How can you spot hearing loss early?

Do you struggle to understand what someone is saying in a noisy room, feel the need to turn up the television, or have to ask people to repeat themselves more often? These signs should not be ignored. Hearing loss usually begins subtly and develops gradually, and it can significantly affect quality of life. Our clinic’s otolaryngologist, Dr. Anita Dombrovska, explains how to recognise the signs that your hearing should be checked, how hearing is tested in children and adults, and why timely action is especially important.

How can you notice changes in your hearing?

When we are used to conversing freely in everyday life, initial changes in hearing may seem too minor to warrant attention. Yet people can easily become accustomed to gradual hearing loss without noticing it, as the brain adapts readily to change. Often, family members, colleagues or friends notice the deterioration before the person themselves does.

One of the first signs is difficulty understanding conversation, particularly with background noise. A person may feel comfortable in a quiet room, but in a café, at a family gathering, in a car or on the street, words merge into a hum. Patients often say: I can hear that someone is talking, but I cannot understand what they are saying. It can also be difficult to hear one’s own or other people’s whispers, higher-frequency sounds such as women’s and children’s voices, and words containing consonants such as “s”, “ch”, “sh” and “z”, as these have the highest sound frequencies.

Changes in hearing can lead both to domestic disagreements, when one partner feels the other is deliberately ignoring them, and to dangerous situations: declining hearing can make it easy to miss a vehicle’s reversing alarm or other high-frequency warning signals. Any changes in hearing should therefore be discussed with an ENT specialist, including a sudden deterioration in someone who already uses a hearing aid. For example, if a person has always listened to loud music, that is simply a habit; if they suddenly begin turning the volume up high, their hearing should be checked.

Most hearing difficulties develop gradually with age, and the brain adapts, so people do not always notice abrupt changes. However, hearing difficulties also place a greater burden on the brain, which must work harder to understand speech. This can cause fatigue and difficulty concentrating after long conversations or meetings.

Pay particular attention to these signs:

• difficulty understanding speech in noisy surroundings – a typical sign of declining hearing;
• wanting to turn up the television or radio, often noticed first by others;
• difficulty following telephone conversations without the help of lip-reading and facial expressions;
• frequently needing to ask people to repeat themselves;
• difficulty hearing women’s and children’s voices or delicate natural sounds, such as birdsong and rainfall.

How often should hearing be checked?

Do not delay a hearing assessment if hearing difficulties appear suddenly. Pay attention to accompanying symptoms: pain, a feeling of fluid in the ear or tinnitus. A sudden increase in existing tinnitus (ringing in the ears) in someone who has had it for a long time also warrants assessment.

A doctor may recommend preventive or targeted testing based on the patient’s age, lifestyle, coexisting conditions and use of particular medicines. Up to the age of 50, testing can be performed every ten years; afterward, annual testing is recommended, especially if hearing problems have occurred before.

The risk of hearing problems increases after the age of 50–60 due to natural ageing.

People with diabetes or cardiovascular disease should pay particular attention to their hearing, as these conditions can affect the small blood vessels in the inner ear and consequently hearing.

Certain medicines, such as aminoglycosides, cisplatin or high doses of loop diuretics, can affect hearing.

Annual hearing tests are advisable for people who spend prolonged periods in noisy environments: construction and road workers using heavy machinery, drills and hammer drills; manufacturing and factory workers who are around loud equipment daily; military personnel and police officers who may be exposed to gunfire and explosions; aviation workers near aircraft engines; farmers and forestry workers who use tractors, combine harvesters and chainsaws for long periods; musicians, DJs, sound engineers and producers; and bar, nightclub and event staff who spend extended periods around loud music.

Regular hearing checks are recommended for people who have experienced acoustic trauma. Noise has a profound and often irreversible effect on hearing. Loud noise damages the hair cells of the inner ear and cells of the auditory nerve, and these delicate hair cells do not grow back.

How can you spot hearing difficulties in a child early?

Children do not always complain about hearing problems or know how to assess their hearing, so parents’ attentiveness is important. A child’s hearing should be checked if:

• the child does not respond to surrounding sounds or their parents’ voices;
• age-appropriate language development or vocabulary is delayed;
• the child frequently asks for repetition and closely watches their parents’ lips when they speak;
• the child turns the television or tablet volume up high;
• the child follows instructions incorrectly because they mishear or catch only part of what was said, for example bringing something else when asked to fetch a book;
• the child has learning or concentration difficulties because listening to the teacher takes a great deal of effort.

These signs do not always mean hearing loss. Similar behaviour may result from attention and concentration difficulties, fatigue, stress, intense focus on another activity, cognitive factors, an earwax blockage or poor room acoustics. An ENT consultation can help identify the cause.

How is hearing tested in adults and children?

Adults and children from around 5–6 years of age, when they can follow a specific task, have their hearing tested using audiometry. This is a precise and completely painless method. The patient sits in a sound-insulated booth and hears signals of different pitches and volumes through headphones. Their task is to press a button whenever they hear a sound. Pure-tone audiometry determines the hearing threshold: the quietest sound level in decibels (dB) at which the person hears a particular frequency. Speech audiometry can also be performed to assess not only whether a person hears sound, but how well they understand words at different volumes.

The test usually takes approximately 15–30 minutes. The only requirement for the patient is to concentrate as fully as possible, because some sounds are barely audible. For the specialist, the results reveal not only the sound levels a person can hear, but also provide clues about where in the auditory pathway the problem lies and whether one or both ears are affected.

Other methods are used for younger children whose ability to cooperate is still limited. In infants up to approximately six months of age, hearing is checked using otoacoustic emissions (OAE), usually already performed by the third to sixth day of life: a special device is placed in the ear to send a sound signal and record the response of the inner ear’s receptor. A slightly more complex examination is auditory brainstem response testing (ABR), which uses special electrodes. Parents need not worry: these tests are performed while the baby sleeps and are so unobtrusive that the baby continues sleeping peacefully while the doctors complete their work.

For children aged six months to 2–3 years, visual reinforcement audiometry (VRA), in which sounds are accompanied by images, can be used. For children aged 3–5 years, play audiometry turns responding to sounds into an engaging task the child can understand.

Hearing can be helped!

Audiometry shows how well a person hears, but the otolaryngologist’s task is to investigate the cause of hearing difficulties through a comprehensive examination. Hearing loss is not always irreversible. If the cause can be accurately identified and addressed, hearing may improve fully or partially. Immediate treatment is not always necessary: sometimes observation and follow-up audiometry, for example once a year, are sufficient to monitor age-related changes. If an earwax blockage is responsible, hearing returns as soon as it is removed. Gradual damage to the auditory nerve, however, is irreversible, and hearing devices can help in these cases. Contrary to a widespread myth, the earlier they are used, the better the outcome.

Depending on the situation, the patient may also need an endoscopic examination, tympanometry to assess the eardrum, acoustic reflex testing, or imaging such as magnetic resonance imaging or computed tomography. Sometimes other specialists, such as a neurologist or otoneurologist, are involved to clarify the diagnosis.

The key is to identify changes in hearing promptly. Timely improvement in hearing helps people remain socially active and able to work, communicate fully with family, friends and colleagues, and respond to environmental signals in time to protect themselves and others from injuries and accidents. This is not simply a matter of hearing sounds. Hearing directly affects brain function, mental health and quality of life. Timely hearing correction provides ongoing stimulation for the brain, may reduce the risk of cognitive decline and makes adjusting to a hearing aid easier. When hearing is restored, less energy is needed to understand the surrounding world, and the fatigue associated with that extra effort decreases. Conversations become easy and enjoyable again.