Deafness

About hearing loss

Hearing loss affects around one out of six people in the UK. Most of these people are over 60 and have lost their hearing gradually as part of the natural ageing process. More than half of people over 60 in the UK have some degree of hearing loss. However, hearing loss can also happen at a younger age.

Sound and the ear

Your ear consists of three parts: the outer ear, middle ear and inner ear.

The outer ear is the visible part of your ear. It collects sound waves, which travel down your ear canal to your eardrum. The sound waves cause your eardrum to vibrate. This vibration is passed on to your middle ear, which consists of three small bones called ossicles. The ossicles amplify and conduct the vibrations to your inner ear.

Your inner ear contains the cochlea and the auditory nerve. The cochlea is full of fluid and contains tiny hair cells. Vibrations cause the hair cells in your cochlea to move. Movement of these hair cells produces electrical signals that travel along the auditory nerve to your brain, where they are converted into meaningful information, such as language or music.

Types of hearing loss

There are two main types of hearing loss.

  • Conductive hearing loss – this is caused when sound can’t pass freely from your outer ear to your inner ear.
  • Sensorineural hearing loss – this happens when there is damage to the inner ear or to the pathway between your inner ear and your brain.

You may have a combination of conductive and sensorineural hearing loss – this is known as mixed hearing loss.

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

Symptoms of hearing loss

In adults, hearing loss may be very gradual, for example in age-related hearing loss. You may start to notice you find it difficult to hear and understand people when you're in a noisy place. Hearing loss can also be very sudden, for example if it’s caused by a viral infection of the inner ear. Some people find that their hearing loss is associated with a continual ringing in their ears (tinnitus).

If you have an infection, you may have some other symptoms, such as earache and discharge from your ears.

Hearing loss can affect the speech and language development in children.

If you, or your friends and family, think that your hearing is getting gradually worse, see your GP. For example, you may have started to notice that you have difficulty hearing what is being said when you are in a group.

If you have sudden hearing loss in one or both ears, seek immediate advice, as treatment may need to be started very quickly.

Causes of hearing loss

Conductive hearing loss

The following are possible causes of conductive hearing loss.

  • Middle ear infection. This is particularly common in children.
  • Glue ear (a build-up of fluid in your middle ear). This is also common in children.
  • Blockage of your outer ear, usually caused by a build-up of wax.
  • Otosclerosis – bone growth in the middle ear, which causes the ossicles of your middle ear to become fixed. As a result, they become less able to vibrate.
  • Perforated (pierced) eardrum, which can be caused by an untreated ear infection, a head injury or from poking something in your ear.
  • Cholesteatoma – a benign skin growth behind your eardrum.

The causes of conductive hearing loss can often be treated, so it’s usually only temporary.

Sensorineural hearing loss

Sensorineural hearing loss happens when the hair cells within your cochlea are damaged. The following are some possible causes.

  • Age-related hearing loss (presbycusis) – a natural decline in your hearing as a result of damage that occurs to your cochlea as a part of the ageing process.
  • Regular exposure to loud noises, for example if you work in a noisy place or listen to a lot of loud music.
  • Certain infections such as rubella, measles or meningitis.
  • Meniere's disease – a condition that affects your inner ear, causing dizziness and tinnitus, as well as leading to hearing loss.
  • Certain medicines, such as some strong antibiotics.
  • Certain cancer treatments, such as chemotherapy and radiotherapy.
  • Acoustic neuroma – a benign (non-cancerous) tumour that affects your auditory nerve.
  • An injury to your head.

Sensorineural hearing loss is usually permanent as once the hair cells in your cochlea are damaged, they can’t be repaired.

Diagnosis of hearing loss

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may do a hearing test, or he or she may refer you to either an otolaryngologist (a doctor who specialises in ear, nose and throat disorders), an audiologist (a specialist in hearing) or an audiovestibular physician (a doctor who specialises in hearing, balance and communication problems).

You may have the following tests.

  • Whispered speech test. Your doctor will whisper a combination of numbers and letters from behind you and ask you to repeat the combination to check if you can hear anything. He or she will test each ear separately.
  • Tuning fork test. Different tuning forks can be used to test your hearing at a variety of frequencies. They can also help determine the type of hearing loss you have.
  • Pure tone audiometry. You will be asked to wear a set of headphones attached to a machine called an audiometer. The audiometer produces sounds of different volumes and frequencies, and you will be asked to indicate when you hear the sounds in the headphones. The level at which you can’t hear the sound of a certain frequency is known as your threshold.
  • Otoacoustic emissions. This test is used to measure your cochlear function by recording signals produced by the hair cells.
  • Auditory brainstem response. This test measures the activity of your cochlea, auditory nerve and brain when a soundis heard.

If your hearing loss has a sensorineural cause, a number of other tests can be done to pinpoint where the problem lies.

If one ear is hearing better than the other, your doctor may organise a scan – usually an MRI scan. This is to rule out rare causes of hearing loss such as an acoustic neuroma or cholesteatoma.

Treatment of hearing loss

Self-help

You may find it easier to hear and understand people if you:

  • tell people that you have hearing loss – that way the person can get your attention before they start speaking and don’t be embarrassed to ask the person to repeat anything
  • sit close to the person you’re talking to so that you can see the person’s face and lips
  • sit so that your better ear is closer to the person you’re talking to
  • stay calm – although it can be frustrating, it’s important to keep calm so you can follow what is being said
     

Medicines

If you have a bacterial infection of your middle ear, it can sometimes be treated with antibiotics. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatments

If your outer or middle ears are blocked by ear wax or fluid caused by an ear infection, a nurse will often be able to remove the blockage with a syringe after it has been softened.

If there is no cure for your hearing loss, for example if it’s caused by ageing, a hearing aid for one or both of your ears may help. Hearing aids can work for both conductive and sensorineural hearing loss. Many different types of hearing aid are available, and your audiologist will advise you as to which type best suits your needs.

Surgery

If you have a large perforation of your ear, you may need to have surgery to repair it.
An acoustic neuroma may only need monitoring. However, if needed, it can be removed with surgery or treated with radiotherapy. Ossicles affected by otosclerosis can sometimes be treated with surgery.

If a hearing aid doesn’t help (eg in profound deafness), your doctor may suggest you have a cochlear implant. This is a device that turns sounds into electrical signals, which directly stimulate your auditory nerve allowing you to hear.

My child is having trouble hearing - what could be causing it and is it likely to be permanent?

Answer

It’s likely that your child has temporary hearing loss caused by an ear infection or illness. However, some children are born with, or can develop, permanent hearing loss. If you’re concerned about your child’s hearing, see your GP.

Explanation

If your child is having trouble hearing and has earache or discharge from his or her ear, he or she may have a middle-ear infection. Middle ear infections are very common, particularly in young children – three-quarters of middle ear infections occur in children under 10. See your GP, who may give your child painkillers or, sometimes, antibiotics. Once the infection has cleared up your child’s hearing should return to normal.

Your child may have temporary hearing loss caused by fluid collecting behind his or her eardrum – this is known as glue ear. It’s most common in children aged between two and five. If your child has lost his or her hearing and is complaining of earache, he or she may have this condition. See your GP who will be able to advise you on treatment options.

Meningitis can cause permanent hearing loss in children. If your child has had meningitis and is now having hearing problems, visit your GP for advice.

Although your child’s hearing loss is probably temporary, in some children it can become permanent. In the UK, around 840 children are born with permanent hearing loss each year. Your child will have a hearing test soon after he or she is born (the Newborn Hearing Screening Programme), which should pick up any problems early on.

If you think your baby or child is having trouble hearing, visit your GP who will test your child’s hearing.

I work in a noisy environment. Could this be damaging my ears and how can I protect my hearing?

Answer

Loud noises, especially when you’re around them for long periods of time, can damage your hearing. You should wear ear protection whenever you’re in a noisy area at work.

Explanation

According to the World Health Organization, noise-induced hearing loss is the main cause of permanent hearing loss worldwide. If you work in a noisy place, such as a factory, building site or nightclub, your hearing can be damaged gradually. You may find that you have a ringing in your ears or that your hearing is muffled after you leave work. These are both signs that your hearing has been affected by the loud noises around you, so if you have these symptoms, speak to your employer in the first instance.

Your employer should provide ear protection, usually earplugs or earmuffs, for you to wear to help prevent damage to your hearing. You must wear these whenever you’re in a ‘hearing protection area’, which should be clearly marked. Remember, once damage has been done to your hearing it can’t be reversed.

Make sure you attend hearing tests provided by your employer, as they may pick up any problems with your hearing early on.

Outside of the workplace, you can protect your hearing by standing back from speakers in nightclubs and bars, and carrying ear plugs with you – these won’t block out the sound, but will make the noise safer for your ears.

How can I stop my hearing getting worse as I get older?

Answer

Most people get a certain amount of hearing loss as they get older, but you can try to protect your hearing as much as possible by looking after your ears and reducing how much time you spend in noisy places.

Explanation

As you get older, your hearing will probably get worse – this is known as presbyacusis. This type of hearing loss is caused by damage to the tiny hair cells in your ear, which help sound to travel to your brain. You may find that you have difficulty hearing people speak in noisy places and on the telephone, and find trying to keep up with a group conversation difficult and tiring.

This type of damage to your hearing is difficult to prevent: more than half of people over 60 in the UK have some degree of hearing loss.

However, there are ways you can help to limit the damage.

  • A history of middle ear infections may contribute to age-related hearing loss. See your GP if you have earache, deafness or any painful discharge so this can be treated properly.
  • Certain medicines, such as diuretics, and conditions, such as osteoporosis, may contribute to hearing loss – speak to your GP about how these may affect your hearing.
  • Your hearing can also be affected by exposure to loud noises. If you work in a noisy place, wear earplugs or earmuffs to protect your ears and try to keep the volume of any music you listen to as low as possible. This will help protect you against noise-induced hearing loss.

If you’re concerned about hearing loss, speak to your GP. Age-related hearing loss can be successfully treated with hearing aids.