Hearing loss

Signs of hearing loss 

Hearing loss is sometimes sudden, but often it's gradual and you may not notice it at first.

Being aware of the early signs can help you identify the problem quickly.

It's important to spot hearing loss as soon as possible. This is because treatment is often of more benefit if begun early.

General signs of hearing loss 

Early signs of hearing loss can include:

• difficulty hearing other people clearly and misunderstanding what they say, especially in group situations
• asking people to repeat themselves
• listening to music or watching television with the volume higher than other people need
• difficulty hearing the telephone or doorbell
• finding it difficult to tell which direction noise is coming from
• regularly feeling tired or stressed, from having to concentrate while listening

In some cases, you may recognise signs of hearing loss in someone else before they notice it themselves. Research has suggested it takes 10 years from the time someone notices they have hearing loss, before they do anything about it.

If you also hear a ringing, buzzing or whistling sound in your ears, this could be a sign of tinnitus, which is often associated with hearing loss.

Signs of hearing loss in children 

Babies are routinely screened within the first few weeks of their birth as part of the newborn hearing screening programme (NHSP).

However, there are signs you can look out for which may suggest you should see your GP to arrange another hearing test.

Signs of hearing loss in babies 

You should consider seeing your GP if you notice that your baby or toddler:

• isn't startled by loud noises
• doesn't turn towards the source of a sound while under four months old
• doesn't say single words by the time they're one year old
• notices you when they see you, but not when you call their name
• hears some sounds but not others

Signs of hearing loss in children 

You should consider seeing your GP if you notice that your child:

• is slow to learn to talk, or they're not clear when they speak 
• often asks you to repeat yourself or responds inappropriately to a question
• doesn't reply when you call them
• often talks very loudly
• often turns up the volume of the TV so it's very loud
• watches other people to copy instructions, because they haven't heard

When to see your GP 

See your GP if you're having problems with your hearing, or your child is showing signs of hearing difficulty. If you lose your hearing suddenly, in one or both ears, you must see your GP as soon as possible.

Your GP can check for any problems and may refer you to an audiologist (hearing specialist) or an ear, nose and throat surgeon for further tests.

You can also visit the RNID website for an online hearing test.

Causes of hearing loss 

Hearing loss is the result of sound signals not reaching the brain. There are two main types of hearing loss, depending on where the problem lies:

• sensorineural hearing loss – caused by damage to the sensitive hair cells inside the inner ear or damage to the auditory nerve; this occurs naturally with age or as a result of injury
• conductive hearing loss – when sounds are unable to pass from your outer ear to your inner ear, often because of a blockage such as earwax, glue ear or a build-up of fluid from an ear infection, or because of a perforated ear drum or disorder of the hearing bones

It's also possible to have both these types of hearing loss. This is known as mixed hearing loss.

Some people are born with hearing loss, but most cases develop as you get older.  Age is the biggest single cause of hearing loss.

Most people begin to lose a small amount of their hearing from around 40 years of age. This hearing loss increases as you get older. Research suggests hearing loss affects over 70 per cent of people over 70.

Hearing loss caused by age and exposure to loud noises are both types of sensorineural hearing loss.

Sensorineural hearing loss can also be caused by:

• the genes you inherit – some people may be born deaf or become deaf over time because of a genetic abnormality
• viral infections of the inner ear – such as mumps or measles
• viral infections of the auditory nerve – such as mumps or rubella
• Ménière's disease – where a person suffers with vertigo, spells of hearing loss, tinnitus and the feeling of a blockage in the ear
• acoustic neuroma – a non-cancerous (benign) growth on or near the auditory nerve
• meningitis – an infection of the protective membranes that surround the brain and spinal cord
• encephalitis – inflammation of the brain
• multiple sclerosis – a neurological condition affecting the central nervous system (brain and spinal cord)
• a head injury
• an autoimmune condition
• malformation of the ear
• stroke – where the blood supply to the brain is cut off or interrupted

Some treatments and medicines, such as radiotherapy for nasal and sinus cancer, certain chemotherapy medicines or certain antibiotics can also damage the cochlea and the auditory nerve, causing sensorineural hearing loss.

People with diabetes, chronic kidney disease and cardiovascular disease are also at increased risk of hearing loss.

• Read more about causes of hearing loss

Preventing hearing loss 

It isn't always possible to prevent hearing loss if you have an underlying condition that causes you to lose your hearing.

There are several things you can do to reduce the risk of hearing loss from long-term exposure to loud noise.

This includes:

• not having music or the television on at a loud volume at home
• using ear protection at loud music events or in noisy work environments

You should also see your GP if you have signs of an ear infection, such as flu-like symptoms, severe earache, discharge or hearing loss.

Treating hearing loss 

The way hearing loss is treated depends on the cause and how severe it is.

In cases of sensorineural hearing loss, there are several options that may help to improve a person’s ability to hear and communicate.

These include:

• hearing aids – which are available through the Health and Social Care (HSC) Trusts, or from a number of outlets, if you choose to buy a hearing aid privately
• bone anchored implants – suitable for people who are unable to use hearing aids and for some levels of sensorineural hearing loss
• middle ear implants – suitable for some people who are unable to use hearing aids
• cochlear implants – for people who find hearing aids aren't powerful enough
• lip reading and/or sign language 

Conductive hearing loss is sometimes temporary and can be treated with medication or minor surgery, if necessary.

More major surgery may be required to fix the ear drum or hearing bones. If conventional hearing aids don't work, there are also some implantable devices for this type of hearing loss.

• Read more about treating hearing loss

How hearing works 

Sound waves enter your ear and cause your eardrum to vibrate. These vibrations are passed to the three small bones (ossicles) inside your middle ear.

The ossicles amplify the vibrations and pass them on to your inner ear.

In your inner ear tiny hair cells inside the cochlea (the coiled, spiral tube inside the inner ear) move in response to the vibrations.

They send a signal through a nerve called the auditory nerve to the brain.

• Find out more about hearing loss on the NHS website

More useful links

• How to use your health services
• Your hearing (RNID website)
• Northern Ireland Deaf Youth Association
• British Deaf Association