Tips to tackle hearing loss as you get older 

What is hearing loss?

It is important to get help for hearing loss but how does hearing loss happen? Hearing loss is the result of sound signals not reaching your brain.

There are two main types of hearing loss you can experience.

• Sensorineural hearing loss – caused by damage to the hair cells inside your inner ear (cochlear) or damage to the auditory nerve which transmits sound to your brain. This occurs naturally with age or because of injury. This type of hearing loss is permanent.

• Conductive hearing loss – when sounds are unable to pass from your outer ear to your inner ear. This is usually temporary. This can be the result of a blockage such as earwax, a build-up of fluid in the ear, an ear infection, a perforated ear drum, otosclerosis which is an abnormal growth of bone in the middle ear, a foreign body in the ear or damage to the hearing bones.

A person can have mixed hearing loss which is both these types of hearing loss.

It’s possible to have the same level of deafness for all frequencies or to have different hearing levels at different frequencies.

What are the different levels of hearing loss? 

Based on British Society of Audiology definition of hearing loss, this is the decibel hearing level range:

• Mild hearing loss (21–40 dB).
• Moderate (41–70 dB).
• Severe (71–95 dB).
• Profound hearing loss/ deafness (95 dB).

Symptoms of hearing loss  

• Difficulty hearing people and understanding what they say.
• Difficulty following a conversation face to face or on the phone.
• Asking others to repeat what they say.
• Difficulty hearing doorbell or phone ringing.
• Not knowing which direction a noise comes from. 
• Listening to the radio, music or watching TV with the volume up higher than others would have it. 

What causes hearing loss?

Hearing loss typically happens due to damage to the inner ear called the cochlea.

Sensory hair cells and auditory nerve cells in the cochlea can identify sound and carry signals from the ear to the brain, which helps people hear. When these cells are damaged this causes hearing loss.    

Cause of hearing loss

Hearing loss can be caused by:    

• Ageing. This is called age-related hearing loss or presbycusis. It is the largest cause of hearing loss and results in gradual hearing loss in both ears. Many people start to lose their hearing from the age of 40. High-frequency sounds, such as female or children’s voices, can become tricky to hear, as well as consonants such as ‘s’, ‘f’ and ‘th’.
• Noise-induced hearing loss. Loud noise is a common cause of hearing loss. Loud music (e.g. in nightclubs) and noise from machinery such as construction/farming equipment (e.g. pneumatic drills) can damage the inner ear and cause permanent hearing loss. Regularly listening to music at high volume through headphones can also damage hearing.
• Acoustic trauma as a result of a sudden very loud sound (e.g. an exploding bomb) can cause sudden hearing loss.  
• Head injury.
• Ear infection. Hard to hear in one ear, ear ache, pressure in ear feeling, ear discharge.
• Perforated ear drum. This can lead to sudden hearing loss after ear infection, loud noise or a change in air pressure (e.g. on aeroplane).
• Too much ear wax. This makes it difficult to hear in one ear, leads to itchiness and a blocked ear feeling.
• Glue ear. Build up of fluid in the middle ear.
• Hereditary hearing loss. Hearing loss because of inherited genes.      
• Labyrinthitis. An inflammation of the inner ear called the labyrinth, which helps with balance and hearing. This can be caused by an infection. It can lead to hearing loss in one ear and vertigo (a spinning sensation).
• Meniere’s disease. Buildup of fluid in the labyrinth. This can lead to sudden hearing loss, dizziness, vertigo or ringing in ears (tinnitus).
• Viral infections of the inner ear e.g. mumps, measles or viral infections of the auditory nerve e.g. mumps, rubella.
• Acoustic neuroma. Non-cancerous growth on or near the auditory nerve.
• Malformed ear.
• Meningitis.  
• Encephalitis. 
• Multiple sclerosis.  
• Stroke.
• Medication. Some medication can damage the cochlea and the auditory nerve.

Is there a cure for hearing loss?

There is no cure to restore hearing because a human’s auditory hair cells do not regenerate once lost.

Help for hearing loss    

It may not be possible to prevent hearing loss if you have an underlying condition that causes it. To tackle hearing loss you could:  

• Get your hearing tested. Try to identify hearing loss early on to make treatment more effective. Take the RNID’s online hearing test
• Use hearing protection when exposed to loud sounds/music. 
• Avoid noisy activities/environments.
• Stop smoking to get rid of toxins.
• Limit alcohol intake to prevent toxic environment for ears.
• Manage blood pressure. High blood pressure can damage cells in the inner ear.  
• Manage diabetes to prevent damaged inner ear cells.
• Get earwax removed.
• Take vitamins and minerals, e.g. B12, potassium and magnesium boost good hearing. 

Can hearing loss be treated?

Treatment for hearing loss depends on the cause and level of a person’s hearing loss.

Hearing loss caused by damage to the inner ear or to nerves that transmit sound to brain. Sensorineural hearing loss is permanent. Hearing and communication can be improved with treatment.

Sensorineural Hearing Loss Treatment

• Middle ear implants. Used if you cannot use hearing aids.
• Cochlear implants. Used if you find hearing aids are not powerful enough.
• Sign language e.g. British Sign Language (BSL).
• Lip reading.
• Hearing aids.

When it comes to help for hearing loss, hearing aids can improve hearing. A hearing aid is a digital or analogue device that consists of a microphone, an amplifier, a loudspeaker and a battery.

Hearing aids raise the volume of sound entering the ear, to enable the wearer to hear more clearly. The microphone picks up sound near the wearer’s ear, which is made louder by the amplifier.  

Your GP or audiologist (hearing specialist) can advise you about whether a hearing aid is suitable. The hearing aid is adjusted to suit your level of hearing impairment.

Types of hearing aids

• Behind-the-ear (BTE) hearing aids These have an ear mould, which sits inside your ear. The rest of the hearing aid is connected to the ear mould and lies behind your ear.

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

• In-the-ear (ITE) hearing aids These are like an ear mould. They fill the area outside the ear canal and fill the opening of the ear canal.

• 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 These are smaller and ess visible than ITE or ITC hearing aids.

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

• CROS hearing aids These hearing aids can detect sounds from the side that does not have hearing and transmitting them to the ear that can hear. They are recommended for people who only have hearing in one ear.

• BiCROS hearing aids These aids amplify the noise entering the ear that is able to hear. They’re useful for people who don’t have any hearing in one ear and some hearing loss in the other ear.

• Disposable hearing aids The battery inside a disposable hearing aid lasts for about three months. After this the hearing aid is binned and replaced.

• Hearing loops If you use a hearing aid, a hearing loop can help you pick up speech sounds more easily. It focuses your hearing aid to pick up sound from the loop system microphone, rather than all noises surrounding you, which helps eradicate background noise. To use a hearing loop, turn on your hearing aid to the hearing loop setting. In public places, you will know there is a hearing loop if you see the ‘T’ sign displayed. 

Conductive Hearing Loss Treatment

Conductive hearing loss is usually temporary.

• Bone conduction hearing aids. This hearing aid is recommended for people with conductive or mixed hearing loss who cannot wear a conventional hearing aid. It vibrates in response to the sounds going into the microphone. The part that vibrates is held against the bone (mastoid) behind the ear by a headband. The vibrations pass through the mastoid bone to the cochlea. This is converted into sound.

• Medication. Hearing loss caused by a bacterial infection can be treated with antibiotics. Earwax build up can be removed with drops, a syringe or suction.

• Implantable devices such as a Bone Anchored Hearing Aid (BAHA). A BAHA transmits sound directly to the inner ear (cochlea) by vibrating the mastoid bone to transit sounds through the skull bone. Instead of being inserted into the ear canal or held behind the ear, this device is attached to a band worn on the head or it may be fixed to a metal implant inserted into the skull.  

• Surgery. Major surgery can drain a fluid build-up, repair a perforated eardrum or fix problems with hearing bones.

How can people with hearing loss communicate?

• Face people when they’re talking, so you can see their mouth, facial expressions and gestures. You can learn how to speech-read. This involves using visual cues to understand what is said.
• Ask people to repeat themselves, speak slowly or write things down. 
• Move to a quieter area to talk to others.

Even if you have a hearing aid, you may still need help hearing sounds in private and public places.

Assistive Listening Devices (ALDs) and Assistive Listening Systems (ALSs)

Aids that can help someone with hearing loss to communicate include Assistive Listening Devices (ALDs) and Assistive Listening Systems (ALSs).

ALS describes any technology that improves the reception of speech for people with hearing loss in situations where it is difficult to hear.

ALDs are small, portable devices that detect speech and make it louder. The microphone for the ALD is put near the sound source (e.g. presenter in a lecture hall) and the ALD amplifies the sound and minimizes background noise. 

E.g:

• Telephone amplifier. Amplified phones allow people with hearing loss to turn up the volume as they wish to hear speech clearly. They can make it easier to hear  high-pitched sound. They may also have amplified ring tones. 

• Captioned phones offer real-time captioning.

• Speech to text software allows individuals to read a transcription of everything said in a conversation. Smartphone and tablet apps can be an ALD. E.g. caption apps can provide text translation for speech.

• Telephone IP relay service allows people with hearing and speech disabilities to make and receive phone calls using an operator/communication assistant. Relay UK is a free service to help deaf people and those who have hearing loss to communicate over the phone. It connects people to a relay assistant to make a phone call. The relay assistant will type what the caller is saying so you can read their responses. It can also read written responses to the caller, if you can’t speak. For details, check with your phone provider.

Can hearing loss be hereditary?

Action on hearing loss estimates that more than 10 million (1 in 6) people in the UK have some level of hearing loss or deafness.

Hearing loss can be hereditary, with or without a family history of hearing loss.    

Hugh Strickland has genetic hearing loss in his family. Both his parents are deaf and deafness has impacted uncles, aunts, cousins and his daughter Mary. Mary’s hearing noticeably declined over four years, from the age of 18 to 22 years-old.

In his family, deafness includes a loss of the lower frequencies (25% loss). Higher frequencies have become harder for him to hear over time.

‘I lost the last of my hearing in my left ear… almost overnight’

The solicitor spoke about being profoundly deaf at the 2023 Hearing Therapeutics Summit.  

“I could cope without hearing aids until my early 20s and my deafness has not impacted my speech”, Hugh Strickland told the Royal National Institute for Deaf People (RNID).

“I lost the last of my hearing in my left ear in 2016, almost overnight”.

While Mr Strickland could have a cochlear implant he says “so far, I’ve been able to cope with just one hearing aid. I worry that getting cochlear implant surgery would affect my residual hearing and prevent me from benefitting from treatments in the future.” 

Mr Strickland has tinnitus which “has a constant and never-ending presence.

“It is like a low hum – more noticeable in my left ear and especially when I think about it”.

“My tinnitus is exacerbated by certain things, such as stress, lack of sleep and too much caffeine. For some it can be cheese, chocolate, red wine, the quinine in your gin and tonic. Sometimes, the sound almost becomes like a clicking. When that happens, it’s usually linked to a headache or migraine, and possibly certain things in my diet.”

He would like to stop further hearing loss in his right ear and regain some hearing in his left ear. He does not use his hearing aid during outdoor activities, like gardening, swimming, or in noisy environments.

Mr Strickland says: “The technology is good, but following a family discussion at the kitchen table with everyone speaking at once is exhausting.”

What should I do if I think I’m losing my hearing? 

If you suspect you are losing your hearing, you should:

• Check your hearing by taking the RNID’s online hearing test.  
• Talk to your GP. 
• Call 111 for advice.   

How serious is my hearing loss?

You should seek medical help immediately, if:

• You experience sudden hearing loss in one or both ears.
• Your hearing loss has been getting worse in recent days or weeks.
• You have hearing loss and other symptoms.