What's causing my hearing loss?

What causes hearing loss?

Hearing loss can develop for a wide variety of reasons. Sound waves are focused on to your eardrum, where vibrations are passed through tiny bones attached to your middle ear. From there, they travel to your hearing nerves, which pass them to your brain and interpret them.

You also have an inner ear, where your balance mechanisms reside. Problems with a structure called the cochlea in the inner ear can lead to hearing loss. In addition, your Eustachian tube connects your middle ear with the outside world, allowing you to equalise the pressure between the two.

Conductive hearing loss

Issues which affect how sound is conducted to your eardrum or middle ear is called conductive hearing loss.These include:

• Inflammation of outer ear - called otitis externa.

• Earwax or a foreign body in your ear canal.

• Perforated eardrum.

• Scarring of the eardrum from repeated perforation.

• Glue ear, a condition most often seen in children, in which the air in the middle ear is replaced by a sticky liquid.

• Eustachian tube dysfunction, often experienced when you have a cold.

• An uncommon growth in the ear called a cholesteatoma.

• Middle ear infection - known as otitis media.

• Otosclerosis, which affects one of the three bones in the middle ear.

Sensorineural hearing loss

Hearing loss related to the onwards passage of messages to the brain from the hearing nerve is known as sensorineural hearing loss. Causes include:

• Age-related hearing loss, or presbyacusis - the commonest reason for hearing loss.

• Noise damage.

• Meniere's disease, which causes episodes of hearing loss, vertigo - dizziness with a spinning sensation - and tinnitus.

• A tumour on the hearing nerve called an acoustic neuroma.

• Some conditions affecting the brain, including stroke, brain trauma, inflammation of the brain (encephalitis) and multiple sclerosis.

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Ear, nose and throat

Glue ear

Glue ear is a condition where the middle ear fills with glue-like fluid instead of air. This causes dulled hearing. In most cases it clears without any treatment. An operation to clear the fluid and to insert ventilation tubes (grommets) or temporary use of hearing aids may be advised if glue ear persists.

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When should I worry about hearing loss?

Tinnitus is the medical term for noise that comes from inside your ears, rather than from the world outside. It's often perceived as a ringing, buzzing, roaring or whistling. It usually affects both ears and often goes hand in hand with hearing loss.

Treating the hearing problem may cure or significantly improve your tinnitus. However, if you develop tinnitus in just one ear, contact your doctor urgently - occasionally this is a sign of an acoustic neuroma - a tumour on the hearing nerve. The same applies if you get sudden complete hearing loss in one ear, or hearing loss and tinnitus on one side.

What is Eustachian tube dysfunction?

If your Eustachian tube gets blocked by mucus when you have a cold, there's a mismatch of pressure which affects how efficiently messages from your eardrum are passed to your hearing nerve. This can result in dulled hearing and sometimes pain. The same principle applies if you're in an aeroplane which is changing height as it takes off or lands.

The hearing loss from blocked Eustachian tubes is common but usually temporary. With age, you're much more likely to have persistent age-related hearing loss. As many as one in three 40- to 69-year-olds have hearing problems and one in 10 fail a hearing test - but only one in 50 of them use a hearing aid. That means there are around 4 million people in the UK who could benefit from a hearing aid but don't wear one.

How does age affect your hearing?

One in six adults in the UK has some degree of hearing loss, and age is the single biggest cause - 8 million of those affected are 60 or over. By 2035, it's estimated that around 14.2 million UK adults will be affected by hearing loss.

One of the first signs of age-related hearing loss is difficulty in hearing when there's a lot of background noise. This can make it difficult to take part in social gatherings. As hearing loss progresses, even one to one conversations in quiet settings become harder. As a result, people with untreated hearing loss often avoid social situations.

Loss of social contact increases the risk of anxiety and depression. But without mental stimulation from conversation with others, there's also a higher risk of cognitive decline - memory loss and even dementia.

In fact, people with even mild untreated hearing loss are twice as likely to develop dementia as those without it. Moderate untreated hearing loss increases the risk three fold, while those with severe hearing loss are five times more likely to develop dementia as those with normal hearing.

The good news is that research has shown that people with hearing loss who used hearing aids were not at increased risk, and had the same chance of staying independent as those with normal hearing.

Yet hearing tests - and hearing aids - are underused. While about 6 million people in the UK could benefit from using a hearing aid, only 2 million do.

Do you need a hearing test?

Most of us are in the habit of having our eyes checked every couple of years, or more often if advised. Yet on average, it takes 10 years for someone to seek help when they develop hearing loss. Doctors spend a lot of time advising patients to get into the habit of having hearing checks as they get older.

British and Irish Hearing Instrument Manufacturers Association goes one step further. It wants to see annual NHS hearing tests introduced routinely for everyone over the age of 55. On average, it's nine years since people aged 55 or over have had a hearing check, even though people of this age believe they should be getting their hearing tested every three years.

Mohammed Ismail, audiologist at the hearing specialist Amplifon, advises: "There's compelling clinical evidence linking untreated hearing loss to anxiety, depression and social isolation. There is even clear evidence that untreated hearing loss significantly increases the risk of cognitive decline, especially in older people. Yet all too often people wait many years before getting the issue sorted.

"Getting a first check early means you can be alerted to early signs of hearing loss, and monitored for any decline in hearing that needs treatment. If we could all get into the habit of having regular hearing checks over 55, in the same way as we get our eyes and teeth checked, it would make a real difference to the incidence of mental health and cognitive issues."

How do I get a hearing test?

You can book a free hearing test directly through many high street hearing centres. Alternatively, speak to your GP - they'll be happy to refer you on the NHS. The audiologist will carry out several tests.

One involves listening to different sounds through headphones and pressing a button when you hear something; another is similar but with speech; another checks for fluid behind your eardrum.

If there's an issue, your audiologist will talk about the options for hearing aids. Many are available on the NHS - and they are very different from the cumbersome, whistling devices of just a couple of decades ago.

Newer technologies - some of them only available through private providers - allow you to link your hearing aid to your phone or television, and even fine-tune your settings through bluetooth-enabled technology.

So if you've noticed your hearing is less sharp, don't delay - it could revolutionise your life!

With thanks to 'My Weekly' magazine where this article was originally published.