Common questions about hearing loss
Frequently asked questions about hearing loss, hearing protection and hearing technology.
Because hearing loss often comes on gradually, you may not immediately notice its impact on your daily life. You may be making subtle compensations, such as lip reading in noisy environments or slowly increasing the television volume. Your friends and family members may be the first to point out your reduced hearing ability.
Symptoms of a hearing loss include:
- feeling other people are constantly mumbling
- problems understanding conversation in background noise
- frequently asking others to repeat themselves
- finding it easier to understand people when looking directly at their faces
- turning up the television or radio volume to a level that others complain is too loud
- missing essential sound cues like doorbells, alarm clocks and smoke alarms
- difficulties hearing on the telephone
- turning one ear towards a person who is speaking, to hear them with your ‘better’ ear.
If you experience more than one of the above signs of hearing loss, you should visit an audiologist to have your hearing tested.
Hearing loss may be accompanied by physical side effects such as:
- Tinnitus, the perception of ringing, roaring, hissing, or buzzing in the ear. Tinnitus is a common side-effect of noise-related hearing loss.
- Ear pain, itching or irritation.
- Pus or fluid leaking from the ear, if the hearing loss results from an injury or infection.
- Vertigo, a condition characterized by dizziness and balance problems. Vertigo often accompanies hearing loss caused by Ménière's disease, acoustic neuroma or labyrinthitis (inflammation of the inner ear).
- Aural fullness – the feeling of fullness or pressure in the ear. Sometimes this is physical, i.e. it literally feels like something is in the ear. Other times it is related to the sensation of hearing, for instance it feels and sounds like cotton is stuffed in the ears.
Hearing loss can also have psychological side effects such as depression, anxiety and a loss in confidence in social and professional situations.
The causes of hearing loss are many and varied. Hearing requires your outer, middle and inner ear, so damage to any of these parts can impact your hearing. Hearing loss caused by an outer or middle ear issue is called conductive hearing loss, while damage to the inner ear is called sensorineural hearing loss.If both types occur together, the condition is called mixed hearing loss.
In general, most hearing loss is caused by:
- The natural aging process (permanent sensorineural hearing loss)
- Hereditary factors (permanent conductive, sensorineural or mixed hearing loss which starts at birth or later on in life).
- Middle ear problems (temporary conductive hearing loss, which may require treatment).
- Exposure to damaging noise (work noise, leisure noise) that injures the cochlea.
Less frequently hearing loss is caused by:
- A head injury, trauma or operation (temporary or permanent conductive, sensorineural or mixed hearing loss).
- Exposure to certain chemicals and medication that damage the ears (permanent sensorineural hearing loss).
- Your brain having difficulty processing what your ears hear, as is the case with Central Auditory Processing Disorder (normal hearing or in combination with sensorineural hearing loss).
- A combination of the above. For example, a noise-related hearing loss will compound hearing loss that develops with age.
Yes. According to Access Economics, around 37 per cent of all cases of hearing loss in Australia are caused by exposure to excessive noise,1 which is completely preventable. Loud noise damages the sensitive structures in the inner part of the ear, leading to irreversible hearing loss that accumulates over a lifetime. The higher the level of sound and the longer your exposure, the more damage is likely to occur. You can limit your noise exposure with simple steps such as wearing ear plugs to music concerts and nightclubs and only listening to your personal stereo at a moderate volume.
Audiologists are specially trained to diagnose, measure and treat the broad spectrum of hearing losses. Other doctors, nurse practitioners and physicians assistants can also identify a potential hearing loss, but will generally refer you to an audiologist for further assessment and treatment
An audiogram maps your hearing loss across a range of different sound frequencies. An audiologist uses it to help assess the best way to manage your hearing loss.
There are many different hearing technologies available to help people manage hearing loss. An audiologist can determine which hearing technology is best suited to your hearing needs. Some forms of hearing loss require medical and/or surgical treatment.
Hearing aids are electronic devices which give people with mild to severe hearing loss better access to sounds. They do not restore normal hearing, but instead detect sounds and amplify them to levels that make speech easier to hear. Hearing aids are generally worn behind the ear, in the ear or in the ear canal. They come in a range of designs for different kinds of hearing loss.
Cochlear implants are surgically implanted devices which replace the function of the damaged cochlea in people with moderately severe to profound sensorineural hearing loss. Cochlear implants pick up sounds and transform them into electrical pulses which stimulate the hearing nerve, mimicking the process of natural hearing. They can be programmed according to your specific needs and degree of hearing loss.
Hybrid cochlear implants combine hearing aid and cochlear implant technology for people who have both low frequency residual hearing and severe high frequency hearing loss. The hearing aid amplifies low frequency sounds, while the cochlear implant converts high frequency sounds into electrical stimulus for the hearing nerve.
Auditory brainstem implants are small devices surgically implanted to the surface of the brainstem in people who have a missing or severely damaged auditory nerve. As the condition is very rare and the surgery very delicate, to date these type of implantations have been limited.
Bone anchored hearing devices (Baha) are for people with a conductive hearing loss, mixed hearing loss or single-sided hearing loss caused by a problem in the ear canal, eardrum or middle ear. The device generally uses a titanium plate which is surgically placed on the skull to pick up, amplify and transmit sound vibrations to the bones around the cochlea. These devices should not be confused with bone conduction hearing aids, which are specific types of hearing aids.
Middle ear implants are used to treat people with sensorineural, conductive and mixed hearing losses who are unable to benefit from traditional hearing aids. These surgically implanted devices pick up and amplify sound before transmitting it as an electronic signal. The signal then vibrates a device attached to a tiny middle ear bone near the cochlea, simulating how the middle ear functions in natural hearing.
Your hearing loss should be managed by an audiologist who can provide additional care and training beyond a one-off hearing aid fitting. With regular visits, your audiologist can ensure your hearing aid continues to meet your changing hearing needs. They can also keep you abreast of new technologies which could help you.
The cost of a hearing aid depends largely on how complex its processing is. A hearing aid that automatically adjusts to different listening environments (such as quiet, noisy, music etc) requires more complex processing and is more expensive. However, a more adaptable and expensive hearing aid may not necessarily be better for you. Speak to your audiologist about trialing different hearing aids so you can choose the one best suited to your lifestyle and hearing needs.
If you have moderate to profound sensorineural hearing loss then a cochlear implant could be an effective option for you. Research shows that adults receiving cochlear implants were able to understand sentences on average almost seven times better than they could with a hearing aid.2 Unlike hearing aids, cochlear implants do not just make sounds louder but improve the clarity of sound.3
A cochlear implant has two components:
An external sound processor is worn on the ear and looks much like a behind-the-ear hearing aid. Attached to the processor is a small coil, held in place next to the skin with a small magnet. The internal cochlear implant is placed behind the ear and just under the skin by the implant surgeon. It is attached to a tiny array of up 22 electrodes, which are surgically placed in the snail shaped cochlea in the inner ear.
The coil picks up sound and sends it to the sound processor, which changes the sound to electrical information the cochlear implant can understand. The implant stimulates the hearing nerve to send a message to the brain, just as happens with natural hearing.
Unlike hearing aids, cochlear implants are typically covered by most Australian private and government health insurance plans.
After implantation, your brain will need to adjust to understanding sounds again. Your audiologist will provide training to help you communicate and hear effectively with your cochlear implant. The amount of rehabilitation you need will depend on the degree of your hearing loss and how long you lived with it before getting a cochlear implant.
All types of hearing instruments need to be kept clean, protected from water, and have their batteries changed regularly. Your audiologist will provide specific instructions on how to care for your hearing technology, and also advise on the process for maintenance and repairs.
Please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.
1. THE ECONOMIC IMPACT AND COST OF HEARING LOSS IN AUSTRALIA - A report by Access Economics Pty Ltd February 2006, http://www.audiology.asn.au/public/1/files/Publications/ListenHearFinal.pdf.
2. Oyanguren V, Gomes MV, Tsuji RK, Bento RF, Brito Neto R (2010) Auditory results from cochlear implants in elderly people. Braz. J
3. Migorov L, Taitelbaum-Swead R, Drendel M et al (2010) Cochlear implantation in elderly patients: surgical and audiological outcome. Gerontology. 56(2)123-8.