Hearing loss
Hearing leaves quietly. Almost nobody wakes up deaf one morning: what usually happens is that over the years the television creeps louder, you ask people to…
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Hearing leaves quietly. Almost nobody wakes up deaf one morning: what usually happens is that over the years the television creeps louder, you ask people to repeat themselves in a café, you come home exhausted after an evening of conversation, and you blame the noise around you and other people mumbling. Yet some causes are cleared up in ten minutes in a consulting room, and others need attention within days, or the hearing does not come back at all.
How to tell that your hearing has slipped
Hearing loss is rarely experienced as silence. Far more often it sounds like this: the words are audible, but they cannot be made out. Especially against background noise — in the street, in a restaurant, at a family meal where several people talk at once.
- You ask people to repeat things more often than you used to, or answer something beside the point.
- The family says the television is blaring and to you the volume seems ordinary.
- Phone calls have become hard work, particularly with an unfamiliar voice.
- Consonants blur into one another and it seems as though people swallow the ends of words.
- After an hour of talking a heavy tiredness sets in: the brain has been spending energy reconstructing what it did not hear.
- There is ringing, buzzing or humming in the ear, most noticeable in the quiet.
- You have started avoiding noisy places you used to enjoy.
Very often it is not the person themselves who notices first but those living alongside them. If someone mentions it to you, that alone is a reason to have your hearing checked, even if it all seems fine from the inside.
Why hearing declines
There are dozens of causes, but they all fall into two groups, and literally everything depends on which group a particular case belongs to.
The sound is not reaching the inner ear. Something is in its way: a plug of wax, a foreign body, inflammation of the ear canal, fluid in the middle ear after a cold, a perforated eardrum, otosclerosis, which is bone growing around the tiny hearing bones. The ear usually feels blocked, sound comes through muffled and your own voice booms inside your head. The good news is that most of these causes can be put right and the hearing returns in full.
The hair cells of the inner ear or the hearing nerve are damaged. This group covers age-related loss, the legacy of noise, the effect of certain medicines, Ménière's disease, inflammation of the inner ear, head injury and inherited factors. This kind of hearing rarely comes back, and the aim becomes a different one: to halt the decline and arrange the right help in good time.
Two causes deserve a separate word because people seldom think of them. The first is noise, which damages the ear cumulatively rather than in one stroke: the factory floor, the building site, the angle grinder in the garage, earphones at full volume, concerts. High-pitched sounds go first, and with them the ability to follow speech in a noisy room. The second is medication: some aminoglycoside antibiotics, certain cancer drugs, and loop diuretics and salicylates in high doses. They are prescribed for serious reasons and should never be stopped on your own initiative, but if ringing appears or hearing worsens during treatment, tell the doctor straight away.
Sudden hearing loss: here it is counted in days
There is one situation in which waiting for an appointment is the wrong move. Hearing in one ear vanishes or drops sharply within hours, two days at the very most. It is usually accompanied by ringing and a blocked feeling, as though the ear were stuffed with cotton wool. There is often no pain at all, and that is precisely why people calmly wait a week, assuming it is wax or a chill.
In reality this is sudden sensorineural hearing loss, and treatment starts with corticosteroids. The timing is the whole point: started in the first few days it restores hearing for a substantial share of people, started a month later it achieves next to nothing. An ear that has gone suddenly deaf is therefore a reason to seek help the same day, not after the weekend.
A doctor is needed the same day in other situations too:
- hearing disappeared after a head injury, a blow to the ear, an explosion or a sharp change in pressure;
- along with the loss came vertigo severe enough to make standing impossible, with vomiting;
- pus or blood is coming from the ear, the ear hurts and there is a fever;
- the skin behind the ear is red and swollen and the ear is pushed outwards;
- one side of the face has become weak and droops.
One more thing worth knowing. If hearing is worsening in one ear only and that same ear rings constantly, it needs to be investigated to the end, up to and including an MRI scan. Occasionally behind such a one-sided picture sits a benign tumour of the hearing nerve, an acoustic neuroma. It grows slowly, and found early it is far more straightforward to treat.
How hearing is tested and what can be put right
It all begins with a look inside the ear: half of the cases are explained at that very moment by wax, inflammation or fluid behind the eardrum. Next comes audiometry: sounds of different pitch and loudness come through headphones, and the result is drawn as a curve showing both the degree of loss and where the transmission of sound breaks down. Tympanometry assesses how the eardrum moves and what the pressure is in the middle ear, and one-sided loss adds a scan.
What can be put right:
- a wax plug is softened with drops and removed by irrigation, suction or an instrument; it is quick and the hearing returns immediately;
- infections of the outer and middle ear are treated with drops and, where needed, antibiotics;
- fluid behind the eardrum after a cold clears by itself within a few weeks in most people; if it lingers and interferes, a ventilation tube is fitted;
- a torn eardrum usually heals on its own within weeks while the ear is kept dry; a hole that fails to close is repaired surgically;
- otosclerosis is operated on by replacing the fixed bone with a prosthesis, or compensated for with a hearing aid.
Hearing aids and implants
Where hearing cannot be restored, it is amplified. A few facts about modern aids remove half the disappointment.
An aid does not make hearing what it once was. It makes sounds louder and crisper, but the brain has to learn all over again how to separate speech from background, and that takes weeks, sometimes months. In the early days your own voice and the rustle of a bag sound unnaturally loud; that passes. If both ears are affected, aids are usually fitted to both: that is how directional hearing works and how conversation in noise becomes easier. The settings almost always need adjusting after the first weeks, which is a normal part of the process rather than a sign of a poor choice.
Putting it off is a mistake. The longer the ear and the hearing part of the brain go without sound, the worse speech understanding recovers afterwards, even once the volume is given back. And then there is the point of the whole exercise: people whose hearing has been corrected do not drop out of conversations, withdraw less and sink into low mood less often. Uncorrected hearing loss is regarded as one of the factors linked to decline in memory and thinking in later life.
For severe loss, when aids no longer help, a cochlear implant is discussed: it stimulates the hearing nerve directly. There are also bone conduction implants for people whose outer or middle ear does not work. Finally, plenty of simple equipment makes daily life easier: telephone and television amplifiers, induction loops in theatres, vibrating and flashing alarm clocks, subtitles and speech-to-text apps.
Hearing in children
With children the stakes are higher: while hearing is reduced, speech suffers, and after speech, schoolwork and friendships. That is why in many countries hearing is screened in the first days of life, and parents do well to know the result of that check.
The commonest cause in young children is fluid in the middle ear following colds and ear infections. It is painless, so the child complains of nothing, while the adults see something else: no response when called, cartoons turned up louder, less talking or less clear speech, and an inattentive, distracted look at nursery or school. Often it is taken for temperament or laziness. Where that doubt arises, the hearing is tested rather than left to pass on its own.
Protecting your hearing and making conversation easier
- In noisy work use plugs or ear defenders: this is not a formality, lost hearing is not given back.
- Keep earphones at around half of maximum volume and take breaks; if your ears ring after a concert or a session at the gym, the ear has already taken a hit.
- Put nothing into the ear: cotton buds do not clean it, they push wax deeper and injure the skin and the eardrum.
- Do not put off treating ear infections and do not tolerate a blocked ear for weeks.
- If you work in noise or have already noticed a decline, have your hearing checked regularly.
Conversation can be made easier too. Ask the other person not to repeat the same thing more loudly but to say it in different words. Watch the face of whoever is speaking: lips and expression add more than you would think. Turn off background music when there is talking to be done, and in a café sit facing the room. And say plainly that you do not hear well: almost everyone adjusts willingly once they know.
Online consultation
Remotely it is straightforward to work out which group your case falls into and how urgent it is. The doctor will ask how and when it started, whether one ear or both, whether there is ringing, dizziness or discharge, what medicines you take and whether you work in noise, and will say whether you need examining today, whether an audiogram should be arranged, or whether the wax should be dealt with first. Online is also a convenient place to go through an audiogram you already have, to talk about getting used to a new aid and about what to do with ringing in the ears. Sudden deafness and the signs in the list above are not assessed remotely: with those, help is sought the same day.
This material is for information only and does not replace medical advice.
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