Condition Basics

What is hearing loss?

Hearing loss is a sudden or gradual decrease in how well you can hear. Gradual hearing loss happens over time. It can affect people of all ages. Hearing loss may range from slight to profound. Depending on the cause, hearing loss may improve with treatment (reversible) or be lasting (permanent).

What causes it?

The most common causes of hearing loss are noise and aging. Being exposed to everyday noises, such as using a power lawn mower, can lead to hearing loss over many years. As you get older, changes in the inner ear cause slow but steady hearing loss. Many other things can cause hearing loss too.

What are the symptoms?

Common symptoms of hearing loss include muffled hearing and a feeling that your ear is plugged. You may have trouble understanding what people are saying, especially when there is background noise, such as a radio. You may listen to the TV or radio at a higher volume than in the past.

How is it diagnosed?

Your doctor will do a physical exam and ask about your symptoms and past health. The doctor also may look in your ears with a lighted device. If your doctor thinks that you have hearing loss, you'll have hearing tests to check whether you have hearing loss and how severe it is.

How is hearing loss treated?

Treatment depends on the type and cause of hearing loss. Permanent hearing loss can be treated with hearing aids or devices that alert you to sounds around the house like the doorbell. If hearing aids don't work for you, cochlear implants may be an option. Reversible hearing loss can often be treated successfully.

Cause

The most common causes of hearing loss are:

Noise.

Noise-induced hearing loss can happen slowly over time. Being exposed to everyday noises, such as listening to very loud music or using a power lawn mower, can damage the structures of the inner ear. This can lead to permanent hearing loss. Sudden, loud noises, such as an explosion, can also damage your hearing.

Aging.

In age-related hearing loss, changes in the inner ear that happen as you get older cause a slow but steady hearing loss. The loss may be mild or severe. It is always permanent.

Other causes of hearing loss include earwax buildup, an object in the ear, injury to the ear or head, an ear infection, a ruptured eardrum, and other conditions that affect the middle or inner ear. Some medicines also can cause it. And some people are born with hearing problems.

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Prevention

Being exposed to loud noise over and over is one of the most common causes of permanent hearing loss. It usually develops slowly and without pain or other symptoms. You may not notice that you have hearing loss until it is severe.

Here are some steps you can take to lower your risk of noise-induced hearing loss.

• Be aware of and avoid harmful noise.

  You can be exposed to harmful noise at work, at home, and in many other settings. Know what kinds of situations can cause harmful noise levels. To learn more about hearing protection in workplaces in the United States, contact the Occupational Safety and Health Administration (OSHA).

• Use hearing protectors.

  If you know you are going to be around harmful noise, wear hearing protectors, such as earplugs or earmuffs.

• Control the volume when you can.

  Reduce the noise in your life by turning down the volume on the stereo, TV, or car radio, and especially on personal listening devices with earphones or ear buds.

• Don't wait to protect yourself.

  After noise-related damage to the ear is done, it cannot be reversed. But if you already have some noise-related hearing loss, it is not too late to prevent further damage and preserve the hearing that you still have.

Preventing hearing loss not caused by noise

Being exposed to loud noise over and over is one of the most common causes of permanent hearing loss. But there are other causes of hearing loss. Here are some steps you can take to lower your risk of other types of hearing loss.

• Don't put anything in your ear.

  Never stick a cotton swab, hairpin, or other object in your ear to try to remove earwax or to scratch your ear. The best way to prevent earwax problems is to leave earwax alone.

• Swallow and yawn during a plane landing.

  If you have an upper respiratory problem (such as a cold, the flu, or a sinus infection), take a decongestant a few hours before landing or use a decongestant spray just before landing.

• Stop smoking.

  You are more likely to have hearing loss if you smoke.

• Get immunizations.

  Receive all the recommended immunizations to protect against pneumococcal disease, meningitis, and other conditions that can cause hearing problems.

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Symptoms

Common symptoms of hearing loss include:

• Muffled hearing and a feeling that your ear is plugged.
• Trouble understanding what people are saying. This is most common when other people are talking or when there is background noise.
• Listening to the TV or radio at a higher volume than in the past.

Other symptoms may include:

• A ringing, roaring, hissing, or buzzing in the ear (tinnitus).
• Ear pain, itching, or irritation.
• Pus or fluid leaking from the ear.
• A feeling that you or your surroundings are spinning (vertigo).

People who have hearing loss are sometimes not aware of it. Often, family members or friends are the first to notice the hearing loss.

Social situations can be tiring and stressful for people who don't hear well. They may start to avoid those situations as their hearing loss gets worse. Many adults become depressed because of how hearing loss affects their relationships and social life.

What Happens

Hearing loss can happen slowly or suddenly. It's often a natural result of aging. Long exposure to loud noise can make it worse. If hearing loss is caused by something that can be treated, hearing will sometimes come back. But most hearing loss is permanent. Hearing aids and other devices can help.

Types of hearing loss

Hearing loss can be temporary or permanent.

• In conductive hearing loss, sound is blocked before it reaches the inner ear. This type of hearing loss may be temporary or reversible. For example, a buildup of wax in the ear or an ear infection can cause hearing loss that goes away with treatment.
• In sensorineural hearing loss, sound reaches the inner ear. But a problem in the inner ear or in the nerves that allow you to hear prevents proper hearing. This type of hearing loss is usually permanent. Hearing loss caused by exposure to loud noise over time is an example of this type of hearing loss. Another example is age-related hearing loss.
• In mixed hearing loss, you have both sensorineural and conductive hearing loss.

Hearing loss can range from slight to moderate to profound.

When to Call a Doctor

Call 911 or other emergency services immediately if:

• Hearing loss occurs with an injury to the head or ear.
• Hearing loss occurs suddenly with other symptoms such as:
  • Facial droop.
  • Numbness or paralysis on all or one side of the face or body.
  • Eye or vision problems, including blurred or double vision or only being able to see out of one eye.
  • Slurred speech, not being able to speak, or trouble understanding speech.
  • Difficulty standing or walking (ataxia).
  • Severe nausea or vomiting.

Call a doctor now if you:

• Develop sudden, severe hearing loss.

Call your doctor if you:

• Have hearing loss that you think may be caused by earwax.
• Have hearing loss after taking medicine.
• Have hearing loss after having cold or flu symptoms.
• Have hearing loss after traveling on an airplane.
• Feel your hearing is gradually getting worse.
• Wonder if you need hearing aids.
• Think your baby or child may not be hearing well.

Watchful waiting

Watchful waiting is a wait-and-see approach. Although hearing loss usually isn't dangerous, it can affect your personal safety. It can also reduce how much you can do in the workplace and at home and limit you socially. It's important that you talk to your doctor about hearing loss.

Exams and Tests

To diagnose hearing loss, your doctor will do a physical exam and ask about your symptoms and past health. Your doctor also may look in your ears with a lighted device called an otoscope.

If your doctor thinks that you have hearing loss, you'll have hearing tests to check whether you have hearing loss and find out how severe it is. You may be referred to an audiologist for the tests. These tests may include:

• Tuning fork tests.
• Pure tone audiometry.
• Speech reception and word recognition tests.
• Otoacoustic emissions test.
• Auditory brain stem response test.
• Tympanometry.
• Other tests to find out what kind of hearing loss you have, or which part of your ear is affected.

You may be referred to an ear, nose, and throat specialist for other tests or treatments.

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Treatment Overview

Treatment depends on the type and cause of the hearing loss. Your doctor can help you choose the best treatment.

Permanent hearing loss.

Proper treatment is important. Hearing loss may lead to loneliness, depression, and loss of independence. Treatment can make communication, social interaction, and daily activities easier and more enjoyable.

• Treatment can't bring back your hearing. But hearing devices, such as hearing aids, can help you hear and communicate better. Other devices can help alert you to sounds around the house, like the phone or doorbell.
• Cochlear implants may be an option.
• You can learn ways to live with reduced hearing, such as paying attention to people's gestures, facial expressions, posture, and tone of voice.

Reversible hearing loss.

Reversible hearing loss can often be treated successfully. Treatment depends on its cause. For example, removing earwax or taking medicine for an infection may help your hearing come back.

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Self-Care

• Avoid loud noises whenever possible. This helps keep your hearing from getting worse.
• Always wear hearing protection around loud noises.
• Wear a hearing aid as directed.
  • A professional can help you pick a hearing aid that will work best for you.
  • You can also get hearing aids over the counter for mild to moderate hearing loss.
• Have hearing tests as your doctor suggests. They can show whether your hearing has changed. Your hearing aid may need to be adjusted.
• Use other devices as needed. These may include:
  • Telephone amplifiers and hearing aids that can connect to a television, stereo, radio, or microphone.
  • Devices that use lights or vibrations. These alert you to the doorbell, a ringing telephone, or a baby monitor.
  • Television closed-captioning. This shows the words at the bottom of the screen. Most new TVs can do this.
  • TTY (text telephone). This lets you type messages back and forth on the telephone instead of talking or listening. These devices are also called TDD. When messages are typed on the keyboard, they are sent over the phone line to a receiving TTY. The message is shown on a monitor.
• Use text messaging, social media, and email if it is hard for you to communicate by telephone.
• Try to learn a listening technique called speechreading. It is not lipreading. You pay attention to people's gestures, expressions, posture, and tone of voice. These clues can help you understand what a person is saying. Face the person you are talking to, and have them face you. Make sure the lighting is good. You need to see the other person's face clearly.
• Think about counseling if you need help to adjust to your hearing loss.

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Hearing Devices

If you have hearing loss, you may find that it takes extra effort and energy to talk with others. Hearing may be especially difficult in settings where there are many people talking or there is a lot of background noise. The increased effort it takes to be with other people may cause stress and fatigue. You may begin to avoid social activities, feel less independent, and worry about your safety.

Hearing devices you may want to use include:

Hearing aids.

Hearing aids make all sounds louder (amplify), including your own voice. Common background noises, such as rustling newspapers, magazines, and office papers, may be distracting. When you first get hearing aids, it may take you several weeks to months to get used to this. Most hearing aids can be adjusted to fit your hearing loss and reduce background noise.

Assistive listening devices.

These devices make certain sounds easier to hear by bringing the sound directly to your ear. They shorten the distance between you and the source of sound and also reduce background noise. You can use different types of devices for different situations, such as one-on-one conversations and classroom settings or auditoriums, theaters, or other large public spaces. Commonly used listening devices include telephone amplifiers, personal listening systems (such as auditory trainers and personal FM systems), and hearing aids that you can connect directly to a television, stereo, radio, or microphone.

Alerting devices.

These devices alert you to a particular sound (such as the doorbell, a ringing telephone, or a baby monitor) by using louder sounds, lights, or vibrations to get your attention.

Closed-captioning.

Closed-captioning shows the words at the bottom of the screen while you're watching TV or your computer screen. Most newer TVs and online programs have a closed-captions option.

Text messaging.

You can type messages and send them from your mobile device to someone else's. You can also use voice-to-text if you have trouble typing.

TTY (text telephone).

A TTY (also called TDD, or telecommunication device for the deaf) allows you to type messages back and forth on the telephone instead of talking or listening. When messages are typed on the TTY keyboard, the information is sent over the phone line to a receiving TTY and shown on a monitor. A telecommunications relay service (TRS) makes it possible to call from a phone to a TTY or vice versa.

Many other communication devices, such as pagers, fax machines, email, and custom calling features offered by phone companies, can be helpful. To get more information about selecting and using listening, alerting, and telecommunicating devices, talk to an audiologist.

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Giving Support

It's easy for a person with hearing loss to feel cut off from conversations and social interactions. But you can take steps to help keep this from happening.

• Make sure the person knows that you are speaking to them.

  It can help to use the person's name.

• Speak to the person at a distance of 3 ft (1 m) to 6 ft (2 m).

  Make sure that the person can see your face, mouth, and gestures. Arrange furniture and lighting so that everyone in the conversation is visible.

• Don't speak directly into the person's ear.

  Your facial expressions and gestures can provide helpful clues about what you are saying.

• Speak slightly louder than normal.

  It's best to speak slowly and clearly. But don't shout.

• Don't repeat the same word over and over again.

  If a certain word or phrase isn't understood, find another way to say it.

• Tell the person when the topic of conversation changes.
• Cut down on background noise.
  • Turn off the TV or radio during conversations.
  • Ask for quiet sections in restaurants.
  • Try to sit away from the door at theaters.
• Include the person in group conversations.

  Don't talk about the person as though the person isn't there.