Hearing Loss and Impairment: Causes, Diagnosis, and Treatment

What is Hearing Loss and How Does It Manifest?

Hearing loss, or impairment, is a condition in which a person's ability to perceive sounds deteriorates. It can manifest in various ways: from slight difficulty in understanding speech to complete deafness. Often, hearing loss is accompanied by tinnitus—the sensation of noise, ringing, or buzzing in the ears in the absence of an external sound source [8].

Sensorineural hearing loss, caused by damage to the inner ear or auditory nerve, is one of the most common types. It can be sudden (idiopathic sudden sensorineural hearing loss, ISSHL)—a medical emergency requiring immediate medical attention [2], or develop gradually, for example, with age.

A Variety of Causes of Hearing Loss

The causes of hearing loss are diverse and can include both external factors and internal bodily diseases:

• Age-related changes and noise exposure. With age, hearing naturally deteriorates (presbycusis). Prolonged or intense noise exposure is also one of the leading causes of acquired hearing loss. Studies show that regular intake of magnesium at a dose of more than 200 mg per day may have a protective effect against the development of age-related hearing loss and, presumably, reduce the risk of noise-induced hearing loss [1].
• Thyroid diseases. Thyroid dysfunction, including hypothyroidism, hyperthyroidism, and autoimmune thyroiditis, can affect inner ear function. Hormonal, immune, and vascular mechanisms can lead to sensorineural hearing loss and vestibular disorders such as Meniere's disease and benign paroxysmal positional vertigo (BPPV) [6].
• Vestibular migraine. This neurological disorder is often accompanied by auditory symptoms. Although vestibular migraine can coexist with idiopathic sudden sensorineural hearing loss, studies show that its presence does not always have a significant impact on the prognosis of hearing recovery after ISSHL treatment [2].
• Ototoxicity of medications. Certain drugs can cause damage to the inner ear. For example, teprotumumab (Tepezza), a monoclonal antibody used to treat thyroid-associated ophthalmopathy, can cause hearing impairment as a serious side effect [4].
• Somatosensory factors and tinnitus. In some people, tinnitus can be somatosensory, meaning it is modulated by head and neck structures, particularly the craniomandibular (jaw-facial) areas. Hyperactivity of the masseter muscle may be associated with this type of tinnitus [3].
• Unclear etiology. In some cases, especially in ISSHL, the exact cause of hearing loss remains unidentified [2].

Modern Approaches to Diagnosis and Treatment

Diagnosis of hearing loss includes a comprehensive examination by an otolaryngologist and an audiologist. Treatment depends on the cause and type of hearing loss:

• Magnesium as a protector and adjuvant therapy. In addition to preventing age-related and noise-induced hearing loss, magnesium can be useful as an adjunctive therapy for sudden hearing loss and tinnitus, complementing standard treatment (e.g., corticosteroids and CO2 inhalations) [1].
• Treatment of sudden sensorineural hearing loss. ISSHL is an emergency. Basic therapy often includes corticosteroids and CO2 inhalations [1].
• Management of vestibular disorders. For benign paroxysmal positional vertigo (BPPV), otolith repositioning maneuvers are effective. The Japan Society for Equilibrium Research has developed clinical guidelines confirming their effectiveness [7]. To relieve acute vertigo in vestibular migraine, rimegepant (75 mg) has shown high efficacy, providing symptom relief in a significant number of patients within two hours [5].
• Promising methods for treating tinnitus.
  • For somatosensory tinnitus associated with masseter muscle hyperactivity, botulinum toxin type A (BoNT/A) is considered a potential therapeutic option, although its clinical validation is still required [3].
  • Given the common pathophysiological mechanisms between tinnitus and migraine, calcitonin gene-related peptide (CGRP) blocking drugs, which are successfully used for migraine prevention, may play a potential therapeutic role in reducing tinnitus intensity [8].

Prevention and Prognosis

Prevention of hearing loss includes protecting hearing from excessive noise using earplugs or reducing noise levels, as well as maintaining overall health. Regular magnesium intake can be an additional preventive measure [1]. Timely consultation with a doctor at the first signs of hearing loss or tinnitus is crucial for successful treatment and an improved prognosis. Although vestibular migraine can coexist with ISSHL, in some cases it does not significantly affect hearing recovery [2].

Important Aspects and Future Research

The connection between migraine, vestibular disorders, and auditory symptoms such as tinnitus continues to be actively studied. Understanding the common pathways of development of these conditions opens up new opportunities for therapy [8]. Further clinical research is needed to confirm the effectiveness of new approaches, such as the use of botulinum toxin for somatosensory tinnitus [3] and CGRP drugs for migraine-related tinnitus [8]. It is also important to consider the potential side effects of medications that can affect hearing, as is the case with teprotumumab [4].

References

1. The role of magnesium in otology - A narrative review. https://pubmed.ncbi.nlm.nih.gov/42439044/
2. The Effect of Vestibular Migraine on the Prognosis of Idiopathic Sudden Sensorineural Hearing Loss. https://pubmed.ncbi.nlm.nih.gov/41642090/
3. Masseter Muscle in Somatosensory Tinnitus and Potential Therapeutic Role for Botulinum Toxin Type A: A Scoping Review. https://pubmed.ncbi.nlm.nih.gov/42506730/
4. Safety profile of teprotumumab-trbw, the first and only FDA-approved treatment for thyroid-associated ophthalmopathy. https://pubmed.ncbi.nlm.nih.gov/42295149/
5. Effectiveness and clinical predictors of rimegepant for acute vertigo in vestibular migraine: A real-world cohort study. https://pubmed.ncbi.nlm.nih.gov/42377393/
6. Inner Ear Dysfunction in Thyroid Disease: A Scoping Review. https://pubmed.ncbi.nlm.nih.gov/41155780/
7. Therapeutic strategies for benign paroxysmal positional vertigo of the Japan Society for Equilibrium Research. https://pubmed.ncbi.nlm.nih.gov/42259062/
8. Potential therapeutic role of calcitonin gene-related peptide medications for tinnitus. https://pubmed.ncbi.nlm.nih.gov/41612541/

The information presented in this article is for informational purposes only and cannot replace professional medical advice. Before starting any treatment or changing your therapy regimen, be sure to consult a specialist.