What is hearing loss?
The ear is a sensitive organ and plays a role in hearing and balance. To hear well, you need a clear conduction system through which sound can travel and healthy sensory organs to detect the sound waves and turn them into nerve signals to the brain. If hearing loss occurs it may be 'conductive' or 'sensorineural' or sometimes a mixture of both:
- In conductive hearing loss the sound waves cannot pass properly into the inner ear, because of reasons such as copious ear wax blocking the outer ear canal, damage to the ear drum or fluid in the middle ear. As a result sounds become quieter or muffled.
- Sensorineural loss results from damage to the cochlear in the inner ear or to the hearing nerve (or both). Rarely hearing loss occurs as a result of damage to the area of the brain responsible for hearing.
Causes of hearing loss
Causes of hearing loss include:
Sensorineural loss:
- Exposure to loud noise
- Infectious diseases (for example rubella)
- Some medications including some anti-cancer drugs and certain antibiotics
- Genetics and inherited diseases
- Birth trauma
- Head injuries
- Tumours
Conductive loss:
- Blockage by wax
- Fluid or infection in the middle ear
- Ruptured ear drum
- Abnormal growth of the small bones in the middle ear (otosclerosis)
When to see your GP about hearing loss
You should see your GP if you notice any of the following symptoms:
- If you have difficulty hearing (deafness)
- Tinnitus (ringing or buzzing)
- Vertigo (dizziness)
- Loss of balance
- Ear pain
- Discharge from your ear
- Ear wax
Among people who have previously had normal hearing, the most common cause of hearing loss is a build-up of wax. The ear canal makes wax to protect itself from infection. The amount different people's ears make varies from large amounts to very little.
If you suspect you may have a wax blockage, apply ear drops twice a day for four days (but don't use drops if you have a perforated eardrum). This may soften the wax enough that it dissolves and falls out. It doesn't matter which drops you use - cheap olive oil drops or sodium bicarbonate drops from your chemist are just as good as expensive brands.
If you still have hearing problems, see your practice nurse, who can check your ears. If wax is present it can be syringed, or removed by suction. Although there is general agreement that syringing is effective in clearing wax, there is some controversy because there may be significant side effects, including pain, dizziness and even perforation of the ear drum.
Otitis media or glue ear
Another common cause of deafness is inflammation of the middle ear, or otitis media, especially if it persists and results in a collection of 'glue' in the middle ear (known as glue ear). This is a thick mucus which can develop when you have a cold or catarrh (normally the middle ear contains only air, so the ear drum and tiny bones can move freely). If it doesn't drain after your cold, it can prevent the passage of sound through the middle compartment of the ear, and result in hearing loss.
In four out of five cases, an acute otitis media clears up within a few days without any specific treatment. Even if the ear drum has perforated this may heal by itself. Antibiotics are not usually needed. But if the infection causing otitis media persists, or the inflammation becomes chronic, antibiotics may be prescribed. Long-term antibiotics can help prevent long-term or recurrent otitis media but they have side effects and research has not been able to prove they are the best treatment.
Other medicines may also help – simple pain relievers such as ibuprofen or paracetamol may control pain and fever, while decongestants may be worth trying. These might possibly reduce swelling of the membranes in the nose and back of throat, helping the Eustachian tubes to drain fluid from the middle ear – however this has not been proven to be an effective treatment for otitis media or glue ear. Children with recurrent severe otitis media may need an operation to insert tiny tubes called grommets (or tympanostomy tubes) through the ear drum to drain fluid, or removal of adenoids and tonsils if they are blocking the Eustachian tubes.
Rarely a chronic infection may develop (chronic suppurative otitis media) which needs specialist treatment from an ear, nose and throat (ENT) surgeon.
Hearing tests
If you are worried about your hearing, talk to your doctor, who may recommend that you have a hearing test known as an audiogram. They should be able to refer you to a hospital or local community hearing clinic for this test (although you may have to wait several weeks). Alternatively you may be able to book a hearing test yourself for free through the larger branches of certain high street chemists offering specialised hearing services.
An audiogram is a painless test that measures your range of hearing. The results show what sort of hearing loss you have and can give some idea of the cause, and what might be done to help you.
In older patients the problem is often inner ear damage which is due to deterioration in tiny hair-like structures in the cochlear. This irreversible age-related hearing loss is known as presbycusis.
In most cases a hearing aid can help to improve hearing, and there are many types to choose from. Modern hearing aids, based on digital rather than analogue technology are much more sophistacted and discrete than older types, and generally don't have problems they once had such as whistling noises or uncontrolled sound levels. Sometimes other treatments, including surgery, may be needed.
Protecting your hearing
The delicate sensory organs in your ear don't take kindly to loud noises, and when they are damaged they can't be replaced. You can protect your hearing by:
- Avoiding loud noise where possible (it’s especially important to protect your children’s ears from loud noise)
- Wearing ear plugs or ear muffs or defenders when doing noisy activities
- Not inserting anything into the ear canal
- Seeking prompt treatment if you suspect an ear infection
