Hearing loss

Some people experience hearing problems after brain injury. This can be caused by damage to the ear or damage to the parts of the brain that control hearing. Depending on what kind of damage the hearing systems have sustained, the deficits may be temporary or permanent. Treating hearing problems is done by a specialist such as an ear, nose and throat (ENT) doctor or audiologist. They will do an assessment to determine the cause of the hearing problems and the extent of the injury. They will then recommend appropriate assistive devices, treatment and develop a plan to help the person cope with the changes they are experiencing.

Hearing loss is a difficult effect of brain injury that can change the way a person completes activities of daily living (ADLs) and communicates with others. It can lead to social isolation, which in turn leads to feelings of loneliness, depression, and anxiety. Socialization is important to mental health and well-being. 

It will take time and patience to cope with the changes that come with hearing loss. With the right assistive devices, treatment plan, and motivation it is possible to be social, work and complete activities of daily living.

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Types of hearing loss

Hearing loss can happen in one or both ears. It generally means that while hearing has changed, a person retains some level of hearing. Levels of hearing loss are classified in the following categories [1]:

  • Mild – they struggle to hear quiet/soft sounds
  • Moderate – they struggle to hear speech when someone is speaking at a normal volume, especially in loud environments
  • Severe – they can’t understand speech without an assistive device when someone is speaking a normal volume, and they only hear some loud sounds
  • Profound – they may only hear extremely loud sounds, and no speech without an assistive device

There are three main types of hearing loss [2]:

Conductive hearing loss

Conductive hearing loss refers to injury to the outer ear or the middle ear. Damage to the outer ear can harm the eardrum or dislocate/break the small bones in the middle ear. This can happen through a traumatic injury such as a fall, assault or motor vehicle accident. The middle ear can also be affected through ear infections or fluid buildup, which affects the nerves that help us hear. Damage to the outer and middle ear will usually heal using medicine or just with time and patience.

Sensorineural hearing loss

This refers to damage to the inner ear. This can include damage to the auditory nerve, or damage to the cochlea. This is the most common type of hearing loss, and is typically caused by aging or exposure to noise. For example, people who work in loud workplaces like factories are at risk of sensorineural hearing loss. It’s also common in the elderly.

Unfortunately this kind of hearing loss is permanent. Audiologists will most commonly recommend hearing aids to help with any hearing deficits.

Mixed hearing loss

Mixed hearing loss is when a person experiences both sensorineural hearing loss and conductive hearing loss. For example, a person may experience hearing loss because of a traumatic brain injury. This is conductive hearing loss. As they age, their hearing may deteriorate as well. This is sensorineural loss. Therefore, they have mixed hearing loss.

Hearing loss due to brain damage

If the part of the brain that controls hearing is damaged, it can cause problems with the brain’s ability to process sounds and connect them to words or meanings. This means the ear may work properly, but it’s difficult to understand sounds. This may be permanent.

Depending on the diagnosis, an ENT physician or audiologist may recommend using hearing aids, learning adaptive methods of communication and working with rehabilitation specialists. 

Additional hearing impairments

There are additional hearing impairments that can contribute to hearing loss.

Auditory agnosia

Auditory agnosia occurs when there is damage to the temporal and parietal lobes of the brain. It refers to a person not being able to recognize nonverbal sounds (like alarms or dog barking), but still being able to speak. If a person is experiencing auditory agnosia, they will need to work with a specialist. 

Tinnitus

Tinnitus is described as a ringing or buzzing in the ears. It can happen from damage to the inner ear or from damage to the parts of the brain that control hearing. It often comes and goes, but for some people it can be there constantly. Tinnitus can be incredibly distracting and frustrating for the people who experience it: it can be so severe that it can stop someone from living their lives.

People with tinnitus may require cognitive behavioural therapy or other coping methods such as using hearing aids. More tips for coping with tinnitus include[3]:

  • Avoiding noisy environments
  • Using earplugs
  • Using a white noise machine during the night
  • Speak with a medical provider about medications – some medications can make tinnitus worse
  • Focus on getting good sleep and supporting them taking care of their mental health 
Hyperacusis

Hyperacusis is a rare condition. It means that a person has an increased sensitivity to everyday noises or rapid changes in volume because of trauma to the ear systems. This means that sounds like dishes clinking together, alarms, keyboard tapping, listening to music or even clapping can cause physical pain of varying degrees.

While a person with hyperacusis will need to work with an audiologist to determine treatment, there are some things that can be done to help minimize the effects.

  • Go out to public places during quieter hours
  • Use ear plugs to muffle noise
  • Use hearing aids
Meniere’s syndrome

Meniere’s is when there’s excessive pressure on the chambers of the inner ear. In most cases it only affects one ear. Meniere’s causes hearing loss, vertigo, imbalance, and more. It’s a debilitating syndrome that can impact a person’s ability to do tasks like work, drive, or walk. This syndrome has no cure and is a chronic condition that can come and go. Doctors are able to recommend courses of treatment that may include medication [4].

Deafness

According to the Canadian Association of the Deaf (CAD), deafness is defined as the extent of loss of functional hearing, and the person relies on their eyesight rather than their hearing for communication, or they require an assistive hearing aid. This includes lip reading, sign language, reading and writing [5].

Deafness can be caused by damage to the parts of the brain that help with auditory processing – turning sounds into words, and associating sounds with their meanings. This can be caused by meningitis, stroke, and other causes of brain injury. Deafness can also be caused by irreparable damage to the cochlea and inner ear.

When a person loses their hearing to the point of deafness, they need to learn new ways to cope with this change. This includes communicating with others and navigating their environment.

Impact of age and exposure to noise on hearing

The most common causes of hearing loss are age and over-exposure to noise. This can happen if a person works in a loud environment. If a person experience hearing loss due to a brain injury, this could worsen over time as they are or if their workplace is loud. That’s why it’s important for individuals to wear proper ear protection in loud environments. While it may not be possible to stop age-related hearing loss, an audiologist may recommend a hearing aid to the individual to help with deficits.

Dizziness

The inner ear is part of the vestibular system, which plays a role in keeping a person balanced. If there is damage to the actual ear systems or the parts of the brain that work with the vestibular system, a person may experience dizzy sensations or balance problems along with hearing loss.

Deafblindness

Deafblindness is when a person has a degree of deafness and blindness that prohibits them from communicating in traditional methods. While people with deafblindness retain some vision or hearing, it poses a significant challenge for daily living and working. But it’s not impossible for someone with deafblindness to live and work independently. 


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Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:

  • The product or service promises a quick fix
  • Sound too good to be true
  • Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
  • Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
  • The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
  • Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based 

Always proceed with caution and with the advice of your medical team.