What is hearing loss?

Hearing loss is the inability to hear sounds in a normal range. It can be caused by a number of factors, including disease and damage to the inner ear.

The severity of hearing loss depends on how well you can hear. Hearing loss can range from mild (an inability to understand speech unless it’s very loud) to profound (an inability to understand even whispered speech).

There are two types of hearing loss: conductive and sensorineural.

Conductive hearing loss occurs when sound waves are blocked or prevented from reaching the inner ear by something that is blocking or plugging up the ear canal. For example, if you swim too long with water in your ear, or have an object such as cotton stuck deep in your ear canal, conductive hearing loss may occur.

Sensorineural hearing loss occurs when there is some type of damage to the inner ear or auditory nerve that prevents sound waves from being translated into electrical signals that travel through nerves to the brain for processing into meaningful information about sound.

Symptoms of hearing loss

Hearing loss is a common problem. In fact, more than 10 million people in the UK have some degree of hearing loss.

If you think you may be suffering from hearing loss, it’s important to get it checked out by your GP or a qualified hearing healthcare professional, who can recommend the best treatment for you.

Symptoms of hearing loss

The main symptom of hearing loss is difficulty in understanding speech when there’s background noise, such as other people talking or TV programmes. This might mean that you have to ask people to repeat themselves often, or that you have trouble following conversations in noisy environments.

Other symptoms include:

difficulty hearing the phone ring when there’s background noise (for example, in a busy restaurant)

having to turn up the volume on the TV or radio because you can’t hear clearly enough

being unable to hear someone speaking directly into your ear (for example, in a conversation where you’re very close together).

Types of hearing loss

Hearing loss is the inability to hear sounds at a normal level and can be caused by damage to the ears, the auditory nerve that connects the ears to the brain or any combination of these.

Sensorineural hearing loss (SNHL) is caused by damage to the cochlea or hair cells in the inner ear. This damage can be caused by aging, exposure to loud noises or certain infections.

A conductive hearing loss occurs when fluid or other substances block sound waves from reaching the eardrum. Causes may include earwax buildup, an infection, a perforated eardrum or impacted cerumen (ear wax).

Mixed hearing loss is a combination of both conductive and sensorineural problems that occur together as one condition.

Causes of hearing loss

Noise-induced hearing loss is the most common type of hearing loss, accounting for about one-third of all cases. Noise-induced hearing loss occurs when loud sounds damage the delicate structures inside the ear that convert sound waves into electrical signals in the brain. Continued exposure to loud noises can lead to permanent damage.

Age-related hearing loss is another common cause of hearing loss in older adults. As we age, changes occur in the inner ear that make it harder to understand speech and other sounds at a normal volume level. Hearing aids or cochlear implants may help if you have age-related hearing loss.

Hearing loss may also be caused by certain medications or medical conditions, including:

• Ear infections (otitis media) — especially if they recur often or spread to both ears
• Ménière’s disease — a condition that causes episodes of dizziness and ringing (tinnitus) in one ear
• Menstrual cycle — changes in hormone levels during this monthly process can cause temporary ear wax buildup leading to temporary change in hearing.

Hearing loss risk factors

Here are some of the most common risk factors for hearing loss:

Age. Age is the biggest risk factor for hearing loss. While it’s not inevitable, most people will experience some degree of hearing loss as they age.

Genetics. If your parents had problems with their ears, you may be at greater risk too. Some people inherit a tendency toward hearing loss, while others may develop it as a result of an illness or infection they had as children.

Noise exposure. Exposure to loud noises can damage delicate hair cells in the inner ear that help you hear sounds clearly. These cells do not regenerate and are lost forever once damaged. Prolonged exposure to loud noises — such as working in construction or attending concerts frequently — can cause permanent damage to these sensitive cells over time and lead to permanent hearing loss.

Obesity and diabetes. Obesity and diabetes are linked with an increased risk of developing hearing loss over time because both conditions can lead to high blood pressure, which can damage blood vessels in the ears and impair blood flow to the brain and inner ear (where sound is processed).

Less common causes of hearing loss

There are several other less common causes of hearing loss, some of which are genetic.

Ménière’s disease is a form of vertigo that can cause a sudden hearing loss. It’s usually accompanied by ringing in the ears (tinnitus) and fluctuating hearing loss. Ménière’s disease usually affects just one ear at a time. The cause isn’t known, but it may be related to abnormal fluid pressure in the inner ear or brain.

Otosclerosis is another rare cause of hearing loss. It occurs when bony growths inside the ear restrict normal movement of the stapes bone, which transmits sound from your eardrum to your inner ear. Otosclerosis can affect both ears or just one ear. Surgery may be needed to remove the bony growths and restore normal function to your stapes bone.

Trauma to the head or neck can also cause sudden and temporary hearing loss by damaging the middle or inner ear structures responsible for hearing (such as blood vessels).

Tests for hearing loss

Most people don’t know they have a hearing problem until they’re 60 or older. But if you start to notice trouble hearing, it’s important to get screened as soon as possible.

Your doctor will ask about your medical history, including any previous ear infections or head injuries, and your family history of hearing loss. She’ll also look inside your ears with an otoscope — a lighted magnifying device — and possibly conduct other tests.

People who are at risk for hearing loss can take steps to protect their ears from loud noise and reduce their risk of developing tinnitus. The following are some common tests for hearing loss:

Audiometry test. This test measures how well you can hear sounds at different frequencies (pitches), such as low and high tones, soft and loud sounds, or spoken words, sentences and conversations. The results help determine whether you have a hearing loss that needs treatment.

Tympanometry test. A tympanometer is a soft rubber tube that fits into the ear canal and measures how much pressure is present in the middle ear space behind the eardrum during an ear infection or blockage of fluid traveling through the Eustachian tube between the throat and ear canal on airplanes; this pressure isn’t usually seen.

Hearing loss treatments

Treatments for hearing loss depend on its cause and severity. Some people can use hearing aids to improve their hearing while others may need surgery or cochlear implants.

Hearing aids

Hearing aids help people with mild to moderate hearing loss to hear better by amplifying sounds in the ear canal. They’re available as behind-the-ear (BTE) devices, which fit over the outer ear, or in-the-ear (ITE) devices, which fit into the opening at the front of your ear canal. BTEs and ITEs both come with a choice of different features, such as wireless connectivity and directional microphones for listening selectively to one conversation in a noisy environment. The cost of hearing aids varies but is usually between £400 and £3,000 per device.

Cochlear implants

Cochlear implants are surgically implanted electronic devices that directly stimulate the auditory nerve to produce electrical signals that travel to the brain and are interpreted as sound. Cochlear implants aren’t suitable for everyone – those who have had long-term nerve damage may not benefit from this treatment.