Symptoms of hearing loss

Gradual hearing loss often goes unnoticed for a long time. Those affected get used to the changes in their hearing and unconsciously adapt their behaviour. But this is precisely where the risk lies: if hearing loss is detected too late, it is not only hearing that suffers, but also social, psychological and cognitive well-being. Find out how hearing loss can manifest itself, what the typical symptoms are and why early diagnosis is so important.

What is hearing loss, and why does it often go unnoticed?

Hearing loss refers to a permanent impairment of hearing in one or both ears. The causes are varied: ageing (presbycusis), disorders of the middle or inner ear, head injuries, ototoxic medication or infections. Sudden acute hearing loss can also lead to a severe reduction in hearing.

The problem is that many forms of hearing loss develop very slowly. Often, those affected do not initially notice that their hearing is deteriorating. They turn up the volume on the radio, avoid conversations in noisy environments or interpret misunderstandings as concentration problems. The longer hearing loss remains untreated, the more difficult it becomes to compensate for it later on.

Typical symptoms of early-stage hearing loss

Common signs are subtle but persistent everyday occurrences. Conversations are perceived as tiring, particularly when there is background noise. Understanding speech in group situations or when people speak softly becomes increasingly difficult. This does not always have to result in hearing loss. A common but often overlooked problem is speech discrimination loss. Those affected can hear all sounds and noises, but have difficulty understanding spoken words.

It is also typical that high frequencies are the first to be perceived less clearly. These include, for example, the doorbell ringing, birdsong or children’s voices. Often, these sounds are no longer consciously perceived at all. The feeling that people are speaking unclearly or ‘mumbling’ is also an early indication of possible hearing loss.

Many people affected turn up the volume on the television or only use their ‘good ear’ when making phone calls. In conversations, they often ask for clarification or nod in agreement, even though they haven’t understood what was said. These coping strategies allow for a normal daily life for a while, but in the long term lead to a loss of natural hearing ability.

Accompanying symptoms and warning signs

In addition to the actual hearing loss, other symptoms often occur which can provide clues as to the cause or severity. These include:

Tinnitus (ringing in the ears)

A buzzing or hissing sound in the ear can occur alongside or independently of hearing loss. Tinnitus is often a sign that the inner ear or neural processing in the brain is impaired.

Pressure in the ear

A dull pressure or the feeling of a ‘blocked’ ear may indicate a ventilation problem in the middle ear, e.g. in the case of a middle ear infection or a dysfunction of the Eustachian tube.

Dizziness

The vestibular system in the inner ear is closely linked to the auditory system. Disorders of the inner ear can lead to vertigo, unsteadiness when walking or visual disturbances. A medical examination is particularly important in such cases.

Earache

or noises Inflammation or infections in the ear often lead to pain or pulsating noises. If there is a discharge of pus or a fever, you should see a doctor immediately.

Sudden hearing loss

A sudden, unilateral hearing loss is a medical emergency. This is usually sudden sensorineural hearing loss, which must be treated promptly with cortisone. The earlier treatment begins, the better the chances of success.

Causes of hearing loss, from ageing to illness

Hearing loss can have many causes. In older people, so-called age-related hearing loss (presbycusis) is particularly common. In this condition, sensory cells in the inner ear gradually die off, usually without any identifiable trigger. Genetic factors or general ageing processes can also influence this progression.

In younger people, exposure to noise, inflammation or injury are often the triggers. These include middle ear infections, acoustic trauma caused by sudden loud noises or long-term exposure to noise, for example at work or from loud music.

Certain medications can also damage hearing. So-called ototoxic drugs (e.g. some antibiotics, chemotherapeutic agents, diuretics) can lead to inner ear damage in individuals with a predisposition. Close consultation with the treating doctor is essential in such cases.

Other causes include viral infections (e.g. mumps, measles, COVID-19), circulatory disorders in the inner ear (e.g. ear infarction) or brain disorders that disrupt sensory processing. Head injuries involving the skull or changes in pressure, e.g. when diving or flying, can also lead to hearing loss.

Risk groups and special cases

Children

Hearing loss is particularly critical in children, as hearing plays a central role in language development. Frequent middle ear infections, fluid in the middle ear or congenital hearing problems should be identified and treated at an early stage. Symptoms may include slurred speech, a lack of response when spoken to or watching the television at an unusually high volume.

Older adults

In older people, gradual age-related hearing loss is widespread. It leads to difficulty understanding speech, particularly in social situations or in the presence of background noise. Many affected individuals delay visiting an ENT specialist, even though modern hearing aids are now discreet and effective.

Hearing aid users

Anyone who already uses a hearing aid should be alert to sudden changes. A deterioration in hearing despite using a hearing aid may indicate a technical problem or a medical cause. Regular hearing tests are important here too.

Tinnitus patients

Tinnitus is not the same as hearing loss, but it often occurs alongside it. Anyone suffering from ringing in the ears should have their hearing professionally tested to rule out possible damage to the inner ear.

When to see a doctor? Typical signs indicating the need for further investigation

You should see a doctor promptly if you experience the following symptoms:

• Hearing loss in one or both ears
• Sudden hearing loss
• Persistent tinnitus or new ringing in the ears
• Dizziness or balance problems
• Persistent pressure or pain in the ear
• Difficulty hearing conversations or in crowds

The first point of contact is usually an ENT specialist. In many cases, a hearing care professional can also provide an initial assessment and advise you to see a doctor. You should not hesitate, particularly if symptoms appear suddenly, as early treatment can be crucial to the success of the therapy.

How the diagnosis of hearing problems works

The assessment begins with a detailed consultation (medical history), during which the patient is asked about their symptoms, accompanying symptoms, medication use and any family history of hearing problems. This is followed by a hearing test, usually consisting of pure-tone audiometry and speech audiometry.

For further investigation, tympanometry (middle ear function), otoacoustic emissions (inner ear) and imaging techniques such as computed tomography or magnetic resonance imaging may be used. Laboratory tests may also be carried out if an infection is suspected.

The doctor then makes a well-founded diagnosis and recommends further steps: medical treatment, hearing aids, observation or referral to a specialist.

What to do if hearing loss is diagnosed?

Treatment depends on the cause and severity. For infections, for example, antibiotics or corticosteroid-based medication are used. For inner ear problems such as sudden hearing loss, corticosteroids are usually administered to reduce inflammation.

In cases of permanent hearing loss, hearing aids are prescribed. Modern devices are powerful, discreet and can be individually adjusted. Hearing training may also be beneficial to specifically improve speech comprehension. In complex cases, ENT specialists, audiologists, neurologists and GPs work together to find a solution.

Lifestyle also plays a role: avoiding noise, maintaining good blood pressure control, being mindful of medication use and having regular check-ups all help to preserve hearing in the long term.

Recognising the symptoms of hearing loss - the self-test

In today’s fast-paced world, we are often surrounded by a flood of different sounds. It is easy to overlook the subtle signs of early-stage hearing loss. Hearing loss is a widespread problem that can affect people of all ages. It is important to recognise the symptoms early so that appropriate measures can be taken in good time. Test yourself - these simple everyday situations provide initial clues:

1. Silence
testFind a quiet room with no background noise. Close your eyes and listen for the soft sounds around you. Can you hear birdsong, the ticking of a clock or other subtle sounds?

2. Telephone test
: Have a conversation on the telephone, preferably in a quiet environment. Can you follow the conversation effortlessly, or do you frequently have to ask the other person to repeat themselves?

3. Conversation test:
Have a conversation in a noisy environment, e.g. in a restaurant or café. Do you find it difficult to follow the conversation, or can you understand the words clearly?

4. TV test
: Watch TV as you normally would. Ask a friend or family member to stand in another room and assess the volume. If the volume is clearly too loud for others, this may be a sign of early hearing loss.