Hearing loss

Next review due April 2024

Hearing loss can affect both children and adults. It can happen gradually or suddenly, and can be temporary or permanent. Gradual hearing loss is common as you get older, but sudden hearing loss means you need to seek help urgently.

How your ear works

Your ear is made up of three parts:

• Your outer ear – this is the part you can see. It’s shaped to focus sound waves into your ear canal and onto your eardrum.
• Your middle ear, which contains tiny bones (called the ossicles). These strengthen vibrations from soundwaves as they move through your ear.
• Your inner ear, which picks up vibrations and converts them to electrical signals. These are transmitted by your auditory nerve to your brain.

Types of hearing loss

There are three types of hearing loss. Which type you have depends on which part of your ear is affected.

• Conductive hearing loss. This is when a problem with your outer or middle ear means sound can’t pass freely through to your inner ear.
• Sensorineural hearing loss. This happens when there’s damage to your inner ear or to the nerve pathway between your inner ear and your brain.
• Mixed hearing loss. This is a combination of conductive and sensorineural hearing loss.

You may have hearing loss in one ear only (unilateral) or both ears (bilateral).

Causes of hearing loss

Conductive hearing loss

Conductive hearing loss is when sound can’t pass freely from your outer ear to your inner ear. The following are possible causes of conductive hearing loss.

• Infections of your outer or middle ear. Middle ear infections are a particularly common cause in children.
• Glue ear. This is the most common cause of hearing loss in children. It usually follows a middle ear infection and means that sticky fluid has collected in the middle ear.
• Blockage of your ear. This is usually due to a build-up of wax, but can be because something is stuck in your ear.
• Otosclerosis. This is a condition when extra bone grows on one of the three small bones (ossicles) in your middle ear.
• Perforated eardrum. This means your eardrum has been pierced or torn. This can be caused by an untreated ear infection, from poking something in your ear, or from changes in pressure – eg during scuba diving.
• Cholesteatoma. This is an abnormal skin growth that forms in your middle ear.
• A type of skin cancer that can develop in your ear, called squamous cell carcinoma.
• Bony growths inside your ear canal (exostoses). These are often caused by swimming in cold water.

Conductive hearing loss can be temporary or permanent, depending on the cause and whether it can be treated. 

Sensorineural hearing loss

Sensorineural hearing loss happens when there is damage to part of your inner ear, or to the pathway of nerves between your inner ear and your brain. The following are some possible causes of sensorineural hearing loss.

• Ageing. Hearing usually worsens with age. This is known as presbycusis and is the most common cause of sensorineural hearing loss.
• Exposure to loud noise. This can cause temporary or permanent damage to your hearing.
• Ménière's disease. This is a condition affecting the parts of your inner ear that are responsible for hearing and balance. It can cause tinnitus and dizziness as well as hearing loss.
• Labyrinthitis. This is inflammation of your inner ear, usually resulting from an infection.
• Certain medicines, such as some types of antibiotic and some loop diuretics (water tablets used to treat heart and kidney disease).
• Acoustic neuroma. This is a non-cancerous tumour that can grow on a nerve.
• Head injury. This can sometimes affect the bones around your ears, leading to hearing loss.
• Any other conditions that can affect your ear. These may include multiple sclerosis, stroke, rheumatoid arthritis and infections such as meningitis. It also includes congenital conditions (conditions you’re born with).

Sensorineural hearing loss is usually permanent because the damage to your inner ear can’t be repaired.

Symptoms of hearing loss

If you’re having trouble with your hearing, your ear may feel muffled, blocked or plugged. You may also feel as though there is water or pressure in your ear. Sometimes if your hearing loss happens gradually, you may not be aware of it at first. A common first sign is difficulty in following conversations, particularly in noisy places. You may feel like others are mumbling and need to ask them to repeat themselves. You might find you need to turn up the TV louder to hear it.

Children who can’t hear properly might have trouble concentrating and paying attention. This can then affect progress at school or nursery. They may also have problems with speech and language development.

Other symptoms you may have will depend on what’s causing your hearing loss. For instance, you may have:

• pain in your ear
• discharge from your ear
• tinnitus – buzzing or ringing in your ear
• a feeling of fullness or pressure in your ear
• dizziness or vertigo – (a spinning sensation)

If your hearing is gradually getting worse, it’s best to have a hearing test. You can get a referral from your doctor. Many pharmacies and opticians also offer hearing tests, where you don’t need a referral from your doctor. Always contact your doctor (or doctor’s team) who performed the surgery first if you have other symptoms, such as ear pain or discharge. You’ll need an appointment with your doctor or nurse to check for too much earwax or an infection.

If your hearing goes suddenly, over three days or less, arrange to see your doctor as soon as possible. Depending on what’s causing your symptoms, you may need to start treatment quickly.

Diagnosis of hearing loss

Seeing your doctor

If you see your doctor with hearing problems, they’ll ask about your symptoms and examine you. They’ll look in and around your ears to check for earwax and signs of infection. They may also ask about any medicines you take, other conditions you have, and family history of hearing loss. They may do some initial hearing tests using tuning forks. These can test whether just one or both your ears are affected, and help determine which type of hearing loss you have.

Depending on your symptoms, your doctor may refer you for further investigation. This may be with an ear, nose and throat (ENT) or an audiovestibular (hearing and balance) specialist.  If your doctor thinks you need a full hearing test, they’ll recommend you see an audiologist. This is a health professional specialising in hearing problems. They may refer you, or you can arrange your own test.

Hearing tests

An audiologist can carry out a full hearing test, called a pure tone audiogram. For this test, you’ll be asked to wear a set of headphones and press a button every time you can hear a sound. It lasts around 15 minutes. Your results will show the lowest level at which you can hear sounds.

Sometimes your audiologist will suggest other tests too. These may include:

• Speech audiometry. This involves playing words through headphones, which you then have to repeat. The level at which you’re able to repeat half of the words is recorded.
• Tympanometry. This is a test that looks at how much your eardrum moves, when a small amount of pressure is applied to your ear. It can show if you have fluid in your middle ear, a perforated ear drum or other problem in your middle ear.

Sometimes your audiologist may suggest other tests, including tests to measure the electrical signals produced by your ears. Depending on what your doctor thinks may be causing your hearing loss, they may also suggest an MRI or CT scan.

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Treatment of hearing loss

What treatment you have for your hearing loss will depend on what’s causing it. If it’s caused by something temporary, like an infection, it might get better on its own and you won’t need any treatment at all.

If your hearing loss is caused by a build-up of earwax, glue ear or a growth, these can be treated with simple procedures. If your hearing loss is permanent, then there is a variety of devices and aids that can help.

Treatable causes of hearing loss

If you have an infection that isn’t going away on its own, your doctor may prescribe antibiotics to help get rid of it.

If your hearing loss is caused by a build-up of earwax, your doctor will recommend removing it. You may also need earwax removed if it’s preventing your doctor from examining your ear properly. You may be able to have this done at your doctor practice or at a local clinic. A doctor or nurse may remove earwax by:

• irrigation (flushing your ear with warm water)
• microsuction (having the wax sucked out)
• using a probe to manually remove it

Sometimes there might be an underlying cause of your hearing loss that can be corrected with surgery. For instance, if your child has glue ear, your doctor may recommend surgery to relieve pressure in their ear. They can also insert tiny tubes called grommets. You can also have surgery to remove growths, such as a cholesteatoma or acoustic neuroma. Otosclerosis can also be treated with surgery, to remove part of the bone in your middle ear.

Devices to help with permanent hearing loss

If there’s no cure for your hearing loss, your audiologist will talk to you about the different devices available that can help you hear better. These include the following.

Hearing aids

Hearing aids pick up sounds around you, make them louder, and direct them into your ear. They won’t restore your normal hearing, but they can improve your hearing – especially if you wear them in both ears. There are many different types of hearing aids available, including ones that sit in your ear and ones that sit behind it. Most hearing aids are digital nowadays. They can be programmed to you and give a clearer sound than old analogue ones. Your audiologist can advise you on which types are best for you.

It can take a bit of getting used to wearing hearing aids, so be prepared to give it some time. Your audiologist will tell you what to expect and help you adjust to wearing one.

Implants

Your doctor may suggest an implant if you can’t wear a hearing aid for some reason, or you’re getting little or no benefit from them. There are different types of implant, including the following.

• Cochlear implants. This device turns sounds into electrical signals, which directly stimulates your auditory nerve. This gives you the sensation of hearing. One part of the device is worn behind your ear, outside of your head, while the other part is surgically implanted under the skin. Electrodes are also inserted into a part of your inner ear called your cochlea.
• Bone-anchored hearing aids. These pick up sounds and transmit them as vibrations through your skull bone and to your cochlea. This then sends signals onto your brain as normal. A bone-anchored hearing aid has two parts. There’s either a magnet or small screw implanted under your skin. You then have a processor with microphone, worn outside your head.

Other, newer types of implants and devices are being developed all the time. Your doctor can tell you what else may be available.

Assistive living devices

Assistive living devices are tools and devices that can be used to help you to hear specific things better, or alert you in other ways. For instance, you can have amplifiers for televisions to make them louder and direct the sounds straight into your ears. There are also devices that can alert you with loud sounds, vibrations or flashing lights. You can use them with doorbells, baby monitors and smoke alarms.

Communicating if you have hearing loss

If you have hearing loss, there are several things you can do to make things easier when you’re trying to communicate with others.

• Tell people that you have hearing loss. This will give them the opportunity to get your attention before they start speaking.
• Reduce any background noise as much as possible.
• Sit close to people you’re talking to and make sure you’re somewhere well lit, so that you can see their face and lips clearly.
• If your hearing loss is worse in one ear, sit with your better ear nearer the person you’re talking to.
• Ask the person to speak clearly and at a steady pace – but not to shout, as this can make it harder to understand lip movements.
• Stay calm and don’t be embarrassed to ask people to repeat anything or to write down important points if necessary.

It’s useful to bear these points in mind if you’re trying to communicate with someone who has hearing loss too.

Prevention of hearing loss

Although not all hearing problems can be prevented, avoiding exposure to loud noise will help to reduce the risk of damaging your hearing. The following tips may help.

• If you have to shout to be heard by someone a metre away, the background noise is probably loud enough to cause hearing damage.
• If your hearing seems dulled after being in a noisy environment, you’ve probably temporarily damaged your hearing. This can become permanent if you regularly expose yourself to this level of noise.
• Reduce your time around loud noise. Take frequent breaks if you can’t remove yourself from the noisy environment altogether.
• Wear ear protection (ear defenders or ear plugs) if you know you’re going to be somewhere noisy.
• Limit time and volume listening to music through earbuds or headphones. Only use earbuds for a maximum of 60 minutes per day; or use noise-cancelling headphones.
• If you work in a noisy place or with noisy equipment, make sure you wear ear protection.