Hearing Loss in Adults
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Common causes

  • External meatus blocked by wax
  • Presbyacusis
Audiology hearing test showing hearing loss
Audiology hearing test showing hearing loss. Image by by OpalMirror is licensed under CC BY-NC-SA 2.0

Sensorineural hearing loss


  • Loss of hair cells on cochlear as increase in age
  • Audiogram; High frequencies lost first, low frequencies stay in normal range, no increased air-bone gap
  • Usually noticed clinically after 60
  • Variability in degree of hearing loss and age of onset
  • No treatment to prevent worsening
  • Can cause significant social and work handicaps
  • Aural hearing aids used to improve hearing

Idiopathic hearing loss

  • Sudden deterioration of hearing. Ear may feel blocked
  • Tinnitus and vertigo can be present
  • Thought to be due to viral infection of vascular event
  • Rx; bed rest and vasodilators

Noise exposure

Either due to sudden or prolonged exposure
Commonly occupational exposure; should wear ear protectors if exposed to more than 90dB
Tinnitus and ‘wooly ears’ experienced after exposure
Audiogram; loss of very high frequencies first
Rx; aural hearing aids

Inflammatory diseases

Ototoxic drugs

  • Systemic aminoglycosides
  • Cytotoxic agents
  • Salicylates and quinine cause reversible damage
  • Can cause hearing loss and imbalance as can affect cochlear and/or labyrinth.


  • Rare
  • Tumours of CNVIII
  • Causes progressive unilateral hearing loss and tinnitus
  • Investigate with MRI
  • Rx; surgical removal

Conductive hearing loss

Classified according to the anatomical location of the pathology
External auditory meatus

  • Wax; removal by cotton buds usually impacts wax and worsens obstruction.
    • Rx; soften using sodium bicarbonate TDS or hydrogen peroxide then syringe or remove by blunt hook.
  • Keratosis obturans; accumulation of desquamated skin which can erode the canal
  • Exostoses; bony growths which occlude external meatus. Common in swimmers. No treatment needed unless causing problems.


  • Perforation; traumatic or due to chronic otitis media.
    • Rx; either heal naturally or tympanoplasty carried out

Middle ear

  • Discontinuity of ossicles
  • Otosclerosis;
    • New bone growth in middle ear causes fusion of stapes footplate to oval window
    • Causes conductive hearing loss in young adults
    • Ear drum looks normal on examination
    • Often a family Hx
    • Pregnancy worsens symptoms
    • Rx; surgery or hearing aid


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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