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Hearing care in the UK
The basics

Here we provide policymakers and commissioners with a quick overview of the ear, hearing, hearing loss and hearing care in the UK. 

Anatomy of the ear

Watch this video for a quick recap of the anatomy of the ear.

This video is by Armando Hasudungan[1].

Hearing

Hearing is the ability to detect sounds in everyday life and listening is the ability to interpret them - e.g. follow conversations in a noisy environment.

Loudness
(intensity)“This is often measured in terms of hearing level (dB HL) - louder sound, higher number”
and
pitchFrequency is measured in kilohertz (kHz) - higher pitch, higher number”
frequency are two basic properties of sound. People with a hearing loss might experience difficulties
  • with quieter sounds or pitch, or both 
  • in a quiet or noisy environment, or both

Hearing Loss

Hearing loss can be

  • unilateral or bilateral
  • temporary or permanent, and
  • stable or progressive.
SensorineuralSometimes referred to as presbycusis, sensorineural hearing loss is when the tiny sensory hairs in the ear wear down – often as a natural part of the ageing process. The effect of this is different for everyone. For some people it means that although they can hear most sounds, they seem muffled or distorted; some can hear well when it’s quiet but struggle when there is lots of background noise; some struggle to hear particular sounds; or some people can’t hear any sounds at all. Whilst sensorineural hearing loss is a normal part of ageing, we don’t have to accept it. Research shows that over 40% of over 50-year-olds suffer some form of hearing loss, whilst over 70% of over 70-year-olds do. The majority of people with presbycusis can have their hearing and quality of life enhanced with simple forms of hearing support, such as a hearing aid.
and
conductiveThis can happen when certain sounds can no longer pass freely into your ear. It can happen because of a blockage, for example from earwax or something trapped in your ear. It can also be because of a medical condition like an ear infection, or ruptured eardrum. Conductive hearing loss can cause sounds to become quieter and can often be treated and cured with medical management.
are the names given to the two main types of hearing loss.
  • Sensorineural hearing loss accounts for more than 90% of all hearing loss in adults. In most cases it is permanent and there is no medical or surgical treatment [2]. Age-related hearing loss is the main cause of sensorineural hearing loss [3].
  • Conductive hearing loss accounts for 8% of hearing loss in adults. There is often a mechanical cause - e.g. impacted wax, perforated eardrum [4]. It is usually temporary but can be permanent. There are medical and surgical treatments for certain forms of conductive hearing loss.  

People that have a sensorineural and conductive hearing loss are said to have mixed hearing loss. Read more about the causes of hearing loss.

The ears first become less sensitive to higher pitched sounds – e.g. children and female voices. This can make conversations difficult to follow and communication more difficult. This can have a negative impact on quality of life but is often missed because people think about hearing loss in terms of “loudness” and not “pitch.” This early stage of age-related hearing loss might wrongly be perceived as “slowing down with age”.

The ears then become less sensitive to quieter sounds, and people might turn-up the volume on the TV. This is the more stereotypical and identifiable sign of hearing loss – i.e. not hearing quieter sounds. However, at this stage people are likely to have difficulty with both loudness and pitch.

Unsupported hearing loss can increase the risk of social isolation, loneliness, depression and reduce quality of life. Read more about the impact of hearing loss.

It is therefore important that reported hearing difficulties are assessed and not dismissed just because a person can hear a doctor (GP) in quiet room for example.

Ear and hearing examination

In the vast majority of cases a hearing care professional can examine and manage people with hearing loss without the need for a medical opinion from a GP or ENT. A typical ear and hearing examination will include:

  • History and symptoms, including an assessment of communication needs
  • Otoscopy - examination of ear health
  • Audiometry
  • Tympanometry where clinically indicated.

An audiologist needs to record history and symptoms, perform audiometry and other tests before it is possible to understand an individual's hearing ability and address their communication needs.

Audiometry tests hearing acuity. It measures sensitivity to pitch and loudness under specified conditions. The test produces an audiogram. The audiogram compares an individual's hearing sensitivity to a reference standard of 'average hearing'. It can also help establish whether somebody has sensorineural, conductive or mixed hearing loss. The audiogram does not define whether an individual will benefit from a specific intervention.

The audiologist can also assess the ear using other tests - e.g. tympanometry and otoscopy - to help confirm the type and cause of hearing loss and decide whether a referral to a medical colleague is required.

Updates 

Originally published:  2016

Reviewed: September 2020

Next review date: September 2021

Info: The original resource was updated as part of the NCHA website upgrade in 2020.

References and notes

[1] Armando Hasudungan, anatomy, ear overview. Permission granted via email 10 September 2020 , https://armandoh.org/

[2] Yueh, B. et al. 2003. Screening and Management of Adult Hearing Loss in Primary Care: Scientific Review. JAMA: Journal of the American Medical Association, 289(15), pp. 1976-1985.

[3] Zahnert T. The Differential Diagnosis of Hearing Loss. Deutsches Ärzteblatt International. 2011;108(25):433-444. doi:10.3238/arztebl.2011.0433;

Yueh, B. et al. 2003. Screening and Management of Adult Hearing Loss in Primary Care: Scientific Review. JAMA: Journal of the American Medical Association, 289(15), pp. 1976-1985.

[4] Zahnert T. The Differential Diagnosis of Hearing Loss. Deutsches Ärzteblatt International. 2011;108(25):433-444. doi:10.3238/arztebl.2011.0433.