Hearing loss and hearing tests
When you miss words in conversation or struggle to follow in noisy places, the question is not how much you hear, but where the sound stops. If sound is blocked in the outer or middle ear, the cause can often be corrected. If the problem lies in the inner ear, the treatment is different and, in some cases, urgent. A hearing test (audiogram) and tympanometry tell the two apart in the same visit.
What is hearing loss?
Hearing loss is any reduction in your ability to hear, from the feeling that your ears are blocked to a complete loss of hearing. It rarely comes on suddenly. Usually it develops so gradually that the people around you notice it first, from the volume of the TV or from how often you ask them to repeat something.
There are 2 kinds, and the difference between them is what matters.
Conductive hearing loss means that sound is blocked somewhere in the ear canal or the middle ear before it reaches the inner ear. This is the form that can often be reversed.
Sensorineural hearing loss (inner ear hearing loss) means that the problem lies in the cochlea or the hearing nerve, and here the treatment is different. There is also a mixed form, with features of both.
What can cause hearing loss?
When it is conductive
- Earwax, a plug of wax blocking the ear canal
- Fluid behind the eardrum, often after a cold or because the Eustachian tube is not working properly
- A hole in the eardrum (perforation) or long-standing inflammation of the middle ear
- Otosclerosis, where one of the tiny bones of the middle ear loses its ability to move
When it is sensorineural
- Age-related hearing loss, the gradual loss that comes with age and starts with the high frequencies
- Noise exposure, at work or from headphones and concerts
- Medicines that can damage hearing (ototoxic drugs) and certain conditions that affect the inner ear
- Sudden hearing loss, which develops within hours and is an emergency
When should you get it checked?
If you recognize any of the following, a hearing check gives you an answer in a single visit.
- You often ask people to repeat themselves, or they tell you the TV is too loud
- You struggle in a group or in a noisy place, even though you hear well one to one
- One ear feels blocked, with or without ringing in the ears
- You have worked for years in a noisy environment
- You notice a difference between your 2 ears
One exception cannot wait. Sudden hearing loss in one ear, within hours or overnight, needs a hearing test within 14 days and treatment ideally within the first 2 weeks, because after that the chances of recovery fall.
What happens at the appointment?
First comes your history and an ear examination (otoscopy), meaning a look at the ear canal and the eardrum. Some cases are solved right here: if the cause is earwax, it is removed and your hearing returns in the same visit.
Hearing test (audiogram)
You listen to sounds at different pitches and volumes and indicate when you hear them. The result is a chart that shows your hearing threshold at each frequency, for each ear separately. It shows how much hearing has been lost, exactly where, and whether the loss is conductive or sensorineural.
Tympanogram
This measures how the eardrum moves when the pressure in the ear canal changes. It shows whether there is fluid in the middle ear, whether the Eustachian tube is working and whether the eardrum has a hole. It takes seconds and requires nothing from you.
Together, the 2 tests answer the question of where the sound stops, and the treatment follows from there.
Why is it not worth putting off?
Hearing loss is put off more than any other symptom, because it does not hurt and because it develops slowly. The average patient waits years before having it checked.
There is, however, one reason that has changed the picture. The Lancet Commission on dementia prevention ranks untreated hearing loss among the most important modifiable risk factors, attributing about 7% of dementia cases worldwide to it. This is an estimate at population level, not a prediction for any individual, but it is enough reason to stop treating hearing as a matter of comfort.
In practical terms, the argument is simpler. The harder it is for you to hear, the less you take part in social gatherings and conversations, and it is this withdrawal that takes its toll.
Treatment
Non-surgical treatment
- Removing earwax, when it is the cause
- Treating fluid in the middle ear and Eustachian tube problems
- Hearing aids, when the loss is sensorineural and permanent. The doctor decides whether they are needed, and a hearing aid specialist fits them based on your audiogram
- Protection from noise, the only cause you can fully control
Surgery
Surgery is mainly for conductive hearing loss, when there is a structural cause that can be corrected: repairing a hole in the eardrum, treating long-standing inflammation of the middle ear, or an operation for otosclerosis. The decision is made after a full assessment and, where needed, imaging.
Frequently asked questions
Often yes, but a reversible one. Earwax, fluid behind the eardrum or a Eustachian tube problem cause exactly this feeling, and all of them can be treated.
This is the typical sign of sensorineural hearing loss, where the high frequencies that carry the consonants are lost first. You hear the voice, but not the words, especially in noise.
No. Noise exposure, certain medicines, family history and middle ear conditions can produce the same picture, and several of them can be treated.
The doctor makes the diagnosis and decides whether a hearing aid is appropriate. A hearing aid specialist then fits and adjusts it, based on your audiogram.
A few minutes. The audiogram and tympanometry are painless, need no preparation and are done in the same visit.
Not exactly. In children, hearing is tested with different methods depending on age, and it is closely linked to speech development.
When should you not wait?
Urgent
Sudden hearing loss in one ear
Hearing test within 14 days, treatment ideally within the first 2 weeks.
Soon
A difference between your 2 ears
Hearing loss on one side, especially with ringing in the ear, needs investigating rather than waiting.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγές: Chandrasekhar SS et al., Clinical Practice Guideline: Sudden Hearing Loss (Update), AAO-HNSF, 2019 · Livingston G et al., Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, Lancet, 2024.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
