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Adult’s hearing assessment & management

Adult’s hearing assessment & management

How Common is Hearing Loss?
What will happen during a hearing assessment?
Can I refer myself?

Nearly all of us will experience some degree of hearing loss during the course of our lives.  There are many signs of hearing loss, but as it often happens slowly over several years, many people do not notice the gradual loss of everyday sounds.


If you do not need a hearing aid, but require information on hearing protectiontinnitussound sensitivity, or any other aspect of your hearing care, this will be discussed during the assessment appointment. We offer annual hearing checks free of charge once you are registered with us.


Can I refer myself?

In the UK you are not required to be referred to us by a specialist, but we are required to ensure you do not suffer with any condition which requires medical investigation. If we find something of concern we will refer you to your GP or relevant specialist.


What will happen during a hearing assessment?

You can expect to spend between an hour and an hour and a half with one of our Audiologists who will take a careful history of your hearing problems, and the difficulties you are experiencing. They will then check your ears carefully and carry out a series of Audiological investigations. After this they will explain the results of the tests to you and discuss various management options. You are very welcome to bring a companion with you to this appointment.


If a decision is made to try hearing aids, or provide auditory training, then the Audiologist will discuss various models with you. We will also arrange management of your tinnitus or sound sensitivity as required and provide specialist swim plugs or hearing protection if needed.


How common is hearing loss?

Approximately 9 million people in the UK have a hearing loss. This is approximately 19% of the total population or 1 in every 7 persons. Hearing loss increases sharply with age. About one third of the population aged between 60-70 years and three quarters of the population aged over seventy years have a hearing loss. Hearing loss is the third most common chronic health condition after high blood pressure and arthritis. This means that if you do have a hearing loss you are in very good company.

What causes hearing loss?

What causes hearing loss?

There are many causes of hearing loss, the most common being ageing. Excessive earwax is also a common cause, and your Audiologist can check for this and remove it if necessary.

Factors that increase your risk of hearing loss a family history of hearing loss, exposure to loud occupational or recreational noise, some medications and some illnesses such as diabetes.


Ototoxic drugs include antibiotics such as gentamicin, loop diuretics such as furosemide and platinum-based chemotherapy agents such as cisplatin. A number of nonsteroidal anti-inflammatory drugs (NSAIDS) have also been shown to be ototoxic.


Hearing loss can be temporary or permanent. You may also have other symptoms such as earache, unusual noises in your head or ears (tinnitus), or a spinning sensation (vertigo).

Sometimes hearing loss is only in one ear, but more often it occurs in both ears. Signs of a hearing problem in one ear include finding that your hearing is worse when sound comes from one side and finding it hard to tell where sound is coming from.

If you have a sudden drop in your hearing, please contact your GP immediately.

Types of hearing loss

Hearing loss is sometimes sudden, but more often it happens gradually and you may not notice it at first. Often it is friends or family who first notice the problem. This is because we are tremendously adaptable as human beings – the brain copes by making adjustments for as long as it can. However often there comes a “tipping point” when either the person with the hearing loss or those around them just can’t cope any more. This is the point at which they think “I really need to do something about this”, however, they would do so much better if they had “done something about it” earlier.


There are two major forms of hearing loss: conductive and sensorineural. A clinical examination by an ENT Surgeon (a doctor specializing in the ears, nose, and throat) and a hearing test by an Audiologist (an expert in hearing testing and hearing aids) can determine the type of hearing loss.


Conductive hearing loss is usually due to abnormalities in the middle or external ear such as a punctured eardrum, presence of fluid in the middle ear, or accumulation of cerumen (ear wax) in the external ear canal.

Sensorineural hearing loss is usually caused by damage to the tiny hair cells inside the inner ear that are crucial for picking up sound vibrations and translating them into nerve impulses. These impulses are relayed to the brain, which interprets them as sound. Sensorineural hearing loss accounts for about 90% of hearing loss in adults. Ear protection, such as ear plugs, should be worn to dampen sound if loud noise is unavoidable. Sensorineural hearing loss that occurs with aging (presbycusis) or that occurs from noise damage usually occurs in both ears and is gradual.

How do you test for hearing loss?
How do you test for hearing loss?

How do you test for hearing loss?

Specialised facilities and expertise are required to test hearing. The environment, equipment and Audiologist skills are designed to accurately assess your hearing. Methods of Self testing are not reliable and are often very misleading.

What are the signs I may have hearing loss?

Woman straining to hear

1. Muffled speech: Speech and other sounds are quiet and unclear

The most common response when testing hearing is “I don’t really have much of a problem, but other people really don’t speak very clearly”. And of course, that is true – regional accents, foreign accents, people who speak faster than normal, people who speak more quietly than normal or who don’t face you when they speak to you – all of these are more difficult to hear. However even a mild hearing loss in the higher frequencies really enhances these difficulties. If you are experiencing them, it may be a very early sign that there is a hearing loss developing.


The second most common response is “well I don’t really have a problem, but my husband / wife / friends / children / grandchildren think that I do”. If this applies to you then you probably have a hearing loss that has developed very slowly over time.


2. Poor hearing in noise: Difficulty understanding words, especially in background noise or in a crowd of people

The majority of the clarity of speech, and ability to distinguish words, comes from the higher-frequency elements of speech – for example, to tell the difference between /CAT/ and /SAT/ and /FAT/ and /THAT/ and /PAT/ or /SAY/ and /PAY/ you need good high frequency rather than low frequency hearing. Guess what goes first as we age – that’s right – high frequency hearing! Even a slight hearing loss causes these problems.


So, put a high frequency hearing loss in an environment with lots of background noise or echo, and the lower pitched noise obscures the higher-pitched speech clarity. This is exactly what happens in social gatherings, restaurants, or presentations when the speaker is some distance from you.


People with normal hearing have these problems too of course, however they have a much greater reserve of sound than people with even a slight hearing loss.


​3. Pardon? Asking people to repeat themselves

If you often find yourself asking others to speak more slowly, clearly and loudly you may have a hearing loss. People with a hearing loss often feel that those around them are speaking less clearly than they should, or are mumbling. Unfamiliar accents can be particularly difficult to hear clearly.

You may also be having difficulty keeping up with conversations. People often rely on catching key words in a conversation, and fill in the gaps. However if the key words are heard incorrectly, this becomes impossible.

A hearing loss can also make you feel tired and stressed from having to concentrate harder while listening. This generally makes hearing far more effortful. This in turn makes it even more difficult to follow conversations.


​4. Turning up the volume: The radio, TV or music is louder for you than for others

One of my first questions is “do you turn the TV up”, and a sure sign of a hearing loss is yes. The style of TV drama has changed enormously over the years and has become far more “reality” orientated. This means that there will often be music or other background sounds behind the dialogue, main characters will not speak to the camera, lighting will be poor and all those vital visual cues will be lost.


Even news presenters have changed their vocal and presentation style. This makes them far more “on trend” but doesn’t do a hearing loss any favours.


Of course, a hearing loss also means that the quality of speech and music is not as good as before as you hear less of it. The problem is made worse by poor sound from your TV – flat screens tend to have small speakers that face outwards rather than forwards, and one of the easiest solutions may be to get a good quality sound bar to connect to your TV.


If you are considering hearing instruments, make sure that you try out TV accessories – usually a small box that plugs directly into your TV and streams sound wirelessly to your hearing instruments. You can therefore adjust the TV to suit you exactly, and maximise the sound that you hear.


Another solution is putting the subtitles on, however these vary in quality. There is nothing worse than only getting the punchline of a joke some time after it has been spoken.

​5. The Phone: Difficulty hearing on the phone

When we listen over the phone we are totally reliant on what we hear – you cannot use your eyes! Interestingly people hear relatively well over the phone with a mild hearing loss but start having difficulties beyond that point. This may take the form of having to turn the phone volume (if you have one) up, or not being able to hear unfamiliar voices. Often people get key words mixed up, especially numbers, with potentially disastrous consequences.

People with mobile phones often resort to using them on speaker, with the volume cranked right up. The problem is that everyone else can hear your conversation too.

Mobile phone companies, particularly Apple, have been very proactive in recognising this difficulty, and that hearing instruments can be at the heart of the solution. You can link many hearing instruments to a mobile phone, and this means that the conversation comes directly to your hearing instruments. You can then adjust the volume to suit you, and no-one else will hear what is being said. People love this solution – it really has been groundbreaking.


Of course the other advantage of linking your phone to your hearing instruments is that you can control them with an App if you would like (although they will work without this).


Some hearing instruments also allow you to connect your hearing instruments to your landline phone.


​6. Feeling isolated and down: Avoiding social settings has a big emotional impact

If you don’t hear so well, then listening will require more concentration, be more effortful and more tiring. Some people cope by withdrawing from settings where they know that it will be difficult for them to hear. However over time this can leave you feeling left out and isolated. This is not good for healthy brain ageing.


Be aware that not hearing well can also make you feel anxious and depressed. If you are feeling this way it will be even more difficult to concentrate on what is being said.


You may be surprised at how much having a hearing loss can affect your emotions – you may feel helpless or depressed, and get angry or frustrated. Getting help with your hearing loss as soon as possible, and having a good social support system will help you to avoid many of the emotional problems that can be associated with having a hearing loss.


Being hard of hearing doesn’t mean that you are not thinking as clearly – in fact there is increasing evidence that the earlier you get help with your hearing the better your brain function is preserved.

Life is too short to miss hearing friends and loved ones, enjoy music and get back to a normal life.


7. Tinnitus: Noises in the head or ears that others can’t hear

Tinnitus remains one of the most common auditory symptoms. Depending on the definition of tinnitus and the criteria applied, prevalence rates in adult populations vary from 8.2 to 20.0% rising to 17.9 to 30.3% in those over 50 years of age. It is more common with hearing loss, but it is not true to say that the worse your hearing is, the worse the tinnitus will be.


In most cases it is not associated with anything serious, however you should always mention it to your Audiologist so that they can refer you for a medical opinion if necessary.


Sometimes tinnitus only lasts for a short period, often after loud noise, and sometimes it goes on for longer. Most people do not find it to be a problem, however a significant minority of people find it troubling.


There are a number of ways of managing tinnitus very effectively, whether or not you have a hearing loss. A hearing instrument is often one of the most effective management strategies. Other ways include low level sound, and many hearing instruments can be programmed to provide bespoke sound options.


By far the most important way of managing tinnitus is avoiding the “vicious circle” of hearing it, focussing negative thoughts on it, and becoming anxious and worried about it. The tinnitus sound that you hear is really in most cases a tiny nerve signal that the hearing pathways have incorrectly labelled as a threat. This causes other parts of the brain that govern our emotional and physical reactions to threats to become fixated on the tiny nerve signal, and give it a “fast track” pathway to the brain.


Reversing this can take time, however most people do it on their own unless something unexpected happens.

What are the effects of a hearing loss?

So, now we’ve gone through the 7 signs that you may have a hearing loss, what is the result of that hearing loss? Apart from the obvious “not hearing” you will probably notice:


  1. Informal communication in the home with your loved ones is harder

  2. Difficulty hearing or discriminating between speech sounds such as "s," "sh," "f," "t," and "k"

  3. You may want the TV at a different volume to your loved ones

  4. You may struggle more on the telephone

  5. Background noise or echo is your enemy

  6. Increased tiredness

  7. Listening is more effortful

  8. If you have Tinnitus, it is louder if you are struggling to hear

  9. A tendency to develop some sound aversion; finding loud sounds or raised voices very uncomfortable

  10. A loss of spatial awareness, localization and environmental sounds


This can lead to a gradual development of social isolation as situations become embarrassing or impossible to hear in, resulting in frustration, unhappiness, a loss of self confidence, and sometimes other psychological problems.


Hearing loss can also make it more difficult to talk to health care providers and emergency workers creating a significant health risk.

Hear with your eyes

Did you know that we hear with our eyes?

About 40% of what we “hear” comes directly from the words that we hear. Another 20% comes from the context of the conversation and picking up one or two key words which allows you to fill in the gaps where you didn’t hear all the words. The rest comes from a combination of lip reading, expression, gesture and body language.


So, if you are not hearing so well you must rely on a lot of other things to understand people. For example, if you are not hearing 25% of speech sounds, you have to rely more on the other factors. This works up to a point, however nine times out of ten you will need to ask for some words to be repeated. If you miss a vital key word you may well get completely the wrong end of the conversational stick.


Of course, your hearing will be only as good as what you can see in situations where you really cannot hear the words. So, people with their faces turned away, in poor lighting, or who are some distance away will be particularly difficult to hear.


All of this can be very stressful and tiring. Having to concentrate so hard on all these cues makes hearing far more effortful. The increase in effort and tiredness in turn makes it even more difficult to follow conversations.

Don’t Delay
Why hearing as well as we can is so important

Is there a choice of treatments?

At the consultation, options for treatment will be discussed thoroughly with you. Surgery is sometimes the choice for conductive hearing impairment, but not exclusively, whilst hearing aids are the only option for sensorineural loss. It is important to fully understand and have confidence in the recommended treatment. 


Why hearing as well as we can is so important

There is a lot of evidence that unaided hearing loss is associated with poor memory, social isolation, a faster rate of cognitive decline, and a general increase in brain ageing. It is also true that the sooner something is done about hearing loss, the easier it is. In other words, fitting a mild hearing loss will be far more effective than waiting until it becomes severe, as well as protecting the person from brain ageing.


Most people as they get older retain good hearing for lower pitched sounds but have real difficulties with mid to higher-pitched sounds. It is these mid to higher pitched sounds that give speech clarity – so if you don’t have good hearing for higher pitches then people will appear to mumble even though the volume is ok. To make matters worse, background noise or echo simply masks out high frequency sound, so people with even a small degree of high frequency hearing loss can really struggle in noisy conditions.


So hearing well helps to:
  • Reduce listening effort

  • Maintain better cognitive function

  • Boost brain stimulation and possibly slow the decline in dementia sufferers

  • Maintain better communication skills

  • Reduce a major factor in social isolation 


Don’t Delay

Don’t delay – adults wait an average of 7 years to accept that they have a hearing problem and get it treated, and 71% of people with hearing aids wished that they had got them sooner. That is 7 years of missing out on hearing friends, family, birdsong and other sounds that you love.

When to get a hearing test?

What to do next

If you suspect that you have a hearing loss it is important to have a hearing test carried out.

In most cases there is no medical or surgical management for hearing loss, but in some cases a hearing loss can be an indication of another medical condition. You will be referred to a medical practitioner if we have any concerns.

However, if your hearing loss is sudden, particularly if it is only in one ear you should see your GP as soon as possible.

We will examine your ears, and then carry out a hearing test which will show exactly what sounds you are hearing and whether or not you have a hearing loss.

Based on the test results, we will discuss various management options, which may include hearing aids and other hearing devices, listening exercises, local support groups, or perhaps just keeping an eye on things. No matter what you decide, you will always be offered annual reviews of your hearing.


Use us for advice – we will not only test your hearing, but also give you all the information you need to make the best decision about how to manage your hearing loss.

Tips to help you

Don’t get frustrated – talk to friends and family about the things that you are missing and how these situations can be improved. Planning where and how you will communicate can help enormously.


You may worry that you’ll never be able to communicate properly again – that is not the case. Hearing aids, listening exercises and making minor changes to the places that you communicate in and how you communicate will make a huge difference.


Be aware of your options – these may include hearing aids and other devices, a programme of listening exercises or local support groups.


Communication is actually around 40% what we hear, and 60% what we see from body language and lip reading. So make sure that you can see the person speaking clearly, that they are not covering their mouths, and that you are tuned in to their non-verbal cues.


You don’t need to hear every word to understand the conversation – your mind works far more quickly than you hear words or speak. So try to pick out key words, and use context and non-verbal cues to fill in the rest.


Make communication easier with these tips:
  • Try to talk in areas that are well lit, quiet, and calm.

  • Turn down background noise, like the TV or radio.

  • Ask the person speaking to get your attention before they start talking, and make sure that they are close to you.

  • Get the person talking to face you when they speak so you can see their mouth and gestures.

  • Ask them to speak slowly and clearly. A raised voice can distort the sound of words, and over-exaggerating speech is unhelpful.

  • Ask people to speak to you in full sentences rather than short phrases – they are easier to understand

  • If you still cannot understand what is being said, ask the speaker to re-phrase a conversation or to break it down into simper “chunks” of information.

  • Allow yourself time to process the information and then check your understanding if necessary by repeating back key points to the speaker.

  • Don’t expect to hear everything but try to remain calm and focussed on the conversation.

  • Try to minimise sound around you by sitting with your back to a wall, or in a corner

  • In a restaurant sitting with your back to a wall, or a corner can help to minimise background noise from behind you.

And remember – hearing speech in background noise is difficult – most people will struggle to some extent. You are not alone.

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