Newborn to 3 months
- Does not startle at a sudden loud noise
- Does not settle or stir at a familiar voice
Patient guide
Hearing loss, explained without the jargon
What the different kinds are, what causes them, what to watch for in a child, why ears ring, and how to keep a hearing aid alive through a Lahore summer.
The three kinds
Not all hearing loss is the same
Which kind you have decides what can be done about it, and the difference is often the difference between a treatment and a hearing aid.
Nerve hearing loss
Sensorineural
The hair cells in the inner ear, or the nerve behind them, no longer send the full signal to the brain. This is the common one: it covers age-related loss and noise damage. It is permanent, and it is what hearing aids are designed for.
Usually affects the high frequencies first, which is why speech sounds mumbled.
Blocked or blocked-up hearing loss
Conductive
Sound cannot get through the outer or middle ear to reach the inner ear. Wax, fluid behind the eardrum, an infection, a perforation, or a problem with the small bones. Often treatable, sometimes with nothing more than having the wax removed.
Sounds are quieter but still clear once they are loud enough.
Both at once
Mixed
A nerve loss with a conductive problem sitting on top of it. Common in someone with long-standing hearing loss who then gets an ear infection. The treatable part is treated, and the rest is managed with a hearing aid.
Both quieter and less clear.
Why it happens
The usual causes
- Getting older
- The most common cause by a distance. The hair cells that pick up high frequencies wear out first, which is why the first thing to go is the ability to tell consonants apart rather than the ability to hear at all.
- Noise
- Generators, factory machinery, workshop tools, traffic, loud music through earphones. Noise damage is cumulative and permanent, and it takes the 4 kHz region first, which leaves a distinctive notch on the audiogram.
- Ear wax
- Genuinely one of the most common reasons people arrive convinced they are going deaf. It is also the easiest to fix, which is why we look in your ear before doing anything else.
- Infections
- Repeated middle ear infections, especially in childhood, can leave lasting damage. An infection that keeps coming back is worth having looked at rather than waited out.
- Certain medicines
- Some antibiotics, some chemotherapy drugs and very high doses of aspirin can damage hearing. If your hearing changed after starting a new medicine, tell us and tell your doctor.
- Diabetes and blood pressure
- Both are common in Pakistan and both affect the small blood vessels that feed the inner ear. Hearing loss turns up earlier and more often in people with poorly controlled diabetes.
In children
What to watch for, by age
Hearing loss in a child is a language problem before it is a hearing problem. The early years are when speech is built, so waiting to see if they grow out of it costs more than the test does.
3 to 12 months
- Does not turn towards a sound or a voice
- Has not started babbling, or babbling has stopped
- Does not respond to their own name by about 12 months
1 to 2 years
- Very few words by two years old
- Does not follow a simple instruction without gestures
- Speech is much less clear than other children the same age
3 years and older
- Turns the television up loud
- Does not answer when called from another room
- Says what often, or watches your face very closely when you speak
- Is struggling at school, or has been called inattentive
- Speaks louder than the situation needs
Any one of these is a reason to book a test, not a reason to panic. Most children we test hear perfectly well, and the ones who do not are far better off found early.
Tinnitus
Why your ears ring
Tinnitus is hearing a sound with no source: ringing, buzzing, hissing, a high whine. Almost everyone experiences it briefly after a loud noise. When it stays, it is usually a sign that a frequency has gone missing from your hearing.
The most useful way to think about it is that the brain has turned up its own gain looking for a signal that stopped arriving, and what you are hearing is that gain. It explains why tinnitus so often sits at the same frequency as the dip in someone's audiogram, and why giving the brain that frequency back through a properly programmed hearing aid frequently quietens it.
It also explains why it is loudest at night. Tinnitus does not get worse in a quiet room; there is simply nothing else to hear.
Do not wait for these
- Tinnitus that pulses in time with your heartbeat
- Sudden hearing loss in one ear
- Ringing together with dizziness or loss of balance
- Tinnitus in one ear only, that started suddenly
Any of these should be seen quickly rather than booked for next month. Call us and say so, or see a doctor.
Looking after it
Keeping a hearing aid alive in Lahore
Heat, dust and humidity are what kill hearing aids in this city. None of these take more than a minute a day.
Wipe it every night, dry
A dry cloth or tissue, never water and never alcohol. Water is the single most common way a working hearing aid becomes a dead one.
Use a drying capsule
Keep the aid in its case overnight with a drying capsule or a dehumidifier jar. In a Lahore summer this is the difference between an aid that lasts years and one that fails in a season.
Take it out first
Before a shower, before wudhu, before hair oil, before spray. Put it in last when you get ready and take it out first when you undress.
Open the battery door at night
For battery models, leaving the door open lets moisture escape and stops the battery draining. Rechargeable models just go on the charger.
Change the wax guard
The small white filter at the tip blocks with wax and is the most common cause of an aid going quiet. Changing it takes seconds and we will show you how.
Bring it in every few months
A proper clean under magnification, a tube check, and a listening test. Most of what we see in the repair lab could have been prevented by this.
Find out what your own audiogram says
Reading about hearing loss only gets you so far. Half an hour with headphones on tells you exactly which sounds you are missing.