If your hearing is declining more severely in one ear compared to the other, this can seem alarming at first. When losing hearing worse in one ear, this is referred to as “asymmetrical hearing loss” or “interaural asymmetry.” Typically, for someone who is struggling with hearing loss, the effects on both ears are pretty much the same. However, it is possible that a hearing test conducted by your hearing healthcare provider can demonstrate that you have asymmetrical hearing loss. In this case, it is vital that your provider refer you to an ear, nose, and throat doctor (ENT). Your asymmetrical hearing loss can warn you about an underlying medical condition, and it is important to see an ENT for this before being fitted for hearing aids.
Below are a few of the common causes of asymmetrical hearing loss and some solutions that hearing professionals can provide you with.
A little unevenness in hearing loss is normal
In order to determine whether you have even hearing loss as opposed to asymmetrical hearing loss, your hearing healthcare provider will test your ability to hear different volumes and pitches of sound in each ear. The results of this test can then be mapped on a line graph called an audiogram. Two different colored lines will denote the hearing abilities of each of your ears, and the lines should match up pretty closely if your hearing loss is even.
As you can expect, there are cases when the lines on the graph representing each ear’s hearing ability are substantially different. Experts say that there is cause for concern when there is more than a difference of 10 decibels in the line height at three or more frequencies. If your hearing healthcare provider cannot determine an explicit cause for the unevenness, then it is important to do further testing.
In another scenario, you could have “ringing” in your eyes, referred to medically as tinnitus, that is more severe in one ear than the other. It is important to also have something like this investigated by a physician. According to experts, the underlying causes of asymmetric hearing loss are often the same as the underlying causes of asymmetric tinnitus.
Common causes of uneven hearing loss
There are a plethora of underlying causes of asymmetrical hearing loss. One of the more common causes is noise damage from your surrounding environment, and a more rare cause is a tumor in the ear. Furthermore, it is common for there to be multiple causes for one person’s asymmetrical hearing loss that compound the difference in hearing ability between their ears. Because of this, it is vital that you receive an in-depth evaluation by a doctor if you begin experiencing uneven hearing loss. Here is a list of some potential causes.
● Loud noise exposure: This can seem like an obvious cause of uneven hearing loss. However, there are a few groups of people that are at significantly higher risk because of much more noise exposure to just one of their ears. Experts say that people who serve in the military and hunters, for example, are at risk of developing “shooter’s ear.” This is a result of gunfire and often causes noise-induced hearing loss that is more severe in the ear of your “shooting side.”
● Earwax: Earwax can build up in your ear and cause pain and affect your hearing. This is referred to medically as “cerumen impaction” and is pretty common, especially for people who attempt to clean their ears the wrong way. This condition ought to be treated as soon as possible to avoid any extensive damage to your hearing. Your primary care doctor might give you some suggestions for at-home treatments that will remove the build-up of earwax before you have to get any professional ear cleaning done.
● Ear infection: You could have temporary uneven hearing loss due to an ear infection. If you have had a cold or sinus infection recently paired with some ear pain, it is important to see a doctor who can prescribe you antibiotics to treat your potential ear infection. Though this is an easy fix for acute asymmetrical hearing loss secondary to an ear infection, experts say that having a history of chronic middle ear infections can develop permanent asymmetrical hearing loss due to a change in inner ear bone structure.
● Otosclerosis/other bone disorders: Otosclerosis is a condition that results in the middle ear bones hardening. This hardness causes the bones to not be able to vibrate properly and decreases your ability to hear sounds properly. Otosclerosis runs in families and typically affects young white women according to studies. Congenital stenosis is another medical condition that can cause uneven hearing loss. This condition in particular narrows the ear canal and can affect one ear more than the other, resulting in asymmetrical hearing loss.
● Meniere’s disease: This disease is an autoimmune disorder that messes up the pressure inside of your ear. This typically only happens in one year and can lead to conditions like tinnitus and vertigo. In addition, Meniere’s disease causes fluctuation in hearing ability in the one ear that generally will decline over time. This is certainly one of the more common causes of asymmetrical hearing loss.
● Acoustic neuroma: Tumors beginning in the brain and extending to the inner ear are generally pretty rare, but do cause uneven hearing loss. These tumors are known as acoustic neuromas (vestibular schwannoma) and are benign and slow-growing. The nerves that are affected by acoustic neuroma play an important role in both hearing as well as balance. Because of this, the condition can often cause both dizziness and uneven hearing loss. It is important to see your family practice physician if you are experiencing these symptoms.
“Dual diagnosis”
Given the sensitivity of the inner ear, it is possible to have a combination of causes for asymmetrical hearing loss. You can have hearing loss due to brain injury and also have progressive hearing loss due to old age, for example. In this case, you would likely have hearing loss in both ears that is exacerbated in one ear due to the brain injury.
Acute hearing loss in one ear
If you all of a sudden experience hearing loss in one ear, when your hearing is typically healthy, it is important to see your healthcare provider right away. This is a medical emergency and can have many different causes. One of these causes that is more common is an infection of the hearing nerve of one ear.
What is the result of asymmetrical hearing loss on your overall hearing?
Depending on the cause(s) and severity of your asymmetrical hearing loss, your perception of the sounds you hear can be drastically different from what you perceived before the hearing loss occurred. For example, experts say that it is possible to experience something called the “head shadow” effect which is also known as single-sided deafness.
How is it different getting hearing aids with asymmetrical hearing loss?
Because of how complicated this condition can be, depending on how severe the difference is in hearing ability between the ears, it may take some trial and error with hearing aids. Your hearing healthcare specialist will want to pick out the right hearing aids that will allow you to perceive sounds as similar between the ears, as you did before your hearing loss. Because modern hearing aids are programmable, your hearing provider may be able to customize a set of hearing aids on each side to allow you to hear “normally.” There is always the chance though that the difference in hearing ability between ears is so extensive that you need bone-anchored hearing devices instead. This is why consulting an audiologist who works closely with your ENT is so important.
Step one: find a hearing provider that will work through this with you
Because of how complicated asymmetrical hearing loss is, it may take a good amount of time and adjustments to your hearing aid for you to finally be able to perceive sounds as similar in both ears. Remain patient throughout this process and be sure to find a hearing healthcare provider with good reviews and experience working with people who have uneven hearing loss.