Five things that you need to know about hearing loss

Hearing impairment, deafness or hearing loss is a total or partial inability to hear sounds. It is estimated that about 11 million people in the UK have some type of hearing loss. This makes hearing loss the second most common disability in the UK.  Mr Ananth Vijendren, Consultant Ear, Nose and Throat Surgeon at Highgate Hospital sees patients with all kinds of hearing loss.

Although hearing loss is common, it is a hidden condition and often misunderstood by others. People living with hearing loss can feel ignored or forgotten in society.

In this article, I briefly discuss:

• the different types of hearing loss
• the impact of living with a hearing impairment
• possible future ways of preventing and reversing hearing loss

1. Hearing loss can happen at any age.

About 1 in 1,000 children are born with hearing loss. This is called congenital hearing loss. It can be caused by complications before, during or after childbirth, but sometimes has no obvious cause.

Hearing loss in babies is usually discovered during the newborn hearing screening test. This screening test is offered to all babies soon after birth. Cases of suspected hearing loss are referred to a specialist clinic, which investigates the cause and helps to plan treatment.

During adolescence and adulthood, hearing can be affected by:

• an injury to the head or ear
• medications, such as aminoglycoside antibiotics (a group of antibiotics used to treat serious bacterial infections) and platinum-based chemotherapy (anti-cancer drugs that contain the metal platinum)
• brain infections
• chronic middle ear diseases, such as
• Eustachian tube dysfunction (when the small tube that connects the middle ear to your throat is not working properly)
• cholesteatoma (abnormal, non-cancerous skin growth behind the eardrum)
• otosclerosis (abnormal bone growth and thickening inside the ear)

During the later stages of life, the cells and nerves in the cochlea (the inner ear hearing organ) gradually stop working so well. This can result in age-related hearing loss called presbyacusis. It is a type of sensorineural hearing loss caused by damage to the inner ear or auditory (hearing) nerve. High-pitched (high frequency) sounds are usually affected the most.

Other health conditions and genetic or environmental factors can sometimes contribute to age-related hearing loss. Examples of environmental factors are repeated exposure to loud noise or recurring ear infections.

2. There are three main types of hearing loss.

The main types of hearing loss are:

• Conductive hearing loss: This is when the sound does not reach the inner ear due to problems in the outer and middle ear. Common causes include infections, a build-up of ear wax, eardrum perforation and chronic middle ear disease (for example, cholesteatoma).
• Sensorineural hearing loss: This is when there is damage to the structures of the inner ear, such as the cochlea, balance organs, hearing nerves or hearing pathway to the brain. The most common cause is ageing. There can also be hereditary (inherited) and other causes, such as an injury or the side effects of some medications. Most cases of sensorineural hearing loss happen slowly over time. A sudden case is a medical emergency. You need to see an ear, nose and throat (ENT) doctor as soon as possible. They can diagnose the problem, start your treatment and help to reverse the condition.
• Mixed hearing loss: This is a combination of conductive hearing loss and sensorineural hearing loss. It occurs as a result of conditions that affect the outer, middle and inner ear. Mixed hearing loss normally has more than one cause.

3. Untreated hearing loss can affect your quality of life.

Living with hearing loss can be debilitating. Many people find it isolating when they cannot hear conversations in a group situation. This makes them feel embarrassed and they may become withdrawn.

People with hearing loss find it harder to hear if there are background sounds. This has implications when working in a noisy environment, such as a factory or building site. Even household conversations can be affected. The speaker or listener may become irritated due to the communication barrier and this may result in domestic arguments.

A variety of hearing aids are available, but many people still associate them with older devices. They fear that a hearing aid will look big, bulky and unsightly.

In addition to the social impact, living with untreated hearing loss can damage your health. Experts from John Hopkins Medicine in the United States tracked 639 adults for nearly 12 years. They found that:

• mild hearing loss doubled the risk of dementia
• moderate hearing loss increased the risk of dementia by three times
• severe hearing loss increased the risk of dementia by five times

4. The treatment for hearing loss depends on the type, cause and severity of the condition.

If you have mild to moderate hearing loss or presbyacusis (age-related hearing loss), you can get good benefits from wearing a hearing aid. Many modern hearing aids are small and cosmetically hidden, and can connect to smartphone or tablet devices. In some cases, surgical treatment could be a better option. This may involve:

• grommets (small tubes that are inserted into the eardrum to allow air to enter the middle ear)
• eardrum repair
• removal of disease from the middle ear
• reconstruction of the hearing bones (an ossiculoplasty or stapedotomy procedure)

If you struggle with your hearing in spite of a hearing aid or previous surgery, you may need an implantable hearing device. This is specially fitted during an operation. Examples of hearing implants are:

• a bone conduction hearing implant (this sends sound vibrations directly to the inner ear through the skull bone)
• an activated middle ear implant (a small device that directly stimulates the bones of the middle ear)
• a cochlear implant (a small electronic device that stimulates the hearing nerve)

5. There are exciting potential future developments in treating hearing loss.

Treatments for sensorineural and mixed hearing loss have always focused on managing the symptoms of these conditions. Future treatments are likely to target the causes of hearing loss.

Various studies are taking place that aim to prevent or reverse hearing loss. Researchers from Israel and the United States are exploring whether defective parts of the cochlea can be reversed and regrown with gene therapy.

In the UK, there is currently a trial called REGAIN. This project aims to develop and test a new drug for treating hearing loss caused by damaged sensory hair cells in the inner ear.

Another UK trial is called the SeaSHeL national prospective cohort study. This is investigating the most likely cause of sudden sensorineural hearing loss and the most successful treatment.

About Mr Vijendren

At Highgate Hospital, Mr Vijendren is happy to see anyone who has concerns about their hearing. During your appointment, Mr Vijendren spends time talking to you about your worries and asks you about your symptoms and medical history.

Mr Vijendren examines you to help identify the type and cause of your hearing loss. He arranges for you to have a hearing test and any other diagnostic tests. By looking at your audiogram (a graph showing your hearing test results) and any scans, Mr Vijendren can recommend the best treatment option.

You can find out more about Mr Vijendren here.