8-07: Diseases of the Inner Ear

1. SENSORY HEARING LOSS

Diseases of the cochlea result in sensory hearing loss, a condition that is usually irreversible. Most cochlear diseases result in bilateral symmetric hearing loss. The presence of unilateral or asymmetric sensorineural hearing loss suggests a lesion proximal to the cochlea. Lesions affecting the eighth cranial nerve and central auditory system are discussed in the section on neural hearing loss. The primary goals in the management of sensory hearing loss are prevention of further losses and functional improvement with amplification and auditory rehabilitation.

A. Presbyacusis

Presbyacusis, or age-related hearing loss, is the most frequent cause of sensory hearing loss and is progressive, predominantly high-frequency, and symmetrical. Various etiologic factors (eg, prior noise trauma, drug exposure, genetic predisposition) may contribute to presbyacusis. Most patients notice a loss of speech discrimination that is especially pronounced in noisy environments. About 25% of people between the ages of 65 and 75 years and almost 50% of those over 75 experience hearing difficulties.

B. Noise Trauma

Noise trauma is the second most common cause of sensory hearing loss. Sounds exceeding 85 dB are potentially injurious to the cochlea, especially with prolonged exposures. The loss typically begins in the high frequencies (especially 4000 Hz) and, with continuing exposure, progresses to involve the speech frequencies. Among the more common sources of injurious noise are industrial machinery, weapons, and excessively loud music. Personal music devices used at excessive loudness levels may also be injurious. Monitoring noise levels in the workplace by regulatory agencies has led to preventive programs that have reduced the frequency of occupational losses. Individuals of all ages, especially those with existing hearing losses, should wear earplugs when exposed to moderately loud noises and specially designed earmuffs when exposed to explosive noises.

C. Physical Trauma

Head trauma (eg, deployment of air bags during an automobile accident) has effects on the inner ear similar to those of severe acoustic trauma. Some degree of sensory hearing loss may occur following simple concussion and is frequent after skull fracture.