluid, trauma or fixation of the ossicles in the middle ear (which is called otosclerosis). A sensorineural hearing loss is due to a problem of the inner ear or of the nerve that carries the signal from the inner ear to the hearing centres in the brain.
While some inner ear problems are reversible, generally speaking the hearing loss is irreversible (i.e. The main difficulty with sensorineural hearing loss is an inability to hear adequately in conversations, especially when there is background noise. Although frequent in older people, it is not uncommon for people to notice problems with speech discrimination whilst they are in their 30s or even earlier, especially if they have had regular exposure to loud noise, for example by going clubbing.
Whilst there is no absolute cure for a sensorineural hearing loss, hearing aids help to amplify or increase the sounds that are transmitted to the inner ear and so partially overcome the hearing loss.
You should always see your doctor urgently if you have a sudden hearing loss, as sometimes treatment for sudden deafness should be started within 48 hours of its onset. If you notice a hearing loss only in one ear, you should see your doctor, who will probably refer you on to an ENT specialist or an audiological physician.
A hearing aid is a device that is used to increase the loudness of the sound reaching the ear of a person with a hearing difficulty.
The most commonly used type of aid is the behind-the-ear hearing aid, where all the electronic components are contained in a skin-colored plastic case that sits behind the ear. Cosmetically more popular is the in-the-ear hearing aid, which is a smaller, more compact device worn in the ear canal, but it is inappropriate for people with severe deafness because it is not powerful enough to compensate for their hearing loss.
Even smaller is the completely-in-the-canal hearing aid, which is virtually invisible when worn. People tend to benefit from this type of hearing aid if they have problems in the ear canal or middle ear, for example because of recurrent ear infections, previous surgery, or anatomical abnormalities such that they are unable to wear conventional hearing aids. People who have such a severe deafness that they hardly derive any benefit from conventional hearing aids (i.e. In this type of implantable hearing aid a wire electrode is surgically inserted into the inner ear (the cochlea). If you (or people around you) notice a gradual deterioration of your hearing you should seek advice from your doctor who will advise you of the appropriate action to be taken, and will be able to organize a hearing test. If some one gets impaired vision, they run to the opticians and fit eye glasses at whatever cost, similarly if one is hard of hearing they are not very enthusiastic to see an audiologist or ENT doctor and get a hearing aid. Dr Paulose FRCS, DLO is a Consultant ENT Plastic & Laser Surgeon with over 38 years of world class experience in Ear, Nose, Throat and Laser Surgery treating patients across the world from UK, US, Middle East to Asia. Sensorineural Hearing Loss is a hearing loss due to impairment or degeneration of the cochlear (inner ear) resulting in an irreversible hearing loss. Bilateral Hearing Loss is a hearing loss, either sensorineural or conductive, in both ears.
Unilateral Hearing Loss is a hearing loss, either sensorineural or conductive, in one ear only. A video of a 7-week-old baby has gone viral, showing his reaction after hearing for the first time. Baby Lachlan can be seen in the clip crying on his mom's laps as doctors are fitting hearing aids into his ear canals. Lever revealed on YouTube that the boy has now become two years old and is doing really well. The video has gone viral now, but it surprising because the video was first published two years ago. Objective: The purpose of this study was to observe the effectiveness of immune modulator –Inosine Pranobex (Isoprinosine) in the treatment of sudden sensorineural hearing loss of suspected viral origin. Setting: This study was performed in the Clinic of Otorhinolaryngology in the Medical Institute of Ministry of Interior, Sofia.
Patients: The study included 28 patients with sudden hearing loss of suspected viral origin, divided randomly into two groups. Intervention: The first group of 14 patients was treated with corticosteroids and vasodilators.
Main Outcome Measures: The patients passed precise otorhinolaryngological examination, pure tone audiometry, speech audiometry, stapedial reflex testing, ABR, CT scan, hematological testing –complete blood count (CBC) and sedimentation rate, biochemistry and serologic testing for syphilis. Results: We compared the two groups before and after the treatment regarding mean hearing level at each frequency, speech reception threshold improvement, and tinnitus and balance complaints. Conclusions: Administration of a combination of corticosteroids, vasodilators and immune-modulator should be recommended for treatment of patients with sudden sensorineural hearing loss. Sudden sensorineural hearing loss is defined as 30 dB or more sensorineural hearing loss over at least three contiguous audiometric frequencies occurring within 3 days or less. The vascular courses include vasospasm, thrombosis, embolism, hemorrhage, hypercoaguability and rheologic abnormalities. The viral-vascular combination theory suggests that a viral infection initiates a hypercoagulable state secondary to the effect of viruses on the vascular system.
The therapy that has been proven to be effective in the treatment of sudden sensorineural hearing loss is the etiologic based one.
28 patients of either gender (24 male and 4 female), aged between 12 and 47 years with sudden hearing loss were enrolled in the study.
Pure tone audiometry was performed weekly during the first 14 days of the treatment, 4 weeks after the onset of the disease and 2 months later. After 14 days of the treatment in the Clinic of Otorhinolaryngology and 2 weeks more at home, the results were as following in Table 2.
We compared the two groups before and after treatment regarding mean hearing level at each frequency, speech reception threshold improvement, and tinnitus and balance complaints.

It is not surprising that the cochleovestibular blood supply may be affected by circulatory disorders such as embolic phenomenon, thrombosis, vasospasm and hypercoagulable or high viscosity states resulting in sudden sensorineural hearing loss. Administration of a combination therapy of corticosteroids, vasodilators and immune-modulator should be recommended for treatment of patients with sudden sensorineural hearing loss of suspected viral origin. The sounds cause vibrations first of the eardrum and then of the little bones, called ossicles, which bridge the gap between the drum and the cochlea (part of the inner ear). A problem with the translation of the sound waves into an electrical signal by the inner ear or the onward passage of those electrical impulses via the nerves to the brain is referred to as a sensorineural hearing loss. This can occur either because the sound waves are not reaching the eardrum, for example because of wax blocking the ear canal, or because the vibrating mechanisms of the eardrum or ossicles are not working properly, for example because of current or previous infections. Fortunately, they can often be treated and hearing in the infected ear can be corrected or improved.
Again there are many causes, the most common being that of hearing loss in old age (presbyacusis), which usually affects both ears to a similar degree and can be associated with noises in the ear (tinnitus).
Many people complain that they can hear the sounds of a conversation, but cannot discriminate exactly what is being said.
The technology in hearing aids is continuing to improve and they can work very well for many people. Modern hearing aids consist of three basic electronic components: a microphone, an amplifier and a loudspeaker. It is not suitable for those with some loss of manual dexterity, because the control switches are quite small. Again, because of its small size, its casing is too small to be able to hold a very powerful amplifier and so it is only useful for mild hearing losses.
Bone conduction aids can work very well, but can be quite bulky and obvious, and a more sophisticated type of bone conduction aid has been developed. The a€?digital’ part of the hearing aid implies that these types of aids are more sensitive and better at restoring hearing than the older type of aids, and this is often, but not always, the case.
This means that it is possible for digital aids to be more selective in filtering out irritating background noise, but no hearing aid, digital or analogue is capable of only amplifying the sounds that you want to hear. Intense speech and hearing therapy is required often for several years following this operation. Sensorineural hearing loss can be caused by aging, noise exposure, birth defects, medication and viral or bacterial infections.
This can be caused by impacted cerumen (wax), punctured eardrum, birth defects or otosclerosis. The recording was shared by his father on YouTube alongside a message, "Our beautiful son Lachlan was diagnosed as having moderate to severe hearing loss in both ears.
Hi darling" in the clip and when the baby lifted his head, the father could not resist himself from saying "hi" to his son.
The boy's parents, Michelle Lever and Toby Lever from Victoria, Australia, wanted to get their son cochlear implants after they were confirmed by doctors that their child had moderate to severe hearing loss in both ears since birth. The second group of 14 patients was treated with corticosteroids, vasodilators and immune modulator - Isoprinosine. The patients with vertigo passed observation for nystagmus, static and kinetic tests, posturography and electronystagmography (ENG). 4 patients recovered totally, 19 patients improved their hearing with 20 dB and 5 patients showed no improvement. The phylogenetically newer portion of the inner ear, which includes the cochlea and saccule, is relatively more susceptible to various agents than the pars superior. Experimental studies have shown that the ganglion cells are the most sensitive to ischemia, while the pathologic data indicates that the organ of Corti, stria vascularis and tectorial membrane are the predominant structures affected in cases of sudden sensineural hearing loss (7). One of the mechanism by which hearing loss develops is through changes in cellular immunity. We used a combination of medicines, according to the viral-vascular etiologic theory (8-10). 8 patients noted their hearing loss upon first awakening in the morning, 2 patients – after stress situation, 18 patients had in their history a viral upper respiratory infection as 2 patients were in contact with varicella – infected persons, 1 woman was with rubeolla and 15 patients had in their history symptoms of influenza.
Ophthalmologic, neurological and rheumatologic consultations were carried out to rule out systemic vasculitic diseases. The vascular etiologic theory is favored because of the sudden nature of the onset of hearing loss. This type of treatment result in earlier hearing recovery and less extensive cochlear destruction compared to steroids and vasodilators.
Therapy of idiopathic sudden sensorineural hearing loss: antiviral treatment of experimental herpes simplex virus infection of the inner ear.
Oral steroid treatment of sudden sensorineural hearing loss: a ten-year retrospective analysis. Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy: a prospective, randomized, double blind clinical trial.
Recovery of hearing: results of delayed medical treatment in patients with idiopathic sudden hearing loss.
Children are the next most common group to be affected, usually due to fluid or infection in the middle ear but also due to congenital problems or viral illness during early childhood. Other common conditions which affect the inner ear are infections (particularly by viruses), trauma, the side effects from certain medication and congenital causes. Extremely rarely, but more seriously, the hearing loss may be due to a growth, otherwise known as a tumor, on the hearing nerve in the brain. There is no cure for this type of hearing ,loss; however, most patients with sensorineural hearing loss can be helped with hearing aids.
Surgery or medication can be an appropriate therapy for conductive hearing loss in some cases. But after the hearing aids were properly fitted by the doctors, the child reacted to his mom's and dad's voice, which is truly priceless and made everyone who watched the video feel different.
The findings in animal models of hearing loss of vascular origin are of extensive cochlear fibrosis and ossification.

The otorhinolaryngologic examination included otoscopy, anterior rhinoscopy and pharyngoscopy. The treatment of sensorineural hearing loss often proves to be frustrating to the clinician as, in the majority of cases, the etiology is unknown and the underlying disease process is irreversible. The underlying pathophysiology can be explained by the occurrence of sudden anoxic injury to the cochlea. The recovery is significantly related, as well, to onset of hearing loss and audiogram type.
Sudden hearing loss may be idiopathic but also significant differential diagnoses must be considered. Additional evidence of that type of etiology is indicated by the fact that patients had substantial hearing improvement with mono steroid treatment. Otorhinolaryngologists make efforts to treat the sudden sensorineural hearing loss according to the established etiologic courses as viral, vascular or viral-vascular combination (11-15). Effects of anoxia result in changes in the cochlea microphonics with loss of the action potential.
So the combination of immune-mediator (Isoprinosine), corticosteroid (Methylprednisolon) and vasodilator (Cavinton) proved to be effective in treatment of sudden sensorineural hearing loss. Treatment aimed at the possible etiologic agent might be beneficial only in the very early phase of the hearing loss. The audiometric patterns from the pure tone audiometry were variable with mild to profound hearing losses. Support for a viral theory is the antecedent history of a viral upper respiratory infection and epidemic of viral diseases, such as parainfluenza, mumps, varicella, rubeola, and adenovirus infections. Despite restoration of the cochlea blood flow, loss of endocochlear potentials may be irreversible after 30 minutes (4). The patients, included in our study, did not have in their history any of these well-established courses or mentioned upper diseases. The entire examined group had tinnitus, which preceded the hearing loss by several hours with usually a roaring quality. Patients treated by the same course of corticosteroids and vasodilators and in addition immune-modulator – Isoprinosine – 3g per day (3x2 tabl.) for a period of 5 days.
Histological analyses of temporal bones from patients who suffered from sudden sensorineural hearing loss displayed atrophy of the organ of Corti, stria vascularis and tectorial membrane. Hearing recovery in profound losses tends to occur in the low tones, which correlates with involvement at the apex of the cochlea rather than the basal end. Etiology of the sudden sensorineural hearing loss includes as well viral, vascular and viral-vascular combination. The arterial supply to the cochlea is such that the basal turn is fed first by the main cochlear artery with the cochlear apex fed last. Patients in our study reported antecedent history of upper respiratory infection within a month or less of onset of the hearing loss. Haemaglutination and slaging of blood may occur when virus particles attach to erythrocytes.
The findings in animal models of hearing loss of vascular origin prove extensive cochlear fibrosis and ossification.
The viruses of mumps, measles, herpes simplex, herpes zoster, adenoviruses and influenza deserve particular attention in view of their clearly demonstrated etiologic role in sudden sensineural hearing loss.
In the histological findings the organ of Corti was absent throughout the cochlea; the stria vascularis was atrophic throughout. The spiral ganglion cells were considerably decreased in the basal turn and somewhat decreased in the apical turn.
Patients with measurable speech discrimination scores on presentation uniformly improved with treatment, even if their pure tone-average was profound. The cutaneus lesions associated with herpes zoster infections make this form of viral neurinitis and ganglionitis relatively easy to diagnose clinically and to relate etiologically the sudden sensorineural loss to the virus (6).
Presence of vertigo is associated with more severe losses and represents a greater insult to the labyrinth and those patients recover worse.
The patients with vertigo passed observation for nystagmus, static and kinetic tests, posturography and ENG.
The vascular endothelium is invaded and inclusion bodies may be seen in the endothelial cells in viral diseases. Application of combination of steroid, vasodilator and immunostimulater significantly improves the recovery outcomes in cases of sudden sensorineural hearing loss.
There is, however, overall hyperemia at the site of inflammation and total effective blood flow may not be altered. Infiltration of lymphocytes, plasma cells, macrophages and polymorphonuclear leukocytes occurs. Necrosis of neuroepithelium may occur and is indicated by hyperchromatism, fragmentation and lysis of nuclei (5). The most common route of access of viral particles to the inner ear is a viremia in the early phase of viral illness in which virions are deposited within the membranous cochlea. Isoprinosine was used to support the mechanism of immune answer to the foreign agent – the virions and to reduce the damage of the cochlea structures. Medications like Acyclovir may be unhelpful when the cause is a virus that is not in the herpes family, that’s why Isoprinosine is favored. The corticosteroids, as well, have an anti-inflammatory effect on the organ of Corti and the microvasculature.

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