Sudden hearing loss Hearing loss that comes on all of a sudden is considered an urgent matter and requires expert otologist review within 48 hours. It can be caused by an infection or an interruption of the blood flow to the inner ear. It can be treated by a course of steroids, which are either taken orally, or as a series of targeted injections under local anaesthetic through the ear drum, or both. In most cases the hearing will improve, although return to complete normality is less common. Intermittent hearing loss Hearing loss that comes and goes (hearing loss followed by return to normal hearing), is rarer. It is frequently part of Meniere’s disease. This form of hearing loss may benefit from as a series of targeted steroid injections under local anaesthetic through the ear drum. Progressive hearing loss Hearing that is slowly getting worse over time (months or years) is the most common type of hearing loss. The risk of further hearing loss can be partly reduced by avoiding heavy and loud noise exposure. The channels through which sound information is processed from ear to brain may slowly be made redundant – similar to muscles which wither if left un-used. Hearing aids continue to provide greater sound stimulation to these channels and reduce their redundancy.

The process of hearing can be broken into these steps, where sounds (vibrations of the air) are: Channelled through the outer ear Amplified in the middle ear Converted to an electrical signal in the inner ear Transmitted to the brain, where the signal is decoded and you ‘hear’ the sound Hearing loss can occur when there is a problem anywhere on this sound-to-hearing journey. If a blockage reduces how much of the sound (air vibrations) gets to the inner ear, we class this as a conductive hearing loss. If there is a problem with the inner ear converting or conveying the sound vibration into an electrical signal, we call this sensorineural hearing loss. Conductive hearing loss There are many causes of conductive hearing loss, from heavy wax build up in the outer ear through to stiffening in the joints of hearing bones in the middle ear. The good news is that most of these can be fully reversed or at least significantly improved by an ear surgeon. Depending on the cause of your hearing loss, the following treatments can be instigated by your otologist: wax removal, grommet insertion, tympanoplasty, ossiculoplasty, stapes surgery and middle ear implants, and bone conduction device implantation. Sensorineural hearing loss There are many ways (processes) that sensorineural hearing loss develops and gets worse. We are starting to understand these processes better and are working hard to develop treatments that can specifically target the underlying problem. Please speak to your otologist if you want an update on these. There are certain risks that make people more likely to develop this type of hearing loss: Age Loud noise exposure Family history of hearing loss Particular medications As of yet, we cannot reverse this type of hearing loss. Treatments consist of new generation hearing aids and assisted hearing devices that are programmed to reshape sound and remove noise, to maximise the quality of sound you hear. These newer generation hearing aids are more discrete and have good connectivity with devices allowing a better user experience. However, if despite using hearing aids, significant hearing difficulties persist, a cochlear implant may be considered.

It is important to know whether the hearing problem is in one ear (unilateral) or both (bilateral). Sounds from the right side of your head are channelled through the right ear, and sounds from the left side of your head through the left ear. Your brain brings this sound information together in a clever way so that you hear in stereo (surround sound), know where sound is coming from and can remove background noise to focus on conversation. If you lose the hearing in one ear, this balance is affacted; for example, you may struggle to hear where sounds are coming from, and care must be taken in situations like crossing the road. Additionally, you will struggle to understand speech in a noisy environment, such as a classroom or workspace. In the past, one-sided hearing loss was managed without treatment. Nowadays we encourage patients to push for good hearing in both ears so they can make the most of their hearing environments. Treatments for one-sided hearing loss depend on the underlying cause. If hearing aids are not providing sufficient benefit, surgical solutions exist, including BAHA, bone conduction and cochlear implants.

Hearing loss is classed as mild, moderate, severe or profound, based on performance in standard hearing tests. By grading the severity we can predict the types of sounds you may miss, the environments you may find challenging and the treatment strategies that work best for you. Mild hearing loss With mild hearing loss, f, s, k and th sounds are often missed. The brain can easily fill in the missed sounds if adequate language has developed, so people may miss this problem, especially if they are affected equally on both sides. Patients with mild hearing loss may miss sounds such as leaves rustling and birds chirping. People often are unaware of missing these sounds as the brain can fill in blanks. Moderate hearing loss With moderate hearing loss, there are more difficulties with word sounds. The brain uses non-auditory cues (lip reading, body language) to help fill in the missing sounds. If this hearing loss has developed slowly, the person may have developed these coping strategies, without even knowing it. They may be unaware of the severity of their hearing loss. The use of these coping strategies is not without effect. The effort required to understand is far greater for these patients who are often more prone to fatigue, stress and headaches. Hearing aids are effective in this group of patients. Severe hearing loss In addition to missing speech, these patients struggle to hear sounds such as music, doorbells and telephone ringtones. They almost completely rely on non-auditory cues (lip reading, body language, written word) to communicate. Benefit from hearing aids is possible but does not provide normal hearing levels. In this group we may start to consider cochlear implantation, especially if hearing has progressively been getting worse and they are not benefitting from high power hearing aids. Profound hearing loss These patients will no longer hear vehicles of any kind. Hearing aids provide very little benefit for this group. Communication will be with lip reading, sign language or written words. If patients develop this severity of hearing loss later in life, the impact on social and emotional wellbeing is high. Cochlear implants provide significant benefits to this population.