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DESCRIPTION
Hear loss occurs when the passage of sound waves to the brain is impaired. Hearing loss may be partial or complete, temporary or permanent, depending on the cause. Hearing loss affects more than 23.2 million Americans. Nearly 30 percent of adults over the age of 65 have sustained some degree of hearing impairment. Diagnosis and assessment of the degree of hearing loss is a complicated process involving a variety of different tests.
Health care providers divide hearing loss into two basic categories:
- Conductive hearing loss, which occurs when the passage of sound waves is impeded in the external or middle ear.
- Sensorineural hearing loss, which results from damage to the structures or pathways of the inner ear. This type of hearing loss affects both the acuity and clarity of hearing. Initially, it is noticed at higher pitches, and then, as it progresses, it is noticed at lower pitches, where speech is heard.
CAUSES & SYMPTOMS
Conductive hearing loss may result from factors such as:
- Ear wax buildup or impaction.
- Changes in atmospheric pressure.
- Middle ear infection and inflammation.
- Excessive rigidity of the tiny bones in the middle ear that convey the vibrations of the eardrum to the inner ear structures.
Sensorineural hearing loss may result from: Sensorineural hearing loss can be present from birth, or it can be caused by:
- Damage to the acoustic nerve (the eighth cranial nerve, also known as the auditory nerve), which carries information from the inner ear to the brain.
- Damage to tiny cells called hair cells in the inner ear. If the hair cells die, they are unable to repair themselves and the resulting hearing loss is permanent.
- Certain drugs.
- Illness, especially those involving high fever.
- Exposure to noises.
- Smoking.
- Trauma.
It is also possible to have mixed hearing loss, in which both conductive and sensorineural loss are present. Hearing loss can be sudden or gradual, occurring over a period of days, weeks, or years.
Sudden Loss of Hearing: Infection, trauma, changes in atmospheric pressure, and earwax buildup or impaction can cause a sudden loss of hearing. Infection and inflammation often follow an upper respiratory infection or trauma to the ear, such as from the overuse or improper use of cotton swabs. Bathing or swimming in water that is overly chlorinated or contains high levels of bacteria and/or fungi can also lead to ear infections. Persistent and recurrent ear infections are often linked to fungal infection (candidiasis) and are frequently seen in people with allergies, cancer, diabetes, or other chronic disease.
Gradual Loss of Hearing: If hearing loss develops gradually, the individual experiencing it may be unaware of it until it reaches a fairly advanced stage. In fact, it is not uncommon for friends and family members to notice signs of hearing loss before the person experiencing it does. Some signs that may point to a hearing problem include:
- Seeming inattentiveness.
- Unusually loud speech.
- Irrelevant comments.
- Inappropriate responses to questions or environmental sounds.
- Requests for statements to be repeated.
- A tendency to turn one ear toward sound.
- Unusual voice quality.
PAIN & HEARING LOSS
Hearing loss associated with ear pain may result from:
- Eardrum damage, strain, or perforation.
- An infected cyst in the eardrum or middle ear.
- Mastoiditis (inflammation of the mastoid, the bone behind the ear).
- Metabolic disorders such as hypothyroidism.
- Vascular disorders such as hypertension.
- Neurological disorders such as multiple sclerosis.
- Blood disorders such as leukemia.
- Tooth and/or mouth disorders.
Hearing loss associated without ear pain may result from:
- Acoustic neuroma (a benign tumor in the cells covering the acoustic nerve).
- Infection of the inner ear.
- Osteosclerosis (overgrowth of bone in the middle ear).
- Kidney dysfunction.
- Paget's disease of bone.
- Meniere's disease.
- Hearing loss can also occur if the bones of the skull are out of alignment with one another.
COMMON ADULT HEARING DISORDERS
Two of the most common hearing disorders in adults are presbycusis and tinnitus.
- Presbycusis is the gradual loss of hearing due to aging. It is prevalent in adults over the age of 50 years.
- Tinnitus is a continuous buzzing or ringing in the ears with no obvious cause. It may occur by itself or as a symptom of another disorder, such as infection, obstruction of the ear canal, head trauma, noise-induced hearing loss, or Meniere's disease.
INFANT & CHILD HEARING LOSS
Suspected hearing deficits in infants deserve close and immediate attention, as an undiagnosed hearing impairment can lead to delayed and/or diminished acquisition of language skills and, possibly learning disabilities. Risk factors for hearing loss:
- Known hereditary disorders.
- Congenital abnormalities of the ears, nose, or throat.
- Maternal exposure to rubella or syphilis.
- Ototoxic drugs such as tobramycin (Nebrin), streptomycin, gentamicin (Garamycin), quinine (Quinamm), furosemide (Lasix), or ethacrynic acid (Edecrin).
- Birth related problems such as prematurity, trauma and/or lack of oxygen during delivery, low birth weight, or jaundice.
Otitis media (middle ear infection) is the most common cause of hearing loss in children. For the most part, this is temporary, but chronic or recurrent ear infection can cause permanent hearing loss due to inflammation and infection of the middle ear. Sensorinerual hearing loss in children can also be caused by childhood diseases such as meningitis, mumps, and rubella.
Warning Signs of hearing problems in infancy include:
- Failure to turn the head toward familiar sounds.
- A consistent ability to sleep through loud noises.
- Greater responsiveness to loud noises than to voices.
- A failure to babble, coo, or squeal.
- Monotonal babbling.
Warning Signs of hearing problems in toddlers include:
- Failure to speak clearly by age two.
- Showing no interest in being read to or in playing word games.
- Habitual yelling or shrieking when communicating or playing.
- Greater responsiveness to facial expressions than to speech.
- Shyness or withdrawal (often misinterpreted as inattentiveness, dreaminess, and/or stubbornness).
- Frequent confusion and puzzlement.
Warning Signs of hearing problems in older children are similar to those in adulthood and include:
- A failure to respond to verbal requests.
- Inappropriate responses to questions or other sound stimuli.
- A seeming inattentiveness.
HEARING LOSS AND NOISE
Hearing loss caused by exposure to loud noises is an increasing problem in our society today. When the delicate mechanisms of the inner ear are assaulted by loud noises, a phenomenon called temporary threshold shift occurs. If you have ever walked away from a concert or a construction site with a buzzing or hissing in your ears, or with everything sounding as if you are underwater, you have experienced temporary threshold shift. While overnight rest usually restores normal hearing, this is a sign that damage has occurred to the hair cells in your inner ear, and if this type of damage is lengthy and/or repeated, permanent damage and hearing loss will be the eventual result. Most people who develop noise-related hearing loss say they were unaware that anything was wrong until they developed tinnitus or speech became inaudible, but in fact, the damage begins long before that and temporary threshold shift is a clear sign of it.
Noise-related hearing loss is common in train engineers, military personnel, and workers subjected to constant industrial noise, as well as in hunters and musicians, especially rock musicians. Recent National Institutes of Health (NIH) statistics indicate that as much as one=third of all hearing loss is associated with loud noises, and while conclusive data are as yet lacking, many researchers believe that more young people are losing their hearing today than in previous years. The National Center for Health Statistics reports that young people account for one-third of today's hearing loss statistics. They also report that in most cases, this type of hearing loss could have been prevented.
PREVENTION
For earwax buildup, clean or irrigate your ears using either a solution of 1 part vinegar to 1 part warm water or a few drops of hydrogen peroxide. Using an eyedropper, place a few drops in your ear, allow them to settle for a minute, then drain. Repeat the process with the other ear. Do this two or three times a day. Do not use cotton swabs to clean the inside of the ear canal, as this can push wax further into the ear canal and exacerbate the problem. If the wax is hard and dry, apply garlic oil for a day or two to soften it. Then wash out the ear with a steady stream of warm water. Be patient, continue to irrigate the ear canal, and flush with warm water. Most cases of earwax buildup can be treated by this method.
Another method of removing excess earwax, called ear candling or ear coning, uses special candles available at health food stores. Instructions for the procedure are included with the candles. The candling procedure requires assistance, so do not attempt this by yourself. See Alternative Therapies: Ear Candling (Coning) for more information and resources.
When flying or traveling where there will be a great change in altitude, chew gum during the descent to prevent the discomfort and hearing loss associated with changes in atmospheric pressure. Or pop your ears by holding your nose and gently blowing air through your closed mouth. This clears the eustachian tubes. A decongestant such as pseudoephedrine (found in Sudafed and other products) may also be helpful, but remember, these medications are dehydrating (and so is the lack of humidity in an airplane cabin). If you use them, be sure to drink plenty of water and juice during the flight, and skip the cocktail and coffee, as alcohol and caffeine also are dehydrating.
Always wear ear protection (disposable ear plugs or ear-phone style) when using loud appliances such as power tools or lawn mowers and when you know you are going to be exposed to sudden loud noises, such as when shooting a gun. The U.S. Occupational Safety and Health Administration (OSHA) recommends using ear plugs rated for at least twice as many decibels as you need to ensure protection.
Protect your ears when listening to music. A general guideline is to keep the volume low enough that you can easily hear the telephone and other sounds over the music. If you are using a personal stereo unit with headphones, you should be the only one able to hear your music. If someone standing next to you can hear it, it's too loud.
Take measures to reduce your cholesterol level. Studies suggest that people with high cholesterol levels have greater hearing loss as they age than people with normal cholesterol levels. See High Cholesterol for more information.
If you are prone to ear infections, wear ear plugs while swimming.
If you are planning to become pregnant, make sure you have achieved immunity to German measles (Rubella), either through having had the disease or through considering vaccination. A health care provider or midwife can perform a blood test to determine immunity. If you choose to become vaccinated, you must guard against becoming pregnant for at least three months to avoid the risk of serious birth defects, such as hearing loss. If you are not immune and you choose not to obtain vaccination, avoid exposure to anyone that may have been exposed or may be ill with the measles. See Rubella for more information.
If you become ill during pregnancy and medication is required, question your health care provider, pharmacist, or midwife thoroughly about possible side effects on the developing fetus and do some research on your own. This will reduce the risk of giving birth to a child with impaired hearing (as well as other birth defects or problems).
TREATMENT
DIAGNOSIS
If you have an infant, pay very close attention to his or her reactions to noises. If you have any doubt about your child's hearing, consult with your health care provider. Be aware, however, that many physicians are not expert at picking up on hearing loss. If your health care provider seems too quick to dismiss your concerns, talk to another provider. Keep in mind that early detection is vitally important since detection of hearing loss before a child's first birthday greatly reduces the chances that he or she will be disadvantaged by hearing problems in the years to come.
If you have experienced permanent hearing loss, advise family members, friends, and co-workers to speak slowly and distinctly, and avoid shouting. Depending on the nature of the hearing loss, a hearing aid may be helpful. Consult with your health care provider or a professional audiologist.
PHYSICAL EXAMINATION
A physical examination may show wax in the ear that can be a contributing factor. It may also detect a rupture of the eardrum or external ear infection. Often the exam is unrevealing and an Audiology Test or other testing may be used to determine extent of hearing loss.
AUDIOLOGY
(Audiography, Audiogram, Audiometry, Hearing Test)
An audiology exam tests your ability to hear sounds. Sounds vary according to the intensity (volume or loudness) and the tone (the speed of sound wave vibrations).
Hearing occurs when sound waves are conducted to the nerves of the inner ear and from there to the brain. Sound waves can travel to the inner ear by air conduction (through the ear canal, eardrum, and bones of the middle ear) or bone conduction (through the bones around and behind the ear).
INTENSITY of sound is measured in decibels (dB):
- A whisper is about 20 dB.
- Loud music (some concerts) is around 80 to 120 dB.
- A jet engine is about 140 to 180 dB.
Usually, sounds greater than 85 dB can cause hearing loss in a few hours. Louder sounds can cause immediate pain, and hearing loss can develop in a very short time.
TONE of sound is measured in cycles per second (cps) or Hertz (Hz):
- Low bass tones range around 50 to 60 Hz.
- Shrill, high-pitched tones range around 10,000 Hz or higher.
TEST PREPARATION: No special preparation is needed for this test.
For infants and children: The preparation you can provide for this or any procedure depends on your child's age, interests, previous experiences, and level of trust. For older children, research has shown that preparing ahead can reduce crying or resisting the procedure. In addition, children report less pain and show less distress. Proper preparation for a test or procedure that can reduce an older child's anxiety, encourage cooperation, and help develop coping skills. Knowing this from the onset may help relieve some of your anxiety about what to expect. Having specific information about the test may further reduce your anxiety. For more information please see the appropriate test. For specific information regarding how you can prepare your child:
- INFANTS (0 TO 1 YEAR): Given the developmental level of your child (0 to 1 year), little pre-test preparation will be of benefit, but some considerations may ease your anxiety. Before the test, know that your child probably will cry, and restraints may be used. But the most important way you can help your child through this procedure is by being there and showing you care. During any infant test or procedure a child will be more comforted if a parent is able to be present, although the child will probably still show anxiety and cry. A child may also find comfort in a favorite toy or blanket. Crying is a normal response to the strange environment, unfamiliar people, restraints, and separation from you. Your infant will cry more for these reasons than because the test or procedure is uncomfortable.
- TODDLER (1 TO 3 YEARS): Proper preparation for a test or procedure can minimize anxiety and help a child cope. Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try the use of play in demonstrating what will happen during the test and in discovering your child's concerns. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure.
- PRESCHOOLER (4 TO 6 YEARS): Preparation can be effective in reducing distress in children undergoing medical tests and can minimize the amount of crying and resistance to the procedure. Research finds that lowering anxiety can actually decrease the sensation of pain felt by people during uncomfortable procedures. Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try demonstrating what will happen during the test in advance to learn about your child's particular fears and concerns. Using a doll or other object to "act out" some of the procedure may help reveal worries that the child may not be willing to discuss directly. This can help reduce your child's anxiety, because most people are more frightened of the unknown than they are when they know exactly what to expect. If a child's fears are unrealistic, you can explain what will actually happen; if he or she is worried about something that is an unavoidable part of the test, do not minimize his or her concerns but reassure the child that you will be there to help as much as you can. Make sure your child understands that the procedure is not a punishment. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure.
- SCHOOL AGE (6 TO 12 YEARS): Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try the use of play in demonstrating what will happen during the test and in discovering your child's concerns. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure. Explaining the procedure will also be of value in reducing your child's anxiety. Let your child participate and make as many decisions as possible.
- ADOLESCENT (12 TO 18 YEARS): There are a number of ways to help an adolescent prepare for a difficult medical test or procedure. First, provide detailed information and explain reasons for the procedure. You can use videos in which other adolescents do the teaching to demonstrate the procedure and provide information, if available. Let your child participate and make as many decisions as possible. Depending on his or her age and independence, your child may or may not wish you to be present during the procedure, and his or her wishes should be respected. During adolescence privacy is important and should be protected.
TEST USES: The normal range of human hearing is about 20 Hz to 20,000 Hz, and some animals can hear up to about 50,000 Hz.
This may be a screening test to detect a hearing loss at an early stage. It may also be used when there is difficulty in hearing from any cause. This test may determine the extent of hearing loss.
TEST PROCEDURE: The first steps are used to estimate the need for an audiogram. The specific procedures may vary, but they generally involve blocking one ear at a time and checking for the ability to hear whispers, then spoken words or the sound of a ticking watch. A tuning fork may be used. The tuning fork is tapped and held in the air on each side of the head to test the ability to hear by air conduction. It is tapped and placed against the mastoid bone behind each ear to test bone conduction. Audiometry provides a more precise measurement of hearing. Air conduction is tested by having you wear earphones attached to the audiometer. Pure tones of controlled intensity are delivered, to one ear at a time. You are asked to raise a hand, press a button, or otherwise indicate when you hear a sound. The minimum intensity (volume) required to hear each tone is graphed. An attachment called a bone oscillator is placed against the bone behind each ear (mastoid bone) to test bone conduction.
There is no discomfort. The length of time varies. An initial screening may take about 5 to 10 minutes. Detailed audiometry may take about 1 hour.
TEST RESULTS: Normal and Abnormal Values
Normal Test Values:
- The ability to hear a whisper, normal speech, and a ticking watch is normal.
- The ability to hear a tuning fork through air and bone is normal.
- In detailed audiometry, hearing is normal if tones from 250 Hz through 8000 Hz can be heard at 25 dB or lower.
Abnormal Test Results: There are many different kinds and degrees of hearing loss. Some include only the loss of the ability to hear high or low tones, or the loss of only air or bone conduction. The inability to hear pure tones below 25 dB indicates some extent of hearing loss. The extent and kind of hearing loss may give clues to the cause and the prognosis (probable outcome). The following conditions may affect test results:
- acoustic neuroma
- acoustic trauma
- age-related hearing loss
- Alport syndrome
- labyrinthitis
- Meniere's disease
- occupational hearing loss
- otosclerosis
- ruptured or perforated eardrum
SPECIAL CONSIDERATIONS: There are many hearing function tests, from simple screenings (such as producing a loud noise and observing the test subject for a startle response) to complex, detailed measurements such as the brainstem auditory evoked responses test (BAER), in which an electroencephalogram is used to detect brain wave response to sounds.
RISKS: There is no risk.
SKULL X-RAY
(Head X-ray, Skull Radiography)
The skull X-ray is used to examine the bones of the skull, including the facial bones, the nose, and the sinuses. This test may be performed when there has been trauma and/or injury to the skull or when symptoms indicate a disorder involving structural abnormalities may be present inside the skull (such as tumors or bleeding). The X-ray is also used to evaluate an unusually shaped child's head.
TEST PREPARATION: Inform the health care provider if you are pregnant. Remove all jewelry.
Infants and children: The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For older children, research has shown that preparing ahead can reduce crying or resisting the procedure. In addition, children report less pain and show less distress. Proper preparation for a test or procedure that can reduce an older child's anxiety, encourage cooperation, and help develop coping skills. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:INFANT (0 TO 1 YEAR): Given the developmental level of your child (0 to 1 year), little pre-test preparation will be of benefit, but some considerations may ease your anxiety. Before the test, know that your child probably will cry, and restraints may be used. But the most important way you can help your child through this procedure is by being there and showing you care. Crying is a normal response to the strange environment, unfamiliar people, restraints, and separation from you. Your infant will cry more for these reasons than because the test or procedure is uncomfortable. Knowing this from the onset may help relieve some of your anxiety about what to expect. Having specific information about the test may further reduce your anxiety.
- TODDLER (1 TO 3 YEARS): Proper preparation for a test or procedure can minimize anxiety and help a child cope. Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try the use of play in demonstrating what will happen during the test and in discovering your child's concerns. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure.
- PRESCHOOLER (4 TO 6 YEARS): Preparation can be effective in reducing distress in children undergoing medical tests and can minimize the amount of crying and resistance to the procedure. Research finds that lowering anxiety can actually decrease the sensation of pain felt by people during uncomfortable procedures. Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try demonstrating what will happen during the test in advance to learn about your child's particular fears and concerns. Using a doll or other object to "act out" some of the procedure may help reveal worries that the child may not be willing to discuss directly. This can help reduce your child's anxiety, because most people are more frightened of the unknown than they are when they know exactly what to expect. If a child's fears are unrealistic, you can explain what will actually happen; if he or she is worried about something that is an unavoidable part of the test, do not minimize his or her concerns but reassure the child that you will be there to help as much as you can. Make sure your child understands that the procedure is not a punishment. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure.
- SCHOOL AGE (6 TO 12 YEARS): Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try the use of play in demonstrating what will happen during the test and in discovering your child's concerns. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure. Explaining the procedure will also be of value in reducing your child's anxiety. Let your child participate and make as many decisions as possible.
- ADOLESCENT (12 TO 18 YEARS): There are a number of ways to help an adolescent prepare for a difficult medical test or procedure. First, provide detailed information and explain reasons for the procedure. You can use videos in which other adolescents do the teaching to demonstrate the procedure and provide information, if available. Let your child participate and make as many decisions as possible. Depending on his or her age and independence, your child may or may not wish you to be present during the procedure, and his or her wishes should be respected. During adolescence privacy is important and should be protected.
TEST PROCEDURE: The test is performed in a hospital radiology department or in the health care provider's office by an X-ray technician. You will be asked to lie on the X-ray table or sit in a chair. Your head may be placed in a number of positions. Generally, there is little or no discomfort during an X-ray. If there is a head injury, positioning the head may be uncomfortable.
ABNORMAL TEST RESULTS: A skull X-ray may show fractures, tumors, erosion or decalcification of the bone, or shifts in the soft tissues inside the skull. The X-ray may detect increased intracranial pressure, and congenital (existing at birth) anomalies (unusual structure). Additional conditions under which the test may be performed include the following:
- Dementia
- Friedreich's ataxia
- Hydrocephalus
- Malocclusion of teeth
- Mastoiditis
- Meningitis
- Multi-infarct dementia
- Occupational hearing loss
- Otitis media; chronic
- Otosclerosis
- Petit mal seizure
- Pituitary tumor
- Senile dementia, Alzheimer's type
- Acute sinusitis
- Chronic sinusitis
SPECIAL CONSIDERATIONS: A CT scan of the head is often preferable to a skull x-ray to evaluate head injuries.
RISKS: There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks associated with X-rays.
CRANIAL CT-SCAN
(Head CT Scan, Skull CT Scan, Sinus ST Scan, Orbits CT Scan)
A cranial CT scan involves computed tomography of the head, including the skull, brain, orbits (eyes), and sinuses. A CT scan is recommended to help:
- evaluate acute cranial-facial trauma
- determine acute stroke
- evaluate suspected subarachnoid or intracranial hemorrhage
- evaluate headache
- evaluate loss of sensory or motor function
- determine if there abnormal development of the head and neck
- CT scans are also used to view the facial bones, jaw, and sinus cavities.
TEST PREPARATION: Inform the health care provider if you are pregnant. Remove all jewelry.
Infants and children: The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For older children, research has shown that preparing ahead can reduce crying or resisting the procedure. In addition, children report less pain and show less distress. Proper preparation for a test or procedure that can reduce an older child's anxiety, encourage cooperation, and help develop coping skills. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:INFANT (0 TO 1 YEAR): Given the developmental level of your child (0 to 1 year), little pre-test preparation will be of benefit, but some considerations may ease your anxiety. Before the test, know that your child probably will cry, and restraints may be used. But the most important way you can help your child through this procedure is by being there and showing you care. Crying is a normal response to the strange environment, unfamiliar people, restraints, and separation from you. Your infant will cry more for these reasons than because the test or procedure is uncomfortable. Knowing this from the onset may help relieve some of your anxiety about what to expect. Having specific information about the test may further reduce your anxiety.
- TODDLER (1 TO 3 YEARS): Proper preparation for a test or procedure can minimize anxiety and help a child cope. Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try the use of play in demonstrating what will happen during the test and in discovering your child's concerns. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure.
- PRESCHOOLER (4 TO 6 YEARS): Preparation can be effective in reducing distress in children undergoing medical tests and can minimize the amount of crying and resistance to the procedure. Research finds that lowering anxiety can actually decrease the sensation of pain felt by people during uncomfortable procedures. Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try demonstrating what will happen during the test in advance to learn about your child's particular fears and concerns. Using a doll or other object to "act out" some of the procedure may help reveal worries that the child may not be willing to discuss directly. This can help reduce your child's anxiety, because most people are more frightened of the unknown than they are when they know exactly what to expect. If a child's fears are unrealistic, you can explain what will actually happen; if he or she is worried about something that is an unavoidable part of the test, do not minimize his or her concerns but reassure the child that you will be there to help as much as you can. Make sure your child understands that the procedure is not a punishment. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure.
- SCHOOL AGE (6 TO 12 YEARS): Before the test, know that your child probably will cry and that preparation may not change the fact that your child will feel some discomfort or pain. You can try the use of play in demonstrating what will happen during the test and in discovering your child's concerns. The most important way you can help your child is through this kind of preparation and by providing support around the time of the procedure. Explaining the procedure will also be of value in reducing your child's anxiety. Let your child participate and make as many decisions as possible.
- ADOLESCENT (12 TO 18 YEARS): There are a number of ways to help an adolescent prepare for a difficult medical test or procedure. First, provide detailed information and explain reasons for the procedure. You can use videos in which other adolescents do the teaching to demonstrate the procedure and provide information, if available. Let your child participate and make as many decisions as possible. Depending on his or her age and independence, your child may or may not wish you to be present during the procedure, and his or her wishes should be respected. During adolescence privacy is important and should be protected.
TEST PROCEDURE: A head CT will produce an image from the upper neck to the top of the head. If the patient cannot keep his/her head still, immobilization may be necessary. All jewelry, glasses, dentures, and other metal should be removed from the head and neck to prevent artifacts. A contrast dye may be injected into a vein to further evaluate a mass. (The mass becomes brighter with contrast dye if it has a lot of blood vessels). Contrast dye is also used to produce an image of the blood vessels of the head and brain. The total amount of time in the CT scanner is usually a few minutes.
As with any intravenous iodinated contrast injection, there may be a slight temporary burning sensation in the arm, metallic taste in the mouth, or whole body warmth. This is a normal occurrence and will subside in a few seconds. Otherwise, the CT scan is painless.
ABNORMAL TEST RESULTS: There may be signs of trauma, bleeding (for example, chronic subdural hematoma or intracranial hemorrhage), stroke, masses or tumors, abnormal sinus drainage, sensorineural hearing loss, malformed bone or other tissues, brain abscess, cerebral atrophy (loss of brain tissue), brain tissue swelling, hydrocephalus (fluid collecting in the skull). Additional conditions under which the test may be performed: acoustic neuroma, acoustic trauma, acromegaly, acute (subacute) subdural hematoma, amyotrophic lateral sclerosis, arteriovenous malformation (cerebral), benign positional vertigo, throat cancer, central pontine myelinolysis, cerebral aneurysm, Cushing's syndrome, deep intracerebral hemorrhage, delirium, dementia, dementia due to metabolic causes, drug-induced tremor, encephalitis, epilepsy, essential tremor, extradural hemorrhage, familial tremor, general paresis, generalized tonic-clonic seizure, hemorrhagic stroke, hepatic encephalopathy, Huntington's disease, hypertensive intracerebral hemorrhage, hypopituitarism, intracerebral hemorrhage, juvenile angiofibroma, labyrinthitis, lobar intracerebral hemorrhage, Ludwig's angina, mastoiditis, melanoma of the eye, Meniere's disease, meningitis, metastatic brain tumor, multi-infarct dementia, multiple endocrine neoplasia (MEN) I, neurosyphilis, normal pressure hydrocephalus (NPH), occupational hearing loss, optic glioma, orbital cellulitis, otitis media; chronic otosclerosis, partial (focal) seizure, partial complex seizure, petit mal seizure, pituitary tumor, primary brain tumor, primary lymphoma of the brain, prolactinoma, retinoblastoma, Reye's syndrome, schizophrenia, senile dementia/Alzheimer's type, acute sinusitis, stroke secondary to atherosclerosis, stroke secondary to cardiogenic embolism, stroke secondary to FMD, stroke secondary to syphilis, subarachnoid hemorrhage, syphilitic aseptic meningitis, temporal lobe seizure, toxoplasmosis, transient ischemic attack (TIA), Wilson's disease.
CONVENTIONAL MEDICAL TREATMENT FOR HEARING LOSS
Appropriate treatment for hearing loss depends on the underlying cause.
CONSIDERATIONS
Food allergens, especially allergies to wheat and dairy products, can be the culprit in recurrent middle ear infections. See Allergies for more information.
You can minimize the level of hearing loss you will experience as you grow older if you reduce your exposure to loud noises in the earlier years of your life. Hearing can also be improved with proper diet and supplements.
If you have to raise your voice to be heard over your surroundings, your environment is too noisy. You should try to limit your exposure to such places. If such exposure cannot be avoided, you should wear proper ear protection.
Most cases of early childhood hearing deficit are first detected by the parents, not health care providers. You know what is "normal" for your child and you are more likely to pick up on subtle signs of hearing difficulty during normal routines throughout the day. If you have concerns, discuss it and arrange hearing loss testing for your child.
The average rock concert or stereo headset set at full blast (about 100 decibels) can damage your hearing in little as half an hour. Similar damage can occur after about two hours spent in a video game arcade.
Any hearing loss that does not resolve on its own within two weeks should be evaluated by a professional. Some of the symptoms associated with hearing loss can be a sign of a serious health problem that requires treatment.
HERBAL & HOLISTIC RECOMMENDATIONS
Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
HERBS
- Bayberry bark, burdock root, goldenseal, hawthorn leaf and flower, and myrrh gum purify the blood and counteract infection. Caution: Do not take goldenseal internally on a daily basis for more than one week at a time, as it may disturb normal intestinal flora. Do not use it during pregnancy, and use it with caution if you are allergic to ragweed.
- Echinacea aids poor equilibrium and reduces dizziness. It also fights infection and helps reduce congestion. It can be taken in tea or capsule form.
- Ephedra, eucalyptus, hyssop, mullein and thyme have decongestant properties, which may alleviate ringing in ears.
- Ginkgo biloba helps to reduce dizziness and improves hearing loss related to reduced blood flow. Other herbs that may help to improve circulation and blood flow to the ear area include butcher's broom, cayenne, chamomile, ginger root, turmeric, and yarrow.
- To soothe inflammation and fight infection, mullein oil can be used as ear drops. If mullein is not available, garlic oil or liquid extract may be substituted.
NUTRITIONAL RECOMMENDATIONS
Eat fresh pineapple (contains bromelain) frequently to reduce inflammation.
Limit your consumption of alcohol and sugars, which encourage the growth of yeast. This is particularly important if you have recurrent ear infections and have been treated with antibiotics. Also eliminate or keep to a minimum your intake of caffeine, chocolate, and sodium.
Avoid saturated fats, which contribute to excess production of earwax.
Nutrients Supplement Suggested Dosage Comments Important Coenzyme Q10 30 mg daily. Powerful antioxidant. Crucial in the effectiveness of the immune system and circulation to the ears. Manganese 10 mg daily. Deficiency has been linked to ear disorders. Multivitamin and mineral complex As directed on label. To provide a balance of all nutrients. Potassium 99 mg daily. Important for a healthy nervous system and transmission of nerve impulses. Ultimate Oil from Nature's Secret As directed on label. Blend oil of essential fatty acids. Helps reduce tendency to produce excessive earwax. Vitamin A
Plus
Natural beta-carotene15,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily.
15,000 IU daily.To boost immunity, increase resistance to infection, and strengthen mucous membranes. Vitamin B Complex injections As prescribed by physician. Essential for healing. Reduces ear pressure. Injections (under a health care provider's supervision) are best. If injections are not available, use a sublingual form. Vitamin C with Bioflavonoids 3,000-6,000 mg daily. Needed for proper immune function and to aid in preventing ear infections. Plus
N-acetylcysteineAs directed on label. To remove excess fluids from the ear canal. Vitamin D 400 IU daily. Enhances immunity. Vitamin E 600 IU daily. A powerful antioxidant that improves and increases circulation. Zinc lozenges
(Ultimate Zinc-C Lozenges from Now Foods)50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Quickens immune response. Aids in reducing infection.
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NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You suspect you or a family member has a hearing loss and needs to be tested. If you or a family member experience ear pain, bleeding from the ear, or other serious signs of infection or trauma, get medical assistance immediately.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
Diagnosis and Treatment of Hearing Impairment in Children
-- by Dennis G. Pappas
Helpful Links
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