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Hearing loss, hearing aids and tinnitus

Hearing loss is part of the normal ageing process. It begins as early as your 40s but usually happens very gradually, affecting both ears.

Approximately 42% of individuals over the age of 50 and 71% over age 70 have some degree of hearing impairment. However, only one third of people in the UK who could benefit from hearing aids wear them. 

How does the ear work?

The ear is divided into 3 parts:

Outer ear: the visible external part or “pinna” and the ear canal.  The outer ear funnels sounds towards the ear drum or “tympanic membrane”, causing it to vibrate.

Middle ear: an air-filled cavity behind the ear drum, containing a chain of 3 small bones called the ossicles which pass sound vibrations along to the inner ear. 

Inner ear: the cochlea, an organ shaped a bit like a snail-shell, filled with fluid and special hair cells. Sound vibrations stimulate the hair cells which send messages along the hearing or auditory nerve to the brain where they are interpreted as sounds. Another part of the inner ear is the vestibular apparatus. Movement of fluid inside this part sends messages to the brain about changes in position of the head, and so is important in balance. 

Types of hearing loss

There are 2 main types of hearing loss, although it is possible to have both. 

Conductive hearing loss; failure of conduction of sound waves to the cochlea. There are many causes including ear wax, diseases of the ear drum or ossicles or fluid in the middle ear cavity (“glue ear”). Sometimes the hearing loss is temporary. 

Sensorineural or “nerve” deafness due to faulty signalling from the cochlea. This latter type is what happens in age-related hearing loss, although there are other causes too such as genetic factors, noise-induced deafness and certain drugs. Age-related hearing loss is caused by wear and tear of the hair cells and is permanent but hearing aids can be a huge help. 

Do I need to see a doctor?

Gradual hearing loss is not usually of concern but some symptoms can suggest an underlying medical problem.

Sudden hearing loss occurring over less than 72 hours , in one or both ears,  should prompt an urgent medical opinion. 

Other signs for which you should seek medical advice include:

  • rapidly increasing hearing loss
  • persistent hearing loss or tinnitus in ONE ear only (see section on tinnitus)
  • hearing loss associated with other symptoms such as vertigo (dizziness or a spinning sensation), ear pain or discharge, altered sensations in the face or drooping of the face.

Age related hearing loss (presbycusis)

In presbycusis, the higher frequency sounds are the first to be lost, so it may be harder to hear women’s or children’s voices, bird song and the beeps of alarms and devices, for example. Consonant sounds such as “s”, “f” and “h” are higher-pitched and this means that it becomes hard to make out speech clearly, particularly in a noisy background. This is often one of the first signs. You might also notice that the person with hearing loss asks you to repeat things or turns up the TV quite loud.

Loss of hearing, if not treated, can be socially-isolating, leading to increased feelings of loneliness, frustration and sometimes depression. There is even some evidence linking hearing loss with a higher risk of dementia, from 2x the risk for mild hearing loss up to 5x the risk of dementia with severe hearing loss. It also appears that correcting hearing loss may slow cognitive decline, although research into this area is still ongoing.

The good news is that help is readily available and the earlier you get hearing aids, the more you will benefit from them.

If you are concerned about hearing loss, you can see your GP. They will ask you some questions and examine your ears. If there is an obvious cause like ear wax or an infection, they will treat this. If they think it is an age-related problem, they can refer you to an audiologist (a hearing healthcare professional) for a free NHS hearing test. The audiologist may be based in a local hospital or sometimes a high street chain. Either way, the assessment will be free. It may take a few weeks to see an NHS audiologist. Very occasionally, if they think you have a different kind of problem, they might refer you to be seen by an Ear, Nose & Throat consultant for an opinion.

Alternatively, you could book a hearing test directly with a private company (eg many high street opticians offer this service, along with independent hearing clinics). You will usually be offered an appointment quickly and won’t have to pay. If a private hearing test shows that you need a hearing aid, you can buy a private hearing aid or ask your GP to refer you for an NHS one.

You can read more about what happens during a hearing test here.

The information in the link also gives you information on a simple hearing screening test provided by the charity, “RNID” which can be taken over the telephone. This is not a replacement for a full test but can give you some basic information.

A hearing aid consist of a microphone which picks up sound and converts it into an electrical signal. This is then amplified and converted back into louder and clearer sounds. It is battery-operated and you put it in or behind your ear. It won’t make your hearing perfect, but it will make it much easier to carry on a conversation, to hear everyday sounds such as the telephone and can reduce some background noise too. If you have hearing loss in both ears, you’ll benefit more from wearing two hearing aids.

There are many different types and sizes available and your audiologist will advise you of what your options are. The suitability of hearing aids depends on factors such as how severe the hearing loss is, the size of your ear canal and how much (if anything) you want to pay. The NHS provides the most common “behind-the-ear” or BTE type. This is a small plastic device which sits behind the ear and connects by a piece of plastic tubing to a custom-made ear-mould or a soft earpiece. There are several other types of smaller and less visible hearing aids which sit within the ear if you opt to buy them privately but these are more expensive, can be fiddly to use and some may not be suitable for more severe hearing loss.

You can read about the different types of hearing aid here.

NHS hearing aids are provided free of charge as a long-term loan. Aftercare, batteries and repairs are also free, as is a new aid when it wears out. However, if you lose or break one, you will have to pay for a replacement. After your hearing test, you may have to wait 2 or 3 months to have them fitted and you will have a limited choice of the style of hearing aid.

Private hearing aids are usually available much quicker, within a couple of weeks, and you’ll have a much bigger choice of styles including the smaller, less visible models. A single hearing aid can cost anywhere between £500 to £3,500 although there’s usually a discount if you buy a pair. You’ll have to sign a contract and, when the guarantee runs out, you’ll have to pay for repairs. You’ll also have to buy replacement batteries and pay for a new hearing aid when it wears out.

Hearing aids last, on average, about 5 years.

It can take some time to adjust to using hearing aids and background noises may seem louder to begin with.

At your fitting appointment, the audiologist will check the fit of the earmould and adjust the sound level and quality to suit you. They will also show you how to turn them on and off, put them in and take them out, change the batteries, adjust the volume or use any different setting they might have, and how to clean and look after them. They will also tell you where to get new batteries from and how to make any follow up appointments.

A good tip is to turn the hearing aid off at the end of the day ( to save the batteries), give the earmould a quick wipe with a tissue or wet wipe to clear any wax and store it in its box. When you turn it on each morning, it should whistle when you cup it in your hands; this is due to normal “feedback”. If it doesn’t whistle, check the ear mould isn’t blocked with wax and, if necessary, change the battery.

Take note – if the hearing aid whistles when it is IN the ear, this has various causes including a build-up of ear wax, an earmould which is not fitting/inserted properly, worn or kinked tubing, volume setting too high or not on the correct setting. See troubleshooting information below.

The ear mould and soft part of the tubing should be regularly disconnected from the hearing aid and cleaned in warm soapy water but ask your audiologist how to do this as you mustn’t get the hearing aid itself wet.

The battery will need replacing every week or two; many hearing aids give a low-warning beep.

The tubing will need replacing every 4-6 months, or if you notice it has become hard or splits. You may be able to do this for your relative or get help from your audiology clinic.

If you have NHS hearing aids, you can get free batteries and repairs from your NHS Hearing Aid service. If you are unsure where this is based, ask at your GP surgery.

RNID also partners with NHS audiology clinics to support patient with hearing aids. Their website provides information on where to find local help along with videos on troubleshooting problems and how to adjust, clean and repair your hearing aid. Follow the links at the bottom of this RNID page.

For queries about private hearing aids, contact the manufacturer or supplier.

Sometimes hearing aids alone aren’t quite enough and there is a range of additional equipment which can help in particular situations such as using the telephone, watching TV, attending a medical appointment or hearing a doorbell. Some of these work with your hearing aid and others are separate.

Typical examples include:

Using the hearing loop setting on your hearing aid (if available). This is a special setting which reduces background noise and helps you to hear conversation more clearly. Look for the “T” sign in places such as banks, hospitals, shops, theatres and churches. See more at the hearing link website.

Alerting systems for doorbells, phones, alarm clocks, smoke alarms etc. These often involve additional flashing lights or vibrations and can be portable or body-worn devices.

Bluetooth and streaming systems which can be worn on a neck-loop and connect devices such as phones, TVs, lap-tops directly to the hearing aid.

Relay UK – this is a free speech-to text service for using the telephone, either via a smartphone/tablet app or a special textphone.

For more information on assistive listening devices, see action on hearing loss.

Tinnitus

Tinnitus is the name given to noises in the ear, often a ringing, buzzing, whooshing or hissing sound, which isn’t coming from an outside source.

Currently there are 7.1 million adults living with tinnitus in the UK and this is expected to rise to 7.7 million by 2028 due to an increasing and ageing population.

It is a common condition and it’s not completely clear why it happens. It isn’t usually serious, may come and go and often occurs alongside age-related hearing loss. Two thirds of people with tinnitus have hearing loss too.

Occasionally it is caused by simple wax build-up, loud noise exposure, ear infections and other disorders of the ears or nervous system. It can also sometimes be associated with medication and other medical conditions such as high blood pressure, diabetes or thyroid problems. It tends to be worse if you are anxious or stressed.

The main thing to remember is that the outlook is usually good; over time you get used to the sounds and they become less noticeable. Treatments are available and correcting any hearing loss also helps.

You should see your GP if your tinnitus is very frequent or constant, if it is getting worse or if it is bothering you.
Ask for an urgent appointment if you also suddenly lose your hearing, experience vertigo ( a spinning sensation), notice facial muscle weakness, have ear pain or discharge, if the tinnitus beats in time with your pulse, if it is in one ear only or if you have had a recent head injury.

No one treatment works for everyone but current options include

– Correcting any hearing loss. If you are straining to hear, it will make your perception of the sounds worse.

– Self-help: Techniques that some people find helpful include relaxation therapies such as deep breathing or yoga, listening to music, hobbies and activities which distract you, sharing your experiences with a support group.

– Sound therapy. Tinnitus is most noticeable in quiet backgrounds and sound therapy uses neutral sounds to distract you. At it’s simplest, this could be having a radio playing quietly in the background or opening a window. There are also small portable sound generators which produce either “white noise” or quiet natural sounds like lapping waves. Sound generators can also be built into a hearing aid, an ear piece or even a pillow, to help with tinnitus when you go to sleep.

– Cognitive behavioural Therapy (CBT). Changing the way that you think about tinnitus and how you react to it can help you to feel differently about it and manage it better. This is the basis of CBT, which is successfully used to treat a number of conditions including anxiety and depression. Counselling is another type of talking therapy which is also sometimes used. It is important to realise that the tinnitus is not usually caused by anxiety or depression but that these conditions can sometimes be a result of the tinnitus and will also make it worse. These treatments are effective for tinnitus even when no anxiety or depression is present.

– Tinnitus Retraining Therapy (TRT). This is a special type of therapy involving sound therapy combined with counselling which aims to retrain your brain into not noticing the tinnitus. It is available privately and sometimes on the NHS for severe cases. It can take 1-2 years for a full course of treatment

For more information

Contact the Tinnitus helpline provided by Action on Hearing Loss. Phone (freephone) 0808 808 6666 or email : [email protected]

Find out about Local Tinnitus Support Groups using this link.

For general information about tinnitus including treatments, see the British Tinnitus Association website.

What our carents say

Sometimes I had to write things down just to make sure she understood properly

I kept reminding dad to put his hearing aids in - it was frustrating but worth it because they made a big difference

It would be much easier if you could get the replacement NHS batteries at GP surgeries or local chemists

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Created November 2020

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