Hearing Problems - Fact Sheet

Our hearing process has two stages: the mechanical and a neurological process. The mechanical process is carried out by the ear which has three sections, the outer, middle, and inner ears. The outer ear, consisting of the lobe and ear canal, protects the more fragile parts inside.

The middle ear begins with the eardrum, a thin membrane which vibrates in sympathy with any entering sound. The motion of the eardrum is transferred across the middle ear via three small bones to the inner ear where a tube called the cochlea is wound tightly like a snail shell. From here the neurological process begins and the brain translates vibration into electrical impulses.

Trauma most commonly affects the mechanical process. An eardrum may rupture, any of the small bones could break or there could be bleeding or bruising of the middle ear. Sometimes damage to the parietal or Temporal Lobes can disrupt the neurological process. Thankfully many hearing difficulties are not permanent and can be reduced or eliminated with treatment.

Tinnitus is experienced as noises which are commonly like a buzzing, hissing or ringing in the ears. It is usually caused by damage to the mechanical process. Because accurate diagnosis and treatment are needed a trip to the doctor and possible referral to an audiologist are required.
Tinnitus can be worsened by exposure to loud noises, excessive stress, caffeine, alcohol, nicotine, some illicit drugs and medications, and quinine found in tonic water.

Some audiologists run clinics to help manage tinnitus. Other treatments include hearing aids, tinnitus retraining therapy or Cognitive behavioural therapy to alleviate distress and produce adaptation to tinnitus.

This syndrome is caused by excessive pressure in the chambers of the inner ear. Nerve filled membranes stretch which can cause hearing loss, ringing, vertigo, imbalance and a pressure sensation in the ear. Although it can not be cured, treatment can alleviate the symptoms with medication such as diuretics or steroids, electrical stimulation or simply limiting movement. There are various surgical procedures that may decrease the pressure or remove/deaden the nerves responsible.

This is impaired recognition of nonverbal sounds but intact language function. This rare outcome is normally from damage to the temporal-parietal region of the brain which interferes with the cognitive process of hearing. There may be an inability to understand spoken language while the ability to speak is preserved. Auditory agnosia often gradually resolves itself over time.

Sometimes trauma to the inner ear can cause certain noises or pitches to become extremely loud or soft. Our typical western lifestyle, with its barrage of noise, can be a living hell for some individuals with a brain injury whose sensitivity to sound has been affected. A few examples of difficult situations include dining out, taking a walk, washing the dishes, using a vacuum cleaner or listening to music. Compounding the problem is that the disorder is often not diagnosed, and the person has trouble convincing others that the problem exists.

Trying to escape this deluge of sound is not easy, and sufferers of hyperacusis may resort to a reclusive lifestyle to cope. The problem is normally a collapsed tolerance to normal environmental sounds. The person will often test as normal on an audiology test, but their ears have lost the ability to deal with quick shifts in sound loudness.

As mentioned, ear-plugs and ear-muffs can be a great help. Activities can be restructured so that dining out or shopping can be done outside the peak hours, to avoid excessive noise. A commonsense approach to diet also helps. Avoiding stimulants such as nicotine or caffeine reduces the body’s sensitivity to noise. A proper diet and exercise play their part in better overall health, which will impact indirectly on hyperacusis by reducing stress.

Hearing clinics can provide therapy with a specially programmed hearing aid to manage the hyperacusis. They may also provide a soft noise generator to be worn while awake for up to 18 months. Long-term exposure to gentle sound at a barely audible level can desensitise the ears and improve both hyperacusis and tinnitus. This ‘white noise’ contains every frequency audible to humans, and can be likened to the sound of distant surf or wind, and can help up to 90% of sufferers.

As with many effects of brain injury, hyperacusis is worsened by stress and fatigue. Good sleep and avoiding stressful situations will maximise the ability to deal with noise.

It should be stressed that there are no ‘cures’ for hyperacusis. The most effective solutions involve increasing the tolerance of noise, so the individual with a brain injury needs to walk the fine line between protecting their ears by minimising discomfort, yet exposing themselves to sufficient noise to build up their ‘immunity’. Over-protection will only further increase the effect of hyperacusis.

If you are experiencing auditory problems, see your doctor, as there may be a treatable medical cause. A referral may be needed to have your hearing checked by an audiologist (hearing scientist) or you may be referred to an ear/nose/throat specialist. Some audiologists run specialist clinics to help manage some conditions and they fit hearing aids and/or therapeutic noise generators if needed.

Good quality and properly fitted hearing aids reduce and even eliminate most tinnitus associated with hearing loss. They take away the strain of listening and distract from the tinnitus by increasing sounds in the outside world.

Therapeutic noise generators are a hearing aid type device for people with no hearing loss that produces a blend of external sounds. This stimulates most fibres of the hearing nerve to deviate attention away from the tinnitus.

Tinnitus retraining therapy aims to reduce and ultimately eliminate tinnitus perception. It combines auditory therapy (hearing aids/noise generator) and counselling aimed to change negative beliefs, distract from tinnitus and reduce stress.

Cognitive behavioural therapy aims to alleviate distress and producing adaptation to some conditions. Your GP should be able to refer you to the necessary specialist, usually an ear/nose/throat specialist.

There are practical steps you can take to lessen many hearing problems:

Copyright Brain Injury Association of Queensland, Inc, Australia, 2007. This is one of a range of fact sheets made available by the Brain Injury Association of Queensland. While all care has been taken to ensure information is accurate, these fact sheets are only intended as a guide and proper medical or professional advice and information should be sought. The Association will not be held responsible for any injuries or damages that arise from following the information provided in these fact sheets. You can visit the Association’s website at www.braininjury.org.au or send emails to This email address is being protected from spam bots, you need Javascript enabled to view it