Hearing impairment may be transient or permanent, partial or complete. It can involve the reception of low, medium and high frequency tones and can go unnoticed by the patient if the hearing impairment does not shag speech. Sound waves enter the external auditory canal passing through the middle ear tympanic membrane and the auditory tuberosity, and then enter the inner ear vagus. Hearing impairment can also be caused by trauma, infection, allergy, tumors, and systemic genetic disorders. Generally, most are caused by aging and usually appear after the age of over 50. Other physiological causes include ear wax, pressure imbalances in the eardrum caused by airplanes, elevators, or explosions, and chronic long-term exposure to environments above 90 db can also cause hearing loss. Five common causes of hearing impairment: 1. Auditory neuroma The VIII pair of brain nerve tumors can be unilateral, progressive sensorineural deafness, accompanied by auditory neuritis, vertigo and facial palsy. 2. Hirschsprung’s hypertrophy can cause hearing impairment with intermittent intra-aural pus. Patients may experience breathing through the mouth and a feeling of fullness in the ear. 3.Allergy Allergy involving the auditory nerve canal and the inner ear may cause hearing impairment with ear pain or pus-filled sensation, nasal bleeding and conjunctivitis. 4.Ear polyps Polyps in the external ear canal can also cause hearing impairment, with easy bleeding and purulent secretions on the surface. 5.Cholesteatoma may occur slowly with vertigo and occasional facial paralysis. Check for tympanic membrane perforation and discharge from the external ear canal.