Adult Hearing Loss: Evaluation, Types and Treatment Options

The hearing pathway has three main parts: outer ear (pinna + canal), middle ear (tympanic membrane + three ossicles: malleus, incus, stapes) and inner ear (cochlea and auditory nerve).

Conductive hearing loss: impaired sound transmission at the outer or middle ear. Air-conduction threshold is elevated, bone conduction normal (significant air-bone gap).

Sensorineural loss: damage at the cochlea or auditory nerve. Both air- and bone-conduction thresholds are elevated similarly; small gap (<10 dB).

Mixed type: conductive + sensorineural together. Example: chronic otitis + presbycusis.

Severity by pure-tone average (PTA): mild 26-40 dB, moderate 41-55 dB, moderately severe 56-70 dB, severe 71-90 dB, profound >90 dB. This classification drives treatment selection. Related service: our otology and hearing centre.

Presbycusis (age-related sensorineural loss): the most common adult cause. Starts in the 50s with elevated thresholds at high frequencies (4-8 kHz). Speech consonants (s, t, f) become harder to understand — especially in noise. Usually symmetric.

Noise-induced hearing loss (NIHL): occupational (construction, factory, musician, military) or recreational (hunting, motorcycling, loud music) origin. Classic 4 kHz "notch" on the audiogram.

Ototoxic medications: aminoglycoside antibiotics (gentamicin, amikacin), cisplatin, high-dose aspirin/NSAIDs, loop diuretics, quinine. Typically bilateral, symmetric, beginning at high frequencies.

Otosclerosis: fixation of the stapes to the oval window. Ages 30-50, twice as common in women as men. Pregnancy accelerates progression. Usually bilateral. Corrected by stapedotomy.

Chronic otitis / cholesteatoma: middle-ear inflammation with ossicular erosion. Otoscopy reveals perforation, discharge or retraction pocket.

Sudden sensorineural hearing loss (SSNHL): a loss of ≥30 dB across 3 contiguous frequencies within 72 hours. EMERGENCY — 72-hour steroid start gives a 50-65% recovery chance.

Acoustic neuroma: vestibular schwannoma of CN VIII. Unilateral progressive sensorineural loss + tinnitus. Diagnosis by MRI.

Meniere's disease: episodic vertigo + fluctuating sensorineural loss + tinnitus + aural fullness. Begins at low frequencies.

Pure-tone audiometry (PTA): foundation of hearing testing. Air- and bone-conduction thresholds 250 Hz - 8 kHz. Extended high-frequency audiometry (10-16 kHz) is sensitive for early presbycusis and ototoxicity screening.

Speech audiometry: speech understanding performance. Speech Reception Threshold (SRT) and Word Recognition Score (WRS) matter — especially for patients reporting "I can hear words but miss the meaning".

Tympanometry: middle-ear pressure, tympanic membrane compliance and eustachian tube function. Type A normal, B flat (effusion or perforation), C negative pressure.

Acoustic reflex: stapedius contraction; helps distinguish conductive and sensorineural loss.

Otoacoustic emissions (OAE): outer hair cell function. Used for newborn screening and ototoxicity monitoring.

Auditory brainstem response (ABR): when retrocochlear pathology is suspected (acoustic neuroma) and in patients unable to cooperate with awake testing.

Imaging: unilateral progressive sensorineural loss or asymmetric tinnitus → MRI (for acoustic neuroma). Chronic otitis / cholesteatoma → temporal bone CT.

Surgery has an important role in conductive loss. The choice depends on pathology.

Myringotomy + ventilation tube: for chronic otitis media with effusion. Short-term (6-12 month) effect; permanent tubes are placed in selected adults.

Tympanoplasty: closure of tympanic membrane perforation with graft (usually fascia or cartilage). Hearing typically improves 10-20 dB.

Mastoidectomy: for chronic otitis media + cholesteatoma. The bony bed is cleared of infection. Canal-wall-up (type 1) and canal-wall-down (type 2) variants exist.

Stapedotomy: gold standard for otosclerosis. Partial stapes removal + prosthesis (piston). Hearing improves in 85-95% of patients — marked single-session improvement.

Ossiculoplasty: ossicular chain disruption (chronic otitis, trauma) reconstructed with PORP/TORP prostheses.

Bone-conduction implants (BAHA, Bonebridge): in single-sided deafness or when air-conduction aids are unsuitable due to chronic otitis, sound is delivered directly to the inner ear.

Cochlear implant: for severe-to-profound sensorineural loss (PTA >70 dB) and limited benefit from conventional aids. Post-lingual deaf adults achieve speech comprehension of 60-90%. For the related clinical reference, see hearing loss page.

Hearing aids are the foundation of treatment — especially for age-related sensorineural loss. Modern digital devices have advanced dramatically: speech-in-noise enhancement, Bluetooth connectivity, app control, automatic program switching.

Style options: behind-the-ear (BTE — most powerful, for severe loss), receiver-in-canal (RIC — often preferred for high-frequency loss), completely-in-canal (CIC — cosmetically invisible but smaller battery and limited features).

Proper fitting: gain is programmed to the patient's specific audiogram. Real-ear measurement (REM) verifies real-world performance. Two to three follow-ups in the first weeks are needed.

Adaptation period: average 4-6 weeks. Patients initially hear their own voice differently, noisy environments are uncomfortable, weather and colds change device behaviour. Patient persistence and regular follow-up are key.

Bilateral fitting: in bilateral loss, separate aids for each ear are recommended (binaural fitting). It outperforms unilateral fitting on sound localisation, speech-in-noise comprehension and cognitive load.

For pricing transparency, please contact our clinic — model + technology level + individual needs determine the personalised quote.

One of the most important hearing-science findings of the last decade: untreated hearing loss is an independent and modifiable risk factor for dementia. The Lancet Commission on Dementia 2024 showed midlife hearing loss treatment can reduce dementia risk by 8%.

Mechanisms: increased cognitive load ("listening effort"), reduced social interaction and isolation, underuse and atrophy of auditory brain regions, depression and reduced physical activity.

Clinical implication: everyone over 50 with hearing concerns should undergo audiometry. Early hearing-aid use (during mild-moderate stages) may reduce dementia risk; midlife device initiation is most beneficial.

Social impacts: untreated hearing loss has marked negative effects on marriage, work performance and especially phone use / video meetings. It reduces productivity and quality of life. We share patient experiences on our patient testimonials.