Hearing Loss Signs and Symptoms
Everyone has experienced changes in sensitivity to sound at one point or another. Changes in hearing are a common part of everyday life. You may have found yourself speaking louder or even yelling unintentionally, or maybe you’ve been in a room and wondered why everyone was speaking so softly or quietly.
Hearing loss is nothing to be ashamed of, and it is a common experience for many people. So, how do you know when changes in your hearing are a genuine medical concern?
Most likely, you are missing out. You are either not hearing something due to loudness or intensity of sound or missing certain sounds, such as people's voices in crowded environments due to loss of hearing at different frequencies. Not being able to hear can be isolating.
What Is Hearing Loss?
Hearing loss, impairment, or deafness is the partial or total inability to listen to sounds in one or both ears.
Depending on your hearing loss’s cause and level, the symptoms you experience may be mild, moderate, severe, or profound.
The severity of your hearing loss is determined by how loud the pitch or volume needs to be before you hear a sound.
For example, if your hearing difficulty is mild, you will find it difficult to hear or understand speech when there is a higher-pitched sound or noise around you. If your hearing loss is moderate, you can still communicate with the use of a hearing aid.
Those with severe hearing loss or deafness cannot hear sounds even when the volume is amplified. They are mostly reliant on sign language, lip-reading, or loud speech to communicate. Similarly, patients with profound deafness cannot hear anything or detect sounds at all, so they rely on lip-reading or sign language.
Although most people group mild and moderate hearing loss together, severe hearing loss and profound deafness sit at the end of the hearing spectrum. Because the human ear perceives sound frequencies between 20 Hz (lowest pitch) and 20 kHz (highest pitch), any patient who doesn’t hear a sound within those frequencies has profound deafness.
How Common Is Hearing Loss?
The World Health Organization reports that hearing loss is among the most prevalent health conditions in human beings, with over 450 million people afflicted across the globe.
Hearing is progressively lost with aging, and nearly one-third of individuals above 65 have a measurable degree of hearing loss. This is called presbycusis and is a natural process.
As a result, hearing loss is often underdiagnosed and undertreated. Most types of hearing loss are irreversible. However, consulting with a healthcare professional can help manage your symptoms as early as possible and prevent further hearing damage.
You can fix some types of hearing loss with relatively simple solutions, such as earwax removal. It is best to have a healthcare professional determine your possible treatment options.
The use of hearing aids can also significantly improve your sensitivity to sound and your overall quality of life.
Types of Hearing Loss
Hearing loss is mainly categorized based on the ear’s part and the hearing process that's affected. The three main types of hearing loss include:
- Sensorineural hearing loss
- Conductive hearing loss
- Mixed hearing loss
- Sensorineural hearing loss
Sensorineural Hearing Loss
Sensorineural hearing loss (also known as nerve-related hearing loss) is the most common hearing loss and is typically due to problems in the inner ear.
This type of hearing loss is triggered when the auditory nerves are ruptured or damaged. Because the auditory nerves carry sound frequencies and information about the volume and clarity of sounds, damage to these nerves results in a gradual loss of nerve endings and sound receptors.
In severe cases, this condition weakens or impedes nerve signals transfer to the brain and results in total deafness.
Conductive Hearing Loss
Conductive hearing loss isn't as common or severe as sensorineural hearing loss. Patients who have conductive hearing loss may hear better when sound is loud or during conversations over the telephone.
Conductive hearing loss happens when damage to the ear canal, outer and middle ear, or eardrum. This obstruction impedes the transmission of sound waves into the inner ear.
Depending on the cause, conductive hearing loss may be temporary or permanent. However, it is very rare for patients to experience total deafness resulting from conductive hearing loss. Sometimes, hearing aids or corrective surgery can improve hearing.
Here are some common causes of conductive hearing loss:
Obstruction of the external ear canal
Fusion or fixation of the ear bones (malleus, incus, and stapes)
Infections and diseases of the ear
Perforation of the eardrum
Mixed Hearing Loss
Mixed hearing loss is a combination of both sensorineural and conductive hearing loss. It typically occurs when the ear suffers trauma, causing damage to the cochlea (inner ear), auditory nerves, and the outer or middle ear.
Mixed hearing loss can be temporary or become severe over time. For instance, if you have conductive hearing loss due to an ear infection, you can still experience age-related hearing impairment (presbycusis) as you age. Also, excessive ear wax or impaction can further compound your hearing loss.
What Causes Hearing Loss?
The causes of hearing loss can be congenital or acquired. Congenital causes of hearing loss cause hearing loss before birth, while acquired causes of hearing loss occur later in life.
Congenital Causes of Hearing Loss
Several studies have also shown hearing loss is hereditary and may be triggered by genetic mutations.
Generally, this implies that some people are more prone to hearing loss than others. For example, infants whose parents have hearing problems face a higher risk of hearing loss than others.
The US Centers for Disease Control and Prevention attributes 50 to 60 percent hearing loss in infants to genetic causes. Maternal infections cause about 25 percent or more of hearing loss in babies during pregnancy and childbirth complications.
During pregnancy and childbirth, some of the complications that may trigger congenital hearing loss include:
Disease and infections during pregnancy, such as German measles (maternal rubella), cytomegalovirus, syphilis, and toxoplasmosis
Inappropriate use of prescribed and non-prescribed medicines during pregnancy, such as aminoglycosides, cytotoxic drugs, antimalarial drugs, and diuretics
Low birth weight (LBW)
Perinatal or neonatal asphyxia
Severe jaundice during the neonatal period
Acquired Causes of Hearing Loss
In this section, we will be focusing on the acquired causes of hearing loss. All cases of hearing loss in adults are acquired.
1. Ototoxic Medications
Ototoxic medications are drugs that treat certain health conditions but can affect your hearing as a side effect. Many over-the-counter and prescription medications are ototoxic.
Ototoxic drugs damage the cochlea, and hearing loss develops quickly. Other symptoms like vertigo and tinnitus often accompany hearing loss. Hearing often returns to normal if you stop taking the medication.
Common examples of ototoxic medications are loop diuretics like furosemide or bumetanide used to treat heart failure and high blood pressure, large doses of aspirin, and anti-inflammatory drugs like naproxen and ibuprofen.
Certain antibiotics like gentamicin, neomycin, streptomycin, and cancer medications like bleomycin, cyclophosphamide, and cisplatin can also cause hearing loss.
2. Exposure to Loud Noise
Sudden or constant exposure to loud noise can cause hearing loss. There is a normal noise level that your ears can tolerate. When sound exceeds that level, it can instantly damage your hearing.
Loud noise can cause your eardrum to rupture or damage the hair cells in your inner ear. This is called acoustic trauma.
You can reverse hearing loss caused by eardrum rupture if the tear in the eardrum heals. Most of these eardrum perforations heal independently without any medical treatment other than keeping the ear dry.
Hearing loss caused by damage to the hair cells in your inner ear is irreversible because the hair cells cannot be repaired or replaced.
Another cause of hearing loss in adults is aging. As you age, the organs in your body and the hair cells in your inner ear begin to deteriorate. When this happens, you will experience hearing loss.
Hearing loss caused by aging starts gradually. With time, the hearing loss deteriorates until it becomes profound and permanent. Hearing loss caused by aging is not reversible. The only way you can hear is with the help of hearing aids.
4. Buildup of Earwax
Earwax is produced in the ear canal to procect the ear from particles, water, and bacteria that can cause infections. When the ear produces a normal quantity of earwax, the earwax flows out naturally and is washed away.
In some cases, the ear can produce more earwax than needed. Getting rid of the excess earwax becomes difficult and results in wax accumulation.
As the earwax accumulates, it solidifies and grows in size. With time, the accumulated ear wax grows big and creates a blockage in the ear canal.
This blockage prevents sound coming from the outer ear from getting to the inner ear. When this happens, conductive hearing loss occurs. Hearing returns to normal when the excess wax is removed.
5. Ruptured Eardrum
The eardrum, also known as the tympanic membrane, is a thin membrane between the outer and middle ear. It plays a vital role in the transmission of sound from the outer ear to the middle ear.
A tear or a hole in the eardrum is an eardrum rupture of tympanic membrane perforation, and several factors can cause it.
Sudden exposure to loud noise can instantly rupture the eardrum. Also, sudden changes in pressure, direct impact on the ear, head injury or trauma, and poking the ear with objects can rupture the eardrum.
Ear infections that cause fluid to build up behind the ear can also cause the eardrum to rupture. As the fluid builds up behind the eardrum, it places pressure on the eardrum, making the eardrum tear.
Ruptured eardrums usually heal within a few weeks without any medical intervention. In cases where the healing doesn't happen naturally, a surgical procedure may be required. This may involve an in-office procedure or a surgical procedure. Hearing returns to normal when the tear or hole in the eardrum seals up.
6. Ear Infections and Diseases
Ear infections like autoimmune inner ear diseases and middle ear infections can cause hearing loss.
Autoimmune inner ear diseases occur when the antibodies in the inner ear begin to destroy hair cells in the inner ear. If the condition is not treated immediately, all the hair cells in the inner ear can be lost. This will result in permanent hearing loss.
Other infections like swimmer's ear, otitis externa, and otitis media with effusion can cause hearing loss.
7. Other Factors
Several other factors can cause hearing loss in adults.
Examples of these causes include:
Eustachian tube dysfunction
Certain illnesses like meningitis and high fever
How Does Hearing Loss Impact Patients?
When you lose your hearing, life changes; suddenly, you find it challenging to communicate with people and start to lose critical connections. Even the struggle to cope and find balance can cause a cognitive decline, which may aggravate your situation.
Let's take a look at how hearing loss can impact different aspects of your life.
Hearing loss adversely affects one of life's most essential functions—your ability to communicate with others. In most cases, hearing loss means you may have limited access to educational and job opportunities.
For children, hearing loss is associated with delays in speech and language development. When poorly managed, hearing loss from ear infections and genetic causes means the children perform below par in academics and social activities.
Children with hearing loss need special education assistance to improve their learning abilities, experiences, and academic performances.
Below you’ll find additional information on the functional impact of hearing loss for adults.
1. Difficulty Communicating
Most hearing loss patients do not realize they have a problem with their hearing until they struggle to engage in everyday conversations.
Because this is one of the initial signs of hearing loss for most patients, they may not suspect hearing loss at first.
Some of the difficulties hearing loss patients encounter during conversations are:
Muffled hearing; the voices and sounds they hear sound low, indistinct, or muffled
Difficulty identifying the source of a sound
Constantly asking for repetition
Asking others to speak louder or increasing the volume of the television or radio
Asking others to speak slowly
Inability to hear distant sounds
Difficulty engaging in group conversations
In most cases, it takes the people around the hearing loss patient to realize that they have problems with their hearing.
The hearing loss may make them misunderstand or not hear what you’re saying. If only one ear is affected, they may turn the "good" ear toward you to hear what you’re saying.
An audiologist can test how well someone understands speech by testing speech discrimination on your audiogram. Speech discrimination can be more important than the specific levels of hearing at different frequencies because it translates to usable hearing.
While communicating with hearing loss patients may be frustrating, the use of certain communication strategies can make it easier.
Here are communication tips to use when communicating with a hearing loss patient:
Face the hearing loss patient directly
Ensure that the face of the speaker is properly illuminated
Don't speak from another room or a distance
Say the person's name before beginning the conversation, giving the hearing loss patient time to pay attention to what you say.
Avoid using complex sentences
Speak slowly, distinctly, and clearly
Avoid shouting; shouting distorts the sound of speech.
Pause between sentences and phrases to ensure that the hearing loss patient understands what you’re saying
Take turns speaking and avoid sudden changes in topics
2. Difficulty Understanding Speech in Background Noise
Inability to hear well in background noise is another major sign of hearing loss. Background or ambient noise is any sound other than the primary sound being monitored.
Examples of background noise are noise from electrical devices like air conditioners, motors, refrigerators, animals, traffic noise, water noise, and other types of environmental noise.
Adults with hearing loss can hear properly in quiet environments but struggle to hear when background noise is introduced.
This difficulty to hear can be attributed to the fact that background noises can mask the fine sounds of speech like high-pitched consonants. These fine sounds make hearing easier, but hearing becomes difficult when they are masked.
When these sounds are masked, the brain may not fill up the blank spaces they leave. At that point, the brain is also busy trying to separate speech from the background noise.
These blank spaces left by masked sounds make it difficult for the hearing loss patient to comprehend what you’re saying.
If the brain can fit in the missing sounds through contextual clues, the hearing loss patient may experience fatigue because of the strenuous work the brain had to do during the conversation.
Also, the auditory systems in hearing loss patients’ inner ears are different. The auditory system is responsible for filtering sounds into different channels that are tuned to different frequencies.
In people with normal hearing, the channels are sharp and focused. However, they are broad and scattered in hearing loss patients. When there is background noise, the neurons in the inner ear have to work harder because the channels are spread too thin.
This, coupled with the fact that the neurons are also distracted by background noise, makes the perceived sound fuzzy.
If hearing loss is caused by damage to the hair cells in the inner ear, you may also experience difficulty hearing in background noise. Aside from being responsible for how loud a particular sound needs to be for you to hear it, hair cells also help you understand speech in background noise. If they are damaged, the hearing may be difficult.
3. Difficulty Hearing Children’s Voices
Another common sign of hearing loss in adults is the inability to hear female and children's voices. If you can hear these voices, they may sound muffled or unclear.
This happens because female voices and children's voices are regarded as high-pitched sounds, and the first set of cells to fail when you have hearing loss are the cells responsible for detecting high-pitched sounds.
Asides from female and children’s voices, you may also find it difficult to hear sounds like the beeping of phones and appliances, birds and animal sounds, doorbells, and certain consonant sounds. Examples of consonant sounds you may struggle to hear are "s,” "h," or "f.”
4. Listening Fatigue
Listening fatigue is the feeling of tiredness after listening to someone speak for a while. People with normal hearing can experience listening fatigue, but it’s different for those with hearing loss.
Listening fatigue sets in earlier for people with hearing loss. They also have frequent or increasing episodes of listening fatigue caused by the extra work the brain has to do to interpret sounds.
The hair cells in the inner ear are responsible for converting sound waves into electrical energy, which the brain interprets as sound. When these hair cells are damaged, the ear can no longer convert sound waves into electrical signals.
The implication of this is that the brain will be getting the raw, unconverted soundwaves. This makes the brain do more work to make sense of the sound sent to it from the inner ear.
Also, each hair cell is responsible for translating a specific frequency; when the hair cells are damaged, the auditory system cannot translate the missing frequency. Your brain will constantly have to fill in blank sound spaces left by the lost frequencies when others are talking.
If more than one person is speaking at a time, your brain may have to do more work. This can make you very tired at the end of social events.
Listening fatigue can make hearing loss patients withdraw from social activities and become depressed. This withdrawal is caused by difficulty understanding conversations and the embarrassment associated with constantly asking for repetition.
5. Medical Conditions Comorbid with Hearing Loss
Here are some medical conditions that are comorbid or present when an individual has been diagnosed with hearing loss.
The relationship between hearing loss and the listed condition may not be apparent or causative:
Falls: Dizziness, stumbling, vertigo, and falls are also commonly associated with hearing loss. It is important to be aware of fall risks if you or a loved one has hearing loss. Our hearing and balance are closely related both anatomically and in real-life situations.
Cardiovascular disease: Hearing loss and cardiovascular diseases are both attributable to aging and age-related degeneration.
Diabetes: Hearing loss and diabetes are both considered diseases attributable to age-related degeneration, as well.
Cognitive impairment and dementia: Hearing loss, cognitive impairment, and dementia are all considered diseases attributable to aging and age-related degeneration.
Emotional Impact of Hearing Loss
Hearing loss can be debilitating. Thus, it negatively impacts the health and social well-being of patients.
Despite being a natural process, losing your ability to hear can be embarrassing. It can make social situations more difficult to navigate and everyday life more challenging. You may not know of anyone else who has hearing problems, but the chances are that other people are experiencing similar symptoms in your circle.
In most cases, hearing loss can interfere with your ability to socialize or work, and it can cause you to lose confidence or self-esteem. Hearing loss patients often experience:
Frequent mood swings
Social isolation and loneliness
Additionally, some people find it uncomfortable or ugly to wear hearing aid devices, so there can be significant barriers socially and emotionally to seeking treatment.
It is best to consult a healthcare professional regarding any concerns you have about your hearing. The only way to know if you have significant hearing loss is to have your ears evaluated and get your hearing checked.
The good news is that current treatment methods can help you manage hearing loss’s emotional and psychological effects.
Economic and Financial Impact
The financial and economic implications of hearing loss are immense. According to the World Health Organization, the global cost of unaddressed hearing loss is about $750 billion every year. This estimate encompasses:
Health sector costs (minus cost of hearing aids and devices)
Loss of productivity
Educational support costs
Sadly, the situation is worse in developing countries. Children suffering from hearing loss rarely receive educational and social support. Even some countries with provisions for children in this category have poorly equipped and poorly managed facilities.
Adults with hearing loss find it difficult to get employment. Among those who have jobs, a more significant percentage of them are stuck in the lower cadres of work than others at their level.
Although efforts are being made to raise awareness, improve access to education, provide vocational support services, and create jobs, there's still much more to be done.
Symptoms of Hearing Loss
The signs of hearing loss you may experience are based on different factors like the type and cause of your deafness. While some experience deafness during birth, others experience hearing loss as they age or due to trauma.
Hearing loss may be a symptom of an underlying health condition like tinnitus or infectious disease. So, early detection and diagnosis are crucial and will help you decide what to do next.
Here are some of the common signs you should look out for in newborns:
When the infant does not tilt their head towards a sound or noise before four months old
If the baby has not spoken or made sounds by the age of one
When your child doesn't seem disturbed by a loud noise
If the baby only responds to you when you are in sight but does not answer when you call their name out of sight
When the infant is only conversant with few sounds
Some of the symptoms that may indicate a hearing problem in toddlers and children include:
The child finds it difficult to communicate with other children in the same age group
The child keeps asking you to repeat what you said
The child speaks or produces high-pitched sounds that are louder than normal noises
The child speaks or makes utterances that are muffled and unclear
Some of these symptoms may become profound as your children grow older.
The Mayo Clinic lists common symptoms of hearings loss as:
- Hearing muffled sounds
- Difficulty understanding words in everyday conversation
- Requesting others to speak louder, slower, or more clearly
- Using electronic devices (television, phone, radio, headsets) at higher volumes
- Withdrawal from conversation
- Avoidance of social situations due to embarrassment
Hearing Loss Diagnosis
Because hearing loss is a slow process, many people do not take action between first noticing the onset of the symptoms and their first audiometric examination with a healthcare professional. A recent survey showed that patients waited seven years on average before their first diagnostic hearing exam.
This is not unusual, as the initial degree of hearing loss may not significantly affect your quality of life. Still, as with any health condition, the earlier it is detected, the better the outcome.
With early detection, you can take the proper care to ensure you do not further damage your hearing and get proper treatment. In some cases, you can restore hearing with surgery on the eardrum or the bones behind the eardrum.
We recommend getting your ears evaluated, and your hearing tested at the first onset of symptoms.
Where Can I Get a Hearing Test?
Getting tested for your hearing loss can be complicated, but there are multiple ways for you to find the appropriate care, depending on your needs. You may want to go to your primary care physician, an ENT (ears, nose, throat) specialist, an otologist, or an audiologist.
Keep in mind other factors when deciding where to go for medical care. You should consider your past medical history, insurance coverage, and family history to determine which provider best meets your needs. Hearing loss and diseases that affect the ear, hearing, or balance can run in families.
When you visit a doctor, they will ask questions about your medical history and symptoms. Based on this information, they will perform physical examinations using instruments like an otoscope. Your doctor may detect ear infections or earwax accumulation of fluid in the ear canal.
If they cannot detect ear problems through physical evaluation, they will perform a series of tests to diagnose your condition further:
Audiometric tests: During audiometric tests, your audiologists will use an audiometer to determine your hearing levels, ability to recognize pitch and discern different sound intensities, or differentiate speech from background noise.
Tuning fork tests: Tuning fork tests provide early diagnosis, especially when audiometry is inaccessible. Tuning forks are metal instruments that produce sounds when struck. These tests help detect unilateral or conductive hearing loss.
App-based hearing Tests: If you cannot access medical help, you can use mobile apps to screen yourself for hearing loss quickly.
Bone Oscillator Tests: This test enables doctors to identify the type and severity of the hearing loss. A bone oscillator is placed against the mastoid, and it vibrates and transmits pure tone sound to the cochlea or inner ear. The goal is to gauge how well vibrations pass through the ossicles and test the nerve's function that carries these signals to the brain.
How to Prevent Hearing Loss
You cannot prevent hearing loss due to genetic factors, birth complications, or accidents. Still, here are some preventive measures that can help you avoid hearing loss from acquired causes.
1. Stay Away From Places with Loud Noises
Adults and children are at risk of experiencing sound-induced hearing loss. If you have to scream before someone can hear, the noise is loud enough to cause deafness. Whether at home or in your vehicle, keep your radio and TV volume at a moderate level to protect your hearing.
While using your headphones, keep the volume level moderate and remove headphones at intervals.
2. Wear Hearing Protective Devices During Loud Events
If you attend noisy events like pop concerts, nightclubs, motor racing, or drag racing, you can wear earplugs to reduce the sound intensity. You can also move away from the sound at intervals.
3. Adhere to Strict Hearing Safety Protocols
If you work in noisy environments like nightclubs, factories, and construction sites, wear hearing protective devices like earmuffs and earplugs, and move away from the noise at intervals.
4. Get Frequent Hearing Tests
Again, if you are frequently exposed to loud sounds, visit your audiologists to run physical examinations and hearing tests. Early identification and diagnosis will help you manage the condition.
Hearing Loss Treatments
There are various treatments for hearing loss. The best treatment depends on the type, cause, and severity of deafness. However, if you have sensorineural hearing loss, treatment will not cure deafness; instead, it will help you cope with the condition.
Let's take a look at some of the standard available treatment options.
Use of Hearing Aids
Hearing aids or assistive devices do not cure hearing loss. However, they are designed to improve your hearing and quality of life. The device amplifies the sound vibration that enters your ear and makes sound audible.
Hearing aids come in different sizes and capacities. They consist of a microphone, loudspeaker, amplifier, and battery. Consult your doctor to recommend one that's right for you.
Cochlear implants are suitable for patients that have severe hearing loss. The device is usually inserted inside the cochlea and directly stimulates the hearing nerves. It improves hearing, speech comprehension, and communication.
Recent advancements in cochlear implant technology mean that patients can comprehend speech even with background noises, enjoy music, and use their implants while swimming.
Removal of Ear Obstructions and Ear Wax Impaction
Obstruction in the ear due to excessive ear wax can cause temporary hearing loss. Removing these obstructions can restore hearing. It is advisable to visit a health professional to remove your earwax impaction.
Surgical Procedures and Medications
Surgical operations can improve your hearing if your hearing loss is triggered by abnormal bone growths, tumors, or chronic ear infections such as otitis media.
For instance, if you have infections or fluid in your ear, inserting small tubes can drain the fluids and restore hearing.
Lip Reading and Sign Language
Lip reading and sign languages are alternative communication methods for patients with profound deafness.
The patient watches the speaker's lip, tongue, and facial movements during lip reading or speechreading. They then use data and the environment to understand what the speaker is saying.
Sign language involves the use of hand signs, facial expressions, and body postures for communication. People with permanent hearing loss primarily use sign language.
If you suspect you have hearing loss, we recommend getting your hearing tested. You can take a free test online, or you can get tested at a hearing center by an audiologist. Keep in mind; the results may be more challenging to interpret online.
If you have severe to profound hearing loss, we recommend you consult an audiologist. For your level of hearing loss, you may need a more advanced solution.
If you have mild to moderate hearing loss, you may see improvement from less intense treatments. Audien Hearing’s rechargeable hearing aids are available at one of the lowest prices on the market, starting at only $89/pair for our EV1 hearing aids and costing only $249/pair for our top-of-the-line EV3 hearing aids.
Your hearing treatment depends on your level of hearing loss and your budget. Keep those two in mind, and if you don't need something crazy advanced or expensive, give us a try! With a 30-day money-back guarantee, there's no reason to wait.
Thanks for reading, and good luck on your journey to better hearing!
“The senses of hearing and balance are complex, poorly understood, and often ignored. Audien hearing aids offer a cost-effective solution for many people.” - Drew Sutton, MD, Board-Certified Otolaryngologist.
Drew Sutton M.D.
Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.