Hearing Loss

Hearing loss happens when sound signals cannot reach your brain properly, making it harder to hear speech and other sounds. It's very common, particularly as you get older, and ranges from mild difficulty following conversations, to profound deafness.

Symptoms of hearing loss

Hearing loss usually develops gradually, so you might not notice it happening straight away. Signs to look out for include:

• often asking people to repeat themselves
• difficulty following conversations, especially in noisy places or on the phone
• thinking other people are mumbling
• needing the TV or music turned up louder than other people need
• trouble telling which direction a sound is coming from
• ringing, buzzing or hissing in your ears (tinnitus)
• feeling tired or stressed from concentrating hard to listen.

Hearing loss can be harder to spot in babies and young children. Signs in babies include not being startled by loud noises or not turning towards sounds, while older children may be slow to talk, speak unclearly, or often ask you to repeat yourself.

Causes of hearing loss and who is at risk

Hearing loss usually comes down to one of two problems: sound being blocked from reaching your inner ear, or damage to your inner ear or the nerve that carries sound signals to your brain.

Common causes include:

• A blockage: This could be earwax build-up, or fluid in your middle ear from a cold, allergy or ear infection
• A perforated (ruptured) eardrum: This could be due to an infection, injury or a sudden change in air pressure
• Loud noise: Either long-term exposure to loud noise, or a single very loud noise, such as at a concert
• Getting older: The hair cells in your inner ear naturally wear down over time
• Medicines: Certain medicines can affect your inner ear, including some antibiotics and high-dose aspirin
• Health conditions: Such as diabetes, high blood pressure, heart disease or stroke
• A genetic or inherited condition: Or even an infection before birth, such as rubella.

Are there different types of hearing loss?

There are three main types of hearing loss, depending on which part of your hearing system is affected:

• Conductive hearing loss: This is where something stops sound passing through your outer or middle ear, such as earwax, fluid or a perforated eardrum
• Sensorineural hearing loss: This is caused by damage to your inner ear or the nerve that carries sound to your brain, which is usually permanent
• Mixed hearing loss: This is a combination of both conductive and sensorineural problems.

How hearing loss is diagnosed

Your GP will ask about your symptoms and examine your ears to check for infection, earwax or other visible problems. If needed, they'll refer you to an audiologist (a hearing specialist) or an ear, nose and throat (ENT) specialist for further tests.

Hearing tests can include pure-tone testing, which finds the quietest sound you can hear at different pitches, and tympanometry, which checks how well your eardrum moves.

You can also get a free online hearing check, or pay for a hearing test at some pharmacies, opticians or high street clinics.

How hearing loss is treated

Treatment depends on what's causing your hearing loss and which type you have. If a treatable cause is found, your GP may be able to help directly. For example, an ear infection might be treated with antibiotics, and earwax build-up can be treated with ear drops or removed.

Some causes of conductive hearing loss need surgery, such as tympanoplasty to repair a perforated eardrum, or tympanostomy to insert small tubes that drain fluid from your middle ear. Surgery may also be used to remove a tumour or growth affecting your ear.

Sensorineural hearing loss is usually permanent and cannot be reversed with surgery, but hearing aids can make sounds louder and clearer. Some people benefit from a hearing implant instead, such as a cochlear implant or a bone-anchored implant, both of which are placed surgically. Support such as lip reading or sign language, including British Sign Language (BSL), can also help with communication.

When to see a doctor

See a GP if:

• you think your hearing is gradually getting worse
• you've had treatment for an ear infection or earwax build-up, but your hearing hasn't come back
• you often ask people to repeat themselves or struggle to follow conversations.

Get an urgent GP appointment or call 111 if:

• you have sudden hearing loss in one or both ears
• your hearing has been getting worse over the last few days or weeks
• you have hearing loss along with other symptoms, such as earache or discharge from your ear.