Hearing loss: Causes, diagnosis and treatment

Hearing loss can dramatically impact daily life, making it difficult to carry on conversations and enjoy activities that you once did.

If you or a loved one is experiencing symptoms of hearing loss, you likely have questions regarding the causes and potential treatments for the problem. Read on to learn more about hearing loss causes, diagnosis and treatment.

Hearing loss can occur when part of the auditory or hearing system doesn't work well. It can stem from a problem with the outer, middle or inner ear, auditory nerve (the nerve that sends information from the ear to the brain) or auditory system (the pathway that processes sound as it travels from the ear to the brain).

• Sensorineural hearing loss occurs either when the inner ear has been damaged or the nerves that connect the inner ear to the brain are not functioning properly. This is the type most often associated with age-related hearing loss, known as presbycusis. Sensorineural loss can also be a result of exposure to loud noise, injury, disease, certain drugs or an inherited condition. This form of hearing loss is permanent.
• Conductive hearing loss occurs when sound does not properly travel through the outer or middle ear, making it difficult to hear soft sounds and causing loud sounds to seem muffled. Common causes of conductive loss include earwax buildup, a foreign object in the ear canal, fluid in the middle ear space, ear infection, structural problem with parts of the ear or a head injury. This type of hearing loss can usually be treated medically or surgically.
• Mixed hearing loss is a combination of conductive and sensorineural hearing loss.

You can also experience temporary noise-induced hearing loss after you have been exposed to a loud noise, such as an explosion, a gunshot or music from a concert. The hearing loss is sudden and may be accompanied by tinnitus (ringing or buzzing in the ears). Note that repeated exposure to loud noise can result in permanent sensorineural hearing loss.

Healthcare providers may use a number of terms to describe hearing loss, including:

• Unilateral or bilateral. Unilateral hearing loss refers to hearing loss in one ear. Bilateral hearing loss affects both ears.
• Symmetrical and asymmetrical. With symmetrical hearing loss, the degree of impairment is the same in both ears. Asymmetrical hearing loss is marked by different degrees of impairment in each ear.
• Progressive and sudden. Progressive hearing loss develops over time, while sudden hearing loss occurs quickly.
• Fluctuating and stable. Fluctuating hearing loss improves or worsens over time. People with stable hearing loss experience the same level of impairment over time.

Hearing loss is typically diagnosed through a series of hearing tests. First, healthcare providers may do a physical exam, checking your ears for causes of hearing loss, such as an infection or earwax. Next, they may administer a general hearing test, asking you to cover one ear and then respond to sounds of different volumes. Tuning fork hearing tests can also help providers determine the location of hearing loss. If hearing loss is suspected, your general practitioner may refer you to an audiologist (a healthcare provider who evaluates, diagnoses and treats hearing loss and related problems) who can perform more advanced hearing tests with a hearing tester called an audiometer. During this test, you'll wear earphones to listen for sounds in one ear at a time. You'll then let the audiologist know when you hear sounds.

Your treatment will depend on the cause and severity of your hearing loss. Conductive hearing loss can often be corrected using either medication or surgery. Antibiotics or antifungal medications may help clear up hearing loss caused by chronic ear infections or fluid buildup in the middle ear. Surgical reconstruction may restore hearing in an ear that has been damaged by trauma or a tumor. When an accumulation of earwax or a foreign object in the ear is blocking sound, treatment may be as simple as removing the obstruction.

Sensorineural hearing loss may be managed with a device called a hearing aid. Hearing aids are devices that amplify sounds to make them louder and easier for you to hear. The devices may be worn behind the ear, on the outside of the ear or in the ear canal.

People with severe sensorineural hearing loss, who struggle to hear and understand despite appropriately fit hearing aids, may benefit from cochlear implants. These are small devices surgically implanted in the inner ear. Unlike a hearing aid, a cochlear implant doesn't amplify sound. Rather, it allows sounds to bypass damaged parts of the ear and directly stimulate the auditory nerve. With a cochlear implant, sound is captured by a microphone and then filtered by a speech processor. Then, a transmitter converts the sounds into electrical impulses that cause an electrode array to stimulate auditory nerves. This does not restore hearing, but it can help individuals with severe hearing loss better understand speech and interpret environmental sounds.

While it may not be possible to completely prevent hearing loss, you can take steps to protect your hearing.

• Wear earplugs or protective earmuffs when working with machinery or heavy equipment, attending concerts or sporting events, and being around firearms or firecrackers.
• Listen to music at a low volume, especially when wearing earphones or headphones. Consider using headphones that filter out background noise so you can hear better at lower volumes.
• Avoid inserting cotton swabs and other items into your ear. If you have wax buildup, talk to your doctor about safe earwax removal solutions.
• Let your healthcare provider know if you notice any change in your hearing. If you're exposed to loud noises regularly, consider having your hearing tested before you experience hearing loss.

Clinically reviewed and updated September 2021.