Merck Manual

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Some Causes and Features of Hearing Loss

Some Causes and Features of Hearing Loss


Common Features†

Diagnostic Approach‡

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)

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

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

Imaging for severe or recurrent infections

In a person with an obvious recent injury

A doctor's examination


Often family members with similar hearing loss

Hearing loss that slowly worsens

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


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

Temporary or permanent hearing loss, depending on how loud the noise and how long the exposure are

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

  • 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

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 low-frequency hearing loss (typically in only one ear)

Sense of fullness in the ear

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

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


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)

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

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)

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)

* Causes in each group are 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.

‡ Although a doctor's examination with audiologic testing is always done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination and audiologic testing without any additional testing. In other words, additional tests may not be needed.

§ Mixed conductive and sensorineural loss may be present.

CT = computed tomography; MRI = magnetic resonance imaging.