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 passes 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 your cochlea and auditory nerve. This is the nerve that sends information about sound to your brain. The cochlea is full of fluid and contains tiny hair cells. The vibrations cause the fluid in your cochlea to move the hair cells. When these hair cells move, they produce electrical signals that travel along your auditory nerve to your brain, where they’re converted into meaningful information such as language or music.
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’s damage to your 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).
Your symptoms will differ depending on the cause of your hearing loss. But in general, you (or your friends and family) may notice that you’re having trouble hearing. Your ear may feel muffled, blocked or plugged. You may also feel as though there is water or pressure in your ear.
You may have other symptoms associated with your hearing loss, such as:
- pain in your ear
- weeping of fluid from your ear
- tinnitus – this is when you hear a sound in your head that doesn’t exist in your surroundings
- vertigo – this is a type of dizziness where you feel as though your surroundings are moving or spinning around you
Children may also have problems with developing their speech and language.
If you have sudden hearing loss in one or both ears, seek immediate advice, as depending on what the cause is, your hearing loss may happen gradually or all of a sudden. If your hearing is getting worse gradually, contact your GP. If it goes suddenly, seek advice immediately – you may need to start treatment quickly.
Your GP will ask you about your symptoms and examine you. They may also ask you about your medical history.
Your GP may do a hearing test or may refer you to a specialist; 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 some of 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 what they’ve said. Your doctor will test each ear separately.
- Tuning fork tests. These include the Rinne’s test and Weber’s test. These tests can help determine the type of hearing loss you have.
- Pure tone audiometry. This test can help to work out how bad your hearing loss is. During this test you’ll be asked to wear a set of headphones attached to a machine called an audiometer. The audiometer will produce sounds of different volumes and frequencies, and you’ll be asked to indicate when you can hear them. Your audiologist will then work out your threshold. This is the lowest level at which you can hear the sounds.
- Otoacoustic emissions test. This test is used to work out if you have sensorineural hearing loss (hearing loss caused by damage to your inner ear, or to the pathway between your inner ear and your brain). During this test a microphone is taped to your outer ear to detect the faint sounds that are normally produced by the hair cells in your cochlea. If no sound is detected, it could mean you have sensorineural hearing loss.
- Auditory brainstem response. This test measures the activity of your cochlea, auditory nerve and brain when a sound is heard.
There are other tests that can help pinpoint the cause of your hearing loss. If you need to have one of these tests, ask your doctor for more information.
If you have hearing loss, there are a few things you can do to help.
- Tell people that you have hearing loss. Telling people can give them the opportunity to get your attention before they start to speak, making you less likely to miss parts of the conversation.
- Sit close to the person you’re talking to so that you can see their face and lips.
- If you have hearing loss in one ear, sit so that your better ear is closer to the person you’re talking to.
- Stay calm and don’t be embarrassed to ask the person your’re speaking to repeat anything.
If your hearing loss is being caused by a bacterial infection, you may be prescribed antibiotic drops. Ask your pharmacist for advice on how to apply your medicine, and always read the patient information leaflet that comes with it.
If your hearing loss is being caused by a build-up of ear wax, a nurse will often be able to remove the blockage by flushing your ear through with warm-water. The wax will first have to be softened by applying olive oil drops for several days beforehand.
If there’s 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 - your audiologist will advise you which type best suits your needs.
You may need to have surgery if your hearing loss is caused by any of the following.
- Overgrown adenoids. Your adenoids normally stop growing when your’re around five years old. But if they continue to grow, they can block the tube that connects the middle of your ear to the back of your mouth, and cause hearing loss. See our topic on adenoid and tonsil removal for more information.
- A growth. If you have a growth in your ear, it can block your ear canal and cause hearing loss. If you have a growth called an acoustic neuroma on the nerve that sends messages about hearing and balance to your brain, it can cause hearing loss, dizziness or vertigo. So you may need surgery to remove it.
- Cholesteatoma. This is an abnormal growth of skin that can form in your middle ear. If you have a cholesteatoma, it’s likely that you’ll need to have it surgically removed.
- Otosclerosis (also known as otospongiosis). This is when bone deposits on one of the three small bones (ossicles) in your middle ear. Otosclerosis stops your ossicles being able to amplify and conduct sound to your inner ear.
- Perilymph fistula. This is when a channel forms and connects your inner and middle ear. Fluid from a part of your inner ear called the cochlea leaks into your middle ear and causes hearing loss, tinnitus, and vertigo.
If you’re profoundly deaf, 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. One part of the device is put behind your ear on the outside of your head. The other is surgically implanted in a bone (called the mastoid bone) behind your ear.
Conductive hearing loss
Conductive hearing loss is caused when sound can’t pass freely from your outer ear to your inner ear. The following are possible causes of conductive hearing loss.
- Middle ear infections. Infections of the middle ear are particularly common in children and are usually caused by the bacteria Streptococcus pneumoniae and Haemophilus influenzae
- Glue ear. This is characterised by a build-up of fluid in your middle ear and is one of the most common causes of hearing loss in children.
- Blockage of your ear. This is usually caused by a build-up of wax, but can also be due to something being stuck in your ear.
- Otosclerosis. This is when bone deposits on one of the three small bones (ossicles) in your middle ear. This prevents sound from being amplified, and conducted to your inner ear.
- Perforated eardrum. This is when your eardrum becomes pierced or torn. This can be caused by an untreated ear infection, a head injury, or from poking something in your ear.
- Cholesteatoma. This is an abnormal skin growth that forms in your middle ear and interferes with the transmission of sound to your inner ear.
- The causes of conductive hearing loss can often be treated, so it’s usually only temporary.
Sensorineural hearing loss
Sensorineural hearing loss is caused when the hair cells within your cochlea (a part of your inner ear) are damaged. Or, if the pathway of nerves between your inner ear and your brain is damaged. The following are some possible causes of sensorineural hearing loss.
- Ageing. As you get older, your hearing will probably get worse – this is known as presbycusis.
- Regular exposure to loud noises, for example, if you work in a noisy place or listen to a lot of loud music.
- Certain viral infections such as measles, mumps, rubella, meningitis and shingles.
- Ménière's disease. This condition affects the parts of your inner ear that are responsible for your hearing and balance, and so can cause hearing loss, tinnitus and dizziness. See our resources section for further information on where to find support in your local area if you have Ménière's disease.
- Certain medicines, such as some types of antibiotics and some loop diuretics (a group of medicines used to treat some cardiovascular diseases).
- Certain cancer treatments, such as chemotherapy and radiotherapy.
- Acoustic neuroma. This is a tumour that affects the nerve that sends messages about hearing and balance to your brain. These tumours are usually benign (non-cancerous) and grow slowly.
- An injury to your head.
Usually, sensorineural hearing loss is permanent. This is because your inner ear and the hair cells in your cochlea aren’t very good at repairing themselves.
Although not all hearing problems can be prevented, there are some things you can do to protect yourself against certain types of hearing loss.
- Avoid exposing your ears to loud noises, and if you do, protect your ears where you can. Stand back from speakers in nightclubs and bars, and carry ear plugs with you – these won’t block out sound, but will make noises safer for your ears. If you work in a noisy place, such as a factory, building site or nightclub, make sure you wear the right equipment to protect your hearing. You should also attend hearing tests provided by your employer, so that any problems with your hearing can be picked up early on.
- Where you can, avoid medications that could cause hearing loss.
- Get treatment for any ear infections early on.
FAQ: Children and hearing loss What could be causing my child’s hearing loss and is it likely to be permanent?
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.
If your child’s having trouble hearing, and has earache or discharge from their ear, they may have a middle-ear infection. Middle-ear infections are very common in young children – by the age of three, more than three-quarters of children will have had at least one middle-ear infection. They usually go by themselves, and your child’s hearing should return to normal once the infection has cleared.
If the infection doesn’t clear, or your child keeps getting middle-ear infections, see your GP. Your child may need antibiotics or to be referred to a specialist.
Your child may have what’s called glue ear – this is when fluid collects behind their eardrum and causes temporary hearing loss. Most cases of glue ear follow on from a middle-ear infection.
Although your child’s hearing loss is probably temporary, some children are born deaf. In the UK, around 840 babies are born with permanent hearing loss each year. Your child will have a hearing test soon after they’re born (the Newborn Hearing Screening Programme), so any problems with their hearing can be picked up early on.
Some children may develop permanent hearing loss. Meningitis, for example, can cause permanent hearing loss in children. If your child has had meningitis and is now having hearing problems, visit your GP for advice.
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Produced by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, April 2016.
Peer reviewed by Mr Anil Banerjee, Consultant Ear, Nose and Throat surgeon.
Next review due April 2019.
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