Hearing loss (also called hypoacusis) is a term used for every situation where hearing as a reliable means of communication with the outside world is restricted. Hearing and speech understanding must be distinguished, especially in quiet and in noise. This means that many people who have good speech understanding in quiet and a restricted ability to hear in a noisy environment may still consider themselves as having normal hearing. Owing to the progressive nature of many types of hearing loss, it is extremely important to carry out differential diagnostic procedures and document the current situation as early as possible. This can serve as a ‘snapshot’, which may potentially not only lead to adequate preventive or therapeutic measures but also serve as a dependable basis for
optimal therapy planning in the future.
Hearing disorders can occur in all parts of the ear and are labelled according to their site of origin:
> Middle Ear Hearing Loss
Hearing disorders that have their origin in the middle ear can, as a rule, be treated surgically. The simplest form of treatment, for example in the case of middle ear effusion, is the incision of the eardrum (called paracentesis), if necessary including the insertion of a ventilation tube known as a grommet. If an individual suffers from chronic inflammation (e.g. cholesteatoma), or middle ear injuries caused by accidents, or other disorders (such as otosclerosis), the inflammation can be surgically removed and the ossicular chain reconstructed – either by treating the individual’s own ossicles or by using what is called a passive prosthesis in the middle ear. These are implants which serve as a functional replacement for the ossicles. An example of this is a stapes prosthesis to replace the stapes (one of the ossicles).
> Inner Ear Hearing Loss / Sensorineural Hearing Loss
Hearing disorders that originate in the inner ear (sensorineural hearing loss) can be medically treated only if they progress rapidly. If hearing disorders develop slowly over a fairly long period, hearing systems are usually the treatment of choice. For this purpose, conventional hearing aids are available, which have seen tremendous advances in the last few years – with regard not only to their appearance but also to their technology. Alternative options are partially implantable and fully implantable hearing systems, which provide good speech understanding in noise.
Individuals suffering from bilateral profound sensorineural hearing loss receive an electronic auditory prosthesis called a cochlear implant (CI). Our experts recommend a CI if an individual’s speech understanding is poor despite their hearing aids. In young children, however, because their speech understanding cannot be tested, the results of hearing tests and other ENT examinations form the basis for the decision whether or not they should receive a CI.
> Combined Hearing Loss
In cases of combined hearing loss, it is crucial to determine whether or not the ventilation of the middle ear can be optimised. If this is the case, a hearing aid with less amplification needs to be provided to combat the sensorineural hearing loss.
New treatment approaches combine passive middle ear implants (ossicular prostheses) with active middle ear implants.
Individuals with deafness (total hearing loss) can be treated by cochlear implantation, provided that the auditory nerve is intact.
If the auditory nerve is not intact, a central auditory implant such as the auditory brainstem implant (ABI) or the auditory midbrain implant (AMI) may be an option.