Hearing loss
Understanding hearing loss
Hearing loss is common and usually occurs gradually. A baseline hearing test provides information about your hearing health, and it is complimentary if you are 55 or over.
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The basics
What hearing loss is
Sound travels through the outer ear, causing the eardrum and tiny bones of the middle ear to vibrate. These vibrations reach the inner ear, where thousands of microscopic hair cells convert them into nerve signals that travel to the brain. Hearing loss is anything that interrupts that chain. Where the interruption occurs determines the type of hearing loss, and the type of hearing loss guides the treatment.
Outer ear
Middle ear
Inner ear
Hearing nerve and brain
Three main types
Types of hearing loss
Inner ear or nerve
Sensorineural hearing loss
This is the most common type. Sensorineural hearing loss happens when the hair cells of the inner ear, or the hearing nerve, are damaged. The usual causes are aging and noise exposure. Other causes include certain medications, some illnesses and heredity. Sensorineural loss is usually permanent in nature, as the hair cells do not grow back. However, this type of hearing loss is managed very well with hearing aids. Typical signs: speech sounds muffled rather than quiet, high-pitched sounds and consonants are the first to go, and background noise makes conversation hard.
Outer or middle ear
Conductive hearing loss
Sound is blocked or reduced on its way to the inner ear, in the outer or middle ear. Causes include earwax, fluid behind the eardrum, an ear infection, a perforated eardrum, or conditions affecting the middle ear bones. Conductive loss often makes sound appear lower in volume rather than muffled, and it is frequently treatable: wax can be removed, infections treated, and some middle ear conditions corrected by surgery. Where it cannot be corrected, hearing aids work well because the inner ear is healthy.
Both
Mixed hearing loss
A combination of the two: a sensorineural loss with a conductive element. For example, an age-related loss made worse by a wax blockage or a middle ear condition. Treating the conductive component often creates a noticeable improvement in hearing, while hearing aids can address the inner ear damage caused by sensorineural hearing loss.
Causes
Common causes of hearing loss
- Age. Age-related hearing loss, called presbycusis, is the most common cause. Presbycusis usually affects both ears equally and starts with the loss of high pitches.
- Noise. Loud work, loud hobbies, concerts, firearms and earphones at a high volume damage hair cells over time. Noise-induced loss is permanent, which is why hearing protection matters around loud work and loud hobbies.
- Ear wax. The most common cause of sudden reduced hearing in one ear, and the easiest to fix.
- Infections and fluid. Middle ear infections and fluid behind the eardrum cause temporary conductive loss, especially in children.
- Medications. Some antibiotics, chemotherapy drugs and high doses of certain painkillers can affect hearing.
- Health conditions. Diabetes, heart disease and other conditions are linked to a higher likelihood of hearing loss. See our medical conditions section.
- Heredity. Some hearing loss runs in families.
- Injury. Head injury or a sudden very loud sound.
Sudden hearing loss
If your hearing drops suddenly in one ear, within hours or overnight, treat it as urgent and call us the same day. Sudden sensorineural hearing loss is far more likely to recover when treatment starts within the first 24 to 48 hours. If we are closed, go straight to an emergency department.
Mild to profound
Degrees of hearing loss
A hearing test measures the quietest sound you can hear at each pitch, in decibels (dB). The result places your hearing in one of these ranges.
| Degree | Quietest sound heard | What it is like |
|---|---|---|
| Normal | up to 20 dB | You hear soft sounds and follow conversations easily. |
| Mild | 21 to 40 dB | Soft speech and consonants are missed, especially in noise. Often the stage where people say others mumble. |
| Moderate | 41 to 55 dB | Normal conversation is hard to follow without hearing aids, particularly in groups. |
| Moderately severe | 56 to 70 dB | Most conversational speech is missed without amplification. |
| Severe | 71 to 90 dB | Only loud speech or shouting is heard; powerful hearing aids are needed. |
| Profound | over 90 dB | Very loud sounds only. Hearing aids may help; some people are candidates for cochlear implants, which we would refer for. |
Hearing loss is also described as being in one ear (unilateral) or both (bilateral), and as symmetrical or asymmetrical. A loss in one ear only is worth investigating with a physician, because it can have causes that need medical attention.
Next steps
What to do about hearing loss
Unless your hearing drops suddenly, in which case call us the same day, the first step is always the same: determine the type of hearing loss and the degree. A hearing test at Hear & Co takes under an hour, is complimentary if you are 55 or over, and ends with an easy-to-follow explanation. If earwax is blocking your ears, it is removed before the test. After the test, medical issues are referred, and sensorineural loss is managed with hearing aids you can try at no charge before deciding.
Good to know
Hearing loss questions
What is the difference between sensorineural and conductive hearing loss?
Sensorineural loss is damage to the inner ear or hearing nerve and is usually permanent but well managed with hearing aids. Conductive loss is a blockage or condition in the outer or middle ear and is often treatable. A hearing test differentiates between the two.
Is hearing loss permanent?
Sensorineural loss usually is; the exception is a sudden loss treated quickly. Conductive loss often is not. Mixed loss usually has a permanent part and a treatable part.
What is presbycusis?
The medical name for age-related hearing loss, the gradual loss of high-pitched hearing that comes with age and is the most common type of hearing loss in adults.
Can hearing loss in one ear be serious?
It can be. Loss in one ear only, especially if sudden, should be tested the same day. Sudden sensorineural hearing loss (sudden nerve damage) is often treatable with steroids if treatment starts within the first 24 to 48 hours.
Does hearing loss get worse if untreated?
Age- and noise-related loss tends to progress over time regardless. What research consistently finds is that the effects of untreated loss on daily life, such as social withdrawal and fatigue, are greater than they need to be. People who use hearing aids report doing better in those areas.
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