Hearing issues when living with facial palsy

People with facial palsy often have hearing issues too. Learn about common causes and their effects on hearing on our webpage ‘Facial Palsy and the Ear‘. Note that not all causes of facial palsy cause the same symptoms.

If you suspect you have hearing loss, please discuss with your GP and ask for a hearing test.

These are some of the symptoms people may experience depending on the cause of their facial palsy:

• Pain in and around the ear
• Muffled hearing
• Hyperacusis (sensitivity to loud noise)
• Tinnitus (high pitched ringing in the ear)
• Hearing loss and hearing aids

How to manage your symptoms

Pain

• Unless the pain is severe/intense and persistent, then alternating Paracetamol and Ibuprofen throughout the day, as directed, should be sufficient to overcome the pain.
• When ear pain is intense and interfering with daily functions, for example, preventing you from sleeping then consult with your GP about pain killers which specifically target nerve pain. For example, Pregabalin, or Gabapentin.
• Using heat, for example, a ‘wheaty bag’ over the affected area may help.
• Gentle circular massage may also be beneficial but stop if pain increases.
• If you have had your facial palsy for several weeks/months and your facial muscles are feeling tight and tender on the affected side and/or you have developed synkinesis (involuntary facial movements), your ear pain may be related to tightness in the muscles in and around the ear. For more information about this go to the section on the following link entitled ‘Why does muscle tightness and pain occur around the ear in the synkinetic stage of recovery? Here you will find out how to test for auricular/ear pain and how to manage the pain by stretching.

Muffled hearing

• Muffled hearing is a muted or plugged sensation in the ear. Whilst not serious it is aggravating and distracting to some and can make hearing more difficult.
• Muffled hearing means that sound is not travelling from the outer ear to the middle ear normally.
• Injury to the facial nerve alters the muscle tone in and around the ear which may affect how sound is transmitted causing hearing to be muted.
• This usually gets better within the first few weeks but if symptoms persist you should discuss this with your GP who can examine your ear to exclude other contributory factors, for example, wax plugs or fluid build-up in the middle ear. You can ask to be referred for a hearing test.

Tinnitus

• Tinnitus is often described as high-pitched ringing in the ear/s or inside your head, but it can be any sound that does not come from an outside source.
• It can come and go and may disappear with time or it may be permanent.
• Tinnitus is usually linked to hearing loss and affects 15 – 20% of the population. The hearing loss is usually at the same pitch as the ringing/buzzing sound.
• You can find self-help tips on relaxation, diet, sound therapy, useful technology etc. by visiting the Tinnitus UK charity website self-help tips page.
• Getting support for your tinnitus may help. The Tinnitus UK charity provides support groups.
• Sound therapy can be free or inexpensive and the Tinnitus UK charity provides further information.
• If you have hearing aids it is important to wear them, as this may reduce awareness of your tinnitus.
• Avoid long periods of complete silence as this can make the tinnitus more obvious.
• Loud noises can trigger bouts of tinnitus or make tinnitus worse so avoiding very loud noises may help.
• Wear ear defenders if operating loud machinery, for example, lawn mowers/carpet cleaners/DIY tools.

Hyperacusis

• Hyperacusis is when everyday noises sound much louder than they should.
• Sometimes hyperacusis can be painful when severe.
• People react to hyperacusis in different ways and many people continue life as normal.
• Some people may experience anxiety and may withdraw from social and professional situations which can lead to isolation.
• Wearing ear plugs is not recommended as sensitivity to sound increases through lack of exposure.
• For more information on treatment go to the Tinnitus UK charity website about hyperacusis. They describe the type of sound intolerance people experience and how this can be managed, as well as support for people living with hyperacusis.
• This is a very helpful book, aimed at people living with Tinnitus and Hyperacusis – Living with Tinnitus and Hyperacusis (McKenna, Baguley and McFerran, 2021, Sheldon Press ISBN 978 1529375355.
• Tinnitus UK also have a support team who can answer questions on any tinnitus related topics. See ‘how we can help‘.
• Tinnitus UK also provide ‘The Hyperacusis Network’ which is a self-help resource offering information, forums, and sound therapy CDs for hyperacusis.

Hearing loss and hearing aids

• This can range from a mild hearing loss to the complete loss of hearing on the affected side. If you experience any hearing loss, ask your GP for a referral to your local audiology department for a hearing test. If hearing aids are required, they can be fitted in the department and programmed according to the results of your hearing test.
• The Contra-lateral Routing of Signal (CROS) hearing aid is designed for people with one poor ear and one good ear otherwise referred to as Single Sided Deafness (SSD). CROS hearing aids are designed to pick up sounds from the poorer-hearing ear and transmit them wirelessly to a hearing aid in the better-hearing ear. This enables the person to hear sounds from both sides of their body and helps them to locate the source of the sound and hear better in noisy environments.
• Bone Anchored Hearing Aid (BAHA): A BAHA system sends sound through the skull bone to the inner ear, rather than through the ear canal as with a traditional hearing aid. They are useful for people with SSD, as sound can be sent from one side of the head to the other. It consists of two parts: the external processor which is worn on the side of the head and a way of attaching this to the head.
• There are two types of attachments for the BAHA processor, one is permanent and requires a small operation to insert an abutment or magnet to the skull. The BAHA processor then clips onto the abutment or magnet. The processor can come on or off, but the abutment or magnet is permanent. The other type is non-permanent way of wearing the BAHA processor by wearing a fabric band/plastic headband or special sticker clip depending on the type of BAHA system used.
• The Royal National Institute for Deaf people (RNID) website has information about a range of topics associated with hearing loss including the different types of hearing loss and different hearing aids plus advice about benefits, rights when using public services, and help in the workplace.
• The NHS website also has a lot of information about hearing aids and implants.
• Lip reading is a useful adjunct to help with hearing. Follow the link for communication tips.