Overview
Sound travels down the ear canal, vibrates the eardrum, passes along three small bones in the middle ear, and reaches the inner ear, where tiny hair cells turn it into signals for the hearing nerve. A problem anywhere along that path causes hearing loss.
When the block is in the canal or the middle ear, from wax, fluid or a hole in the eardrum, the loss is called conductive and is often treatable. When the inner ear or the nerve is damaged, the loss is called sensorineural and is usually permanent, though it can be managed well. Hearing loss ranges from mild to profound, and the word deaf is generally used for profound loss with little or no usable hearing.
Symptoms
- Asking people to repeat themselves
- Finding conversation hard to follow in a noisy place
- Turning the television or radio up louder than others need
- Difficulty on the telephone
- Feeling tired from concentrating on listening
- Ringing, buzzing or hissing in the ears
- A blocked or full feeling in one ear
- In a child, delayed speech, inattention or not turning to sounds
When to see a doctor
See a doctor within a few days if hearing has worsened over days or weeks, if one ear is affected along with earache or discharge, if ringing in the ears is new or in one ear only, or if hearing has not come back after an ear infection or after wax was removed. A child who is slow to speak or does not respond to sound should have a hearing test.
Causes
The commonest causes in adults are ageing and long exposure to loud noise, both of which affect the inner ear and usually both ears. Ear wax, middle ear infection, fluid behind the eardrum and a perforated eardrum block sound and often affect one ear.
Other causes include inner ear disorders such as Meniere disease and labyrinthitis, head injury, some infections including meningitis and mumps, medicines that can harm the ear, and inherited conditions. Hearing loss in babies can follow infections in pregnancy such as rubella and cytomegalovirus, problems around birth, or severe jaundice.
Risk factors
- Older age
- Work or hobbies around loud noise, without ear protection
- Loud music through earphones for long periods
- Repeated or long lasting ear infections in childhood
- Family history of hearing loss
- Medicines known to affect the ear, including some and cancer treatments
- Smoking
- Diabetes and other long term conditions
Complications
Hearing loss that is not addressed makes conversation tiring and often leads people to withdraw from company, which can bring loneliness and low mood. It affects schooling, work and safety on the road.
In young children, hearing loss that goes unnoticed delays speech and language. In adults, hearing loss that is left unaddressed has been linked with cognitive decline and a higher risk of dementia.
Prevention
- Keeping personal audio devices at no more than about 60 per cent of full volume
- Taking regular breaks in quiet after loud listening, and limiting how long loud sound goes on
- Choosing well fitting noise cancelling headphones, so the volume can stay lower
- Using earplugs or earmuffs at concerts, weddings, festivals and around loud machinery
- Not pushing cotton buds or anything else into the ear
- Keeping childhood immunisations up to date and treating ear infections properly
- Telling the doctor about hearing changes while taking medicines known to affect the ear
- Having hearing checked from time to time, especially after the age of 50 or with noisy work
Diagnosis
A doctor asks how the hearing changed, whether one ear or both are affected, and about noise, medicines, infections and family history, then looks into the ears to check the canal and the eardrum.
A hearing test measures the quietest sounds that can be heard across a range of pitches, and the result is drawn as a chart. Other tests measure how the eardrum moves, how the inner ear responds, and how well speech is understood. Newborns are screened soon after birth. A scan may be arranged when one ear alone is affected or when the cause is unclear.
Treatment
Treatment depends on the cause. Wax is softened and removed, infections are treated, fluid behind the eardrum may settle on its own or be drained with a small ventilation tube, and a perforated eardrum can sometimes be repaired.
Sudden hearing loss in one ear is usually treated with steroid medicines, given as tablets or injected through the eardrum, and started as soon as possible.
Where hearing cannot be restored, hearing aids amplify sound and suit most people with mild to severe loss. Cochlear implants and bone conduction implants are options for particular kinds of severe loss. Speech and language therapy, sign language, captioning and other assistive technology, and simple habits such as facing the person speaking and reducing background noise, all help.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Losing your hearing is just part of getting old, so nothing can be done.”What is true?
Fact
Age related hearing loss is common, but that does not make it untreatable. Some causes, such as wax, infection or fluid in the ear, can be cleared, and for hearing loss that cannot be reversed there are hearing aids, implants and assistive technology that make a real difference to everyday life.
Myth“Sudden deafness in one ear will settle by itself in a week or two.”What is true?
Fact
Sudden hearing loss in one ear is treated as an emergency. Some people do recover on their own, but delaying the diagnosis and treatment reduces the chance of recovery, and steroid treatment works best when it is given early rather than weeks later.
Myth“Earphones are safe as long as the music does not actually hurt.”What is true?
Fact
Damage from loud sound builds up quietly and without pain. Safe listening depends on how loud the sound is, for how long, and how often, so the advice is to keep the volume no higher than about 60 per cent of maximum and take regular breaks in quiet. Ringing in the ears or muffled hearing after listening is a warning sign.
Myth“Using a hearing aid will make my own hearing lazier and worse.”What is true?
Fact
Hearing aids make sounds louder and clearer so that the ear and the brain keep receiving them. They do not damage the ear. Leaving hearing loss unaddressed is what has been linked with isolation, difficulty at work and a higher risk of dementia.
Myth“Cotton buds clean the ears and keep hearing sharp.”What is true?
Fact
Pushing cotton buds, fingers or anything else into the ear canal tends to pack wax deeper and can injure the canal or the eardrum. Wax that is blocking hearing should be softened or removed by a clinician.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
My hearing went in one ear yesterday. Can I wait and see?
No. Sudden hearing loss in one ear is treated as an emergency and should be assessed within days. Some people do recover by themselves, but treatment is much more likely to work when it is started early, so it is worth being seen straight away.
How loud is too loud through earphones?
Both the volume and the time matter, and the louder the sound, the less time is safe. As a practical rule, keep the volume no higher than about 60 per cent of maximum and take breaks in quiet. Ringing in the ears or muffled hearing after listening means it was too loud or went on too long.
Will a hearing aid make everything sound unnatural?
Modern hearing aids are set to the pattern of each person's hearing loss, and most people need a few weeks to get used to them. An audiologist adjusts them at follow up visits, so it is worth going back rather than leaving an aid in a drawer.
My child fails to respond when I call. Should I get their hearing tested?
Yes. Repeated ear infections and fluid behind the eardrum are common in childhood and can reduce hearing at exactly the age when speech is developing. A hearing test is simple and can be done at any age.
