How hearing loss is treated depends on the underlying cause of the condition.
Hearing loss that occurs when sounds are unable to pass into the inner ear (conductive hearing loss) is often temporary and treatable.
For example, earwax build-up can be removed by drops, a syringe or suction. Hearing loss caused by a bacterial infection can be treated with antibiotics. Surgery can be used to drain a fluid build-up, repair a perforated eardrum, or correct problems with the hearing bones.
However, hearing loss caused by damage to the inner ear or to the nerves that transmit sound to brain (sensorineural hearing loss) is permanent.
If your hearing is impaired, treatment can improve your hearing and quality of life. Some of these treatments are discussed below.
If you have hearing problems, you may be able to wear a hearing aid. About 1.4 million people regularly use hearing aids in the UK, and many more would benefit from them.
A hearing aid is an electronic device that consists of a microphone, an amplifier, a loudspeaker and a battery. It increases the volume of sound entering your ear, so you can hear things more clearly.
The microphone picks up sound, which is made louder by the amplifier. Hearing aids are fitted with devices that can distinguish between background noise, such as traffic, and foreground noise, such as conversation.
Modern hearing aids are very small and discreet, and can often be worn inside your ear.
Hearing aids help improve hearing, but don't give you your hearing back. They're suitable for most people, but may be less effective for people with profound hearing impairment or certain conditions. Your GP or audiologist (hearing specialist) can advise you about whether a hearing aid is suitable for you.
If a hearing aid is recommended, an audiologist may take an impression of your ear so the hearing aid fits you perfectly or may show you an open fit hearing aid. The hearing aid will be adjusted to suit your level of hearing impairment. You'll also be shown how to use and care for it.
After your hearing aid has been fitted, you should have a follow-up appointment within 12 weeks.
If you experience problems using a hearing aid – such as distortion and repeated infections – that can't be corrected by an audiologist, you may benefit from different treatments. An ear, nose and throat (ENT) surgeon can discuss these with you. An ENT surgeon with a special interest in ear surgery is called an otologist.
NHS hearing aids
The NHS loans hearing aids to people with hearing loss free of charge. This includes free repairs, batteries and servicing. Many areas now charge for lost hearing aids, but you'll be told about any costs at your fitting appointment.
In the UK, both analogue and digital hearing aids are commonly used. Most hearing aids prescribed through the NHS are now digital.
Instead of having moving parts, digital hearing aids contain a very small computer that processes sounds. This enables the hearing aid to be programmed to suit different environments, such as a small, quiet room or a large, noisy workshop.
The type of digital hearing aids available through the NHS are usually the behind-the-ear (BTE) type (see below). Other types of hearing aid may be issued in cases where a medical condition prevents an individual from using BTE hearing aids. You can also choose to pay privately for another type of hearing aid if it's not available on the NHS.
Types of hearing aids
The different types of hearing aids are described below.
Behind-the-ear (BTE) hearing aids
BTE hearing aids usually have an earmould, which sits inside your ear. The rest of the hearing aid is connected to the earmould and lies behind your ear.
Some types of BTE hearing aids have two microphones that enable you to listen to sounds in the general vicinity or to focus on sounds that are coming from a specific direction. This can be particularly useful in noisy environments.
Open fit hearing aids may also be available, which are suitable for those with mild to moderate hearing loss. The tube sits in the ear, instead of an earmould.
Receiver in-the-ear (RITE) hearing aids
Receiver in-the ear (RITE) hearing aids are similar to BTE hearing aids, but the piece worn behind the ear is connected by a wire to a receiver (loudspeaker) located within the ear canal.
This means RITE hearing aids are usually less visible than BTE devices.
In-the-ear (ITE) hearing aids
In-the-ear (ITE) hearing aids are like an earmould. They fill the area just outside your ear canal and fill the opening of your ear canal.
The working parts of the hearing aid are inside the shell.
In-the-canal (ITC) hearing aids
In-the-canal (ITC) hearing aids fill the outer part of the ear canal and are just visible.
Completely in-the-canal (CIC) hearing aids
Completely in-the-canal (CIC) hearing aids are even smaller and less visible than ITE or ITC hearing aids.
However, they may not be recommended if you have severe hearing loss or frequent ear infections.
Body-worn (BW) hearing aids
Body-worn (BW) hearing aids have a small box containing the microphone. The box can be clipped to your clothes or you can put it inside a pocket. A lead connects the box to an earphone, which delivers sound to your ear.
This type of hearing aid is an option for people with poor dexterity, who require a high-powered hearing aid.
CROS hearing aids are recommended for people who only have hearing in one ear. They work by picking up sounds from the side that doesn't have hearing and transmitting them to the ear that's able to hear. The sound is sometimes transmitted through wires, although wireless models are available.
BiCROS hearing aids work in a similar way to CROS hearing aids, but they amplify the noise entering the ear that's able to hear. They're useful for people who don't have any hearing in one ear, with some hearing loss in the other ear.
Bone conduction hearing aids
Bone conduction hearing aids are recommended for people with conductive or mixed hearing loss who can't wear a more conventional type of hearing aid. Bone conduction hearing aids vibrate in response to the sounds going into the microphone.
They can also sometimes help people with no hearing in one ear and normal or mild hearing loss in the other ear.
The part of the hearing aid that vibrates is held against the bone behind the ear (mastoid) by a headband. The vibrations pass through the mastoid bone to the cochlea and are converted into sound in the usual way. They can be very effective, but can be uncomfortable to wear for long periods.
Bone Anchored Hearing Aids (BAHA)
A Bone Anchored Hearing Aid (BAHA) transmits sound directly to the cochlea by vibrating the mastoid bone. A minor operation is needed to fix a screw to the skull, on which the hearing aid can be clipped on and off. A BAHA is removed at night and when you swim or take a shower.
Unlike a bone conduction hearing aid, it's not uncomfortable to wear and is used for patients with conductive hearing loss, or in some patients who have no hearing in one of their ears.
Some people may benefit from newer types of implantable bone conduction hearing aids that are held onto the head with magnets instead of a connector through the skin. However, these are only available at some BAHA centres and may require a referral to a different BAHA centre.
Middle ear implants
These are surgically implanted devices that attach to the hearing bones and make them vibrate.
They're suitable for people who can't use a hearing aid, but have hearing loss at a level where a BAHA would not help.
Disposable hearing aids
Disposable hearing aids are sometimes recommended for people who have mild to moderate hearing loss.
The battery inside a disposable hearing aid usually lasts for about 12 weeks, after which time the hearing aid is thrown away and replaced. Disposable hearing aids tend to be expensive in the long term and are only available privately.
Cochlear implants are small hearing devices fitted under the skin behind your ear during surgery.
They have an external sound processor and internal parts, including a receiver coil, an electronics package and a long wire with electrodes on it (an electrode array).
The external processor takes in sound, analyses it and then converts it to signals that are transmitted across the skin to an internal receiver-stimulator, which sends the signals along the electrode array into a part of the inner ear called the cochlea. The signal is then sent to the brain along the hearing nerve as normal. This means cochlear implants are only suitable for people whose hearing nerves are functioning normally.
A cochlear implant is sometimes recommended for adults or children who have severe to profound sensorineural hearing loss in both ears, which isn't helped by hearing aids.
Both ears are usually implanted for children, whereas adults are usually only able to have one implant on the NHS.
Before a cochlear implant is recommended, you'll be assessed to find out whether it will help improve your hearing. During the assessment, any disabilities or communication problems you have will be taken into consideration, which may mean the usual hearing tests aren't suitable.
If a cochlear implant is recommended, it will be inserted into your ear (or both ears) during an operation and switched on a few weeks later.
There are currently around 11,000 people in the UK with cochlear implants and the number is increasing each year.
According to the Medicines & Healthcare products Regulatory Agency (MHRA), evidence suggests that patients with cochlear implants may be at an increased risk from pneumococcal meningitis, especially if they haven't been immunised against pneumococcal disease.
In August 2002, the Department of Health included cochlear implant patients in the population groups who should be immunised against pneumococcal infection.
Although the risk of contracting bacterial meningitis is low, it's slightly higher than for the general population.
Auditory brainstem implants
In some cases of severe to profound hearing loss, where there are problems with the nerve that transmits sound to the brain, an auditory brainstem implant (ABI) may be used.
An ABI is an electrical device made up of:
- electrodes implanted into the part of the brain responsible for processing sound (in the brainstem)
- a receiver device placed under the skin behind your ear
- a small sound processor outside your ear
When the microphone in the sound processor picks up sound, it turns it into an electrical signal and transmits this to the brain through the receiver and electrodes.
An ABI will not fully restore your hearing, but it can usually restore some degree of hearing and can make lip-reading easier. It's often used as a treatment for hearing loss associated with a condition called neurofibromatosis type 2 (NF2).
Lip reading and sign language
Hearing loss can sometimes affect your speech, as well as your ability to understand other people. Many people with significant hearing loss learn to communicate in other ways instead of, or as well as, spoken English.
For people who experience hearing loss after they've learnt to talk, lip-reading can be a very useful skill. Lip-reading is where you watch a person’s mouth movements while they're speaking, to understand what they're saying.
For people born with a hearing impairment, lip-reading is much more difficult. Those who are born with a hearing impairment often learn sign language, such as British Sign Language (BSL), which is a form of communication that uses hand movements and facial expressions to convey meaning.
BSL is completely different from spoken English and has its own grammar and syntax (word order). Other types of sign language include Signed English and Paget Gorman Signed Speech.
The Action on Hearing Loss website has more information on British Sign Language (BSL) and lip-reading.