Deafness - Treating hearing loss

How hearing loss is treated will depend on the underlying cause of the condition.

Hearing loss that occurs when sounds are unable to pass into the inner ear, usually due to a blockage, (known as conductive hearing loss) is often temporary and treatable.

For example wax can be removed by drops, a syringe or suction. Hearing loss caused by a bacterial infection can be treated with antibiotics and surgery can be used to drain fluid that builds up in the ear or repair perforated eardrums or correct problems with the hearing bones.

However, hearing loss caused by damage to the inner ear or the nerves that transmit sound to brain (known as sensorineural hearing loss) is permanent.

This is because once the sensitive hair cells in the cochlea (the coiled, spiral tube inside the inner ear) are damaged, they cannot be repaired and remain damaged for the rest of a person’s life.

If your hearing is impaired, treatment can improve your hearing and quality of life. Some of these treatments are discussed below.

You may also wish to search for hearing impairment services near you.

Hearing aids

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 that you may be able to 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 are not suitable for everyone. For example, they may not be effective if you have profound hearing impairment. Your GP or audiologist (hearing specialist) will be able to advise you about whether a hearing aid is suitable for you.

If a hearing aid is recommended for you, an audiologist will take an impression of your ear so that the hearing aid will fit you perfectly. The hearing aid will be adjusted to suit your level of hearing impairment. You will also be shown how to use and care for it.

After your hearing aid has been fitted, you will have a follow-up appointment three months later.

If you experience problems using a hearing aid - such as distortion and repeated infections - that cannot be corrected by an audiologist, you may benefit from different treatments. An ear, nose and throat (ENT) surgeon will be able to 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.

In the UK, both analogue and digital hearing aids are commonly used. Most hearing aids that are 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 behind-the-ear (BTE) hearing aids. You can also choose to pay privately for another type of hearing aid if it's not available on the NHS.

Read more about getting an NHS hearing aid.

Types of hearing aids

The different types of hearing aids are described below.

Behind-the-ear (BTE) hearing aids

Behind-the-ear (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.

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 either located in a small compartment that is attached to the earmould or inside the earmould itself.

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/BiCROS

CROS hearing aids are recommended for people who only have hearing in one ear. They work by picking up sounds from the side that does not have hearing and transmitting them to the ear that is 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 is able to hear. They are useful for people who do not have any hearing in one ear and have limited hearing in the other ear.

Bone conduction hearing aids

Bone conduction hearing aids are recommended for people with conductive or mixed hearing loss and 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 worn during the day and removed at night.

Unlike a bone conduction hearing aid it is not uncomfortable to wear and it 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 sticking through the skin. However, these types of hearing aid are not always available on the NHS.

Middle ear implants

These are surgically implanted devices which attach to the hearing bones and make them vibrate.

They are suitable for people who can't use a hearing aid but have hearing loss at a level where a bone anchored hearing aid 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 10 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 usually only available privately.

Cochlear implants

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 which 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 that 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 profound sensorineural hearing loss in both ears which is not 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 will be assessed to find out whether it will help improve your hearing. During the assessment, any disabilities or communication problems that you have will be taken into consideration, which may mean that the usual hearing tests are not suitable.

If a cochlear implant is recommended, it will be inserted into your ear (or both ears) during an operation and will be switched on a few weeks later.

There are currently around 10,000 people in the UK with cochlear implants and the number is increasing each year.

Safety

According to the MHRA, evidence suggests that patients with cochlear implants may be at an increased risk from pneumococcal meningitis, especially if they have not 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 is slightly higher than for the general population.

Auditory brainstem implants

In some cases of severe hearing loss where there are problems with the nerve that transmits sound to the brain, an auditory brainstem implant (ABI) may be used.

This is a surgically-implanted electrical device that stimulates the fibres of the hearing nerve once it has entered the brainstem. It is similar to a cochlea implant, but it is used to bypass the cochlea and and hearing nerve and connect directly to the brain.

An ABI is made up of three main parts:

• electrodes implanted in the part of the brain responsible for processing sound
• a receiver device placed under the skin behind your ear
• a small sound processor outside your ear, which captures sound waves converts them into electrical impulses

When the microphone in the processor picks up sound, it turns it into an electrical signal. The processor then transmits this signal 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 is often used as a treatment for hearing loss associated with a condition called neurofibromatosis type 2 (NF2).

Lip reading and sign language

Sometimes hearing loss can 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 have learnt to talk, lip-reading can be a very useful skill. Lip-reading is where you watch a person’s mouth movements while they are speaking in order to understand what they are saying.

For people who are 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.