People with hearing loss rarely notice it themselves. They notice that others mumble, that restaurants have become impossible, and that the television needs turning up. Family members usually recognise it years before the person does.
The average delay between onset and seeking help is around seven to ten years, and that delay has consequences beyond hearing.
The Two Main Types
Where the problem sits determines whether it can be corrected.
Conductive hearing loss occurs when sound cannot reach the inner ear. Causes include wax impaction, fluid in the middle ear, a perforated eardrum, and otosclerosis where a middle ear bone becomes fixed. Much of this is treatable medically or surgically.
Sensorineural hearing loss occurs when the inner ear hair cells or the hearing nerve are damaged. Causes include ageing, noise exposure, certain drugs, infections and genetic factors. This is usually permanent and managed with amplification rather than cure.
Mixed loss combines both, which is common in older adults.
The Signs You Might Miss
Hearing loss is gradual, so people compensate without realising.
- Difficulty following conversation in noisy places such as restaurants or gatherings
- Frequently asking people to repeat themselves
- Feeling that people mumble or do not speak clearly
- Turning the television up higher than others find comfortable
- Difficulty on the telephone
- Missing the doorbell or a phone ringing
- Difficulty with high pitched voices, particularly women and children
- Tinnitus, a ringing or buzzing in the ears
- Withdrawing from social situations because they have become effortful
Difficulty in background noise is typically the earliest symptom, appearing well before difficulty in quiet conversation.
Sudden Hearing Loss Is an Emergency
This deserves its own section because the window for treatment is short and it is frequently missed.
Sudden sensorineural hearing loss means a significant loss developing over hours to three days, usually in one ear, often noticed on waking. It may be accompanied by tinnitus or a sense of fullness.
It is commonly mistaken for wax or a blocked ear from a cold and left for weeks. By then treatment is far less effective.
Treatment with steroids started within the first two weeks, and ideally the first few days, gives the best chance of recovery. Any sudden hearing loss in one ear should be seen by our ENT department the same day.
The Hearing Tests
Assessment is painless and takes under an hour.
- Otoscopy: examining the ear canal and drum, which identifies wax and perforations
- Pure tone audiometry: the standard test, indicating loudness needed at different pitches, plotted on an audiogram
- Tympanometry: measures eardrum movement, detecting middle ear fluid
- Speech audiometry: assesses how well you understand words, which predicts hearing aid benefit
- Otoacoustic emissions and brainstem responses: used in newborns and where behavioural testing is not possible
Newborn hearing screening deserves mention. Congenital hearing loss identified in the first months, with intervention before six months, produces dramatically better speech and language outcomes than later detection.
The Link With Cognition and Isolation
Untreated hearing loss is now recognised as one of the largest modifiable risk factors for dementia, and this is not widely known.
Several mechanisms are proposed: the brain devotes more resources to decoding degraded sound and less to memory, reduced auditory input may accelerate brain changes, and social withdrawal removes the cognitive stimulation that conversation provides.
Depression and social isolation are also considerably more common in people with untreated hearing loss, particularly older adults who gradually stop attending gatherings because following conversation is exhausting.
This is the strongest argument for treating hearing loss rather than accepting it as part of ageing.
Wax: Common and Frequently Mishandled
Wax impaction is one of the most common and most easily treated causes of hearing loss.
Do not use cotton buds. They push wax deeper, and they cause ear canal injury and perforated eardrums. The ear is self cleaning under normal circumstances.
Do not use ear candling, which has no benefit and causes burns.
Softening drops for several days followed by professional irrigation or microsuction is the correct approach. Microsuction is preferred where there is a perforation or previous ear surgery.
Anyone who wears hearing aids or has a narrow canal may need periodic wax removal, which is routine rather than a problem.
Hearing Aids and Why People Resist Them
Uptake of hearing aids in India is low, and the reasons are largely about perception rather than function.
Modern devices are small, often barely visible, and digital processing has improved speech clarity in noise considerably compared with older analogue aids.
Realistic expectations matter. A hearing aid amplifies, it does not restore normal hearing. There is an adaptation period of several weeks during which everyday sounds seem intrusively loud, because the brain has forgotten them. Many people abandon aids during this period, which is a mistake.
Fitting both ears where both are affected gives better direction sense and speech understanding than one. Regular follow up adjustment in the first months is important.
For severe loss where hearing aids give inadequate benefit, cochlear implants are an option, and they are most effective when the loss has not been left untreated for many years.
Protecting the Hearing You Have
Noise induced hearing loss is entirely preventable and permanent once established.
- Use hearing protection for machinery, power tools and loud workplaces
- Follow the sixty rule for headphones: no more than sixty percent volume for no more than sixty minutes at a stretch
- Use noise cancelling headphones, which reduce the urge to raise volume in noisy places
- Move away from speakers at events, and take breaks from loud environments
- Be aware of firecracker exposure, which causes sudden permanent damage
- Ask about hearing effects when prescribed certain antibiotics or chemotherapy
- Control diabetes and blood pressure, both of which affect inner ear circulation
Ringing in the ears after a loud event is a sign that damage has occurred, even if hearing returns to normal. Repeated episodes accumulate.
If family members are commenting on your hearing, they are usually right. A hearing test is quick and painless, and treating loss early protects social life and cognition as well as hearing. Sudden loss in one ear needs same day attention.
Our ENT department at T. Nagar provides audiometry, wax removal and hearing assessment for all ages.
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