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Health condition · Clinically reviewed

Hearing loss, from conductive causes to cochlear implants.

Up to 12 million people in the UK are affected. Most causes are treatable, and where hearing cannot be restored, it can almost always be helped.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, ENT UK, BSA and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including sudden SNHL pathways, cochlear implant referral and BAHA options.

Key facts

Hearing loss at a glance.

The essentials, in plain English - what it is, the types, and how it is treated in the UK today.

  • How common

    Up to 12 million adults in the UK have some degree of hearing loss - one of the most prevalent long-term conditions.

  • Three broad types

    Conductive (outer or middle ear), sensorineural (cochlea or nerve) and mixed - each has its own investigations and treatments.

  • Age-related

    Presbycusis is the biggest single cause - typically bilateral, progressive and worst at high frequencies.

  • Sudden SNHL

    Sudden sensorineural hearing loss is an emergency - urgent ENT review and oral steroids within 2 weeks give the best chance of recovery.

  • Cognition link

    Untreated hearing loss is the largest modifiable risk factor for dementia in the Lancet Commission - hearing aids may reduce that risk.

  • Restoration options

    Hearing aids for most, cochlear implants for severe-to-profound, BAHA for conductive or single-sided loss - all on the NHS with clear criteria.

Why this guide matters

A stepped plan, not a shrug.

Hearing loss is common, often treatable and rarely something to "just live with". The three points below shape everything else on this page.

  • Find the cause first

    Conductive causes like earwax, glue ear or otosclerosis are often reversible. Sensorineural causes need a very different plan.

  • Treat sudden loss urgently

    Sudden sensorineural hearing loss responds best to steroids started within 2 weeks. It is an ENT emergency, not a routine referral.

  • Restore, do not just tolerate

    Modern hearing aids, cochlear implants and BAHA devices restore a great deal - use them, and escalate if they stop being enough.

How the diagnosis is made

From first noticed to a clear plan.

The steps a UK GP, audiologist or ENT surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Careful history

    Onset, progression, one ear or both, tinnitus, vertigo, noise exposure, ototoxic drugs, family history and trauma - each pattern points somewhere different.

  2. 02

    Assessing

    Otoscopy and tuning-fork tests

    Rinne and Weber tests at the bedside separate conductive from sensorineural loss and guide next steps.

  3. 03

    Assessing

    Pure-tone audiometry

    The core test - air and bone conduction across frequencies, plotted as an audiogram to grade and type the loss.

  4. 04

    Confirming

    Tympanometry and speech testing

    Middle-ear pressure, speech discrimination and, in children or unclear cases, OAE and ABR.

  5. 05

    Confirming

    MRI IAM for asymmetry

    Any asymmetric sensorineural loss, pulsatile tinnitus or single-sided deafness needs an internal auditory meatus MRI to exclude an acoustic neuroma.

  6. 06

    Planning

    Selective CT and genetics

    CT temporal bone for suspected otosclerosis, cholesteatoma or trauma - genetic panel for children and inherited patterns via specialist commissioned services.

  7. 07

    Planning

    Specialist ENT and audiology

    The plan is built jointly - hearing aids, surgery, implants or a period of watchful monitoring depending on what the tests show.

Typical timeline: audiology within weeks, ENT and MRI for red-flag features on urgent pathways.

Symptoms

What hearing loss actually feels like.

A gradual creep for most, a sudden drop for some - and a set of features that mean "get seen today" rather than "next week".

  • Gradual hearing loss

    Turning the TV up, missing words in noisy rooms, mishearing consonants - the classic presbycusis pattern.

  • Sudden hearing loss

    A loss of hearing over minutes to 3 days - a medical emergency needing urgent ENT review within 2 weeks.

  • Muffled or blocked ear

    Often earwax, glue ear or middle-ear fluid - conductive causes that are usually treatable.

  • Tinnitus

    Ringing, buzzing or hissing that often accompanies hearing loss - worth investigating rather than ignoring.

  • Vertigo or imbalance

    When hearing loss is joined by spinning or unsteadiness, think Meniere disease, vestibular neuritis or acoustic neuroma.

  • Asymmetric loss

    One ear worse than the other, especially with tinnitus, needs an MRI of the internal auditory meatus to exclude a tumour.

  • Difficulty in noise

    Struggling to follow conversation against background noise is one of the earliest and most disabling symptoms.

  • Red flag - sudden SNHL

    Sudden unilateral sensorineural loss is an ENT emergency - urgent oral prednisolone gives the best chance of recovery.

Treatment

How hearing loss is treated in the UK.

Fix the fixable, restore what can be restored with aids or implants, and rehabilitate the rest with a proper multidisciplinary plan.

  • Treat the underlying cause

    Earwax microsuction, ear-infection treatment, grommets for glue ear, myringoplasty for perforation, stapedectomy for otosclerosis - fix what can be fixed first.

  • Sudden SNHL - urgent steroids

    Oral prednisolone 60 mg daily for 7 days, plus intratympanic steroid injections where indicated. Start within 2 weeks of onset.

  • Hearing aids

    The mainstay for most sensorineural loss - modern digital aids, custom fitted by an audiologist, on the NHS or private.

  • Cochlear implant

    For severe-to-profound loss when hearing aids no longer help - a surgically implanted device with speech-processor programming.

  • BAHA and bone-anchored devices

    A bone-conduction implant for conductive, mixed or single-sided loss - useful when a conventional hearing aid is not enough.

  • Middle-ear implants

    Selective specialist devices for patients who cannot tolerate a hearing aid but do not meet cochlear implant criteria.

  • Auditory brainstem implant (ABI)

    A commissioned specialist option for neurofibromatosis 2 or severe cochlear malformation, where the cochlear nerve is absent.

  • Rehabilitation and support

    Tinnitus management, aural rehabilitation, CBT, lip-reading classes and BSL - hearing loss is a communication condition as well as a medical one.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, audiologist or ENT surgeon knows your ears and your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Hearing loss in adults: assessment and management (NG98).

  • NICE. Cochlear implants for severe to profound deafness (TA566).

  • ENT UK. Consensus statement on sudden sensorineural hearing loss.

  • British Society of Audiology. Recommended procedures.

  • Lancet Commission on dementia prevention, intervention and care (2020, 2024 update).

Red flags

When hearing loss needs urgent attention.

Most hearing loss is managed in audiology or ENT clinics. These are the situations that need faster, and different, action.

  • Sudden sensorineural hearing loss

    A drop of 30 dB or more across 3 contiguous frequencies within 72 hours - an ENT emergency, needing urgent steroids and MRI IAM.

  • Asymmetric hearing loss

    One ear consistently worse than the other, especially with unilateral tinnitus - MRI IAM is needed to exclude an acoustic neuroma.

  • Hearing loss with vertigo

    Consider Meniere disease, labyrinthitis or an acoustic neuroma - each has a very different pathway.

  • Neurological signs

    Facial weakness, double vision, ataxia or a suspected stroke need immediate hospital assessment, not an audiology appointment.

  • Head injury or barotrauma

    New hearing loss after trauma or diving raises the possibility of ossicular disruption, perilymph fistula or temporal-bone fracture.

  • Discharging or painful ear

    Chronic discharge with hearing loss can signal cholesteatoma - a surgical condition that needs early ENT review.

  • Ototoxic exposure

    Aminoglycosides, platinum chemotherapy, high-dose aspirin or loop diuretics - hearing should be monitored before, during and after treatment.

  • Occupational noise exposure

    Persistent industrial noise exposure with new hearing loss is a RIDDOR-reportable condition - occupational health should be involved.

  • Delayed language in a child

    Any concern about a child's hearing or speech development is a same-day audiology referral, not something to watch and wait on.

Living with it

A common condition, with real answers.

Four things that make the biggest difference day to day - wearing aids, shaping your environment, protecting the hearing you have, and escalating when aids stop being enough.

A quiet reminder

Small habits compound - so do small delays.

The earlier the aid, the easier the adaptation. Untreated hearing loss is one of the biggest modifiable risk factors for dementia.

  1. 01 Aids

    Wear them every day

    Hearing aids work best when worn consistently - the brain adapts over weeks, not minutes.

  2. 02 Rooms

    Design your environment

    Face the person you are speaking to, reduce background noise, and ask for hearing loops in public spaces.

  3. 03 Protect

    Look after the hearing you have

    Custom ear protection at gigs and worksites, sensible volume with headphones - and protect a good ear if the other is affected.

  4. 04 Escalate

    Do not accept "you'll get used to it"

    If hearing aids stop helping, ask about cochlear implants or BAHA - modern criteria are broader than most patients realise.

Frequently asked

Everything we get asked about hearing loss.

Quick answers on types, sudden loss, dementia risk, MRI, cochlear implants and BAHA.

  • What are the main types of hearing loss?

    There are three - conductive (outer or middle ear, often treatable), sensorineural (cochlea or nerve, usually managed with aids or implants) and mixed. Presbycusis (age-related sensorineural loss) is by far the most common.

  • Is sudden hearing loss really an emergency?

    Yes - sudden sensorineural hearing loss is an ENT emergency. If a loss of 30 dB or more develops within 72 hours, urgent oral prednisolone within 2 weeks of onset gives the best chance of recovery. An MRI of the internal auditory meatus is arranged to exclude a tumour.

  • Does hearing loss cause dementia?

    The Lancet Commission on dementia lists untreated hearing loss as the single largest modifiable risk factor. It does not cause dementia on its own, but treating it - typically with hearing aids - may reduce risk and clearly improves quality of life.

  • Will I need an MRI?

    Usually only if the hearing loss is asymmetric, one-sided or accompanied by pulsatile tinnitus or vertigo. In those cases an MRI of the internal auditory meatus is standard, to look for an acoustic neuroma or other retrocochlear cause.

  • When are cochlear implants offered?

    When hearing aids no longer give enough benefit in severe-to-profound sensorineural loss, tested against strict NICE criteria (TA566). Referral is via a specialist cochlear implant centre. Single-sided deafness now also qualifies in adults and children.

  • What is a BAHA, and who is it for?

    A bone-anchored hearing aid transmits sound through the skull to the working cochlea. It is offered for conductive or mixed hearing loss that a conventional aid cannot help, and for single-sided deafness where the other ear has normal hearing.

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