Hearing Disorders

The most common hearing disorders are those

that affect hearing sensitivity. When a sound is
presented to a listener with a hearing sensitivity
disorder, one of 2 things may occur:
1. The listener with a HS disorder may be unable
to detect the sound.
2. The sound will not be as loud to that listener
as it would be to a listener with normal hearing.
Note: Vision is different. The most common
vision disorders affect acuity, not sensitivity to
light. Acuity is the ability to resolve differences
amplifying it – but do not improve acuity.
Important: This sensitivity vs. acuity distinction
is not quite so simple with hearing (or vision):
hearing loss of any significance nearly always
involves problems of both sensitivity and acuity
– sounds are harder to hear (sensitivity) and they
are nearly always distorted (acuity). More about
this later.
 The Audiogram
Most common way to measure hearing sensitivity is
to measure pure-tone (sinusoid) thresholds.
Threshold: Sound level required to barely detect a
sound.
Mild high-frequency loss
 Moderate-to-severe bilateral loss

Severe loss
in left ear,
moderate
loss in right
ear.

Pure Tone Average (PTA)

Average thresholds at 500, 1000, 2000 Hz – the
frequencies most important for speech understanding.
From the audiogram above:
Pure-tone Average, Left Ear: 93 dB
Pure-tone Average, Right Ear: 50 dB
 Terminology
Normal Hearing: PTAs < 25 dB
Hearing Impairment: PTAs 25-92 dB
Deaf: PTAs > 92 dB
The term deafness is reserved for cases in which
“ … the handicap for hearing everyday speech …
[is] … total” (Davis & Silverman, 1979).
Despite these conventions: (1) there is no sharp
dividing line between hearing impairment and
deafness, and (2) degrees of deafness are
meaningful; e.g., there is a difference between
PTAs of 110 and 95.
 Types of Hearing Disorders
Many ways to classify hearing disorders
1. Nature of the loss:
Sensitivity vs. Acuity
∙ Dysacusia – Deficit in discrimination or
interpretation of sound: “Don’t shout, I can
hear you just fine. I just can’t understand
what you’re saying.” Disacusia is a good
term that isn’t in very common use.
∙ Acuity deficits sometimes due to disorders
of the central auditory system.
∙ Disorders of sensitivity and acuity are not
mutually exclusive.
2. Functional Classification
∙ Conductive – Disorders involving the
conduction of sound to the cochlea.
∙ Sensori-neural – Disorders involving the
cochlea (usually the hair cells) or 8th N.
∙ Central – Disorders affecting the CNS (brain
stem or auditory cortex).
Two related terms:
Peripheral – Not central; i.e., conductive or
sensorineural.
Retrocochlear – Disorders involving anatomical
structures beyond the cochlea; i.e., 8th N, brain
stem, auditory cortex.
3. Cause or Etiology of the Disorder
Hearing disorders can be classified on the basis of
the cause of the disorder. Some examples:
∙ Ototoxic drugs
∙ Noise exposure
∙ Old age (presbycusis)
∙ Otitis media
∙ 8th N tumors
∙ Meniere’s Disease
In this review, we will proceed by functional
subsystem (conductive, sensorineural, central), and
by etiology within each subsystem.
 Conductive Hearing Disorders
1. External Ear
∙ Congenital malformations. There are many of
these. Most serious is congenital atresia –
collapse or closure of the EAM (ear canal). May
occur in isolation, but typically associated
congenital malformations of the middle ear as
well.
∙ Impacted wax (cerumen) – results in mild
hearing loss ; easily treated by removal of the
wax.
2. Middle Ear
a. Otitis Media
∙ By far the most common cause of conductive
hearing loss.
∙ By far the most common health problem in
children.
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