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Hearing Loss: how we hear

In order to understand hearing loss, it helps to have a general understanding of the parts of the ear and how sound is transmitted to the brain. The ear is divided into three parts:

1. The outer ear
2. The middle ear
3. The inner ear


The middle ear is the cavity behind the eardrum (tympanic membrane). It is an air-filled space and holds the three little bones of hearing (the Ossicles). The bones are called the Incus, the Malleus, and the Stapes. They are so small that you can place all three of them on a five cent piece without touching, and they will not hang over the edge. The Malleus attaches to the eardrum on one end and the incus on the other end. The incus then attaches to the Stapies, which attaches to the Oval window. The Oval window is the division between the middle ear and the inner ear.


The inner ear is called the cochlea. This is a snail shaped cavity filled with three little tubes which are separated by membranous walls and contain fluid. The organ of hearing is housed inside the cochlea. One of the membranes is called the Basilar Membrane, which has lots of little hair cells attached to it. When stimulated, these hair cells communicate with the Auditory nerve (the 8th cranial nerve).


Sound is gathered up by the pinna (outer ear) and funnelled into the ear canal. These sound waves bounce off the eardrum and cause it to vibrate. The vibration of the sound causes the little bones to rock back and forth. The stapes rocks into the oval window, setting it into motion. The motion of the oval window causes a pressure wave to move through the fluid of the inner ear. As this wave passes under the basilar membrane, it causes it to rock up and down. When this happens, the hair cells also move. This movement of the cells results in the release of neurotransmitter, a chemical signal that stimulates the hearing nerve. This sends an electrical impulse which travels up the nerve to the brain, where it is perceived as sound.




An audiogram is a graph of your hearing. It provides information on the softest sounds that a person can hear. The banana shape indicates all the speech sounds when they’re spoken at normal conversational volume. When your hearing thresholds are plotted, the speech and environmental sounds that fall below the line are audible while sounds above the line cannot be heard. If your hearing falls into the severe to profound loss area at the bottom of the graph, then you may not be able to hear all conversational sounds even with strong hearing aids. A cochlear implant may then be a viable alternative.









Types of Hearing Loss

There are three types of hearing loss: conductive, sensorineural, and mixed.




A conductive hearing loss can occur when there is a problem in the outer or the middle ear. This problem blocks the path of the sound, which prevents it from travelling to the inner ear. This type of hearing loss is often medically or surgically treatable and little residual hearing impairment will remain. A conductive hearing loss can be caused by several things including:

  • An ear infection with effusion (fluid in the middle ear space)

  • Failure of the ear canal to develop

  • A foreign object placed in the ear canal

  • A hole (perforation) in the eardrum

  • A congenital abnormality of the little bones in the ear canal

  • Fixation of the bones, causing them to not move properly.




A sensorineural hearing loss occurs when there is a problem in the cochlea that prevents the sound from getting from the middle ear to the brain. This can occur when there are damaged hair cells or supporting structures. It can also happen (although rarely) by damage to the auditory nerve. This type of hearing loss is permanent. Causes of sensorineural hearing loss include:

  • Infections or viruses in pregnancy

  • Inherited hearing loss (if it is recessive, then the child may have no other family members who are deaf).

  • Meningitis or mumps

  • Ototoxic drugs given for extreme illness

  • Sudden very loud sounds or prolonged exposure to loud sounds

  • Birth asphyxia

  • Hyperbilirubinemia (severe Jaundice)

  • Failure for the eighth nerve to develop (very rare).




A mixed hearing loss occurs when there are two problems: one in the outer or middle ear and one in the inner ear or eighth nerve. An example of this would be if there is a congenital sensorineural hearing loss and a middle ear infection. In this case, once the fluid cleared, you would have only a sensorineural hearing loss remaining. Another example is where the ear canal fails to form and the cochlea is not fully formed. In this case, there may be a permanent mixed hearing loss.

If you think you or your child has hearing loss, it’s important to get help early.

To diagnose a hearing loss you need a professional hearing test, but first, consider visiting your doctor or a specialist ear nurse.

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