Hearing loss and deafness in adults

Both ears or just one ear can be affected by hearing problems to different extents. If someone’s hearing is only slightly impaired, they might not understand things like whispering.

If they have moderate hearing loss, they can only hear loud sounds. And if they have severe hearing loss, they can only hear very loud sounds. Deaf people can only feel sounds and noises as vibrations.

Depending on the cause, they may have other symptoms such as tinnitus, pressure in the ears, or dizziness.

Deafness in adults can have a number of causes. Many people’s hearing gets worse as they get older. It is not entirely clear what causes age-related hearing loss. Factors that probably play a role include normal aging processes, many years of exposure to noise, and genes.

Loud sounds can damage the eardrum, the middle ear and particularly the inner ear. This kind of damage is usually temporary, but some hearing loss may be permanent, like after an acoustic trauma (injury to the inner ear due to very loud noise). Chronic hearing loss can also be caused by lower volume sounds if you're exposed to them regularly.

Hearing problems can also be caused by earwax blocking the ear canal, chronic middle ear infections, infections such as meningitis, sudden hearing loss, or a condition called otosclerosis, where the ossicles (tiny bones in the middle ear) get stuck in place. Less common causes include skull injuries, side effects of medication, and tumors.

The World Health Organization (WHO) estimates that around 430 million adults worldwide have hearing problems. Around a third of adults over 65 have hearing loss. There are currently no exact figures for Germany. Experts suspect that about 16 to 25 out of 100 adults in Germany have hearing problems, but that figure is higher in older people.

Some adults were born deaf or hard-of-hearing, and some have had the problem since childhood. But most people only develop hearing problems in older age. Age-related hearing loss typically affects both ears to the same degree, and the problem tends to gradually get worse over time. At first, it is only difficult to hear quiet and high-frequency sounds. Some people may start having trouble hearing and understanding what others are saying, particularly if there's a lot of background noise, like in a restaurant or on the bus. Then their hearing often gets gradually worse over the years.

Other things may cause your hearing to get worse faster, or even all at once – like injuries or 'sudden hearing loss' (also known as sensorineural or idiopathic hearing loss). Depending on the cause, the hearing loss might only be temporary. But it is usually permanent in older people.

Hearing loss also affects your quality of life. A lot of people feel increasingly restricted and isolated, and some become more and more withdrawn.

Hearing loss can increase the risk of depression, and also increases the risk of accidents and falls.

Some studies suggest that impaired hearing can lead to a loss of mental performance in the long term.

If it is thought that you might have hearing loss, a doctor will examine your ears in detail. That is usually done at an ear, nose and throat (ENT) practice. The ENT doctor first takes a very close look at your ears. Using a special device (an otoscope), they will look for things like an inflammation or a build-up of earwax in the ear canal or middle ear. They will also ask when and how you noticed the hearing loss, and whether you have any other symptoms.

Various tests need to be done to find out what type of hearing problem you have and how severe it is. In “subjective" tests, you have to actively join in yourself. For instance, in one test certain sounds are played through headphones. They are very quiet at first and then get louder, and you have to say when you can hear them. In another test, the doctor will strike a tuning fork and place it on your head and in front of your ears in a specific order. You then tell the doctor when you can no longer hear the sound. These tests allow doctors to find out whether the hearing problem is worse in one ear than in the other, and also whether it is caused by a problem in the middle ear or the inner ear.

“Objective" tests are done using special devices to measure activity in the sensory cells or in the brain. In one type of objective test, quiet clicking sounds are played. The sensory cells in the inner ear not only pass the signals on to the brain, but also reflect sound waves back into the ear canal. Special microphones record them there. These measurements can be used to see how good someone’s hearing is.

Sometimes, other examinations like CT or MRI scans are needed. They help to find the exact cause.

It is important that people who work in very noisy environments (e.g. with loud machines or airplanes) wear proper ear protection. Workplaces often have special noise protection rules to prevent hearing loss.

Outside of work, it's important not to expose your ears to very loud music, for instance through headphones. At loud concerts or in clubs you can protect your hearing using earplugs. Even if your ears are only exposed to loud noise for a short time (for example, when doing DIY), it's still important to use proper ear protection.

It is sometimes possible to treat the cause of a hearing problem, such as a middle ear infection. But hearing loss is usually permanent in adults, especially in older people.

Hearing aids are then an option. They amplify sound waves that are too quiet, muffle sound waves that are too loud, and direct them into the inner ear. That makes it easier to join in conversations and social activities again.

If the sensory cells in your ears are so badly damaged that you can hardly – or no longer – hear anything at all, cochlear implants (inner ear prostheses) can help.

Hearing problems make it difficult to communicate. That can cause hearing-impaired or deaf people to increasingly avoid contact with others. Some people feel excluded from many areas of social life, and some feel anxious and down.

Other people in your life may not realize that you have trouble hearing, or how severe the problem is. Then they may wrongly assume that you are being ignorant, arrogant or strange, or even think that you have dementia.

If hearing problems get worse, relatives and friends also have to learn how to deal with it. The communication difficulties can lead to tension and frustration on both sides.

To improve quality of life again, it's first important to recognize and accept that your hearing has got worse. The next step is to seek medical advice and look into suitable treatment options. Although it does take patience and practice to get used to hearing aids and cochlear implants, they can really help in many situations.

Other technical aids like headphones, light signals and wireless transmission systems can also make daily life easier. Lip reading and sign language can improve communication too. Family, friends and colleagues can also help you to understand them by following simple conversation rules.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

Support groups are good places to meet other people who know about the symptoms, feelings and practical problems associated with hearing loss. As well as giving you a chance to share experiences, they often offer further support through information or events.

The German-language website of the National Contact and Information Office for the Promotion of Support Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen, NAKOS) includes a database of support addresses.