Overview of hearing loss

What is hearing loss and what types are there?

Sound travels down the ear canal and makes the eardrum vibrate; the tiny bones of the middle ear pass this vibration to the inner ear (cochlea), where sensory cells turn sound into nerve signals sent to the brain. A problem anywhere in this chain can reduce hearing. Hearing loss ranges from mild to profound and may affect one ear or both.

• Conductive hearing loss: the problem lies in the ear canal, the eardrum or the middle ear — for example an earwax plug, fluid behind the eardrum or a perforated eardrum. This type is often treatable.
• Sensorineural hearing loss: the sensory cells of the inner ear or the hearing nerve are affected; age-related and noise-induced loss belong here. It is usually permanent but can be supported with options such as hearing aids.
• Mixed hearing loss: conductive and sensorineural components are present together.

Common causes

• Ageing: age-related hearing loss (presbycusis) usually affects both ears, progresses slowly and affects high-pitched sounds first.
• Noise: machinery at work, loud music through headphones, concerts and sudden blasts can permanently damage the cells of the inner ear.
• Earwax blockage: common and easily treated; pushing cotton buds into the ear can drive the wax further in.
• Fluid in the middle ear (otitis media with effusion): especially common in children; it may be painless and reduce hearing without being noticed.
• Chronic ear disease: long-standing ear discharge, eardrum perforations, cholesteatoma and otosclerosis (stiffening of the middle-ear bones) can reduce hearing.
• Ear-damaging (ototoxic) medicines: some antibiotics (such as aminoglycosides) and some chemotherapy drugs (such as cisplatin) can affect the inner ear. If you take these medicines, do not stop them yourself; discuss hearing monitoring with your doctor.
• Infections and other causes: infections such as meningitis, rubella and cytomegalovirus, head injury and inherited (genetic) factors can also cause hearing loss.

Signs that may point to hearing loss

• Struggling to follow conversations in crowded or noisy places.
• Often asking people to repeat themselves or feeling that people mumble.
• Turning up the television or phone louder than others find comfortable.
• Ringing in the ear (tinnitus), or a feeling of fullness or pressure.
• One ear hearing clearly less than the other.

When to see a doctor

What happens at the appointment

• History: when and how the hearing loss began, whether one or both ears are affected, noise exposure, medicines and any family history of hearing loss.
• Ear examination (otoscopy): the ear canal and eardrum are examined with a lighted instrument or microscope to look for wax, infection, fluid or a perforation.
• Hearing test (audiometry): in a soundproof booth, tones of different pitches and speech are used to measure hearing and show the type and degree of loss.
• Tympanometry: a short, painless test of eardrum movement and middle-ear pressure; useful for detecting fluid behind the eardrum.
• Imaging if needed: for one-sided or clearly asymmetric sensorineural loss, magnetic resonance imaging (MRI) may be requested to rule out rare causes such as vestibular schwannoma, a benign tumour of the hearing nerve.

Treatment options

Treatment depends on the cause and type of hearing loss. A definite diagnosis and treatment decision are made after examination and testing.

• Earwax blockage: softening with ear drops, or removal at the clinic by suction or suitable instruments.
• Medical treatment of the cause: appropriate medicines for ear infections; in sudden sensorineural hearing loss, steroid treatment by mouth or injected behind the eardrum, depending on the doctor's assessment.
• Surgery: for conditions such as eardrum perforations, chronic middle-ear disease, cholesteatoma or otosclerosis, surgery may be considered in selected patients; in children with long-lasting middle-ear fluid, ventilation tubes may be placed in the eardrum.
• Hearing aids: in permanent hearing loss they make sounds louder and clearer and ease communication; they do not restore normal hearing but can make a meaningful difference to quality of life.
• Implants: cochlear implants for severe to profound sensorineural loss when hearing aids give too little benefit; bone-anchored hearing implants may be an option for some conductive or single-sided losses.

Protecting your hearing and daily life

Noise-induced hearing loss is largely preventable. The World Health Organization gives these safe-listening tips:

• Keep headphone and speaker volume at no more than about 60 percent of the device maximum.
• Use earplugs in noisy places; well-fitted, noise-cancelling headphones reduce the urge to turn up the volume.
• At concerts and clubs, stay away from loudspeakers and rest your ears in a quiet place for about 10 minutes every hour.
• If you work in a noisy job, wear the hearing protection provided and keep up with regular hearing checks.
• Do not put cotton buds or other objects into your ears.

Hearing loss in children

Hearing loss found early is crucial for protecting a child's speech and language development. Newborn hearing screening is routine in many countries, including Türkiye; babies who do not pass need further testing. Passing the screening does not rule out hearing loss that develops later.

• Children who do not react to sounds, do not turn to their name or are late to talk compared with their peers should have their hearing checked.
• Children who sit very close to the TV, often say "what?" or have attention problems at school should be checked for middle-ear fluid.
• A parent's concern about hearing is on its own a good enough reason for assessment.