Hearing Loss

Table of Contents

What Is Hearing Loss and How Common Is It?​

Hearing loss or hearing impairment is the inability to hear, and it can be total or partial and present in one ear (unilateral) or both ears (bilateral).

Hearing loss may occur at birth, be gradually acquired over your lifetime, or even happen suddenly. Hearing impairment is, therefore, categorised as either congenital (from birth) or acquired (develops after you’re born).

Sometimes it’s reassuring to know that hearing impairment is a common issue. When we start listening, we all start the hearing loss journey, as it’s a natural part of the ageing process.

Did you know that back in 2016, a whopping 880,350 Kiwis were estimated to have some form of hearing loss? That’s nearly 19% of us – almost one in every five people! And it seems the blokes are leading this race, with around 473,000 males affected compared to approximately 407,000 females.

Now, let’s chat about age – because, like a fine wine, these stats develop over time. The prevalence of hearing loss increases with age, peaking at the 90+ years old bracket, where almost everyone experiences at least mild hearing loss. Until the ripe age of 80, mild hearing loss is the most common. But after 80, moderate and severe hearing loss starts to take the lead.

And if we’re breaking down the numbers by severity for adults, here’s how it looks: for males, 20.6% have some degree of hearing loss, with 13.9% experiencing mild, 6.2% moderate, and 0.6% severe. Of the ladies, 17.1% have some hearing loss – 11.9% mild, 5.0% moderate, and 0.3% severe.

Phew, that’s quite a bit of number crunching, eh? But it all boils down to this: hearing loss is a common issue among us Kiwis, and as we age, the likelihood increases. So, let’s ensure we’re taking good care of our ears, getting regular check-ups, and spreading the word about the importance of hearing health. 

Otherwise, this hearing loss problem can get a little on the expensive side. The economic and loss of well-being cost of hearing impairment in NZ was estimated to be $4.9 billion in 2016.

Hearing Loss Categories and Causes

Hearing loss can be categorised into congenital or acquired. Congenital hearing loss refers to hearing loss that is present at birth, while acquired hearing loss occurs after birth

Congenital hearing loss is present at birth or soon after. Hearing impairment may be caused by hereditary and non-hereditary genetic determinants or by specific complications throughout pregnancy and childbirth, including:

  • infections during pregnancy like maternal rubella or syphilis
  • low birth weight
  • a deficiency of oxygen during birth (birth asphyxia)
  • in utero exposure to certain drugs potentially cause hearing impairment in the fetus.

Acquired causes of hearing impairment may happen at any age and can include:

  • infectious diseases, including measles, meningitis, and mumps
  • chronic ear infections
  • specific drugs used in the treatment of neonatal conditions, malaria, drug-resistant tuberculosis, and cancers
  • injury to the ear or head
  • excessive industrial noise from farm machinery, building sites and explosions
  • repeated and prolonged exposure to personal audio devices at high volumes

Acquired hearing loss can be temporary or permanent.

Temporary hearing loss is more likely associated with conductive causes, obstruction, or damage to the outer or middle ear that inhibits sound from being carried to the inner ear.

Causes of temporary hearing loss include:

  • impacted earwax
  • surfer’s ear
  • swimmer’s ear
  • glue ear
  • ear canal stenosis or a narrowing of the ear canal
  • ruptured eardrum
  • ear infection
  • Eustachian tube dysfunction
  • thickening of the tympanic membrane called tympanosclerosis.

Causes of permanent hearing loss include:

  • genetics
  • viral infections
  • head trauma
  • certain medications
  • exposure to loud noise or music for extended periods
  • obesity
  • smoking cigarettes
  • chronic illnesses such as diabetes and hypertension
  • autoimmune disorders
  • aminoglycosides or loop diuretics drugs used in the treatment of neonatal conditions, malaria, drug-resistant tuberculosis and cancers
  • injury to the ear or head
  • excessive industrial noise from farm machinery, building sites and explosions
  • repeated and prolonged exposure to personal audio devices at high volumes.

Hearing Loss Types

Hearing loss type is determined by the specific area or location of damage within the auditory system. 

Sensorineural hearing loss affects the inner ear, auditory nerve or central auditory pathway.

Conductive hearing loss affects the outer or middle ear.

Mixed hearing loss is a combination of conductive and sensorineural hearing loss.

Symptoms of Hearing Loss

Hearing loss can be a difficult thing to spot, especially in its early stages. However, a few telltale signs may indicate that your hearing is not as sharp as it used to be.

If you find yourself frequently asking people to repeat themselves or having trouble understanding conversations in noisy environments, it could be a sign that your hearing is starting to deteriorate.

Additionally, if you find yourself turning up the volume on your TV or radio or if you notice that loved ones are complaining about how loud you are speaking, these could also be indicative of hearing loss.

If you suspect experiencing any of these symptoms, it is essential to consult with a hearing specialist for further evaluation. With early diagnosis and treatment, it is often possible to effectively manage hearing loss and protect your overall quality of life.

5 Sensory Signs You Need a Hearing Check

If you experience any or all of these sensory symptoms, it’s a good indication you need to take action about your hearing.

  1. Phone calls are hard work! Do you find it difficult to understand phone conversations clearly?
  2. Your TV volume is turned up to 11. Do family or friends complain about the volume when listening to the radio or television?
  3. It’s difficult to hear in noisy places. Is it a struggle to follow a conversation in a restaurant or when there is a lot of noise around you?
  4. Eye contact is essential. Do you hear much better when looking at the person talking to you?
  5. Being social is exhausting! Are you often exhausted after social outings because listening is such an effort?

Secondary Symptoms

Of course, the main symptom of hearing loss is having trouble hearing. However, there are some other signs and symptoms that indicate a hearing impairment might be present.

Most people have experienced a blocked feeling inside their ears called occlusion. Usually, this feeling is temporary, but it may be an accompanying symptom of hearing loss if it persists. Pain or pressure in your ear is also an accompanying symptom.

Secondary symptoms include:

  • Tinnitus; ringing, buzzing, or other sounds in the ear when no outside noise is present.
  • Hyperacusis; a rare hearing disorder of reduced tolerance to sound with accompanying auditory pain to specific intensities and frequencies of sound.
  • Vertigo; the feeling that you or your surroundings are moving, but they’re not.
  • Disequilibrium or a dizzy feeling of an impending fall or the need to obtain external assistance to be able to move properly.
  • Increased hearing of one’s own voice and respiratory sounds, usually due to a constantly open eustachian tube or the tremor of the soft palate or muscles of auditory ossicles.

The Gradual Decline

There’s nothing quite like hearing loss. It happens gradually. So slowly, in fact, most people don’t take much notice until it starts to have a profoundly negative impact on our lives. Life’s just too short to ignore and evade your hearing health.

Did you know most people wait an average of 10 years after being diagnosed with hearing loss before they decide to do something about it?

Many people find it hard to come to terms with the idea of wearing hearing aids. They put off the decision and only do something about it when the problems associated with poor hearing become too much for them.

A bit of uncertainty about the actual condition of one’s hearing is pretty standard. You can follow a conversation easily while facing someone, but if many people are talking, and you can’t see someone’s face as they speak, it’s hard to follow the conversation.

Often it’s the people we talk to regularly that take note and might politely point out that perhaps our hearing is not as good as we think it is.

The people in your life telling you to turn down the TV often mean well. Because the earlier you do something about your hearing loss, the better. Even when hearing is just starting to deteriorate, hearing aids may help maintain the neural pathways in your brain responsible for decoding all the sounds you hear.

Simply put, hearing keeps your brain active, which in turn keeps your brain healthy.

An indifferent man with hearing loss ignores the pleas of his wife
On average, it takes people ten years to take action on their hearing loss.

How Is Hearing Loss Measured?

Hearing loss is measured in decibels (dB). When your audiologist talks about your degree of hearing loss, they will describe it as a range from mild to profound. The degrees include:

  • Mild (26 – 40 dB) – Quiet speech, such as a child’s voice, may be difficult to detect or interpret.
  • Moderate (41 – 55 dB) – A one-to-one conversation is challenging and tiring, especially in background noise, as you might experience in a crowded room or busy cafe.
  • Moderately severe (56 – 70 dB) – it’s hard to understand conversations in most scenarios, particularly if you don’t have direct eye contact with the speaker.
  • Severe (71 – 90 dB) – conversational speech is inaudible.
  • Profound (91+ dB) – most sounds, including speech, cannot be heard.

After a diagnostic hearing test, your audiologist will likely advise you on the cause of your hearing loss, if it requires further investigation, and any possible treatment options, including hearing aids if appropriate. They will also inform you of the level of your hearing impairment and provide you with an audiogram.

What is an Audiogram?

An audiogram is the result of a pure-tone hearing test to measure hearing sensitivity. The audiogram plots sound you can hear at different frequencies (pitch) and decibels (volume).

Frequency is a measure in hertz (Hz). Humans with normal hearing can hear sounds between 20 Hz and 20,000 Hz.

An audiogram will describe hearing sensitivity from normal to profound loss.

The stylised audiogram below plots normal hearing and all levels of a sloping hearing loss concerning:

  • a speech banana
  • face to face conversational speech between two adults
  • the frequency of various letters when spoken
  • the volume and frequency of multiple sounds like a bird singing and a band playing.
Stylised audiogram of normal to severe sloping loss
Stylised audiogram of normal to severe sloping loss

A speech banana is not a delicious snack for audiologists, but the audible region of phonemes or various human speech sounds is plotted on an audiogram. You can see how isolated sounds from speech cover a wide range of frequencies and volumes.

Try this out for yourself! Phonetically sound out some parts of speech:

  • eɪ – which is in words like, say or eight
  • tʃ – such as in, check or church
  • ɔɪ – for example, boy or join.

Notice the difference in both volume (how loud it sounds) and frequency (how deep or high-pitched it sounds).

People with normal hearing can hear all the frequencies at all the volumes on an audiogram.

People with mild hearing loss fail to hear the sounds above the pink line, such as birds chirping and leaves blowing in the wind.

Even with a mild loss, there is potentially a reduction in speech comprehension. Depending on the severity of mild hearing loss, you may also fail to hear sounds above the green line, including some speech sounds in the speech banana. This loss of ability to hear speech might be unnoticeable as people often alter their behaviour to compensate.

With moderate hearing loss, the level begins at the green line; depending on the severity, it can reach the blue line.

The blue line is where face-to-face conversational speech at an average volume becomes difficult to hear.

Can you start to see the pattern forming? For example, the lower threshold for mild hearing loss is the pink line, and the upper limit is the green line.

Managing Hearing Loss

There is no cure for permanent hearing loss, but there are many effective ways to manage it.

Management options include:

  • hearing aids
  • cochlear implants
  • bone conduction hearing aids
  • brain stem implants
  • assistive technology
  • closed captioning and subtitles.

The degree and type of your hearing loss and personal preference will help determine the most suitable management option.

Be Proactive

It takes a bit of effort, partly because living to an advanced age is a relatively recent achievement. As your age increases, your quality and enjoyment need not decrease. All you need is a little luck and to establish some preventative measures.

The average human life span gained more years during the 20th and 21st centuries than in all previous millennia combined. In many ways, we’re still becoming used to getting “old”. 

There are many ways to lose touch with our youth physically and philosophically. The good news is that your hearing doesn’t have to be that way. That is, if you decide to do something about it.

Picture of Ron Trounson
Ron Trounson
Ron Trounson holds a Master of Audiology (with Distinction) from the University of Canterbury. He has been in the hearing industry since 2010 and has a broad knowledge of ear disorders, hearing loss, hearing aids and specialised hearing devices.

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