Hearing Loss Overview

Key features

Epidemiology

• 12 million people with hearing loss in the UK
• 7 million could benefit from hearing aids
• Many also have tinnitus
• 42% of over 50s; 71% of over 70s have some hearing loss

Terminology

• Deaf: identify as part of Deaf community, communicate mostly with sign language
• deaf: people with hearing loss, communicate orally or with sign language

Consequences

• Hearing loss doubles risk of depression; increases mental illness prevalence
• Risk factor for developing dementia – reduced by hearing aid use

Clinical

Preventing hearing loss

• Volume and exposure duration are important
• Sounds above 85dB are harmful
• Shouting to be heard 1m away indicates potentially damaging background noise

Signs of hearing loss

• Hearing difficulties in places with background noise
• Turning TV up too loud for others
• Mishearing, asking for repetition
• Cannot hear birdsong
• Reporting tinnitus

Red flags

• Aysmmetrical hearing loss
• Sudden hearing loss (72h or less)
• Otalgia + otorrhoea in immunocompromised person with no response in 72h

Conduction and hearing loss

Tuning fork tests

• Compare air conduction (AC) with bone conduction (BC) and difference between ears
• Sensorineural hearing loss (SNHL) - cochlear or VIII nerve damage: BC>AC
• Conductive hearing loss (CHL) - middle/outer ear dysfunction
• Mixed hearing loss (MHL) combination of both

Rinne

• Rinne: ear canal (AC) vs mastoid (BC)
• Positive: louder via AC – SNLH or normal hearing
• Negative: louder via BC – CHL

Weber

• Weber: tuning fork mid-forehead
• Lateralises to ear with loss: CHL – BC better
• Lateralises to hear without loss: SNHL or mixed hearing loss (MHL) as best cochlea detecting sounds
• Normal hearing: midline

Next steps

Referral guidance: immediate

• Unexplained sudden onset (over <72h) hearing loss within past 30 days
• Unilateral loss with focal neurology
• Hearing loss with head injurybor severe ear infection

Referral guidance - urgent

• Unexplained sudden onset (over <72h) hearing loss over 30 days ago
• Unexplained rapid loss (4-90 days)

Communication tips

• Get attention before speaking
• Make face and lips visible
• Make facial expressions and gestures
• Avoid background noise
• Don't look away when talking
• Repeat sentence once if needed, after then rephrase
• Write down important facts
• Allow enough time for consultation