Treatment of Hearing loss
There are different treatments designed to cure or improve the effects of hearing loss or deafness. Their application depends on the origin, causes and characteristics of the lesion causing the deafness or loss of hearing.
Non-drug therapy
Artificial hearing devices
Hearing aids. Their main purpose is to amplify sound and render speech more audible without creating user discomfort. All types of hypoacusis require a greater level of stimulation to improve the patient’s hearing. Besides increasing its strength, the auditory signal must also be customised and adapted to each patient depending on their specific hearing impairment. Hearing aids are designed to give sounds these quantitative and qualitative properties and therefore produce an audible result. Like all electronic devices, modern hearing aids have improved significantly with fewer problems of tolerance and adaptation in patients. They are recommended for mild to severe cases of hearing loss. There are two types available:
- Air conduction. The amplified signal is transmitted to the external ear canal.
- Bone conduction. The amplified signal is transmitted to the inner ear by means of the mastoid bone.
Implantable devices. These devices are designed to mitigate hearing loss. They are either partially or fully implanted by means of a surgical intervention.
- Bone or oseeointegrated conduction implants. These implants are anchored to the parietal bone. They are equipped with a sound processor that converts sound into vibrations before transmitting them through the skull and directly to the inner ear.
- Cochlear implants. These devices replace the function of the cochlea (inner ear) by transforming sound, which is captured by an external processor, into electrical impulses that are sent directly to the auditory nerve through an array of electrodes implanted within the cochlea. Cochlear implants are only prescribed in cases of severe or profound hearing loss.
The most common types of hearing aid
Depending on the degree of impairment measured during each patient’s audiometry test, the hearing aid specialist will decide on the most appropriate type of hearing aid for the given hearing loss.
Behind-the-ear (BTE) hearing aids
- With an earphone placed in the ear. Sound is transmitted along a very discreet, hair-like wire to an earphone positioned in the ear canal and close to the eardrum. A small ear mould holds the earphone in place.
- With a sound tube. Sound is sent down a tube to a mould or adapter that fits perfectly inside the ear. These devices have a larger battery than those with earphones and can produce greater amplification, so they are more powerful and ideal for people with severe hearing loss.
In-the-ear (ITE) hearing aids
Hearing aids placed within the ear canal are customised (made-to-measure) according to the shape of the wearer’s canal. They are ideal for mild to moderate hearing loss but cannot be used for severe cases. The size and shape of each patient’s ear canal determines whether they can use an ITE hearing aid and how visible it will be.
- Completely-in-the-canal (CIC) hearing aids. These are positioned in the deepest part of the ear canal.
- In-the-canal (ITC) hearing aids. These are placed in the outermost portion of the external ear canal.
Hearing aid technology has advanced rapidly and today they can resolve many more types of hearing loss and much better than they did a few years ago.
Drug therapy
This depends on the causes of hearing loss:
Wax plugs or epithelial debris. These are the most common causes of hearing loss found in primary care. In these cases, products that dissolve wax (cerumenolytic) are administered to remove it more easily.
Otitis. Antibiotics can be administered to act against the germs that cause otitis, as well as anti-inflammatories to reduce complications. They can be in the form of drops for otitis externa or oral for otitis media.
Chronic otitis. In chronic otitis, there may be a problem in obstruction of the Eustachian tube, which ventilates the space between the middle ear and nose. In these cases, nasal decongestants, antihistamines and/or corticosteroid anti-inflammatories are prescribed.
Age-related sensorineural hearing loss or presbycusis. There is no specific pharmacological treatment. A large number of substances - antioxidants, vitamin complexes (A, B, C and E), folic acid, pantothenic acid, coenzyme A, coenzyme Q10, gingko biloba and calcium channel blockers - have been studied, but with inconclusive or contradictory results.
Sudden deafness due to a viral or vascular pathology. The only proven treatment in studies is early corticosteroid administration, due to its anti-inflammatory and immunosuppressive effect. These are administered orally or by the specialist via intratimpanic injection.
Surgical treatment
The surgical treatment for hearing loss depends on the location of the underlying lesion.
- In the case of otitis media where the discharged pus remains in the middle ear, and without producing spontaneous perforation and otorrhoea, a myringotomy (incision in the eardrum) may be indicated to allow the pus to discharge.
- When otitis media is caused by Eustachian tube dysfunction, an incision is made in the tympanic membrane, or eardrum, and a drain (or transtympanic ventilation tubes) inserted through the hole. This procedure communicates the middle ear with the outer ear, thus replacing the dysfunctioning Eustachian tube.
- Otosclerosis (a generally hereditary disease that causes calcification of the stapes and ossicles, preventing their normal vibration) can be treated surgically by replacing the stapes with a prosthesis (stapedectomy).
- Tympanoplasty is a surgical procedure conducted to repair alterations in the eardrum (particularly perforations), and can be accompanied by reconstructive surgery of the ossicles.
- A mastoidectomy is a set of surgical interventions used to treat chronic otitis by removing any damaged areas in the different cavities of the middle ear and mastoid bone.
- If the hearing loss is due to a benign tumour located in the upper portion of the auditory vestibular nerve, which is otherwise known as an acoustic nerve neuroma, then it may need to be removed via a surgical intervention.
Complementary therapies
- Aural rehabilitation. Evidence shows that aural rehabilitation programmes implemented to complement the use of hearing aids bring about significant improvements in patients’ perception of their hearing impairment in comparison with the use of hearing aids alone.
- Individual auditory training. Analytical auditory training programmes break speech down into its basic parts (consonants and vowels) to improve the patient’s ability to distinguish between them and recognise them. The primary aim of a synthetic approach is to improve their listening skills by using key points associated with linguistic and contextual redundancy.
- Group aural rehabilitation programmes (communication strategies). In contrast to individual courses, these provide guidance and communication strategies to help patients cope better with any deficits in their social participation.
- Active Communication Education (ACE) programme. The ACE programme was created in Australia by Louise Hicks, Linda Worrall and Nerina Scarinci. The training course focuses on older adults with hearing loss and is based around problem-solving strategies. It contains six modules about daily communication activities that have proven difficult for older adults with hearing loss and their closest relatives, such as using the telephone, watching television, eating in a restaurant and holding a conversation during dinner. The specific modules covered throughout the sessions depend on the communication needs identified by the participants during their first session.
Treatment complications
The complications associated with drug therapies are those inherent to the use of antibiotics, antihistamines, anti-inflammatories and corticosteroids. Health professionals compare the health benefits against possible side effects in each case.
Complications involved with surgical treatments depend on the site of the lesion causing the hearing loss as well as the operation required to resolve the problem. These complications include:
- Tympanic membrane perforation (ruptured eardrum).
- Damage to the chorda tympani nerve, which could result in an altered sense of taste.
- Damage to the facial nerve causing paralysis of facial muscles.
- Dizziness.
- Infections, including meningitis.
- Partial or total deafness.
Advances in surgical techniques and instrumentation have minimised the number of complications in surgeries.
Complications associated with the use of artificial hearing devices are:
- In the case of hearing aids or non-implantable prostheses, the most common complication is that the patient is unable to adapt to the device. The hearing aid specialist will take care of adjusting the device’s fit so the patient finds it easier to adapt.
- In the case of implantable devices, adaptation issues may be occur, which will require optimal adjustment of the implant by the specialist. Problems associated with surgery are very rare. Osseointegrated prostheses may lead to skin problems at the implantation point; while infections, facial paralysis, cerebrospinal fluid fistula and meningitis have been described very occasionally in cochlear implants.
Substantiated information by:
Published: 18 May 2018
Updated: 28 March 2025
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