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Hearing Loss

  • What is hearing loss?

    Hearing loss

    Hearing loss refers to reduced hearing from a disorder in one or more parts of the ear and can affect people of all ages. Sound waves usually move through the external ear canal and vibrate the eardrum. The vibrations then pass through the middle ear bones to the cochlea (the part of the inner ear for hearing). The cochlear sensory cells receive the vibrations and send signals to the auditory nerves (hearing nerves) and to the brain, which recognises these signals as sounds. Disruption in this natural process can lead to hearing problems and hearing loss.

    According to the Ministry of Health’s National Health Survey 2010, the prevalence of mild hearing loss among Singapore residents aged 18 – 69 years in at least one ear was 26.5%. Mild hearing loss refers to the inability to hear sounds that are softer than about 25 decibels for adults and 15 decibels for children.

    Hearing loss can be classified into 3 types:

    Types of hearing loss

    • Conductive hearing loss – It occurs when there are disruptions in the passage of sound waves from the outside environment to the cochlea. For example, this type of hearing loss can result from ear wax in the outer ear, infections of the outer or middle ear, and eardrum perforations.
    • Sensorineural hearing loss – This type of hearing loss occurs when the inner ear structures or the nerve pathways to the brain are damaged. This is commonly seen in presbycusis where age-related gradual hearing loss occurs in both ears.
    • Mixed hearing loss – This is where both conductive and sensorineural hearing loss occur in the same ear.
  • Normal hearing ranges from 0 – 20 decibels. If you have normal hearing, you should be able to hear sounds as soft as human breathing.

    Causes that lead to hearing loss include:

    • Ear wax – This can completely obstruct the outer ear, resulting in conductive hearing loss
    • Infections – Bacteria can cause infections in the outer, middle and inner ear. The outer ear is also commonly affected by fungus and the inner ear by viruses. As the middle ear is connected via the Eustachian tube to the nose, nasal infections can also affect the middle ear.
    • Loud noises – Over prolonged periods of time, loud noises can gradually damage inner ear cells. This can happen during work or even during leisure activities. Accidental exposure to explosive blast sounds can also damage the ear almost immediately.
    • Ageing – Inner ear cells and nerve structures degenerate as one ages.
    • Medications – These include certain antibiotics, diuretics and cancer treatment drugs.
    • Trauma – The eardrum can be damaged accidently, such as during cleaning of the ear with cotton swabs. Severe blunt injury to the head may also indirectly damage ear structures.
    • Hereditary – Genetic causes may result in hearing loss among family members.

    Preventing hearing loss

    To help prevent noise-induced hearing loss, protect your ears by limiting the duration and intensity of your noise exposure, such as using earplugs or earmuffs in the workplace. Consider having your hearing tested if you work in a loud environment. You can also avoid risky recreational activities such as snowmobiling, hunting, using power tools, or listening to rock concerts. Turning down the music volume or taking breaks from the noise can also prevent ear damage.

  • Hearing loss can occur suddenly or gradually, and it can affect 1 or both ears. Symptoms include:

    • Difficulty understanding what other people are saying, especially with background noises
    • Speaking louder than normal
    • Often asking for conversations to be repeated
    • Withdrawal from conversations
    • Associated ear symptoms, such as earache and ear discharge due to ear infections
    • Tinnitus (ringing in the ears)
    • Vertigo (spinning sensations)

    You should contact your doctor when you experience hearing loss that interferes with your daily activities, deteriorating hearing loss, sudden hearing loss and hearing loss together with other ear symptoms such as pain, discharge, blockage and vertigo.

  • If you are experiencing hearing loss symptoms, your doctor may assess you as follows:

    Physical examination

    The doctor will inspect your ear for obvious causes of hearing loss, such as earwax build-up, inflammation from an infection and structural ear problems. The doctor may perform a tuning fork test in the clinic. This simple test that uses two-pronged tuning forks that make a sound when struck. This evaluation can help the doctor detect hearing loss and help determine the type of hearing loss.

    Pure tone audiometry

    In this test conducted by an audiologist, sounds at different speech frequencies will be directed to each ear via earphones. You will be asked to indicate the softest sound that you can hear at each frequency.

    Speech test

    Also known as the word recognition test, a speech test assesses your ability to understand speech with and without background noises. Speech may sound unclear if your speech discrimination is poor. Speech test scores can help predict the usefulness of a hearing aid.


    This test measures middle ear pressures. It can help your doctor determine if you have fluid in your middle ear, middle ear infection, a perforation in the tympanic membrane, or a problem with the Eustachian tube.

  • The treatment of hearing loss depends on the root cause. A doctor will assess your condition and suggest the most suitable treatment based on the cause of hearing loss.

    Earwax / foreign body

    Earwax build-up or a foreign object in the ear canal can be removed by an ear, nose and throat (ENT) surgeon often facilitated by the use of a microscope.

    Ear infections

    Ear infections in the ear canal are treated by the cleaning of pus or infected material, and application of topical medications. Middle ear infections are usually treated by appropriate oral medications.

    Conductive hearing loss

    Conductive hearing loss can often be restored by surgery to reconstruct the conducting hearing mechanism. For example, a perforated eardrum can be surgically repaired to improve hearing as well as to prevent infections.

    Sensorineural hearing loss

    If sudden sensorineural hearing loss occurs, it can possibly be restored by medication if treated early. Longer-term sensorineural hearing loss is usually permanent due to irreversible damage to the hearing cells in the inner ear. If the hearing loss is not too severe, there are usually adequate residual hearing cells left for hearing aids to work well.

    However, significant loss of inner ear hearing cells results in severe to profound hearing loss where amplification of sounds by hearing aids does not work. Such patients may benefit from cochlear implantation. A cochlear implant is a small electronic device surgically implanted to restore hearing by directly stimulating the hearing nerve. Hence, unlike hearing aids, it does not rely on viable hearing cells in the inner ear to work.

    Proper diagnosis is crucial to determine the most suitable hearing loss treatment by an ENT specialist. With the aid of medical equipment, our team of experienced specialists and nurses will work together to come up with an accurate diagnosis and an effective treatment plan for your condition.

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  • In children, hearing loss can affect speech and language development as well as school performance. In adults, it can affect one’s performance at work. With constant communication difficulties, it can have a considerable negative effect on quality of life.

    In addition:

    Mental health problems

    People who have hearing loss, especially older adults, may record feelings of depression and isolation because of difficulty in making a conversation.

    Cognitive decline

    Hearing loss is also linked with cognitive impairment and decline. Treating hearing loss can create a positive impact on cognitive performance, especially in memory.

    Gut problems due to stress

    Being deprived of hearing can be really stressful. Digestive problems like diarrhoea, indigestion and constipation are common symptoms of stress and anxiety.

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