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Deafness Content Supplied by NHS Choices
Introduction

Hearing loss is a common problem that often develops with age or is caused by repeated exposure to loud noises.

Action on Hearing Loss estimates that there are more than 10 million (about 1 in 6) people in the UK with some degree of hearing impairment or deafness.

Hearing loss can occur suddenly, but usually develops gradually. General signs of hearing loss can include:

  • difficulty hearing other people clearly and misunderstanding what they say
  • asking people to repeat themselves
  • listening to music or watching television with the volume turned up higher than other people require

Read more about the symptoms of hearing loss.

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 ENT surgeon for further tests.

You can also visit the Action on Hearing Loss website for an online hearing test.

Read more about diagnosing hearing loss.

Why it happens

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.

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.

However, 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 and 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.

Read more about preventing 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:

  • 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)

Conductive hearing loss is sometimes temporary and can be treated with medication or minor surgery, if necessary. However, 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, such as a Bone Anchored Hearing Aids (BAHAs).

Read more about treating 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, because treatment is often more beneficial if started 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 suggests 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.

Read more about losing your hearing.

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 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 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

Read more about your child's development from birth to five years old.

Seeking medical help

Make an appointment to see your GP if you're having problems with your hearing, or your child is showing signs of hearing difficulties.

If you wake up with a sudden loss of hearing in one ear or lose the hearing in one ear within a couple of days, you should see your GP as soon as possible.

Read more about diagnosing hearing loss.

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 is 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 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.

These causes are explained below.

Age

Age is the biggest single cause of hearing loss. Hearing loss that develops as a result of getting older is often known as age-related hearing loss or presbycusis.

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. By the age of 80, most people have significant hearing problems.

As your hearing starts to deteriorate, high-frequency sounds, such as female or children's voices, may become difficult to hear. It may also be harder to hear consonants such as "s", "f" and "th". This can make understanding speech in background noise very difficult.

Loud noises

Another common cause of hearing loss is damage to the ear from repeated exposure to loud noises over time. This is known as noise-induced hearing loss, and it occurs when the sensitive hair cells inside the cochlea become damaged.

You're at higher risk of developing noise-induced hearing loss if you:

  • work with noisy equipment, such as pneumatic drills or compressed-air hammers
  • work in environments where there's loud music, such as a nightclub
  • regularly listen to music at a high volume through headphones

Hearing loss can also occur suddenly after exposure to an exceptionally loud noise, such as an explosion. This is known as acoustic trauma.

See preventing hearing loss for advice on reducing your risk of noise-induced hearing loss.

Other types of sensorineural hearing loss

Sensorineural hearing loss occurs if the sensitive hair cells inside the cochlea are damaged, or as a result of damage to the auditory nerve (which transmits sound to the brain). In some cases, both may be damaged.

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.

Sensorineural hearing loss is permanent and hearing aids are often required to improve hearing in these cases. Read more about treating hearing loss.

Causes of conductive hearing loss

Conductive hearing loss is usually caused by a blockage, such as having too much ear wax, a build-up of fluid in the ear (glue ear), or an ear infection.

Conductive hearing loss can also be caused by:

  • a perforated eardrum - where the eardrum is torn or has a hole in it
  • otosclerosis - an abnormal growth of bone in the middle ear which causes the inner hearing bone (the stapes) to be less mobile and less effective at transmitting sound
  • damage to the hearing bones from injury, a collapsed ear drum or conditions such as cholesteatoma
  • swelling around the eustachian tube - caused by jaw surgery or radiotherapy for nasal and sinus cancer
  • malformation of the ear
  • Eustachian tube dysfunction
  • something becoming trapped in the ear (a foreign body)

Conductive hearing loss is usually temporary and can often be treated with medication or minor surgery. Read more about treating hearing loss.

Diagnosing hearing loss

See your GP if you're having problems with your hearing. They'll examine your ears and carry out some simple hearing tests.

You may also want to visit the Action on Hearing Loss website for an online hearing test.

Ear examination

During an ear examination, an instrument with a light at the end called an auriscope (or otoscope) is used to look for anything abnormal, including:

Your GP will ask if you have any pain in your ear and when you first noticed the hearing loss.

Referral to a specialist

Your GP may refer you to an ear, nose and throat (ENT) specialist or an audiologist (a hearing specialist). The specialist will carry out further hearing tests to help determine what's causing your hearing loss and recommend the best course of treatment.

Some of the hearing tests you may have include a:

  • tuning fork test (sometimes performed by your GP)
  • pure tone audiometry
  • bone conduction test

These tests are described below.

Tuning fork test

A tuning fork is a Y-shaped, metallic object. It produces sound waves at a fixed pitch when it's gently tapped and can be used to test different aspects of your hearing.

The tester taps the tuning fork on their elbow or knee to make it vibrate, before holding it at different places around your head.

This test can help determine if you have conductive hearing loss, which is hearing loss caused by sounds not being able to pass freely into the inner ear, or sensorineural hearing loss, where the inner ear or hearing nerve isn't working properly.

Pure tone audiometry

Pure tone audiometry tests the hearing of both ears. During the test, a machine called an audiometer produces sounds at various volumes and frequencies (pitches). You listen to the sounds through headphones and respond when you hear them, usually by pressing a button.

Bone conduction test

A bone conduction test is often carried out as part of a routine pure tone audiometry test in adults. It's used to check if you have sensorineural hearing loss, by testing how well your inner ear is working.

Bone conduction involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard.

Bone conduction is a more sophisticated version of the tuning fork test, and when used together with pure tone audiometry, it can help to determine whether hearing loss comes from the outer and middle ear (conductive hearing loss), the inner ear (sensorineural hearing loss), or both.

Read about how hearing tests are performed.

Newborn hearing screening

All newborn babies are offered a hearing test in the first few weeks after birth as part of the NHS Newborn Hearing Screening Programme.

The tests helps to identify babies who have permanent hearing loss as soon as possible so that parents can get the support and advice they need.

Read more about the newborn hearing test.

Levels of hearing loss

Very few people with hearing loss hear nothing at all. There are four different levels of hearing loss, which are defined by the quietest sound you're able to hear, measured in decibels (dB). These are described below.

Mild deafness

If you're mildly deaf, the quietest sound you can hear is 21 to 40dB. Mild deafness can sometimes make hearing speech difficult, particularly in noisy situations.

Moderate deafness

If you're moderately deaf, the quietest sound you can hear is 41 to 70dB. You may have difficulty following speech without using a hearing aid and may find it difficult to hear announcements, for example.

Severe deafness

If you're severely deaf, the quietest sound you're able to hear is 71 to 90dB. People who are severely deaf usually need to lip-read or use sign language, even with the use of a hearing aid.

Profound deafness

If you're profoundly deaf, the quietest sound you can hear is more than 90dB. People who are profoundly deaf can benefit from a cochlear implant. Other forms of communication include lip reading and British sign language or signed English.

Read more about treating hearing impairment, including different types of hearing aids and sign language.

Treating hearing loss

How hearing loss is treated depends on the underlying cause of the condition.

Hearing loss that occurs when sounds are unable to pass into the inner ear (conductive hearing loss) is often temporary and treatable.

For example, earwax build-up can be removed by drops, a syringe or suction. Hearing loss caused by a bacterial infection can be treated with antibiotics. Surgery can be used to drain a fluid build-up, repair a perforated eardrum, or correct problems with the hearing bones.

However, hearing loss caused by damage to the inner ear or to the nerves that transmit sound to brain (sensorineural hearing loss) is permanent.

If your hearing is impaired, treatment can improve your hearing and quality of life. Some of these treatments are discussed below.

You can search for hearing impairment services near you.

Hearing aids

If you have hearing problems, you may be able to wear a hearing aid. About 1.4 million people regularly use hearing aids in the UK, and many more would benefit from them.

A hearing aid is an electronic device that consists of a microphone, an amplifier, a loudspeaker and a battery. It increases the volume of sound entering your ear, so you can hear things more clearly.

The microphone picks up sound, which is made louder by the amplifier. Hearing aids are fitted with devices that can distinguish between background noise, such as traffic, and foreground noise, such as conversation.

Modern hearing aids are very small and discreet, and can often be worn inside your ear.

Hearing aids help improve hearing, but don't give you your hearing back. They're suitable for most people, but may be less effective for people with profound hearing impairment or certain conditions. Your GP or audiologist (hearing specialist) can advise you about whether a hearing aid is suitable for you.

If a hearing aid is recommended, an audiologist may take an impression of your ear so the hearing aid fits you perfectly or may show you an open fit hearing aid. The hearing aid will be adjusted to suit your level of hearing impairment. You'll also be shown how to use and care for it.

After your hearing aid has been fitted, you should have a follow-up appointment within 12 weeks.

If you experience problems using a hearing aid - such as distortion and repeated infections - that can't be corrected by an audiologist, you may benefit from different treatments. An ear, nose and throat (ENT) surgeon can discuss these with you. An ENT surgeon with a special interest in ear surgery is called an otologist.

NHS hearing aids

The NHS loans hearing aids to people with hearing loss free of charge. This includes free repairs, batteries and servicing. Many areas now charge for lost hearing aids, but you'll be told about any costs at your fitting appointment.

In the UK, both analogue and digital hearing aids are commonly used. Most hearing aids prescribed through the NHS are now digital.

Instead of having moving parts, digital hearing aids contain a very small computer that processes sounds. This enables the hearing aid to be programmed to suit different environments, such as a small, quiet room or a large, noisy workshop.

The type of digital hearing aids available through the NHS are usually the behind-the-ear (BTE) type (see below). Other types of hearing aid may be issued in cases where a medical condition prevents an individual from using BTE hearing aids. You can also choose to pay privately for another type of hearing aid if it's not available on the NHS.

Read more about getting an NHS hearing aid.

Types of hearing aids

The different types of hearing aids are described below.

Behind-the-ear (BTE) hearing aids

BTE hearing aids usually have an earmould, which sits inside your ear. The rest of the hearing aid is connected to the earmould and lies behind your ear.

Some types of BTE hearing aids have two microphones that enable you to listen to sounds in the general vicinity or to focus on sounds that are coming from a specific direction. This can be particularly useful in noisy environments.

Open fit hearing aids may also be available, which are suitable for those with mild to moderate hearing loss. The tube sits in the ear, instead of an earmould.

Receiver in-the-ear (RITE) hearing aids

Receiver in-the ear (RITE) hearing aids are similar to BTE hearing aids, but the piece worn behind the ear is connected by a wire to a receiver (loudspeaker) located within the ear canal.

This means RITE hearing aids are usually less visible than BTE devices.

In-the-ear (ITE) hearing aids

In-the-ear (ITE) hearing aids are like an earmould. They fill the area just outside your ear canal and fill the opening of your ear canal.

The working parts of the hearing aid are inside the shell.

In-the-canal (ITC) hearing aids

In-the-canal (ITC) hearing aids fill the outer part of the ear canal and are just visible.

Completely in-the-canal (CIC) hearing aids

Completely in-the-canal (CIC) hearing aids are even smaller and less visible than ITE or ITC hearing aids.

However, they may not be recommended if you have severe hearing loss or frequent ear infections.

Body-worn (BW) hearing aids

Body-worn (BW) hearing aids have a small box containing the microphone. The box can be clipped to your clothes or you can put it inside a pocket. A lead connects the box to an earphone, which delivers sound to your ear.

This type of hearing aid is an option for people with poor dexterity, who require a high-powered hearing aid.

CROS/BiCROS

CROS hearing aids are recommended for people who only have hearing in one ear. They work by picking up sounds from the side that doesn't have hearing and transmitting them to the ear that's able to hear. The sound is sometimes transmitted through wires, although wireless models are available.

BiCROS hearing aids work in a similar way to CROS hearing aids, but they amplify the noise entering the ear that's able to hear. They're useful for people who don't have any hearing in one ear, with some hearing loss in the other ear.

Bone conduction hearing aids

Bone conduction hearing aids are recommended for people with conductive or mixed hearing loss who can't wear a more conventional type of hearing aid. Bone conduction hearing aids vibrate in response to the sounds going into the microphone.

They can also sometimes help people with no hearing in one ear and normal or mild hearing loss in the other ear.

The part of the hearing aid that vibrates is held against the bone behind the ear (mastoid) by a headband. The vibrations pass through the mastoid bone to the cochlea and are converted into sound in the usual way. They can be very effective, but can be uncomfortable to wear for long periods.

Bone Anchored Hearing Aids (BAHA)

A Bone Anchored Hearing Aid (BAHA) transmits sound directly to the cochlea by vibrating the mastoid bone. A minor operation is needed to fix a screw to the skull, on which the hearing aid can be clipped on and off. A BAHA is removed at night and when you swim or take a shower.

Unlike a bone conduction hearing aid, it's not uncomfortable to wear and is used for patients with conductive hearing loss, or in some patients who have no hearing in one of their ears.

Some people may benefit from newer types of implantable bone conduction hearing aids that are held onto the head with magnets instead of a connector through the skin. However, these are only available at some BAHA centres and may require a referral to a different BAHA centre.

Middle ear implants

These are surgically implanted devices that attach to the hearing bones and make them vibrate.

They're suitable for people who can't use a hearing aid, but have hearing loss at a level where a BAHA would not help.

Disposable hearing aids

Disposable hearing aids are sometimes recommended for people who have mild to moderate hearing loss.

The battery inside a disposable hearing aid usually lasts for about 12 weeks, after which time the hearing aid is thrown away and replaced. Disposable hearing aids tend to be expensive in the long term and are only available privately.

Cochlear implants

Cochlear implants are small hearing devices fitted under the skin behind your ear during surgery.

They have an external sound processor and internal parts, including a receiver coil, an electronics package and a long wire with electrodes on it (an electrode array).

The external processor takes in sound, analyses it and then converts it to signals that are transmitted across the skin to an internal receiver-stimulator, which sends the signals along the electrode array into a part of the inner ear called the cochlea. The signal is then sent to the brain along the hearing nerve as normal. This means cochlear implants are only suitable for people whose hearing nerves are functioning normally.

A cochlear implant is sometimes recommended for adults or children who have severe to profound sensorineural hearing loss in both ears, which isn't helped by hearing aids.

Both ears are usually implanted for children, whereas adults are usually only able to have one implant on the NHS.

Before a cochlear implant is recommended, you'll be assessed to find out whether it will help improve your hearing. During the assessment, any disabilities or communication problems you have will be taken into consideration, which may mean the usual hearing tests aren't suitable.

If a cochlear implant is recommended, it will be inserted into your ear (or both ears) during an operation and switched on a few weeks later.

There are currently around 11,000 people in the UK with cochlear implants and the number is increasing each year.

Safety

According to the Medicines & Healthcare products Regulatory Agency (MHRA), evidence suggests that patients with cochlear implants may be at an increased risk from pneumococcal meningitis, especially if they haven't been immunised against pneumococcal disease.

In August 2002, the Department of Health included cochlear implant patients in the population groups who should be immunised against pneumococcal infection.

Although the risk of contracting bacterial meningitis is low, it's slightly higher than for the general population.

Auditory brainstem implants

In some cases of severe to profound hearing loss, where there are problems with the nerve that transmits sound to the brain, an auditory brainstem implant (ABI) may be used.

An ABI is an electrical device made up of:

  • electrodes implanted into the part of the brain responsible for processing sound (in the brainstem)
  • a receiver device placed under the skin behind your ear
  • a small sound processor outside your ear

When the microphone in the sound processor picks up sound, it turns it into an electrical signal and transmits this to the brain through the receiver and electrodes.

An ABI will not fully restore your hearing, but it can usually restore some degree of hearing and can make lip-reading easier. It's often used as a treatment for hearing loss associated with a condition called neurofibromatosis type 2 (NF2).

Lip reading and sign language

Hearing loss can sometimes affect your speech, as well as your ability to understand other people. Many people with significant hearing loss learn to communicate in other ways instead of, or as well as, spoken English.

For people who experience hearing loss after they've learnt to talk, lip-reading can be a very useful skill. Lip-reading is where you watch a person's mouth movements while they're speaking, to understand what they're saying.

For people born with a hearing impairment, lip-reading is much more difficult. Those who are born with a hearing impairment often learn sign language, such as British Sign Language (BSL), which is a form of communication that uses hand movements and facial expressions to convey meaning.

BSL is completely different from spoken English and has its own grammar and syntax (word order). Other types of sign language include Signed English and Paget Gorman Signed Speech.

The Action on Hearing Loss website has more information on British Sign Language (BSL) and lip-reading. You can also visit the Association of Teachers of Lipreading to Adults (ATLA) website to look for lip-reading classes in your area.

Preventing hearing loss

The ears are fragile structures that can be damaged in many ways, so it's not always possible to prevent hearing loss.

The risk of your hearing being damaged by loud noises depends on how loud the noises are and how long you're exposed to them. Experts agree that continued exposure to noise at or above 85dB (similar to a lawn mower or loud traffic) can, over time, cause hearing loss.

However, by following the advice below it's possible to reduce your risk of noise-induced hearing loss (hearing loss from loud noise):

  • Don't have your television, radio or music on too loud. This is particularly important if you have young children in the house, because their ears are more delicate than an adult's. If you can't have a comfortable conversation with someone who is two metres (about 6.5ft) away from you, turn the volume down. You shouldn't have dull hearing or ringing in your ears after listening to music.
  • Use headphones that block out more outside noise, rather than turning up the volume. You can buy add-ons for your existing headphones that block out more outside noise, or noise cancelling headphones.
  • Use ear protection equipment such as ear muffs or ear plugs if you work in a noisy environment, such as a pub, nightclub, a garage workshop or on a building site. It's important to insert ear plugs correctly to gain the benefit of wearing them.
  • Use ear-protection equipment at loud concerts and at other events where there are high noise levels, such as motor races.
  • Don't insert objects into your ears or your children's ears. This includes fingers, cotton buds, cotton wool and tissue.
  • Be aware of the symptoms of common causes of hearing loss, such as ear infections (otitis media) and Ménière's disease
  • Visit your GP if you or your child are experiencing hearing problems.

Read more tips to protect your hearing.

'Through performing, I've managed to grow as a person'

Millie's hearing started deteriorating when she was a child. She talks about learning to cope with the hearing loss and shows that it hasn't stopped her doing what she wants to in life, including dancing.

‘20 years ago, deaf people would have found it difficult to get into this sort of job’

Susan is a community mental health nurse helping deaf people with mental illnesses. She talks about how attitudes to deafness have changed and says deafness need not stop you having a successful career.

 
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