Signs, causes and treatments for the loss of hearing

Hearing loss is common as you age. Around 40% of people over 50 in the UK have hearing loss due to ageing and over-exposure to loud noises. Other causes can be excessive earwax, which reduces how well your ears conduct sounds; however, this cause can often only be temporary. Even if medical treatment cannot reverse your hearing loss, doctors can help you improve what you do hear.

Christophe Locatelli

Christophe Locatelli

How we hear

The ear is made of three parts: The outer ear, the middle ear and the inner ear. All three parts must be functioning correctly for normal hearing to take place. 

We generally hear through air conduction. Air conduction happens when sound waves transfer through the narrow passageway of the ear canal and make the tympanic membrane (commonly called the eardrum) and the ossicles(smallest bones in our body) vibrate in the middle ear.

These vibrations then travel to the inner ear to the cochlear also known as the ‘hearing nerve’. The cochlear contains fluid, and the vibrations cause the fluid to move the tiny sensory hair cells in our ears. These sensory cells, in return, send electrical signals onto the brain, which it recognises as sounds.

We can also hear through the bone behind our ears called the mastoid bone. This form of hearing is referred to as bone-conduction. If vibration is placed on the bone, this causes fluid, which, like in air-conduction hearing, moves nerve cells to pass on electrical signals to the brain.

Signs of hearing loss

Hearing loss may not be easily noticeable to you; a loved one may often be the first to notice you’re having problems with your hearing before you do. However, there are common signs you can look out for to make it easier:

  • You often cannot hear people clearly and misunderstand what they are saying.

  • Needing people to repeat themselves

  • You are struggling to hear when there is background noise
  • You are watching TV or listening to music with the volume higher than other people need

  • Struggling with hearing during phone conversations

  • Feeling tired or stressed after concentrating on listening

Types of Hearing Loss

Hearing loss has many forms and specific symptoms; however, they fall under two general categories:

  • Sensorineural hearing loss happens when the inner ear’s sensitive hair cells are damaged. This type of hearing loss occurs when the auditory nerve (Cochlear), a nerve which sends hearing information to the brain, is damaged. Often this happens with age or from an injury and causes permanent hearing loss.

  • Conductive Hearing Loss – is when sounds cannot pass from your outer ear to your inner ear. Conductive Hearing Loss is a common form of hearing loss caused by blockages from ear wax, fluid from an ear infection or a perforated(punctured) eardrum. This loss of hearing is generally treatable.

Adults with hearing loss can suffer both types, referred to as mixed hearing loss.

An ear condition that’s often associated with later life and hearing loss in tinnitus. People with tinnitus will experience a  ringing, buzzing, hissing, or humming noise in either one of both of their ears. The disturbance may come and go, or be continuous. 

While not strictly a cause of hearing loss, tinnitus can make hearing more difficult. Over time it can make it difficult to concentrate or sleep too. 

It’s widely believed that prolonged exposure to noise and certain environmental factors can lead to Tinnitus. For example, people who have spent decades working in loud factories or building sites may be more likely to experience it. It can also be a side effect of certain medications and linked to some existing conditions such as diabetes. Those living with a condition that affects the blood vessels — such as heart disease, atherosclerosis, or high blood pressure,  may experience a pulsing or ‘whooshing’ tinnitus, due to the blood moving around around the head with greater force. 

Sometimes areas outside of the ear can lead to hearing trouble. The eustachian tube is a narrow passageway that connects the ear to the back of the throat. It helps to drain unwanted fluid, and maintain a healthy air pressure in your ears. In fact it’s these tubes that cause the ‘popping’ sensation you experience when flying or going through a tunnel. 

This tube can become blocked due to things like the common cold, viral infections, or allergies, which causes hearing to become distorted. Often the blockage will resolve itself over time, if not, you may be prescribed medication. 

Causes of Hearing Loss

  • Ageing is one of the most common causes of hearing loss as the inner ear structures age. A symptom of age-related hearing loss is usually the gradual loss in both ears over the years.
  • Illnesses such as ear infections can cause damage to the auditory nerve and ear canal and increase the risk for hearing loss. Symptoms can range from  moderate hearing loss in one ear, pressure in the ear or discharge from the ear, signalling an ear infection.
  • Noise-induced hearing loss is caused by exposure to loud sounds that can damage your inner ear. For example, noise exposure from explosives, loud music or long-term exposure to piercing noises, such as those you may experience at work, can all cause substantial damage. Noise exposure can cause symptoms such as perforated eardrums and ringing in your ears(tinnitus).
  • Some medications can play a role in hearing loss.Medications with hearing loss side effects are called Ototoxic. Such known drugs are the antibiotic gentamicin, sildenafil (Viagra) and certain chemotherapy drugs. Mild hearing loss can also occur when you take very high doses of aspirin or other pain relievers.
  • Hereditary hearing loss may make you more susceptible to all the causes mentioned above due to genetic factors. For example, if your father has progressive hearing loss and other ear diseases, you may be more likely to experience these too because you share a similar genetic makeup.

Available treatment

Treatment for loss of hearing is possible and varies depending on the cause and severity.

Some hearing loss is treatable by your GP. There may be several treatment options. For example, if the cause of your hearing loss is an ear infection, you may be prescribed antibiotics. If you have a build-up of earwax, a standard treatment is a course of ear drops, followed by professional removal with a syringe. If you’re particularly susceptible to earwax build up, using low strength olive oil drops regularly can help with the prevention of hearing loss due to wax buildup. 

If you’re living with severe hearing loss, which is not treatable by your GP, they will refer you to a hearing specialist for a hearing assessment and treatment. Common tests can include a Behavioral Audiometry Evaluation which will assess how you react to sound, and a simple blood test to detect inner ear damage. 

Hearing specialists often recommend electronic devices like hearing aids, which make sounds louder and clearer. On other occasions, specialists may recommend a hearing implant. Hearing implants are attached to the skull or placed deep inside the ear.

Devices to Help with Loss of Hearing

Along with hearing aids and implants, many devices help improve hearing and communication. Despite the advanced technology used in hearing aids and implants, they are not always enough to hear and understand what is being said in environments such as rooms with mixed sounds. However, Hearing Assistive technology (HAT) can reduce the gap between you and the sound by eliminating the effects of distance and poor acoustics.

  • Hearing Loops, called induction loops or Audio frequency induction loop systems, are thin pieces of wire that circle a room. Microphones, TVs, or Telephones transmit amplified sound through the loop and to a receiving device in a hearing loop receiver or a hearing aid.

  • FM Systems use radio signals to send amplified sounds from a microphone, usually worn on a neck loop, to a receiver or a telecoil in a hearing aid or cochlear implant.

  • Alerting devices can notify you about different events to let you know what is happening, especially in your home. For example, Smoke alarms can have alerting devices with flashing lights or vibrating alerts; similar devices are used for doorbells and alarm clocks. These devices can make your home safer when ageing and losing hearing.

  • Telephone amplifiers can be attached to phones or readily built-in to make incoming speech louder. Many amplifiers are portable so you can use them on public phones, at work or on a friend’s phone. If you use a hearing aid, they are usually functional with telephone amplifiers but may need special settings.


How to cope with hearing loss

Losing hearing can be frustrating and isolating, a loss which affects people not only physically but emotionally and mentally. All reactions are normal, but with time and patience, the change can become manageable.

  • First of all, let people know. Change in hearing can be socially isolating, but more so if people aren’t aware that you are struggling to hear them. If your friends and loved ones know that you are experiencing hearing loss, they can take steps to communicate more clearly; such as facing you when talking so you can see their mouths, gestures and facial expressions. You may also be less embarrassed when asking people to repeat themselves or speak more clearly if people know about your loss of hearing.

  • In terms of physically coping, wear hearing protection when exposed to loud noises to reduce discomfort and further damage to the ears. Do not put fingers or objects in your ears, like cotton buds or tissue.

  • Get a diagnosis and medical treatment, especially if you experience sudden hearing loss. You do not have to lose your ability to communicate and socialise if you understand the problem and seek out a clinical evaluation. Once you know the cause of your hearing loss, you can take advantage of all available treatments.

  • Make changes around your home if you need to. For example, any illness or condition that impacts the semicircular canals within your inner ear can cause problems with balance. You may want to remove potential trip hazards, or replace old chairs with ones that are higher and easier to get in and out of. 

  • Don’t hide your feelings. Losing your hearing is a significant loss like any other in our lives, and you are allowed to grieve.When grieving, we all benefit from expressing our grief to others.Therefore, try to reach out to others, letting them know how you are feeling. Finally, Consider a professional therapist who will help you emotionally negotiate the steps of this significant life change.

How to care for someone with a loss of hearing

Hearing loss can be frustrating for everyone involved. However, for the person with hearing loss, it can be hard not to understand everything happening, and they may become angry, frustrated, confused and eventually withdrawn. Yet, caring for a person with profound hearing loss can be challenging too, as it takes patience to speak slowly, repeat yourself and know that you may not always be heard. However, there are proven ways to make life easier for the person with hearing loss and those caring for them.

  • Never speak from a different room; not being able to see a person is a common reason for not understanding what is being said.
  • Always speak to the person with hearing loss face-on; try to be on the same level when possible and in good light. For example, position yourself so the light is on your face, not the listener’s eyes. This positioning will allow them to read your lips, facial expressions and gestures.

  • Say the listener’s name before starting a conversation. This lets the listener know that a conversation is about to start and gives them a chance to focus.

  • Speak slowly, clearly, distinctly, but naturally. Pause between sentences and phrases, and wait to ensure you are understood before carrying on. Do not shout or exaggerate your lip movements. Shouting may be louder, but it often distorts the sound.

  • If you’re aware that the person with hearing loss can hear better in one ear, try to remember which ear this is and position yourself closer to it.

  • Always listen too. Pay attention. A confused look may suggest they misheard. Ask leading questions, and get them to repeat important information you have told them, so you are sure they have heard.

  • Many people with hearing loss are sensitive to loud sounds and background noise; therefore, avoid being in noisy environments with them, and minimise background noise, if possible, when starting a conversation.

  • Remember that everyone has a harder time understanding and hearing when tired, stressed or ill; this is heightened when someone has hearing loss.