Hearing loss: causes, red flags and when to get it checked

Hearing often fades so slowly that other people notice before you do. The NHS lists 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; trouble keeping up with a conversation; and feeling tired or stressed from the concentration listening takes.

It says hearing loss can affect a child's speech development and progress at school, and can be harder to spot in babies, with a checklist on GOV.UK to help notice the signs. For adults, RNID offers a free online hearing check that the NHS page points to.

The NHS pairs the pattern of symptoms with the likely cause, while warning against self-diagnosis.

RNID explains that sudden hearing loss can affect one or both ears, can happen instantly or over a few weeks, and may come with tinnitus or balance problems. If you lose hearing suddenly it advises contacting NHS 111 or your GP, noting it might not be anything serious but can be a medical emergency with a very short window for treatment. If you cannot reach either, go to your nearest emergency department, where an ENT specialist will test the degree and type of loss, and treatment may be as an outpatient or in hospital.

RNID lists possible causes of sudden hearing loss including earwax, ear infections, physical injury, side effects of medication, acoustic neuromas and Ménière's disease. The NHS adds that hearing loss that has been getting worse over days or weeks, or loss accompanied by earache or discharge, also deserves urgent help.

• Ask for an urgent GP appointment or get help from NHS 111 for sudden hearing loss in one or both ears.

• Seek the same urgent help if hearing has got worse over the last few days or weeks.

• Seek urgent help if hearing loss comes with earache or discharge, as the NHS advises; it might not be serious, but it may need treating quickly.

• Seek urgent advice for hearing loss with dizziness, a spinning sensation or new ringing in the ear, which the NHS ties to labyrinthitis or Ménière's disease.

• See a GP if your hearing is getting gradually worse, or if you have been treated for an ear infection or earwax but your hearing has not come back.

• Go to A&E if you cannot reach NHS 111 or a GP for sudden loss, as RNID advises, and if you develop facial weakness, severe headache, confusion or weakness in the limbs alongside the hearing change.

The clinician asks whether the loss is sudden or gradual, one ear or both, and whether there is pain, discharge, tinnitus, dizziness, recent infection, noise exposure, head injury or air travel. They ask about medicines, family history of deafness and occupational noise. An otoscope is used to look at the canal and eardrum, because wax, fluid, a perforation or infection can often be seen directly.

Simple tuning-fork tests may separate a problem in the ear canal or middle ear from one in the inner ear or nerve. If the cause is not something a GP can treat, the NHS says they may refer you to a hearing specialist for further tests, usually an audiogram that maps the quietest sounds you can hear at different pitches. Sudden loss, loss in one ear only or loss that is asymmetric normally prompts ENT review and sometimes an MRI scan.

The NHS says treatment depends on the cause. An ear infection might be treated with antibiotics, and earwax with ear drops or removal. For earwax, the NHS suggests putting 2 to 3 drops of olive or almond oil in the ear lying on your side, repeating 3 to 4 times a day for 3 to 5 days, and not using cotton buds or fingers. It says not to use drops if you have a perforated eardrum and to see a nurse at your GP surgery if symptoms have not cleared after 5 days or your ear is badly blocked.

For permanent loss a specialist will often recommend hearing aids, and some people need a hearing implant attached to the skull or placed deep inside the ear. Communication tactics the NHS lists include reducing background noise, facing people when they speak, asking them to speak more slowly and clearly or write things down, asking about telephone and television amplifiers, flashing or vibrating alarms and smartphone apps, and wearing ear protection around loud noise. It advises keeping music volume comfortable and not putting objects in the ears.

Some pharmacies and opticians offer free hearing tests, as the NHS notes. Private audiology is another route some people use for faster hearing aid fitting, but a sudden loss must still go through urgent medical channels.