Merck Manual

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Some Causes and Features of Hearing Loss

Some Causes and Features of Hearing Loss


Common Features


External ear (conductive loss)

Obstruction (as caused by wax, a foreign body [object], an outer ear infection, or, rarely, a tumor)

Visible during a doctor's examination

A doctor's examination

Middle ear (conductive loss)

Middle ear infection (acute or chronic)

Usually an eardrum that looks abnormal (seen during a doctor's examination)

Sometimes dizziness, pain or fullness in the ear, or a discharge from the ear

Often many previous ear infections


Imaging for severe or recurrent infections

Often visible perforation of the eardrum, blood in the canal or behind the eardrum, or both

In a person with an obvious recent injury

A doctors' examination


Often family members with similar hearing loss

Hearing loss that slowly worsens

Hearing loss that often starts in the 20s and 30s


Tumors (cancerous or not)

Often visible tumor during a doctor's examination

Hearing loss in only one ear

CT or MRI using a contrast agent (gadolinium)

Inner ear (sensory loss)

Genetic disorders

Often family members with similar hearing loss

Often accompanied by disease in other organ systems

Genetic testing

CT and/or MRI using a contrast agent (gadolinium) of the inner ear

Noise exposure

Usually apparent by history

Possibly temporary hearing loss

A doctor's examination

Older age (over 55 in men and over 65 in women)

Progressive loss of hearing in both ears

A doctor's examination

Drugs that can damage the ear (ototoxic drugs), such as

  • Aspirin

  • Aminoglycosides (such as gentamicin and tobramycin)

  • Vancomycin

  • Cisplatin

  • Furosemide

  • Ethacrynic acid

  • Quinine

In a person who recently used a causative drug

Hearing loss in both ears

Sometimes dizziness and loss of balance

A doctor's examination

Sometimes blood drug levels

Infections, such as

  • An inner ear infection that produces pus

Obvious history of infection

Hearing loss during or shortly after an infection

A doctor's examination

Autoimmune disorders such as

Joint inflammation and a rash

Often in a person known to have the disorder

Blood tests

Episodes of hearing loss (typically in only one ear)

Sense of fullness in the ear

Sometimes ringing or buzzing in the ear (tinnitus) and/or a false sensation of spinning or moving (vertigo)

MRI using a contrast agent (gadolinium) to rule out tumor

Pressure changes (as may occur during diving)§

Deafness in one or both ears

Sudden onset during causative activity (for example, scuba diving, rapid descent in airplane) or after a blow to the ear

Sometimes accompanied by pain, an explosive sound, dizziness, or ringing in the ear

Tympanometry (placement of a device in the ear to measure how well sound passes through the ear)

Balance testing with electronystagmography (a test to record involuntary movements of the eye caused by a condition known as nystagmus)

CT or MRI using a contrast agent (gadolinium)

Head injury (often with fracture of the base of the skull)§

In a person with an obvious recent severe injury

Possibly dizziness or drooping facial muscles

Sometimes fluid (bloody, blood-tinged, or clear) coming from the affected ear or blood behind the eardrum

CT or MRI using a contrast agent (gadolinium)

Auditory neuropathy

Good sound detection, but poor word understanding

Specialized auditory testing

MRI using a contrast agent (gadolinium)

Nervous system (neural loss)

Tumors, such as

Hearing loss in only one ear, often with tinnitus

Often dizziness or vertigo, trouble with balance

Sometimes drooping facial muscles and/or numbness of the face and taste abnormalities

MRI using a contrast agent (gadolinium)

Demyelinating disorders, such as multiple sclerosis

Hearing loss in only one ear

Sometimes weakness or numbness that comes and goes and that occurs in different parts of the body

MRI of the brain and spinal cord using a contrast agent (gadolinium)

Sometimes a spinal tap (lumbar puncture)

*Each group is listed in approximate order of frequency.

Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

All people should have a doctor's examination and audiologic testing.

§Mixed conductive and sensorineural loss may be present.

CT = computed tomography; MRI = magnetic resonance imaging.