Hearing loss management

Symptoms of hearing loss can come on gradually and may not be picked up straight away. Symptoms are often different for children and adults.

Symptoms of hearing loss in adults may include:

• Difficulty understanding words, especially in a noisy or crowded environment
• Difficulty following conversations
• Difficulty hearing people on the phone, or when they are not facing you
• Sounds may seem muffled
• Difficulty hearing the letters of the alphabet that aren’t vowels
• Frequently asking people to repeat themselves, or to speak more slowly, clearly, and loudly
• Not hearing the phone or doorbell frequently
• Needing to turn up the volume on the television or radio
• Avoiding some social settings because of difficulty hearing others
• Ringing in the ears (tinnitus)

Symptoms of hearing loss in children may include:

• Not startling at loud noises, or turning their head towards sounds
• Starting to speak later than other children their age
• Unclear speech compared to other children their age
• Not understanding or following instructions as well as other children their age
• Asking people to repeat themselves
• Wanting the TV or computer game volume up high
• Not answering when spoken to
• Not paying attention in class, or falling behind at school

Common causes of conductive hearing loss include:

• Ear wax buildup
• Ruptured eardrum
• Infection in the middle or outer ear (otitis media or otitis externa)
• Growth of abnormal bone in the middle ear (otosclerosis)
• Fluid in the middle ear (glue ear)

Common causes of sensorineural hearing loss include:

• Aging (presbycusis)
• Congenital disorders (a disorder you are born with)
• Infections
• Exposure to loud noise (noise-induced hearing loss)
• Head injuries
• Meniere’s disease, an inner ear condition that causes vertigo, and hearing loss
• Some chemicals or medicines

Hearing loss in children

Most hearing loss in children is caused by glue ear (otitis media with effusion). Your consultant will make a diagnosis and tell you whether a grommet procedure is necessary.

Hearing loss in adults

Impacted ear wax, ear wax build-up and infections are the most common causes of hearing loss in adults. We use microsuction, a gentle suction device, to remove wax from your ears. Other treatments include ear drops and help with managing the symptoms of tinnitus (ringing in the ears).

If you have permanent hearing loss that can’t be helped surgically or medically, hearing amplification could be the answer. The benefits of a hearing aid versus surgery is that it can be placed in the ear and taken out again if you want to try another device or use it for a trial period.

Tinnitus, vertigo, and balance

Tinnitus and hearing loss often go hand in hand. The condition can be caused by age, middle ear infections, earwax, glue ear, exposure to loud noise, and head injuries. Some medical conditions, such as Meniere’s disease and otosclerosis, can also cause dizziness.

If treatments such as micro suction to remove ear wax haven’t improved your tinnitus, we offer a holistic approach to help you cope with the symptoms. With tinnitus training therapy, we’ll work out why you have the condition and counsel you on how to live with it.

Our expert and experienced audiologists and ENT surgeons work closely together to provide a one-stop shop for patients with hearing loss.

Who does the clinic treat?

The joint ENT and Audiology clinic diagnoses and treats both adults and children over the age of three. You’ll be seen quickly by the right specialist in the right place, with plenty of time to go through everything.

What happens at the clinic?

At the joint ENT and Audiology clinic, you will often be seen by two experts on the same day. We’ll diagnose what’s causing your hearing loss and suggest treatments or procedures.

First, you’ll have a hearing assessment with one of our audiologists who pass on the results to an Ear, Nose and Throat surgeon. The ENT surgeon will then continue the consultation and recommend the right treatment.

You’ll also enjoy continuity of service and will see the same audiologist and ENT surgeon for any follow-up care.

If you prefer, you can make an appointment just to see an audiologist. Our audiologists specialise in caring for patients with hearing loss, tinnitus, vertigo, and balance issues.

What tests will I have?

At the clinic, your consultant will ask you about your symptoms, general health, medical history and some questions about your work and lifestyle to determine the level of noise you are exposed to. They will perform a thorough examination of your ear (otoscopy) to check for possible causes of your hearing loss, such as an infection or ear wax. You will then have a hearing test and a test to measure the pressure in your ears.

Hearing test (pure-tone audiometry)

During this hearing test, you will sit in a soundproof room wearing headphones. You will hear a series of sounds over a range of pitches and will be asked to press a button every time you hear a sound. A hearing test is painless and lasts for about 15 minutes.

Pressure test (tympanometry)

This test uses a device called a tympanometer to measure air pressure in your middle ear. Tympanometry is a quick and painless procedure that can diagnose conditions such as middle ear infections (otitis media), fluid in the middle ear and a burst eardrum (perforated tympanic membrane).

How long is the consultation?

If it’s a joint clinic, you will be with the audiologist and ENT surgeon for about half an hour. It takes about 20 minutes to go through your history and have any investigative tests.

How is a diagnosis made?

Your consultant will make a diagnosis based on your symptoms, physical examination, medical history, and test results.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it’s where your consultant will ask you about your symptoms, perform a physical examination, order any necessary tests, provide a diagnosis, and discuss possible treatments.

Your first consultation is also where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible during your time with us, so please ask your consultant any questions you may have.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your symptoms and diagnosis.

Non-surgical treatments include:

• Hearing aids — are used to treat permanent hearing loss and work by making sounds clearer and louder. You can have your hearing aid fitted at the hospital through our private hearing aid dispenser
• Antibiotics — may be prescribed to treat an ear infection
• Ear drops — you may be asked to use ear drops to soften your ear wax and make it easier to remove
• Ear wax removal — we use microsuction to gently remove ear wax and check your ears afterwards using a state-of-the-art microscope
• Tinnitus treatment — includes brain retraining to change how your brain reacts to tinnitus, sound relaxation devices and sleep hygiene techniques to aid sleep
• Diet and exercise advice — vertigo and dizziness can be triggered by certain foods such as caffeine, salt, sugar, and alcohol. Some exercises can also help to relieve vertigo
• Vestibular (balance) rehabilitation — involves learning exercises you can do at home to improve symptoms such as vertigo and dizziness

Surgical treatments include:

• Myringoplasty for perforated eardrums
• Grommet insertion to treat glue ear
• Cochlear implants for severe hearing loss

Myringoplasty

A myringoplasty is a surgical procedure to repair a ruptured (burst) eardrum. The eardrum, or tympanic membrane, is a thin piece of tissue between your middle and outer ear that vibrates in response to sound waves and helps you to hear. Sometimes, your eardrum can rupture due to trauma, infection, or sudden loud noises. In some cases, a ruptured eardrum can heal by itself, but sometimes you may need surgery to repair it. A myringoplasty can be performed on children or adults.

What happens during the surgery?

A myringoplasty is usually performed under general anaesthetic but can occasionally be done using local anaesthetic.

During myringoplasty:

1. Your consultant makes a small incision (cut) behind your ear to access your eardrum
2. The area around the rupture is prepared for the graft to attach
3. Your surgeon may take tissue from another part of your ear, or use synthetic material to make a graft which is placed over the hole in your eardrum
4. Your ear is packed with cotton packing and a bandage is applied to your ear

A myringoplasty normally takes between 30 and 90 minutes.

How long will I need to stay in hospital?

Most myringoplasties are performed as a day case, meaning you should be able to go home later the same day.

Are there any risks involved?

A myringoplasty is a very safe procedure with a high success rate, but like all types of surgery, there is a small risk that complications may occur. Your consultant will explain all the possible risks and complications to you before your surgery. Please discuss any questions or concerns with your consultant and ensure that you are fully informed before your procedure.

Possible risks and complications of any surgery include:

• Infection
• Bleeding
• Blood clots
• Adverse reactions to the anaesthetic

Possible risks and complications of myringoplasty include:

• Infection in the ear
• Dizziness
• Tinnitus
• Hearing loss
• Graft failure
• The eardrum may rupture again

How soon will I recover?

It normally takes around two weeks to fully recover from a myringoplasty. Depending on the job you do, adults should expect to be off work for between one and two weeks. Children will need to take around a week off school. Your healthcare team will give you instructions to follow during your recovery and arrange a follow up appointment to see your consultant around three weeks after your surgery.

Grommet surgery (myringotomy)

Glue ear (otitis media with effusion) is a common condition in children under seven, where fluid builds up in the middle ear. This fluid thickens, causing hearing loss. Glue ear may get better without treatment, but in some cases, your child may need surgery to insert grommets.

Grommets are tiny plastic tubes that allow air to pass through the middle ear, keeping the pressure in the ear equal and preventing fluid from building up. They are not painful.

Grommets immediately improve your child’s hearing and help to prevent recurrent ear infections. They usually fall out by themselves after around six to 12 months. The hole left by the grommets normally heals quickly after the grommets fall out. In some cases, fluid may build up in the ear again and further grommet surgery may be needed.

What happens during the surgery?

Grommet surgery is performed under general anaesthetic, which means your child will be asleep for the procedure and won’t remember anything. During the surgery, your consultant will make a small incision (cut) in the eardrum and remove the fluid. The grommets are then placed in the hole in the eardrum through the ear canal. Grommet surgery normally takes around 15 minutes, but your child will be away from the ward for around an hour as they will spend some time in recovery, waking up after their surgery.

How long will my child need to stay in hospital?

Grommet surgery is normally carried out as a day case, meaning your child should be able to go home the same day.

Are there any risks involved?

Grommet insertion is normally a very safe procedure, but like all types of surgery, there is a small risk that complications may occur. Your consultant will explain all the possible risks and complications to you before your child’s surgery. Please discuss any questions or concerns with your consultant and ensure that you are fully informed before the procedure.

Possible risks and complications of any surgery include:

• Infection
• Bleeding
• Blood clots
• Adverse reactions to the anaesthetic

Possible risks and complications of grommet surgery include:

• Ear infection, which may need to be treated with antibiotic drops
• Grommets may become blocked, needing ear drops to unblock them
• The hole in the eardrum may fail to heal after the grommets have fallen out, which may need to be repaired with surgery (myringoplasty)
• The grommets may fall out too soon or rarely, can move into the middle ear
• The grommets may not fall out by themselves, and your child may need to have a minor procedure to remove them
• Your child may experience mild discomfort when exposed to cold air or water. This is because the hole in the grommet exposes the sensitive lining of the middle ear
• The grommets may trigger inflammation, causing pain and discharge, and may need to be removed. Occasionally, the eardrum may become hardened and calcified
• Rare complications include hearing loss, tinnitus, and dizziness

How soon will my child recover?

Mild oozing and bleeding from the ear are normal for a day or two after surgery. You can clean any discharge from the outer ear, but do not put anything, such as a cotton bud, inside the ear. Your healthcare team will give you instructions about how to care for your child after grommet surgery and arrange any follow-up appointments.

Most children can return to school after a day or two and are back to normal activities after around 48 hours.

Cochlear implants

A cochlear implant is an electronic device that works by stimulating your auditory nerve to send sound signals to your brain. It is made up of an internal part that needs to be implanted by a surgeon and an external part that sits behind your ear like a hearing aid. Cochlear implants may be suitable for you if you have severe hearing loss, or if hearing aids don’t work well for you.

What happens during the surgery?

Cochlear implant surgery is performed under general anaesthetic, which means you’ll be asleep for the procedure. The surgery normally takes around two hours.

During cochlear implant surgery:

1. Your consultant will make a small incision behind your ear
2. A small hole is made in your mastoid bone (the part of your skull just behind your ear)
3. The electrode is then guided through the hole to the cochlea
4. An internal processor is placed between the muscle and bone behind your ear
5. The incision is stitched closed so that the internal device is under your skin

How long will I need to stay in hospital?

Cochlear implant surgery is normally performed as a day case, meaning you’ll probably go home the same day.

Are there any risks involved?

Cochlear implant surgery is a generally safe procedure, but like all types of surgery, there is a small risk of complications. Your consultant will explain all the possible risks and complications to you before your surgery. Please discuss any questions or concerns with your consultant and ensure that you are fully informed before your surgery.

Possible risks and complications of any surgery include:

• Infection
• Bleeding
• Blood clots
• Adverse reactions to the anaesthetic

Possible risks and complications of cochlear implant surgery include:

• Worsening or loss of existing hearing
• Inflammation of the membranes surrounding the brain and spinal cord (meningitis). This is extremely rare and occurs in less than 1 in 1,000 people with cochlear implants
• The implant may not work
• Bleeding
• Facial paralysis
• Infection at the surgical site
• Infection of the implant
• Dizziness
• Balance problems
• Changes in your sense of taste
• New or worsened tinnitus
• Spinal fluid leak

How soon will I recover?

Recovery from cochlear implant surgery is usually within one to two weeks. After around two to four weeks, when you have had time to heal from your surgery, you will return to your audiologist to have the implant activated and receive the external part of the device.

Rehabilitation after cochlear implant surgery

Following cochlear implant surgery, you will need to have regular rehabilitation sessions with an audiologist to train your brain to recognise and process sounds through the implant. In some cases, rehabilitation may also involve seeing a speech therapist.

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about hearing loss management, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in January 2024. Next review due January 2027.

• Hearing loss NHS
• Deafness and hearing loss World Health Organization
• Types of Hearing Loss Centers for Disease Control and Prevention
• Types of Hearing Loss Johns Hopkins Medicine