Hearing loss and deafness in adults

The ear works by picking up sound waves and converting them into neural stimuli that the brain processes. People with a hearing impairment are limited in their perception and understanding of spoken language and sounds. If their ability to hear is (almost) non-existent, this is referred to by medical practitioners as deafness.

Some people are born with a hearing impairment or deaf. In others, it develops in childhood. But hearing only deteriorates for most people as they age. This is also known as age-related hearing loss (presbycusis).

Depending on the severity of the hearing impairment and the nature of the damage to the ears, hearing aids, ear surgery, or auditory prostheses (cochlear implants) can improve hearing and quality of life.

Hearing disorders can affect one or both ears and can vary in severity:

• For example, people with a mild impairment cannot understand when someone whispers to them.
• People with a moderate hearing impairment can only hear loud noises.
• People with severe hearing loss can only hear very loud noises.
• People who can only perceive tones and sounds as vibrations are deaf.

Depending on the cause, other symptoms may occur such as ringing in the ears (tinnitus), pressure in the ear or dizziness.

Hearing deteriorates for many people as they age. The reasons for this age-related hearing impairment are not yet fully understood. It is believed that years of exposure to noise and a genetic predisposition are factors in addition to normal aging processes.

High levels of noise can cause damage to the eardrum, the middle ear and particularly to the inner ear. The damage normally only lasts for a certain amount of time and then disappears. However persistent damage to hearing is also possible, for example following acoustic trauma. At the same time, if a person’s hearing is exposed to noise on a regular basis, lower volumes can also lead to chronic, noise-induced hearing loss.

Apart from noise, there are other factors that increase the risk of a hearing disorder. These include:

• earwax blocking the auditory canal
• chronic middle ear infections
• infections such as meningitis
• sudden hearing loss
• otosclerosis (hardening of the ossicles of the ear)

Rarer causes include skull injuries, side-effects of medication and tumors.

The World Health Organization (WHO) estimates that there are around 430 million adults with hearing problems worldwide. Just over 30 out of every 100 people over 65 have hearing loss. Precise figures are not yet available for Germany.

It is believed that 16 to 25 out of every 100 adults have impaired hearing. The proportion is higher in older people.

Some people are born with a hearing impairment or deaf or develop it in childhood. But hearing disorders only develop for most people as they age. The age-related form of hearing loss normally affects both ears to the same extent, and hearing difficulties increase over time.

People with age-related hearing loss initially only experience a drop in their perception of quiet sounds and tones at higher frequencies. Some also only have problems hearing and understanding a conversation when there is lots of background noise, for example in a restaurant or on a bus. In most cases their hearing deteriorates gradually over the years.

If the cause is a sudden hearing loss or an injury the hearing loss may occur more quickly or even immediately. Depending on the cause, the hearing impairment may subside. But it is usually permanent in older people.

Appropriate hearing protection is essential for people who are regularly exposed to noise, such as machinery or aircraft noise, as part of their job. Specific noise protection regulations apply to the workplace to prevent hearing impairment.

In everyday life it’s important to avoid ear strain from loud music, for example on headphones. Earplugs can help to protect hearing at very loud concerts or in nightclubs. You can avoid damaging your hearing by wearing appropriate hearing protection when carrying out home improvements, even if you are only exposed to noise for short periods.

A specialist in ear, nose and throat medicine (ENT) can carry out special ear tests and examinations in cases of suspected hearing loss.

The ENT specialist starts by examining the ears. He or she will use an otoscope to detect middle ear infections or blockages of the ear canal, for example. He or she may also ask about when and how you noticed the hearing impairment and whether there are any other symptoms.

A number of different hearing tests are used to find out what type of hearing disorder is involved and how severe it is.

A computed tomography (CT) scan or a magnetic resonance imagery (MRI) scan may sometimes be needed to determine the exact cause.

If the hearing impairment is caused by a middle ear infection it can generally be cured. However the hearing disorder will often be permanent in adults, particularly older people.

If this is the case, hearing aids are often used. These amplify sound waves that are too quiet and suppress sound waves that are too loud and channel them into the inner ear. This makes it easier to hold conversations and have a social life. If a person’s hearing is poor or non-existent because of profound damage to the sensory cells (receptors) in the ears, in-ear devices known as cochlear implants may be of help.

Communication is difficult if your hearing is impaired. People who suffer from hearing loss or deafness may thus have less contact with other people. Some feel ostracized in many aspects of social life and some develop anxiety and frequently feel depressed.

Other people may sometimes not recognize a hearing impairment or misjudge it, which can lead to the person affected being seen as inattentive, arrogant, odd or demented.

Family members also need to learn how to deal with their parent’s or partner’s hearing impairment. The communication difficulties associated with the hearing disorder can cause tension and frustration on both sides.

The first step to improving quality of life is for someone to recognize and accept that they cannot hear as well as they used to. The next step is to consult a doctor and discuss the treatment options.

It takes patience and commitment to get used to hearing aids or cochlear implants but using them will significantly improve hearing and the participation in social life.

If you have difficulty hearing you should first of all consult your family doctor. He or she can then make a referral to a specialist practice for ear, nose and throat medicine (ENT).

Self-help groups are a way of networking with other people who know the difficulties, feelings and practical problems that are associated with hearing loss and deafness. Information and advice services can also provide help.

You can search for suitable self-help services via a database on the website of the National Contact and Information Point For Encouraging and Supporting Self-Help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen – NAKOS).