Definition and Overview

A person with hearing loss cannot hear properly. The condition can be mild, moderate or severe. In mild cases, a person has a problem understanding speech. Often, they need to ask people to talk slowly or louder. They also find it difficult to hold a conversation when there is a lot of noise around. Those with moderate hearing loss require a hearing aid. Those with severe cases can hear nothing at all. They depend on lip-reading or sign language to communicate with other people.

Hearing loss can occur in both children and adults. It can develop following an ear infection, due to ageing, and in people who are always exposed to loud noises. Some people are born with it. Some types of hearing loss can be treated with medications and simple procedures. Other cases, on the other hand, are irreversible. But a patient can still restore his ability to hear using hearing aids or cochlear implants.

Causes of Condition

Hearing loss can be caused by:

  • Genetics - Hearing loss can run in the family. A person can inherit an abnormal gene from either parent and be born with the condition. Many babies born with hearing loss also have other abnormalities. These include problems with balance and vision as well as heart problems.

  • Loud noises - Exposure to very loud noises can damage sensitive structures inside the ear. Examples of harmful noises are those caused by explosions, loud concerts, and gunshots.

  • Infections - Ear infections that make the inside of the ear swell can prevent a person from hearing properly. Hearing loss gets better on its own when the infection goes away.

  • Injuries to the ear - A strong blow to the ear and head can dislocate the bones in the middle ear. This can lead to hearing loss. Unless the injuries are treated, hearing loss can become permanent.

  • Ageing - The gradual loss of hearing occurs as people get older. This happens when tiny hair cells inside the ear are damaged or die. Two out of three people age 75 and older have some level of hearing loss.

  • Certain illnesses - Illnesses that result in high fever can cause damage to the inner ear. The same can result from using certain antibiotics and chemotherapy drugs.

  • Clogs - Foreign objects or earwax that has built up in the ear canals can keep a person from hearing well.

Key Symptoms

Many people do not notice that they are slowly losing their hearing. They think that the problem occurs because people mumble or their phone is broken. As long as they can hear sounds, they assume that their hearing is fine.

People with a mild hearing loss can hold conversations with other people. They can understand what is being said. But they struggle to keep up when there is background noise. When the condition becomes worse, they often need to ask people to speak slowly and louder. They may also need to wear a hearing aid.

Other signs are:

  • Cannot follow conversations when people talk at the same time. This causes them to avoid group conversations.

  • Misunderstands what other people are saying. This can cause the patient to respond inappropriately.

  • Often being told that their TV or radio is too loud.

  • Finds it too hard to understand people on the telephone.

  • Often misses the doorbell when it rings.

  • Hears rushing, ringing, or hissing sounds.

  • Has difficulty hearing at the movies.

Who to See and Types of Treatments Available

Most people with hearing problems go to their doctor for initial assessment. Their doctor would ask about their symptoms, when they started, and if they are getting worse. Patients are also asked about their medical history and if someone in their family has hearing problems as well.

The doctor will then continue with a physical exam. Using an otoscope, the patient’s ears are checked. This test can confirm if the inner ear is swollen or the ear canal is infected. It can also confirm if the eardrum has collapsed or if the ear is blocked by a foreign object. The doctor will then instruct the patient to cover his ear one at a time. The doctor will say words at different volumes, and the patient will be asked to repeat them.

If the doctor suspects hearing loss, the patient will be referred to an audiologist or an ear, nose, and throat (ENT) specialist.

The patient will then undergo a few more tests. These include:

  • A tuning fork test - A tuning fork is a device that produces vibrations when its two prongs are struck. It is used to test hearing as well as bone conduction. It is placed against the bone behind the ear and then about 2 centimeters from the auditory canal. It is then vibrated, and the patient is asked if he can hear the vibration.

  • Audiometer exam - For this test, the patient is asked to wear earphones attached to an audiometer. The doctor will then deliver pure tones of controlled intensity to one ear at a time. The patient is asked to press a button or raise a hand when they hear the sound.

Treatment of hearing loss depends on its cause and severity. Options include:

  • Surgery - Surgery is indicated if hearing loss is caused by birth defects, infections, trauma or foreign bodies.

  • Medications - Certain drugs can be used if cochlea hair cells are swollen. They can also be used if hearing loss occurs due to Meniere’s disease.

  • Radiation therapy - Used if hearing loss is caused by tumours.

  • Hearing aids and cochlear implants -If the cause of hearing loss cannot be reversed, patients can take advantage of hearing aids or cochlear implants.


  • U.S. Department of Health & Human Services. Quick guide to health literacy and older adults: Hearing impairment. website.

  • Nash, S. D., Cruickshanks, K. J., Klein, R., Klein, B. E., Nieto, F. J., Huang, G. H& Tweed, T. S. (2011). The prevalence of hearing impairment and associated risk factors: the Beaver Dam Offspring Study. Archives of Otolaryngology–Head & Neck Surgery, 137(5), 432-439.

  • Longo DL, et al. Disorders of hearing. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: The McGraw-Hill Companies; 2015.

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