Deafness Bilateral

When hearing loss affects both ears, it creates unique challenges in daily life—from following conversations in noisy environments to safely navigating the world around you. Understanding this condition and exploring treatment options can help restore connection and improve quality of life.

Table of contents

• What is Bilateral Hearing Loss?
• Types of Bilateral Hearing Loss
• What Causes Bilateral Hearing Loss?
• Recognizing the Symptoms
• Degrees of Hearing Loss
• Treatment Options
• Living with Bilateral Hearing Loss

What is Bilateral Hearing Loss?

Bilateral hearing loss refers to reduced hearing ability in both ears^[1]. This condition is distinct from unilateral hearing loss, which affects only one ear. When both ears are impacted, it can significantly affect your ability to understand conversations, hear environmental sounds, and enjoy everyday activities like music and entertainment^[2].

The condition normally occurs as a result of damage to stereocilia—hair-like cells in the inner ear—or to the auditory nerve itself^[3]. While bilateral hearing loss commonly develops gradually over a long period of time, in some instances it can be sudden, such as from exposure to loud noises^[3].

The experience of bilateral hearing loss varies from person to person. For example, the hearing loss can be symmetrical, where the loss is the same severity in both ears, or asymmetrical, where the loss is unbalanced and you hear better on one side^[3]. In some rare cases, bilateral hearing loss can occur suddenly^[1].

Types of Bilateral Hearing Loss

Bilateral hearing loss can be classified into three main types based on which part of the auditory system is affected^[2].

Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea) or the auditory nerve that transmits sound signals to the brain^[2]. This is the most common form of bilateral hearing loss and is typically permanent. It can be caused by aging, noise exposure, genetics, or illnesses that affect the inner ear^[2].

Conductive hearing loss happens when there is an issue in the outer or middle ear that prevents sound from being conducted to the inner ear^[2]. This can be caused by ear infections, fluid buildup, earwax blockages, or issues with the bones in the middle ear. Conductive hearing loss may be temporary and can often be treated with medical interventions^[2].

Mixed hearing loss is a combination of both sensorineural and conductive hearing loss, meaning that there is damage in both the inner ear and the outer or middle ear^[2]. This type of hearing loss may require a combination of treatments to address the different underlying causes.

What Causes Bilateral Hearing Loss?

There are several potential causes of bilateral hearing loss, and identifying the underlying cause is essential for effective treatment^[2].

Age-related hearing loss, also called presbycusis, is the most common form of sensorineural hearing loss^[1]. As we age, the tiny hair cells in the inner ear gradually break down, leading to hearing loss. This is the most common cause of bilateral hearing loss, particularly for people over 50 years of age^[2].

Exposure to loud noises—whether from attending concerts, working at construction sites, or other sources—can cause temporary or long-term hearing damage^[1]. Being exposed to loud sounds can damage the delicate structures in the ear^[3].

Bilateral hearing loss may be present from birth. The propensity to develop hearing loss can be inherited from one or both parents^[1]. Congenital hearing loss can have various causes, including genetic syndromes with hearing loss as a component^[16].

Some medications, including prescription medicines, can cause damage to the ears and are known as ototoxic drugs^[1]. These include aminoglycosides, loop diuretics, and some chemotherapeutic agents^[16].

Hearing loss can result from physical damage to the hearing organs, including a ruptured eardrum or earwax buildup^[1]. Many people, especially children, are susceptible to ear infections, which can cause blockages or structural damage to the ears and hearing organs^[1].

Other causes include trauma, tumors, inner ear disorders like Ménière’s disease, and systemic conditions such as diabetes and meningitis, which can disrupt blood flow to the inner ear or inflame the vestibulocochlear nerve^[3][12].

• Inner ear (cochlea)
• Outer ear
• Middle ear
• Auditory nerve (vestibulocochlear nerve)

Recognizing the Symptoms

Since hearing loss often occurs gradually over time, it can be difficult to identify the symptoms^[1]. Whether the signs of hearing loss are obvious or not, it is worth seeking professional advice, even if you only notice the slightest of signs. Being proactive will help you to receive a proper diagnosis as early as possible^[1].

Common symptoms of bilateral hearing loss include^[1]:

• Difficulty understanding others, especially in noisy environments
• Turning up the TV volume louder than usual
• Asking others to repeat themselves
• Relying on lip reading to understand what others are saying
• Muffled speech or sound^[3]
• Problems hearing children and women’s voices^[3]
• Tinnitus (ringing in your ears)^[3]

Unilateral hearing loss is typically easier to spot since sounds will be louder in one ear than the other. Bilateral hearing loss can be identified when sound is generally more difficult to hear in both ears^[1].

Degrees of Hearing Loss

When discussing hearing loss, there are certain degrees used to categorize the severity and how much sound is lost^[3]:

Mild hearing loss: You may hear some speech, but it will be hard hearing softer sounds or speech from a distance. A person with mild hearing loss may hear some speech sounds but soft sounds are hard to hear^[3][4].

Moderate hearing loss: You might have trouble hearing faint speech, and will have difficulty when having a conversation at a normal level. A person with moderate hearing loss may hear almost no speech when another person is talking at a normal level^[3][4].

Severe hearing loss: You’ll likely hear no speech at all when having a conversation at a normal level and will miss some loud sounds. A person with severe hearing loss will hear no speech when a person is talking at a normal level and only some loud sounds^[3][4].

Profound hearing loss: If you’re suffering with profound hearing loss, you won’t be able to hear normal or loud speech, and will have difficulty with loud sounds, unless they’re very loud. A person with profound hearing loss will not hear any speech and only very loud sounds^[3][4].

Treatment Options

Unfortunately, there is no cure for bilateral hearing loss. However, there are a range of treatment options available, depending on the cause and the severity of the case^[3].

Hearing aids are the most common treatment for bilateral hearing loss. For most cases, a hearing aid will be fitted to each ear to improve hearing and minimize any difficulties^[3]. A hearing aid simply amplifies the sound around you, directing it straight into your eardrum, ensuring you hear sounds more clearly. Modern hearing aids are able to provide those with bilateral hearing loss with a natural hearing experience^[1].

Research shows that the use of hearing aids was associated with decreased social isolation and a slower rate of cognitive decline^[14]. From an improved ability to hear conversations in varied environments to increased confidence and connection, there are many benefits to using hearing aids^[3].

For cases where hearing loss is caused by earwax impaction, treating it with irrigation or curettage is potentially curative^[14]. Other aspects of treatment include auditory rehabilitation, education, and eliminating or reducing use of ototoxic medications^[14].

Patients with sensorineural hearing loss should be referred to an audiologist for consideration of hearing aids. Patients with conductive hearing loss or sensorineural loss that does not improve with hearing aids should be referred to an otolaryngologist^[14].

Cochlear implants can be helpful for those with refractory or severe hearing loss^[14]. A cochlear implant bypasses the damaged portion of the ear to stimulate the hearing nerve directly^[9].

In some cases of sudden sensorineural hearing loss, your doctor may recommend medication such as steroid pills or steroid injections. For certain conditions like autoimmune diseases that harm your inner ear, other medications may be prescribed^[18].

Living with Bilateral Hearing Loss

Living with bilateral hearing loss presents unique challenges, but with practical strategies, you can navigate these challenges more easily and continue to enjoy a fulfilling life^[23].

Embrace effective communication: In group settings, position yourself where you can easily see everyone’s faces. This aids in lip-reading and understanding non-verbal cues. Where possible, minimize noise distractions during conversations—for example, turn off the TV or choose a quiet corner in social settings^[23].

Let people know about your hearing loss. Most are happy to speak more clearly or face you directly to help you understand better^[23]. When communicating with someone who has bilateral hearing loss, it’s important to face them directly, on the same level and in good light whenever possible. Position yourself so that the light is shining on your face^[20].

Speak clearly, slowly, distinctly, but naturally, without shouting or exaggerating mouth movements. Shouting distorts the sound of speech and may make speech reading more difficult^[20]. Keep your hands away from your face while talking^[20].

Leverage technology and tools: Devices like amplified phones or TV listening systems can greatly enhance your hearing experience in daily activities^[23]. If you haven’t yet explored hearing aid options, they can significantly affect how you interact and connect with the world around you^[23].

Build a supportive environment: Connect with others who have similar experiences through support groups. Sharing tips and stories can be both comforting and informative^[23]. Consider adaptations like installing doorbell lights or vibrating alarm clocks to ease daily living^[23].

Stay proactive with your hearing health: Keep up with your hearing assessments to monitor any changes and adjust your hearing aids as necessary^[23]. Early intervention is crucial—babies who are diagnosed with hearing loss should begin to get intervention services as soon as possible, but no later than 6 months of age^[17].