Central Auditory Processing Disorders
Sometimes, children exhibit classic signs of hearing loss: they do not hear well, or may only understand a portion of what is being said. They experience learning difficulties, particularly in environments with lots of background noise. When multiple people are talking, they lose focus and can’t follow the conversation. Parents may suspect a hearing loss, but in many cases, the cause is a behavioral disorder known as Central Auditory Processing Disorder (CAPD). An estimated five percent of school-age children suffer from CAPD, a condition that affects their ability to process information correctly due to a disconnect between what they are hearing and how their brain responds.
Most children with CAPD don’t actually have hearing loss. Studies have shown the majority are able to hear normally in quiet environments; the problem is in the way they process auditory information. Symptoms may range from mild to severe and include difficulty with any of the following:
- Hearing in noisy environments
- Following conversations
- Remembering spoken information
- Maintaining focus and attention
- Following directions
- Reading and spelling
- Processing nonverbal information
Children with CPAD may become withdrawn, isolated and depressed. They often become disruptive and may take unnecessary risks or lash out at others. Because many of the behavioral issues closely mimic those associated with Attention Deficit Hyperactivity Disorder (ADHD) and other learning disabilities, an incorrect diagnosis is often made. An audiologist can determine the exact nature of your child’s issues through a routine hearing test, which will rule out any physical hearing problems by testing their ability to hear a range of frequencies. If no hearing loss is present, behavioral and electrophysiological testing is administered.
Ménière’s disease is an inner ear disorder that causes fluctuating hearing loss, tinnitus, vertigo and fullness or pressure in the ear. It is the result of excess fluid in the inner ear. There is no cure for Ménière’s disease, but various strategies can help you manage your symptoms.
What Causes Ménière’s Disease?
The exact cause of Ménière’s disease is unknown. It is believed to be associated with a dysfunction of the endolymphatic sac, an organ responsible for regulating the volume and pressure of fluid in the inner ear. Various theories point to circulation disorders, viral infections, head trauma, allergies, migraines and obstructions of the ear canal as possible causes.
It is estimated that Ménière’s disease affects about one out of every 1,000 people, with most patients between the ages of 40 and 60.
What Are the Symptoms of Ménière’s Disease?
People with Ménière’s disease suffer progressive attacks that are often characterized by warning signs in advance. These include loss of balance, dizziness, headache, increased hearing loss and/or tinnitus, sensitivity to noises, and pressure in the ear. During the attack, you may experience episodes of severe vertigo, fluctuating hearing loss, fullness in the ear, and tinnitus. These symptoms may be accompanied by anxiety, blurry vision, nausea, vomiting, trembling, rapid pulse, and diarrhea.
Afterwards, exhaustion often sets in, leading to an increased need for sleep. Attacks may be brief, lasting for as little as 20 minutes, or may persist for as long as 24 hours. Their frequency is unpredictable and sporadic; they may occur several times a week, or as little as once every few years. Due to the unpredictable nature of this disease, it’s impossible to tell just how much it will affect your life.
How Is Ménière’s Disease Treated?
Because the symptoms of Ménière’s disease resemble those associated with other conditions, we will need to perform hearing and balance tests in order to make a diagnosis. An audiogram will show hearing loss in the low tones, a key indicator of Ménière’s disease. In some cases, imaging scans or blood tests are ordered.
Medical options for treating Ménière’s include motion sickness and anti-nausea medications, diuretics, an antibiotic called Gentamycin, and oral or injectable steroids. These, coupled with a low-sodium diet, can help prevent dizziness or reduce the severity of attacks. Other lifestyle remedies include limiting caffeine, alcohol, chocolate and monosodium glutamate from your diet; drinking six to eight glasses of water per day; quitting smoking; avoiding allergens; and reducing stress and anxiety.
When medications don’t work, you may benefit from vestibular rehabilitation exercises to improve balance. Hearing aids will help treat hearing loss associated with Ménière’s.
Individuals who experience severe attacks and are unable to find relief from other treatments may have success with surgery. Procedures that have proven effective include an endolymphatic sac procedure to drain fluid from the inner ear, a vestibular nerve section to cut the nerve that connects the ear and brain to eliminate dizziness and preserve hearing, and a labyrinthectomy to control dizziness.
Single-sided deafness (SSD), sometimes referred to as unilateral hearing loss, is a condition in which an individual experiences hearing loss in only one ear but can hear normally out of the other ear. While the majority of patients with a hearing impairment suffer from bilateral (two-sided) hearing loss, SSD is diagnosed in approximately 60,000 people in the United States each year. There is no cure, and treatment can be a challenge because traditional amplification devices prove less effective. However, alternative options are available for managing single-sided deafness.
What Causes Single-Sided Deafness?
SSD can be caused by a variety of factors. One of the most common causes is acoustic neuroma, a benign, slow growing tumor that can push against the auditory nerve and affect the ability to hear properly in one ear. Sudden deafness – a rapid onset of hearing loss that occurs with little or no warning, often following a viral infection – is another condition commonly associated with SSD. Patients may fall victim to sudden deafness as a result of an inflammation in the cochlea that causes permanent damage to the hair cells responsible for hearing.
Additional causes of SSD include trauma to the head, genetic disorders, Meniere’s disease, labyrinthitis, microtia, mastoiditis and even common childhood diseases such as measles and bumps.
Patients with SSD find understanding speech in the presence of background noise especially problematic and have great difficulty localizing sound (recognizing the location or origin of a sound source). Sound localization depends on subtle hearing cues from two ears; removing one from the equation confuses the brain. Other symptoms might include anxiety, stress, social isolation, dizziness, difficulty paying attention and speaking loudly.
Treatments for SSD
While there is no cure for single-sided deafness, options exist for helping patients cope with unilateral hearing. Traditional hearing aids don’t offer much help to those suffering from SSD, but Contralateral Routing of Signal (CROS) hearing aids can improve hearing and localization. They utilize a microphone that is placed in the vicinity of the impaired ear and an amplifier near the normal ear. The microphone picks up sounds and transmits them to the patient’s “good” ear. A similar device known as BICROS is suitable for individuals with some degree of hearing loss in one ear and total deafness in the other.
Another option is a Bone Anchored Hearing Aid (BAHA), a surgically implanted device that uses direct bone conduction to transmit sounds from the affected ear to the normal one. Vibrations in the bones of the ear canal and middle ear stimulate the hair cells of the cochlea, boosting the ability to hear.
For most people who experience hearing loss, the condition comes on gradually over a period of years. In rare cases, an abrupt loss of hearing occurs with little or no warning. This condition, known as sudden sensorineural hearing loss (SSHL), is defined as a hearing reduction of 30 dB or greater over three contiguous frequencies, occurring over a period of 72 hours or less. Ninety percent of cases result in unilateral (single-sided) hearing loss, which may be accompanied by dizziness or tinnitus.
The severity of the hearing loss varies. Some patients recover completely and without medical intervention in just a few days. Others find their symptoms improve gradually over a couple of weeks. Fifteen percent of those who experience sudden deafness will have hearing loss that worsens over time.
There are over 100 possible causes for SSHL. These include infectious diseases, head trauma, abnormal tissue growth, circulatory problems, neurologic disorders, toxic causes, immunologic diseases, inner ear problems such as Meniere’s disease and ototoxic medications. Certain groups of antibiotics, in particular, have been shown to destroy the hair cells of the cochlea, causing sudden deafness that is often permanent in nature. These must be used with extreme caution and should be avoided unless they are the only viable course of treatment for a life-threatening illness. Be sure to question your physician or clinic thoroughly when antibiotics are prescribed.
Risk factors for SSHL include a prior diagnosis of meningitis, a recent head injury, ear infection, exposure to loud noise, a sudden change in pressure and starting a new medication.
Symptoms that often precede or accompany sudden deafness include:
- Tinnitus (ringing in the ears)
- Vertigo or dizziness
- Fullness in the ear
- A sudden loud “pop” in the ear, similar to what you’d experience with a change in pressure
- Muffled hearing upon wakening or when trying to use the telephone
If you experience any of these symptoms, see a physician or audiologist immediately. Doctors believe that prompt medical attention offers the best chances for a full recovery. Do not delay – your hearing depends upon it.
Treatment varies and will depend upon the cause (if known). Steroids, which reduce inflammation and swelling and aid the body in fighting illness, are the most common treatment method for sudden deafness.
Call Hearing Health Centers at (712) 262-7774 for more information or to schedule an appointment.