Hearing problems after a brain injury can be caused by damage to the ear or the parts of your brain that control hearing. Depending on the kind of damage, your hearing problems may be temporary or permanent.
If you’re used to being able to hear clearly, any sort of change to your hearing or loss of hearing can be hard (both physically and mentally/emotionally). It takes time and patience to deal with those changes–but with diagnosis, treatments, and assistive devices/supports, you can adjust to your new day-to-day.
Let’s talk about:
Types of hearing loss
Hearing loss can happen in one or both ears. The term hearing loss generally means that you still have some level of hearing. There are different levels of hearing loss [1]:
- Mild – you have a hard time hearing quiet/soft sounds
- Moderate – you have a hard time hearing who are speaking at a normal volume, especially in loud environments
- Severe – you aren’t able to understand speech without an assistive device (like a hearing aid) when someone is speaking at a normal volume, and you only hear some loud sounds
Profound – you may only hear extremely loud sounds, and no speech without an assistive device
There are three main types of hearing loss connected to ears [2].
Conductive hearing loss
Conductive hearing loss means you injured your outer ear or middle ear. Damage to your outer ear can hurt your eardrum or dislocate/break the small bones in your middle ear. This can happen through a traumatic injury such as a fall, assault, or car accident. Your middle ear can also be damaged through ear infections or fluid buildup, which affects the nerves that help you hear. Damage to your outer and middle ear will usually heal using medicine or just with time and patience.
Sensorineural hearing loss
Sensorineural (sen-so-ri-neur-al) hearing loss happens when there is damage to your inner ear. This can include damage to your auditory nerve or your cochlea (cok-le-a), which is the curled cavity in your ear that contains the organ that helps you hear [3]. This is the most common type of hearing loss, and it’s mostly caused by aging or exposure to loud noises over a long period of time (for example, someone who listens to music really loudly every day). Unfortunately, this kind of hearing loss is permanent. Audiologists will most commonly recommend hearing aids to help with any hearing problems.
What’s an audiologist? An audiologist is a professional that treats people with hearing loss and ear issues related to the inner ear and the vestibular system, which is something we all have to help us with balance, moving our head, and understanding where we are in relation to other things.
Mixed hearing loss
Mixed hearing loss is when a person experiences both sensorineural hearing loss and conductive hearing loss.
How can a brain injury affect my hearing?
Besides our ears, our brains play an important role in hearing. If the part of your brain that controls hearing is damaged, it can cause problems with your ability to process sounds and connect them to words or meanings. This means your ear may work properly, but it’s difficult to understand sounds or speech.
Depending on the diagnosis, an ENT specialist or audiologist may recommend using hearing aids, learning adaptive methods of communication, and working with rehabilitation specialists.
What’s an ENT specialist? An ENT specialist is an Ear, Nose, and Throat (ENT) doctor. They specialize in the connected systems in our heads. They are also called otolaryngologists (o-to-lar-yn-jol-o-gists).
There may be additional hearing impairments you experience connected to damage to your brain or ear. You can talk to an audiologist or ENT specialist for more information.
Deafness & important terms to know
The Canadian Association of the Deaf recognizes a person to be deaf when that person has little or no functional hearing and depends upon visual rather than auditory communication [4].
Visual means of communication include:
- Sign language
- Lipreading
- Speech reading
- Reading and writing
The Canadian Association of the Deaf also outlines some community terms, including [5]:
- deaf (lower case d): People who have little to no functional hearing. Can also be used as a collective noun to refer to people who are deaf, but don’t identify with the Deaf community.
- Deaf (with capital D): People who are medically deaf or hard of hearing who identify with and participate in the culture, society, and language of Deaf people, which is based on Sign language.
- Deafened: People who have become deaf later in life and may not identify with the Deaf community.
Hard of hearing: A person whose hearing loss ranges from mild to profound and whose usual means of communication is speech. - Hearing Impaired: “Hearing impaired” is a medical condition. It’s not a collective noun and should not be used for people who have varying degrees of hearing loss. It fails to recognize the differences between the Deaf and the hard of hearing communities.
Treatment for hearing problems
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 figure out the cause of your hearing problems and the extent of the injury, and then develop a plan to help you cope with the changes you’re experiencing.
Tips for coping with hearing loss
While your health care team will make more specific recommendations based on your needs, the following are some general tips you can try.
The more background noise there is, the harder it is for your brain to filter out what’s important. And if you can’t hear what someone’s saying, you can’t respond or engage while they’re speaking. Avoiding noisy environments can make it easier for you to hear and understand conversations.
Some hearing loss is permanent, but it can still be improved with hearing aids. There are a few different types of hearing aids your audiologist may recommend, including [6]:
- In-the-ear (ITE): In-the-ear hearing aids are the smallest and most discreet as they sit inside your ear canal. These might be recommended if you have mild hearing loss.
- Behind-the-ear (BTE): This type of hearing aid fits behind the ear and works for all degrees of hearing loss, including severe. It works with other assistive devices including FM systems, telephone adaptors, and television amplifiers.
- Open fit hearing aids: Open fit hearing aids also sit behind the ear, but they have a slim tube that’s inserted down the ear canal. They’re less visible than BTE aids. This device is best for people with mild to moderate hearing loss.
- CROS (Contralateral Routing of Signal): This system is for people who can’t hear out of one ear. It takes sound from the ear with no or little hearing and transmits it to a hearing aid worn on the stronger ear.
Lip reading is the process of looking at people’s mouths while they’re talking and reading their lips to understand what they’re saying. Lip reading is a difficult skill to learn, but it can come in handy for communicating with others on a daily basis, particularly if sign language isn’t commonly known by the people you interact with.
Subtitles for videos and films make it possible to still enjoy visual content without having to rely on audio to understand what is happening.
Sign language is an effective way for people with hearing loss to communicate. Most people use American Sign Language (ASL), but there are other dialects you can learn depending on where you live and what’s commonly used there. Like learning any new language, it will take time, hard work, and patience to learn. If you do want to learn ASL, you can encourage others in your life to learn it too.
Here are some resources on sign language:
Reading and writing are effective tools of communication. You can have others print or type messages to you if you’re having quick conversations. There are also dictation programs that generate words based on what someone is saying. You will have to do some research and try different programs and apps to find what works for you – and keep in mind that some of them cost money.
These kinds of tools can be helpful if you aren’t using sign language or lip reading, or if you’re communicating with someone who doesn’t know sign language.
It can be extremely difficult to accept the effects of brain injury like hearing loss and learn a new way of living. Luckily the growing awareness around hearing loss and the advancements in technology are making positive strides every day with helping people navigate their lives.
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.
