Hearing-loss in adult should be evaluated & managed properly taking care of emotional & social impact of condition on patient & his family. Bilateral hearing loss may affect professional life of a person. Aim is to know treatable cause and effective management to prevent further loss. Sensorineural loss which can not be cured by medicines should be started with rehabilitation by hearing-aids.

Symptoms of hearing loss

• Sound may be quieter, distorted and less clear.
• Patients usually have difficulty in hearing in noisy area or while in a group.
• Problem in hearing over telephone.
• Turn up volume of television/Mp3 player.
• Ask people frequently to repeat sentence/word.
• Patients often misunderstand what others are saying.
• Patients think others are not speaking clearly.

Evaluation of patient

• Thorough medical history (Age of onset, unilateral/bilateral, progression and other associated symptoms like ear pain, ear discharge, recurrent cold/cough, throat infection, giddiness, tinnitus, recent or past medical illness, medication, trauma, noise trauma, occupational exposure to noise, any surgery ) & family history of hearing-loss.
• Clinical Examination of pinna, external auditory canal and ear drum. Mobility of ear drum, tuning fork test. 
• Examination of nose and throat and patient as a whole is important to reach to diagnosis.
• Investigation: Nasal and nasopharyngeal endoscopy may be required, Audiometry & tympanometry report will show degree & type of hearing loss.Depending upon clinical clues CT/MRI may be required. 

Most common cause of hearing-impairment in adult is wax and after exclusion of wax tympanic membrane perforation is most common cause.

Management of hearing loss:

Management of hearing loss depends on type of hearing loss; loss is of two types conductive and sensorineural. Sometimes it may be mixed loss.

Conductive loss:

When something hampering conduction of sound in your ear to reach inner ear or nerves of hearing, Causes

• Any problem in your canal (wax, foreign body, fungus),
•  Ear-drum (perforation) or
• Small bones of ear (otosclerosis)

Can be corrected with medicine and/or surgery, like:

• Wax/foreign bodies- removal
• Eustachian tube blockade or fluid in the middle ear-medicines or small procedure for .ventilation of middle ear (grommet)
• Infection (Otitis-media)-medicines
• Perforation- cauterization or paper patch or surgery (tymanoplasty)
• Otosclerosis- stapedectomy & piston placement 
• Any cause in nose/throat should be managed by medicine or surgery.

Sensorineural loss:

When problem is in inner ear or auditory nerves (Same as one has weak eye-sight). If it is sensorineural then it is important to know whether it is cochlear or retro chochlear?

Causes:

• Age (Presbiacusis)- hearing loss after age of 65 years, mostly idiopathic (cause not known).
• Noise-trauma
• Menieres disease
• Post-viral infections (like mumps, measeles, influenza and herpes),
• Ototoxic drugs (like aminoglycside antibiotics (streptomycin, neomycin, amikacin, gentamicin, netilmycin) salycylates, loop diuretics, antimalarials (quinines, chloroquine), erythromycin and cisplatinum),
• Hereditary,
• Immune mediated,
• Endocrine & metabolic disorder,
• Vascular or neurogenic disorder,
• Tumor

Management of sensorineural hearing loss:

Treatable causes:

• If it is sudden loss, spontaneous recovery may be expected. Vascular causes, viral infection and inner ear membrane rupture are possible causes, 10 to 15% may have underlying itiology so it is important to find out & treat.
• Immune-mediated: steroids
• Tumor - surgery
• Ototoxicity-stop the drug

Mostly chronic sensori-neural loss can not be cured and person is prescribed to wear hearing-aids. In bilateral severe to profound hearing loss cochlear implant (electronic device, a part is implanted under skin by surgery) may be successful.

Though hearing-aid are not as good as normal ear but if properly met with fitting requirements it can compensate well for hearing-loss.
Hearing-aid should be fitted and customized to individual after thorough hearing evaluation by ENT specialist and audiologist.

Most patients are benefited but there is limitation of sound-quality and back ground noise that means it works well in quiet environment but some users have trouble enjoying music and listening in a crowded room.

Quality of hearing aid is of utmost importance and it takes few days to adjust but eventually initial chaotic sound disappear and person is able to appreciate the difference, usually patients are happy after few weeks of use often coming to tell us it has improved their quality of life.

Improving FM (frequency modulation) boosts the performance of hearing aid. Hearing aid can be optimally set for music also.

Sensorineural hearing loss may be shocking news to patient and his relatives. Good doctor-patient relationship and understanding is required to help accept the fact. Talk with your doctor, friends, family and person with same problem to support you.