Health: from clarity to quiet - the impact of sudden hearing loss

Hollywood has led us to believe that an extremely loud noise like an explosion is the sudden and dramatic reason for our hearing to go. The reality is that is rarely the case. Instead, it is much more commonly related to viral illness, bacterial infection or a vascular problem that involves some impairment of blood flow.

That’s according to Mr Neil Riley, Ear, Nose and Throat surgeon in UPMC hospital in Kilkenny and Whitfield Clinic in Waterford.

“With vascular problems, you could either have a bleed into the inner ear or a clot. It can go either way, the blood can leak or the blood flow can fail. Either way you are going to get a reduction in oxygen to the nerve tissue. Nerve tissue is the part of your body that responds worst to oxygen deprivation,” he says. “In other parts of the body, it could be hours before this has an impact but with hearing, it’s a matter of minutes and usually, almost always, leaves you with sudden, one-sided hearing loss.”

The good news is that it can be temporary. “The younger you are, the quicker you are to recover so it may be safe to go out clubbing at 19 but it’s not safe to do it at 69. Most noise-induced hearing loss is due to years of exposure without ear protection.”

Impact of COVID-19

With some GPs reporting, anecdotally, that there has been an increase in patients presenting with sudden hearing loss since the COVID-19 pandemic and the British Medical Journal (BMJ) publishing a recent paper suggesting a link, does Neil believe there is a connection?

“It has been postulated,” he says. “Being a new disease, of course we will see these studies coming in the next year or two about links and associations. Yes, there was a suggestion that sudden hearing loss which is tied in with other viruses is also arising with COVID-19.”

Fast response is essential

With sudden hearing loss, a fast medical response is very important. “There is very little point in me seeing a person who has suffered acute hearing loss three weeks ago,” he says. “If someone experiences sudden hearing loss, they should see their GP straight away or go to their nearest Emergency Department.

“The treatment for inner ear damage is generally oral steroids given as soon as possible after the event. You have to get the treatment rolling quickly but unfortunately it doesn’t always guarantee success.”

Other symptoms

When sudden hearing loss occurs, usually in one ear, there are usually other symptoms as well.

“Tinnitus (an internal ringing in the ear) often occurs in tandem with sudden hearing loss,” he says.

“Balance upsets can occur on occasion too. Discomfort isn’t common unless the sudden hearing loss has been caused by acute infection.”

Sudden hearing loss, on one side, will also alter your perception of sound, he adds.

“Voices sound different if you are losing certain frequencies. This is particularly the case when the damage tends to be in the higher frequencies as it gives a different quality, a sort of ‘tinny-ness’, to people’s voices. Music will sound different too.”

If the hearing loss is due to bacterial infection, antibiotics will be prescribed.

“Shingles in the inner ear can be astonishingly painful, for example. Steroids, antiviral and painkiller medication would be prescribed in that case.”

Hearing aid

A hearing aid may be required depending on the degree of hearing loss.

“As well as amplifying the sound, it can also reduce tinnitus by making you less aware of it. Tinnitus also tends to reduce as time goes on too. Hearing aids are not a cure, of course. They are effectively a magnifying glass.”

According to research carried out by Hidden Hearing, farmers and contractors are among the people most at risk of hearing loss, with 19 out of the 21 pieces of farm machinery included in the research showing noise levels above 80 decibels — the level that can cause hearing loss. Combine harvesters, balers and tractors are the worst for your hearing, all ranking at over 100db, while cultivators, rotavators, power harrows and milking parlours all ranked at over 90db.

The study also showed that mowers, ploughs and seed planters can also cause lifelong hearing damage if you’re working with them for over 15 minutes without ear protection.

As an ENT surgeon, Neil treats many farmers from Kilkenny, Waterford and surrounding counties. “Farmers usually come to me with long term noise exposure problems - damage caused by machinery noise, grinders, chainsaws, silage harvesters and so on, also guns.”

It’s not just machinery that can cause hearing loss — some farm animals, especially pigs can put farmers at an even higher risk.

“Almost every pig farmer I’ve come across has a certain level of hearing loss. Squealing pigs can seriously damage your hearing particularly in the confined environment of a piggery.”

He also treats farmers who have experienced physical damage to their ears and injuries from working with machinery, specifically when welding. “Occasionally there would be burst eardrums and injuries to the ears from working with hedging and so on. Sometimes a burst eardrum has to be patched surgically.

“I’ve come across scenarios where a person could be under a vehicle, welding an exhaust for example, and something enters the ear and burns a hole in the eardrum. If you put a pencil through your eardrum accidentally, by and large that will heal, but if you get a spark in there it doesn’t heal as well. This is because there is a burn on the margin of the perforation and it’s difficult for that scarred tissue to recover.

“So the key message for farmers is no matter where you are on the farm – wear ear defenders to protect your hearing.”

Margaret Hawkins has been interviewing people affected by health issues in Irish Country Living for years. However, this week she talks about her own experience with sudden hearing loss which occurred when smoke alarms, upstairs and down, malfunctioned and went off randomly and simultaneously.

“The noise was piercing and it took ages to figure out how to stop them.

“It included ringing my son-in-law who is an electrician and getting up on a chair with a broom handle to press the buttons to stop them. All that took time. I had tinnitus immediately and as regards to my hearing, I thought it would improve any minute if I just yawned or swallowed and my ear ‘popped’ but that didn’t happen unfortunately. I had no idea that I should go to a doctor quickly.

“Getting my ears syringed for wax eight days later didn’t solve anything either and by this stage I knew I’d lost a lot of hearing on the right side because when I put my finger in my left ear while looking at TV, I could hear only a mumble.

Major shock

“I got a hearing test appointment the following week and this showed that I had only 25% hearing in my right ear which was a major shock. I was immediately referred to my GP who prescribed steroids and sent me to University Hospital Waterford to the ENT clinic there.

“More steroids were prescribed but nothing made a difference. I was offered a steroid injection into my ear also but I didn’t think it would make any difference at that stage and I also didn’t fancy it so I declined. An MRI a few weeks later showed that I had something called a vascular loop issue in my inner ear – a little artery compressing a cranial nerve – so the sound wasn’t getting through.

“While I had been aware from a medical check-up years before that the hearing in my right ear wasn’t as good as my left it was only marginally less.

“I don’t know to what degree the noise trauma of the alarms going off made my hearing worse but the reality is that surgery can’t be done and I don’t think I’d want to risk it anyway in case my balance is affected.

Hearing aid

“That’s eight months ago now and I’ve had a hearing aid for the past two. It has diminished the tinnitus a bit and I can hear in a more balanced way. The most upsetting aspect of the loss was that I couldn’t hear where sound was coming from and I couldn’t hear myself sing properly or enjoy music properly. My world felt ‘lop-sided’.

“From now on, I’ll need a hearing aid – an expensive commodity – but at least it helps. I’ll just have to get used to it and get on with life. Looking back, had I known that fast treatment was important, I’d have gone to my GP quicker. She and the practice nurse mentioned that they had seen more cases of sudden hearing loss since COVID and I’ve had it twice so maybe that has been part of the cause as well, who knows?”

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