Hearing loss / Audiology

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 is caused by damage to the inner ear or damage to the auditory nerve. This occurs naturally with age or as a result of injury. Sensorineural hearing loss is permanent and hearing aids are often required to improve hearing in these cases.
• Conductive hearing loss happens when sounds are unable to pass from your outer ear to your inner ear, often because of a blockage such as earwax or glue ear. Conductive hearing loss is usually temporary and can often be treated with medication or minor surgery.

Hearing loss can have many different causes. For example:

• sudden hearing loss in 1 ear may be due to earwax, an ear infection, a perforated (burst) eardrum or Ménière’s disease
• sudden hearing loss in both ears may be due to damage from a very loud noise, or taking certain medicines that can affect hearing
• gradual hearing loss in 1 ear may be due to something inside the ear, such as fluid (glue ear), a bony growth (otosclerosis) or a build-up of skin cells (cholesteatoma)
• gradual hearing loss in both ears is usually caused by ageing or exposure to loud noises over many years

For more detailed information about the causes of hearing loss click here.

General

It can be hard to tell if you’re losing your hearing. Other people may notice it before you do.

Early signs of hearing loss include:

• difficulty hearing other people clearly and misunderstanding what they say, especially in noisy places
• asking people to repeat themselves
• listening to music or watching TV with the volume higher than other people need
• difficulty hearing on the phone
• finding it hard to keep up with a conversation
• feeling tired or stressed from having to concentrate while listening

These problems are often caused by hearing loss that can happen as you get older. This is permanent, but treatments such as hearing aids can help.

Signs of hearing loss in children

Your child may have a problem with their hearing if they:

• are slow to learn to talk, or aren’t clear when they speak
• do not reply when you call them
• talk very loudly
• ask you to repeat yourself or respond inappropriately to questions
• turn up the volume of the TV very high

See a GP if you’re worried about your child’s hearing.

Hearing loss in children can be caused by a build-up of fluid in the ear (glue ear), which tends to get better over time and can be treated.

Signs of hearing loss in babies

Babies have a hearing check in the first few weeks after birth, but speak to your health visitor or see a GP if you think they might have difficulty hearing.

They may have a problem with their hearing if they:

• are not startled by loud noises
• seem to hear some sounds but not others
• notice you when they see you, but not when you call their name
• do not turn towards voices by 4 months of age
• have not started to say any recognisable words by around 15 months

Consult 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 should contact your GP as soon as possible.

If you’re concerned about a friend’s or family member’s hearing, encourage them to see a GP

The GP will ask about your symptoms and look inside your ears using a small handheld torch with a magnifying lens. They can also do some simple checks of your hearing.

If needed, your GP can refer you to an audiologist (hearing specialist) or an ENT surgeon for further tests.

Under local clinical referral guidance GP’s will refer non-complex cases of hearing loss directly to audiology for a hearing test and further investigations as required. More complex cases may be referred directly to an Ear Nose & Throat (ENT) specialist.

Children

Local clinical guidelines suggest that specialist referral should be considered where a child has been experiencing significant hearing loss for more than 4 weeks or in cases where there is evidence of developmental speech delay suspected to be secondary to hearing loss.

In the first instance referral should be to the paediatric audiology service unless there is evidence of abnormalities of the tympanic membranes (ear drums) or additional associated nose/throat issues in which case an ENT referral may be warranted.

Adults

Local clinical guidelines recommend that adults with symmetrical non-fluctuating hearing loss of gradual onset with normal appearances of ear canals and tympanic membranes (ear drums) should be referred to audiology in the first instance.

In January 2015 the local Clinical Commissioning Group (CCG) (now One Devon ICB) introduced AQP (“Any Qualified Provider”) criteria for audiology referrals as part of the wider NHS “patient choice” initiative. This means that patients over 55 years of age with uncomplicated age-related hearing loss requiring a hearing assessment or reassessment may be offered a choice of local service provider.

Referral to AQP services is initially through your GP and is subject to certain clinical criteria. Patients choosing an AQP provider will remain under their care for a minimum of 3 years during which time patient’s may “self-refer” back for any issues with the servicing of their hearing aid equipment.

The nature of NHS commissioning is such that the services and hearing aids provided by all AQP providers under NHS funding are broadly similar, although waiting times for specific providers may differ significantly

Patients presenting with any of the following should be referred directly to ENT:

• Sudden hearing loss (following discussion with on call ENT team)
• Unilateral tinnitus
• Pulsatile tinnitus
• Vertigo
• Pain in the ears
• Discharging ears
• Abnormality of ear drum
• Facial weakness (palsy)

Hearing loss sometimes gets better on its own or may be treated with medicine or a simple procedure. For example, earwax can be removed by irrigation, suction, or softened with eardrops.

Other types of hearing loss – such as gradual hearing loss, which often happens as you get older – may be permanent. In these cases, treatment can help make the most of the remaining hearing. This may involve using:

• digital hearing aids – which are available through the NHS
• 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 – such as British Sign Language (BSL)

Read more about treatments for hearing loss

It’s not always possible to prevent hearing loss, but there are some simple things you can do to reduce the risk of damaging your hearing.

These include:

• not having your television, radio or music on too loud
• using headphones that block out more outside noise, instead of turning up the volume
• wearing ear protection (such as ear defenders) if you work in a noisy environment, such as a garage workshop or a building site; special vented earplugs that allow some noise in are also available for musicians
• using ear protection at loud concerts and other events where there are high noise levels
• not inserting objects into your or your children’s ears – this includes fingers, cotton buds, cotton wool and tissues

Read more tips to protect your hearing