Signs of hearing loss and red flags

Hearing loss can affect people of any age. The prevalence of hearing loss increases exponentially with age and approximately 42% of individuals over the age of 50 and 71% of individuals over the age of 70 have some degree of hearing impairment. Only one third of individuals who could benefit from hearing aids in the UK wear them.

Most age-related hearing loss is a gradual process, and often individuals will not notice that they are having difficulty hearing. Relatives, friends or carers may be the first people to notice that an individual may have a hearing loss. It is important to remember that even if someone can communicate on a one to one basis, in a quiet room without difficulty, that they may still have a hearing loss that will benefit from hearing aids.

It is important not to disregard communication difficulties as a dementia and behavioural related issue.

More information:

Potential indicators for hearing loss

  • Age 50+
  • Difficulty hearing in background noise such as pubs and restaurants
  • Having to turn the TV up so that others complain about the volume
  • Asking people to repeat themselves
  • Unaware of conversation when the speaker is not facing the individual
  • Speech sounds muffled or people do not speak clearly
  • Avoiding social situations
  • Withdrawal from conversation
  • Mishearing, and inappropriate responding
  • Unable to hear bird song
  • Reporting tinnitus- noises in the ear, ringing, buzzing, whooshing etc.
  • Difficulty hearing on the telephone

Other risk factors

  • Family history
  • History of occupational or social noise exposure
  • Ototoxic medication- aminoglycosides (such as gentamicin) or chemotherapy drugs (platinum-based chemotherapy)
  • Medical history: diabetes, cardiovascular disease and stroke, and autoimmune disorders

Red Flags

  • Asymmetrical or Unilateral Hearing Loss - Age related hearing loss should be symmetrical. If an individual is reporting hearing loss that is greater in one ear than the other, then further investigation is required.
  • Sudden hearing loss (over >72 hours or less) within the past 30 days is considered a medical emergency. Individuals should be seen within 24 hours by an ear, nose and throat service or an emergency department.
  • If the hearing loss worsened rapidly (over a period of four to 90 days), refer urgently (to be seen within two weeks) to an ear, nose and throat or audiovestibular medicine service.
  • For otalgia (earache) with otorrhoea (discharge from the ear) that has not responded to treatment within 72 hours and the individual is immunocompromised,refer to an ear, nose and throat service to be seen immediately within 24 hours.
  • Persisting middle ear effusion in patients of Chinese or Southeast Asian origin
  • Fluctuating hearing loss
  • Hyperacusis (intolerance to everyday sounds that causes significant distress and affects a person’s day-to-day activities)
  • Persistent tinnitus that is unilateral, pulsatile, has significantly changes in nature or is causing distress

Online hearing check

Royal National Institute for Deaf People (RNID) has launched a new Check Your Hearing campaign to encourage people to take their quick, easy, and free online hearing check.

The digital check, which can be found on RNID’s website and is signposted by the NHS, takes only 3 minutes and can be done easily at home on a desktop, laptop or mobile. While the hearing check is accurate in identifying indicators of hearing loss, it is not a diagnostic tool. Therefore, RNID offers clear and concise next steps for people whose results show signs of hearing loss.

RNID also provides a letter that people can take to their GP explaining the result and recommended next steps for investigation and referral.