Hearing loss: symptoms, causes, treatment and when to see a doctor

The NHS says it is not always easy to tell if you are losing your hearing, and sometimes someone else notices before you do. RNID adds that hearing loss can happen gradually, so you might not notice it at first.

• Difficulty hearing other people clearly and misunderstanding what they say, especially in noisy places.

• Needing to ask people to repeat themselves.

• Listening to music or watching TV with the volume higher than other people need.

• Difficulty hearing on the phone.

• Finding it hard to keep up with a conversation.

• Feeling tired or stressed from having to concentrate while listening.

The NHS says to see a GP if you think your hearing is getting gradually worse, or if you have had treatment for an ear infection or earwax build-up but your hearing has not come back. You can sometimes get a free hearing test at some pharmacies and opticians.

It says to ask for an urgent GP appointment or get help from 111 if you have sudden hearing loss in one or both ears, your hearing has been getting worse over the last few days or weeks, or you have hearing loss along with other symptoms such as earache or discharge from the ear. It might not be serious, but it may need to be treated quickly.

The NHS says there are lots of possible causes and that it may be caused by something treatable or it may be permanent. RNID says hearing loss and deafness happen when sound signals do not reach the brain because of a problem in the hearing system. Causes include ageing, exposure to loud noise, genetics and ear conditions such as earwax, a perforated eardrum and ear infections.

The NHS advises not to self-diagnose and to see a GP.

RNID says there are two main types, and it is possible to have both, known as mixed hearing loss. Sensorineural hearing loss is caused by damage to the hair cells inside the inner ear, or the hearing nerve, or both. It makes it more difficult to hear quiet sounds and reduces the quality of sound you can hear. It is permanent, but can often be treated with hearing aids.

Conductive hearing loss happens when a problem with the ear, such as earwax or an ear infection, stops sound from passing through to the cochlea. Sounds become quieter and may sound muffled. It can be temporary or permanent depending on the cause.

The NHS says treatment depends on the cause. A GP may be able to treat the cause: an ear infection might be treated with antibiotics, and earwax might be treated with ear drops or removed. If the cause is not something a GP can treat, they may refer you to a hearing specialist for tests and treatment.

If you have permanent hearing loss, the NHS says a specialist will often recommend hearing aids, which make sounds louder and clearer, and some people need a hearing implant. It says the earlier you get hearing aids, the more you will get out of them, so do not wait until your hearing gets really bad.

The NHS says a GP can refer you to an NHS hearing aid provider. NHS hearing aids are provided free as a long-term loan, with free batteries, repairs and follow-up appointments, though there may be a charge to replace one you lose or break. NHS aids are usually the behind-the-ear type or, occasionally, receiver-in-the-ear. The NHS notes the waiting time for NHS hearing aids can sometimes be longer than for private treatment.

If you pay privately you may have a wider choice, including smaller models. The NHS says you can pay anything from £500 to £3,500 or more for a single hearing aid, so research typical costs, aftercare and batteries. It says adjusting to hearing aids can take a few weeks or months, with follow-up appointments to check progress.

The NHS says hearing loss can affect a child's speech development and progress at school, and can be harder to spot in babies. Its glue ear page lists signs of a hearing problem in a child: speaking loudly, being difficult to understand, asking people to repeat what they say, asking for the TV or music to be turned up loud, struggling to hear people far away, becoming easily distracted when people talk, and seeming tired or irritable because listening takes more effort. See a GP if you notice these.

Glue ear is where the middle part of the ear fills with fluid, causing temporary hearing loss. The NHS says it usually clears up within 3 months and is much more common in children, so a GP will often wait and see. If it lasts more than 3 months, the child may be referred for hearing tests. The two main hospital treatments are temporary hearing aids or grommets, small tubes placed in the ear, which usually fall out within 6 to 12 months.

The NHS suggests reducing background noise, facing people when they talk so you can see their mouth and expressions, asking people to speak more slowly and clearly or write things down, and asking a GP or specialist about devices such as telephone and TV amplifiers and flashing or vibrating alarms. It advises wearing ear protection around loud noise, not listening to music too loudly, and not putting fingers or cotton buds in the ears.

For earwax, the NHS says to put 2 to 3 drops of olive or almond oil in the ear, 3 to 4 times a day for 3 to 5 days, and see a nurse at your GP surgery if symptoms have not cleared after 5 days or the ear is badly blocked.

On the NHS, hearing loss is assessed by a GP and then by audiology or ENT, with hearing aids and implants provided through NHS services. Private audiologists offer hearing tests and a wider range of aids, usually for a fee. Whichever you choose, ask for a record of your hearing test so it can be shared with your GP.