An insight into how the ear works
The first step to understanding hearing loss is to understand how the ear works.
The ear has three main parts:
- The outer ear. The outer ear collects sound or sound waves which causes the eardrum to vibrate.
- The middle ear. The eardrum is connected to three tiny bones in the middle ear, which amplify and transfer the mechanical vibrations of the eardrum to the inner ear.
- The inner ear. The inner ear, or cochlea, is a fluid-filled snail-shaped organ. The mechanical vibrations pass through the fluid in the cochlea containing tiny hair cells that convert the vibrations into electrical impulses sent to the brain via the auditory nerve. The brain interprets the electrical impulses and turns them into recognizable sounds.
Where does hearing loss occur?
Hearing loss comes from problems or damage to any part of the ear (outer, middle, or inner ear). Also, problems can arise from processing issues in the auditory cortex in the brain. The location of the problem will determine the type and level of treatment.
What are the different types of hearing loss?
To find the best course of treatment for hearing loss, you first need to know the type and degree of your hearing loss. This information is obtained by completing a hearing test. There are three main types of hearing loss.
Sensorineural hearing loss
Sensorineural hearing loss is the most common type of hearing loss. It is caused by damage to the inner ear, affecting your ear's ability to transmit electrical impulses to the brain via the auditory nerve. This type of hearing loss is considered permanent as no cure exists; however, there are treatment options to help sensorineural hearing loss. Learn more in the article about sensorineural hearing loss.
Conductive hearing loss
Conductive hearing loss is caused by damage or obstruction in the outer or middle ear. Damage to these areas prevents the efficient transfer of energy from the environment to the inner ear. Unlike sensorineural hearing loss, conductive hearing loss is often treatable. You can also read the article about conductive hearing loss if you want further insight.
Mixed hearing loss
A mixed hearing loss contains a component of both sensorineural and conductive hearing loss.
What are the different degrees of hearing loss?
The degree of hearing loss is a description of the severity of your hearing loss. The severity falls into one of five categories:
- mild hearing loss: 26 to 40 dB HL
- moderate hearing loss: 41 to 55 dB HL
- moderate-to-severe hearing loss: 56 to 70 dB HL
- severe hearing loss: 71 to 90 dB HL
- profound hearing loss: 91 to 100 dB HL.
Any level measured at 25 dB HL or below is considered normal hearing.
What do the categories mean in daily life?
- Mild hearing loss: Many of the soft daily sounds fall into this level and could be missed by someone with a mild hearing loss. Soft daily sounds include people breathing, leaves rustling, people whispering, refrigerator humming, cat purring and dripping of water. Although people with mild hearing loss can communicate well in quiet surroundings, in situations with background noise there could be word confusion for words starting with certain consonants (“s”, “f” or “th”).
- Moderate hearing loss: People with moderate hearing loss will have more difficulty hearing and understanding speech at normal conversations levels. Following a conversation will require more effort and many of the words could be missed or misunderstood even in quiet. It may not be possible to follow a conversation at normal levels in background noise. Other sounds that could be missed include laughter, rain falling and coffee brewing.
- Moderate-to-severe hearing loss: People with moderate-to-severe hearing loss will have difficulty understanding speech in most situations and have even more difficulty in noise. The TV or radio are not understandable at normal levels and require louder volume levels to be understood. Other daily sounds that could be missed include water running, an alarm clock, children playing, a busy street, an electric toothbrush and a washing machine.
- Severe hearing loss: People with this hearing loss will have difficulty with most conversations at normal and moderately loud levels. Speech at loud levels might be understood as long as there is no competing background noise. Other daily sounds that could be missed include a doorbell or telephone, traffic noise, a vacuum cleaner, a toilet flushing, and people working or various office sounds.
- Profound hearing loss: People with this hearing loss can only hear very loud sounds such as a lawn mower, a motorcycle, an ambulance siren or a blender. Speech at normal levels would not be heard and even when shouting, the speech might not be audible or understood. Those with profound hearing loss are generally candidates for cochlear implants or may rely on sign language or lip-reading to help them understand speech.
Can I have hearing loss in only one ear?
It is possible to have different levels of hearing in your ears. You might also hear the terms ‘unilateral or bilateral’ and ‘symmetrical or asymmetrical’ hearing loss.
When you get a comprehensive hearing test, the left and right ears are tested. Hearing loss in only one ear is called unilateral, and hearing loss in both ears is called bilateral. When the hearing loss on both sides is similar, then the hearing loss is symmetrical. However, when the hearing loss within both ears is not the same, it is considered asymmetrical.
What does hearing loss sound like?
Although hearing loss is always a subjective experience, it is possible to simulate sound where certain frequencies are lacking.
One of the most common experiences is that high-pitched sounds are harder to hear. This type of hearing loss, known as high-frequency hearing loss, occurs most commonly with sensorineural hearing loss. If you want to get an idea of what high-frequency hearing loss sounds like, you can try our hearing loss simulator.
What causes hearing loss?
There are many reasons why hearing loss occurs. Here are some of the most common causes of hearing loss:
- Presbycusis or age-related hearing loss. This hearing loss occurs gradually over time as we age. The first effects are generally not noticed until later in life.
- Noise-induced hearing loss. Noise, when heard or played at high levels, can damage your ears. Depending on the level of sound and the length of time you experience it, it can cause temporary or permanent damage to your hearing. Some causes of noise-induced hearing loss include live concerts, listening to high levels with headphones, shooting/hunting, power tools or equipment, motorcycling, or working in noisy places.
- Obstructions in the outer ear. Anything that closes off the external ear can cause hearing loss. Some common obstacles include a buildup of earwax, an object such as a cotton swab, or medical problems such as exostosis (bony growths in the ear canal).
- Trauma. Trauma to the head, especially if it is close to the ear, can lead to hearing loss. The damage could be to the bony hearing organ, middle ear bones, eardrum, ear canal, or brain.
- Genetic disorders. Many disorders can have an impact on hearing (e.g., Waardenburg syndrome, Usher syndrome). Hearing loss can also be hereditary.
What could be the impact of hearing loss on daily life?
Untreated hearing loss can significantly impact your quality of life. Hearing loss has been shown to affect people socially, emotionally, and cognitively.
Social impact
Hearing loss is more than just the loss of your hearing abilities.
It can impact our ability to effectively communicate with those around us and participate in daily life activities. This can affect us socially in many ways, such as:
- avoiding family gatherings
- no longer participating in conversations
- avoiding going out to places, especially if they are noisy
- avoiding telephone calls
- avoiding friends.
Emotional impact
Hearing loss not only affects social interactions but also can have a significant impact on your emotional well-being.
Not understanding what is being said or having continual misunderstandings due to hearing loss often causes a person to withdraw from their family and friends and other social interactions. This can have many emotional effects, such as:
- depression
- social isolation
- frustration or anger
- anxiety
- embarrassment
- loneliness
- fatigue.
Cognitive impact
The brain is not technically a muscle, but it does need exercise to continue to work effectively. Untreated hearing loss causes the brain to receive less stimulation and, over time, reduces its processing ability. Without the proper exercise, it is no longer able to receive and process information as before. This can cause a decline in your cognitive skills, such as:
- increased rate of memory impairment
- mental fatigue
- reduced processing ability
- increased rate of cognitive decline.
How can I treat my hearing loss?
The treatments for hearing loss will vary depending on its cause. Permanent hearing loss is often treated with a hearing device such as a hearing aid or an implant.
Can hearing loss be reversed?
There is no cure for permanent hearing loss, but treatment can help alleviate the effects of hearing loss.
Temporary hearing losses can be treated with medications, a medical procedure, or may resolve on their own. Any medical treatment is dependent on the medical issues and symptoms present and should be addressed directly with your medical professional.
What are the different types of treatment for hearing loss?
Hearing devices
Various types of devices can help compensate for hearing loss. Your type and degree of hearing loss will determine which devices are most suitable for you.
Hearing aids
The most common devices used to treat hearing loss are hearing aids. They are small electronic devices worn behind or in the ear which amplify sound to make it louder and more precise. To learn more about the different hearing aids and options for you, see this article on hearing aids. Your hearing care specialist can help you select the best hearing aid for your needs.
Implants
In some cases, hearing aids are not enough. Then, an implant might be used instead. The implant is fitted to the patient during an operation. Common types of implants include middle ear implants, cochlear implants, and bone-anchored hearing aids.
Assistive listening device
Assistive listening devices are devices used to help improve communication or hearing in everyday situations. They can be used alone or in combination with specific hearing devices. Some typical assistive listening devices are TV adapters which send the sound directly to the hearing aid or headphones, FM systems used to improve communication in noisy places, and smartphones that let the user stream telephone calls or other sounds directly to the hearing aids.
How do I prevent hearing loss or further damage to my hearing?
We can do several things regularly to help reduce the risk of hearing loss or help prevent further damage to our hearing:
- Protect your hearing with hearing protection. Loud sounds and noise can cause hearing loss. By wearing hearing protection when taking part in noisy activities, such as concerts, shooting, motorcycling, car races, etc., the sound can be reduced to safer levels. There are many types of hearing protection such as earplugs and earmuffs.
- Turn the volume down. When listening to music, radio, TV, etc., it is essential to keep the volume set at safe levels. Some audio devices allow you to set max limits for the volume. If you find you turn up your music because it is noisy, you can try noise-canceling headphones instead.
- Have your hearing regularly tested to monitor for hearing loss or changes in your hearing. An online hearing test can be an easy way to monitor any changes to your hearing and can indicate if you should schedule a comprehensive hearing test.
- Avoid inserting things into the ear. Poking items, like cotton swabs, into the ear canal can cause damage to the ear canal wall or the eardrum or cause ear wax to become impacted in the ear.
- Monitor your medication. Some medications can potentially be harmful to your hearing. These are called ototoxic medications. If you are on such medication, it is crucial to monitor your hearing frequently for any changes. If possible, check with your physician about possible options that are not ototoxic.
