Hearing Loss

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Disabling hearing loss affects 360 million people worldwide. It may be inherited, caused by complications at birth, infectious diseases or the use of certain drugs. Hearing loss can also result from chronic ear infections, exposure to excessive noise and ageing.

Read on to learn more about the causes of hearing loss and deafness. If you are concerned that you might have hearing problems, included is an outline of the signs and symptoms of hearing problems, so that you can spot the early signs of hearing loss when treatment is more effective.

As half of all cases of hearing loss can be prevented, contained in this section are steps that can help reduce your risk of developing hearing loss. You will also find information about how hearing loss is diagnosed, which may involve general screening tests, tuning fork tests and audiometer tests conducted by an audiologist.

Treatment for hearing problems depend on the cause and severity of your hearing loss. Read more about possible treatments and management strategies such as hearing aids, cochlear implants, and the medications available. 

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While hearing loss is sometimes sudden, it is often gradual and may be unnoticeable at first. It's important to spot the early signs of hearing loss because treatment is often more beneficial if started early. General signs of hearing loss can include:

  • Muffling of speech and other sounds
  • Ringing in the ears (tinnitus)
  • Difficulty understanding words, especially against background noise or in a crowd of people
  • Frequently asking people to repeat themselves
  • Needing to turn the volume up high to listen to music or watch television
  • Difficulty hearing the telephone or doorbell
  • Regularly feeling tired or stressed, due to having to concentrate closely while listening
  • Withdrawal from conversations and avoidance of some social settings
  • Discharge or bleeding from the ear
  • Deep earache, or pain in the ear canal
  • Pressure or a stuffy feeling inside the ears
  • Dizziness or problems with balance or equilibrium

It is common to recognise signs of hearing loss in someone else, before they notice it themselves.

Hearing loss symptoms in children

Schedule your child in for a hearing test if you notice that he or she:

  • Is unstartled by loud noises
  • Does not say single words by the time they are 1 year old
  • Often does not turn towards the source of a sound
  • Tends to hear some sounds but not others
  • Is  slow to learn to talk, or they are not clear when they speak
  • Often speaks loudly and asks you to repeat yourself
  • Turns up the volume of the TV so that it is very loud
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A person who does not have hearing thresholds of 25 decibels or better in both ears is said to have hearing loss. Hearing loss may be mild, moderate, severe, or profound. Hearing loss can occur because of damage or disruption to any part of the hearing system from simple wax blocking the ear canals, through to age-related changes to the sensory cells of the cochlea.

Those with mild to moderate hearing loss may find it hard to follow speech, especially in noisy settings. People with severe hearing loss often rely on lip-reading and may benefit from cochlear implants. Deaf people mostly have profound hearing loss, which implies very little or no hearing. They often use sign language for communication.

Causes of hearing loss and deafness

According to the National Institute on Deafness and Other Communication Disorders (NIDCD) , common causes of hearing loss and deafness in adults include:

  • Presbycusis (age-related hearing loss)
  • Use of certain medications called ototoxic drugs, which can sometimes be found in antibiotics and antimalarial medicines
  • Acoustic neuroma (a noncancerous and usually slow-growing tumor)
  • Long-term exposure to loud noise, such as noisy machinery or loud music
  • Chronic ear infections
  • Infectious diseases including meningitis, measles or mumps
  • Injuries to the head or ear/s

Common causes of deafness in children include:

  • Inherited conditions
  • Infection during pregnancy, such as maternal rubella or syphilis
  • Birth complications, such as low birth weight or birth asphyxia (lack of oxygen at time of birth)
  • Chronic otitis media (collection of fluid in the middle ear)
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If you are concerned that you may have hearing loss, see your doctor for an examination. Typically, your doctor will ask about your family history of hearing loss, and whether you have been exposed to persistent loud noise, ear infections or head injuries. Your physical tests can include:

  • General screening tests: This will often include an examination of your ear canal and eardrum using a lighted instrument. Your doctor may ask you to cover one ear at a time to see how well you hear words spoken at various volumes and how you respond to other sounds.
  • Tuning fork tests: Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks, such as the Rinne or Weber tests, can help your doctor detect hearing loss. A tuning fork evaluation can reveal whether hearing loss is caused by damage to the vibrating parts of your middle ear or damage to sensors or nerves of your inner ear. When a vibrating tuning fork is placed in the middle of your forehead, it is also possible to diagnose one-sided hearing loss.
  • Audiometer tests: Audiometer tests are comprehensive tests conducted by an audiologist. During these tests, you wear earphones and hear sounds directed to one ear at a time. The audiologist generates a range of sounds and tones at various intensities to determine whether you can hear them. Each tone is repeated at faint levels to find out your hearing limit. The audiologist will also present a variety of words to determine your hearing ability. 
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Treatment for hearing problems depends on the cause and severity of your hearing loss. Possible treatments and management strategies include hearing aids, cochlear implants, special training, certain medications, surgery or removing wax blockages.

  • Removing wax blockage: Earwax blockage is a common reversible cause of hearing loss. A dense plug of earwax can be dissolved or gently removed by your doctor.
  • Medications: When hearing loss is caused by specific conditions, such as Ménière's disease or drug-induced hearing loss, medications may be the best course of treatment.
  • Surgery: Surgery can also be used to treat hearing loss, particularly when it comes to conductive hearing loss (when sound is not transmitted through the outer and middle ear). Causes of hearing loss, such as trauma-related hearing problems, acoustic neuroma, and severe cases of otosclerosis, often require surgery to fix the ear drum or hearing bones.
  • Hearing aids: If your hearing loss is due to damage to your inner ear, a hearing aid can help by making sounds stronger and easier for you to hear. A hearing aid amplifies sounds electronically and is effective for many people with age-related hearing loss. You may need to try more than one device to find a type of hearing aid that works well for you.
  • Cochlear implants: If you have severe hearing loss, a cochlear implant may be an option for you. Cochlear implants are small hearing devices that are surgically implanted inside the inner ear for people who find that hearing aids are not powerful enough. Unlike a hearing aid that amplifies sound and directs it into your ear canal, a cochlear implant compensates for damaged or non-working parts of your inner ear by translating sounds into electrical signals that can be carried to the brain.
  • Special training: People who are deaf or have hearing loss can learn to communicate through development of lip-reading skills, use of written or printed text, and sign language. They may also benefit from speech therapy, hearing rehabilitation and other related services. According to the American Speech-Language-Hearing Association , hearing rehabilitation services focus on adjusting to hearing loss, making the best use of hearing aids, exploring assistive devices, managing conversations and taking charge of communication. Services can be individualised, in small groups, or a combination of both.
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The ears are fragile structures that may be damaged in many ways, so it is not always possible to prevent hearing loss. However, half of all cases of hearing loss and deafness are avoidable and can be prevented, according to the World Health Organization . To reduce the risk of hearing loss and deafness, follow the steps below:

  • 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.
  • Use headphones that block out more outside noise: Headphones are a better alternative to turning up the volume. You can also buy add-ons for your existing headphones that block out more outside noise.
  • Protect your ears in the workplace: Use ear protection equipment such as ear muffs or ear plugs if you work in a noisy environment, for example a pub, nightclub, a garage workshop or on a building site. Experts agree that continued exposure for more than 5 hours per week to noise at or above 85 decibels, such as a lawn mower or loud traffic, can cause hearing loss over time.
  • Reduce recreational risks: Use hearing protectors at loud concerts and at other events where there are high noise levels. Younger people in particular are at risk of damaging their hearing by not using earplugs at gigs, festivals and nightclubs, and by turning up the volume too high when listening to music.
  • Don’t insert objects into your ears: Avoid inserting objects, such as fingers and cotton buds, into your ears or your children’s ears.
  • Have your hearing tested: Consider regular hearing tests if you work in a noisy environment. Early detection means you're in a position to take steps to prevent further hearing loss.
  • Immunise your children: Immunise your children against childhood diseases that can lead to hearing loss, including measles, meningitis and mumps.
  • Follow healthy ear care practices: Healthy ear care practices can prevent certain common causes of hearing loss, such as otitis media.
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