Hello? Is This Thing On? Hearing Impairment and MS
Although hearing impairment is a relatively rare symptom of MS, it is definitely one that we need to talk about more often. In the past neurologists did not think that MS could affect our sense of hearing, but we now know that relapses can damage the nerves responsible for hearing and language comprehension. Damage to these nerves, which are located in the brainstem and auditory cortex, can cause a variety of difficulties which I want to describe in more detail:
The eighth cranial nerve, known as the auditory nerve, links the ear to the brainstem. Damage to the auditory nerve, or other nerves associated with hearing, can cause “sensorineural hearing loss”. This means the ear itself is perfectly normal, but the nerves are damaged and can’t relay messages between the ear and the brain. It may become difficult to hear certain tones or pitches, and it can be very difficult to follow conversations in noisy or crowded environments. Sensorineural hearing loss can affect one or both ears.
Sensitivity to Noise
This particularly troubling symptom, called hyperacusis, can cause extreme pain to everyday noises. It occurs when a damaged nerve becomes overly excitable, causing it to fire uncontrollably when stimulated. The affected individual may avoid leaving the house because normal sounds can trigger intense pain, irritation, anxiety, and/or tension. Antiseizure medications are typically used to calm down the overactive nerves causing the pain.
Temporary or Sudden Hearing Loss
A sudden change in your hearing, in the absence of any signs of infection, may be a sign of a MS relapse. If this is the case your symptoms will most likely improve as you recover from the relapse, and recovery can be sped up by taking steroids. If you have pain associated with sudden hearing loss you should seek immediate medical attention, because it could be a sign of a ruptured eardrum or other serious issue.
Ringing in the Ears
A lot of people, not just those with MS, experience nagging ringing, buzzing, or whooshing sounds known as tinnitus. They can be occasional or constant, and can really impair your ability to listen to or focus on conversation. Tinnitus can be caused by a relapse, medications, an inner ear problem, or it can be idiopathic (meaning we really don’t know what the cause is). Some people who have persistent tinnitus can cope with it this background noise, such as music or the TV. If you also have hearing loss a hearing aid may be helpful. If you have tinnitus talk to your doctor and try to figure out if there is a treatable cause. They may also send you to an Ear, Nose, and Throat specialist for a more detailed exam.
Vertigo is an intense spinning sensation. Because balance and hearing are controlled by the same area of the brainstem, vertigo can occur hand-in-hand with hearing impairments. Vertigo can be treated with medications and other therapies.
Total loss of hearing, or deafness, is rarely caused by MS. Most hearing impairments caused by MS result in partial hearing loss, and often improve over time to some degree.
Difficulty Understanding Language
The part of the brain that takes the signals from the nerves in the ear and translates them into comprehensible words is known as the Warnicke’s Area. It is responsible for the interpretation and comprehension of spoken language. The Warnicke’s Area is located in the auditory cortex which can, on rare occasions, be damaged by MS. An affected individual will be able to hear normally, but everything will sound like nonsense because they are unable translate or interpret sounds.
Even though MS can cause the symptoms described above, other ear problems are still more likely to be the cause and therefore must always be ruled out. If you have a hearing impairment you absolutely must consult with your doctor, they are the only ones who can tell if it is caused by MS or not. The most common causes of hearing difficulties include a buildup of of earwax, damage to your eardrum, aging, infection, or regular exposure to loud noise. You may need to see an Audiologist or an Ear, Nose, and Throat (ENT) doctor to figure out what the root of the problem is.
If your doctor determines that your hearing impairment is a symptoms of an MS relapse, you may be able to treat them with steroids. If your symptoms don’t improve or return to baseline then you may need an amplifying device or hearing aid. If you also experience vertigo there are medications and even a type of physical therapy for the ear known as “vestibular rehabilitation”.
If you have been affected by hearing impairment please share you story below and let others know that they are not alone!