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Hearing loss


Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
Next review due August 2021

Hearing loss affects both children and adults. Some people are born deaf; older people can lose their hearing gradually with age. One in six people have hearing loss in the UK, but in people over 50 this rises to four in 10.

Hearing loss can be temporary or permanent. Most children with hearing loss are not born deaf. Ear infections are a common cause of temporary hearing loss in children. Other causes of hearing loss include loud noise, earwax and some medicines.

How your ear works

There are three parts to your ear: the outer ear, middle ear and inner ear. The outer ear is the part you can see. It is shaped to focus sound waves into your ear canal, so they travel to your eardrum. The sound waves make your eardrum vibrate. This vibration passes to your middle ear, which contains three small bones (ossicles) called the hammer, anvil and stirrup (named after their shapes). These strengthen the vibrations as they conduct them to your inner ear.

Inside your inner ear is the cochlea. This is a coiled tube that is full of fluid and contains tiny hair cells. The vibrations from the middle ear cause the fluid in your cochlea to move the hair cells. When this happens, the hair cells produce electrical signals that pass to the auditory nerve. The auditory nerves transmits these signals to your brain, which converts them into meaningful information such as language or music.

Also in your inner ear are three structures called the semi-circular canals. They control your balance. This is why some inner ear conditions can cause dizziness and problems with balance.

Types of hearing loss

There are two main types of hearing loss.

  • Conductive hearing loss – this is 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).

Symptoms of hearing loss

Your symptoms will depend on the cause of your hearing loss and your age. For adults, symptoms may include having trouble hearing. A common first sign is difficulty in understanding people, particularly in noisy places. You may complain that others are mumbling. Your ear may feel muffled, blocked or plugged. You may also feel as though there is water or pressure in your ear.

Other symptoms associated with hearing loss include:

  • pain in your ear
  • weeping of fluid from your ear
  • tinnitus – buzzing or ringing in your ear
  • vertigo – dizziness combined with a feeling of the world moving or spinning around you
  • headaches

Children who can’t hear properly often have problems developing speech and language. They may also have signs of chronic infection, such as breathing through their mouth or coughing.

If your hearing is gradually getting worse, make an appointment to see your GP. If it goes suddenly, over three days or less, contact your GP urgently. You may need to start treatment quickly.

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Diagnosis of hearing loss

Your GP will ask about your symptoms and examine you, including looking inside your ears. They may also ask about your medical history.

Depending on your symptoms, your GP may arrange further tests or may refer you to a specialist. This may be 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 can help determine the type of hearing loss you have. Your doctor may hold the tuning fork in line with your ear, just behind your ear or against your forehead.
  • Pure tone audiometry can help to work out how bad your hearing loss is. You wear a set of headphones attached to a machine that produces sounds of different volumes and frequencies. Your doctor or audiologist will ask you to say each time you can hear a sound.
  • Otoacoustic emissions test can show if you have hearing loss caused by damage to your inner ear (your cochlea). A microphone is taped to your outer ear to pick up the faint sounds 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 can show if your hearing loss is caused by a problem with your auditory nerve or brain. Clicks are played into your ear or through headphones and the brainwaves caused by the sound are picked up by electrodes placed on your head.

There are other tests to help pinpoint the cause of your hearing loss. If you need to have one of these tests, ask your doctor for more information.

Depending on what your doctor thinks may be causing your hearing loss, they may suggest a scan – usually an MRI scan or CT scan .

What you can do to help

If you have hearing loss, there are a few things you can do to help yourself.

  • Tell people that you have hearing loss – this will give them the opportunity to get your attention before they start to speak, making you less likely to miss anything.
  • Sit close to people you’re talking to, so that you can see their face and lips.
  • If your hearing loss is worse in one ear, sit with your better ear nearer the person you’re talking to.
  • Stay calm and don’t be embarrassed to ask people to repeat anything or speak more slowly and clearly.

Treatment of hearing loss

Medicines

If your hearing loss is caused by a bacterial infection of the outer ear canal, your doctor may prescribe antibiotic drops. Antibiotics taken by mouth are usually prescribed only for very severe middle ear infections. Ask your pharmacist for advice on your medicine, and always read the patient information leaflet that comes with it. If you keep getting ear infections, your doctor may refer you to a specialist.

Non-surgical treatments

If your hearing loss is caused by a build-up of earwax, it will need to be removed. You may be able to have this done at your surgery by syringing. Warm water is flushed into your ear canal to remove the wax. But first the wax has to be softened by applying olive oil or almond oil drops, or drops containing sodium bicarbonate, for several days beforehand. You can buy these drops from your local pharmacy. In some cases, you may have to go to a specialist clinic to have wax removed by syringing or with microsuction.

If there’s no cure for your hearing loss (for example, if it’s caused by ageing), you may find a hearing aid helpful for one or both ears. Hearing aids can work for both conductive and sensorineural hearing loss. Many different types are available – your audiologist can advise you on which types are best for you.

A hearing aid will help if you give it time, but wearing one can take a bit of getting used to. You need to accept that it won’t be able to return your hearing to normal. Your audiology department will tell you what to expect and help you adjust to wearing a hearing aid.

Surgery

You may need to have surgery if your hearing loss is caused by any of the following.

  • Overgrown adenoids – these normally stop growing when you’re around five years old. But if they continue to grow, they can cause hearing loss by blocking the tube connecting your middle ear to the back of your mouth. See our topic on adenoid and tonsil removal for more information.
  • A growth in your external ear canal can block your ear canal and cause hearing loss.
  • An acoustic neuroma can grow on the nerve that sends messages about hearing and balance to your brain and can cause hearing loss, dizziness or vertigo. You may need surgery to remove the neuroma.
  • A cholesteatoma is an abnormal growth of skin that can form in your middle ear. It is treated with surgery to remove it.
  • Otosclerosis (also called otospongiosis) is when extra bone grows on one of the three small bones (ossicles) in your middle ear. This stops your ossicles being able to amplify and conduct sound to your inner ear.
  • Perilymph fistula is an abnormal opening between your inner and middle ear. Fluid leaks into your middle ear and causes hearing loss, tinnitus, and vertigo. If this doesn’t get better with bed rest, you may need surgery.

Depending on the cause of your deafness, your doctor may suggest you have a cochlear implant. This device turns sounds into electrical signals and uses them to 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 part is surgically implanted in a bone (called the mastoid bone) behind your ear. It will take time and help from a therapist to get used to using a cochlear implant.

Causes of hearing loss

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 – this is 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 caused by a build-up of wax, but can be because something is stuck in your ear.
  • Otosclerosis – this means there is an overgrowth of bone 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 – your eardrum has been 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.

Conductive hearing loss can be temporary or permanent, depending on the cause.

Sensorineural hearing loss

Sensorineural hearing loss is caused when the hair cells within your cochlea (a part of your inner ear) are damaged. Or when there is damage 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.
  • Loud noise – regular exposure to loud noise such as a noisy work place or loud music can permanently damage your hearing.
  • Some viral infections such as measles, mumps and rubella (German measles) can lead to hearing loss.
  • Ménière's disease is a condition affecting the parts of your inner ear that are responsible for hearing and balance. It can cause hearing loss, tinnitus and dizziness. See our information on other helpful websites to find local support groups for Ménière's disease.
  • Certain medicines such as some types of antibiotic and some loop diuretics (water tablets used to treat heart and kidney disease) can cause damage to your hearing.
  • Certain cancer treatments such as chemotherapy and radiotherapy may lead to hearing loss.
  • Acoustic neuroma is a non-cancerous, slow-growing tumour that grows on the nerve that sends messages about hearing and balance to your brain. This can result in hearing loss.
  • Head injury – hearing loss occurs in around two or three out of ten people who have a head injury. Hearing may improve slowly over time.

Sensorineural hearing loss is usually permanent because the hair cells in your cochlea or the nerves related to hearing are damaged.

Prevention of hearing loss

Although not all hearing problems can be prevented, there are some things you can do to protect yourself against certain types of hearing loss.

Noise is the biggest cause of permanent hearing damage. 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. You can also get earplugs that are specially designed for listening to music. They reduce volume rather than muffling sound.

If you work in a noisy place or with noisy equipment, make sure you wear ear protection. Your employer has to provide this for you. Your employer also has to provide hearing tests – make sure you go to them so that any hearing problems can be picked up early on.

Get treatment for any ear infections early on.

Frequently asked questions

  • If your child 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 two-thirds of children will have had at least one. They usually go away 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 the eardrum and causes temporary hearing loss. Most cases of glue ear follow on from a middle-ear infection.

  • If your child has not been born with hearing problems, it is most likely that their hearing loss is temporary. However, some children are born deaf. Each year in the UK, around 840 babies are born with permanent hearing loss. 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 develop permanent hearing loss. Meningitis and some viral infections such as measles can cause permanent hearing loss in children. If your child has had meningitis or a viral infection and is now having hearing problems, see your GP for advice.


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  • Reviewed by Marcella McEvoy, Specialist Health Editor, and Liz Woolf, Freelance Health Editor, Bupa Health Content Team, August 2018
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due August 2021



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