Diagnosis
Diagnosis and Investigation
Born Deaf
It is essential that children who are born deaf or prelingually deafened are identified as early as possible. Hearing loss from birth is not an intellectual disability but is a huge disadvantage for that child’s learning and development. Intervention in terms of hearing aids or cochlear implants, additional special needs, education and monitored development can be planned and delivered.
Hearing loss can be identified at birth by what has come to be known as the UNHS process. This is not automatically done in Ireland. However, since September 2008, DeafHear has introduced screening for infants up to six weeks old. Please click here to visit the Deafhear.ie website.
The Hearing Mechanism
This section focuses on the medical aspects of hearing loss.
Like most of the human body the hearing process is very complicated.
There are essentially 5 stages in the hearing process.
1 Outer ear (lobe and ear canal)
2 Middle ear (ear drum & ossicle bones)
(Hearing loss at stages 1 & 2 is Conductive)
3 Inner ear (cochlea) The semi-circular canals in the diagram are a vital part of the balance mechanisms of the body
4 Auditory nerve
(Hearing loss at stages 3 & 4 is Sensorineural – sometimes the term nerve deafness is used.)
5 Processing of sound in the brain – sometimes the phrase Central Deafness is used
Problems at any stage of the process will cause hearing loss. There are two main categories of hearing loss (Conductive and Sensorineural) with greater or lesser possibilities of correction and issues facing the person with the loss. The effect of a similar hearing loss can be markedly different on people in terms of volume loss, quality loss, tinnitus, balance, vertigo, etc
Sudden or Gradual Loss
A Hearing Loss can come about suddenly, most likely because of an accident or illness, but more normally comes slowly over a period of time.
A sudden loss is very traumatic. The need to consult with your doctor, get hearing tests done and progress through the investigative process tends to happen naturally, just like the treatment of any Illness.
A slow loss of hearing, possibly caused by exposure to loud noise over an extended period of time, or indeed related to the ageing process, is more difficult to spot.
Early Warning Signs
It is easy to feel that the room is too noisy, that people are mumbling or have strange accents – or you just feel you are tired. Indeed it is possible not to notice that you are hearing less well than before and, worst of all, many of us are prepared to put up with a little inconvenience for many years until we are forced to deal with the issue because it is beginning to have a big impact.
The following are a list of things that give early warning of a possible loss:
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Do you have difficulty understanding what is being said in noisy places, such as pubs or restaurants, even though other people manage to have conversations?
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When you are talking to people in a group, is it hard to keep up with the conversation? Do you perhaps say your piece at the wrong time?
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Do you often feel excluded from group conversations?
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Do you find it tiring to listen to conversations because you have to concentrate hard?
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Do you often have difficulty hearing on the telephone?
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Do you find radio difficult to follow?
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Do other people think your television is too loud but you cannot hear it properly if it is turned down?
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Can you hear music but cannot follow the lyrics (words) clearly?
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Do other people seem to mumble rather than speak clearly to you?
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Do people often have to repeat things for you before you understand what they say?
Any of the above may indicate some degree of hearing loss and it is best to check it out. In the first instance visit your doctor. He/she will know about your general health and will have a reasonable knowledge of both hearing loss and the medical system for investigation. Dealing with hearing loss is not a DIY job - you need help.
If you think you are being foolish, RNID provide an anonymous self test, both online (click here) or by telephone( 0044 844 800 3838 – note this is a UK number). It may help to build up confidence to visit your doctor. There is also an excellent online facility at betterhearing.
Your doctor may well determine what the problem is and may in some cases be able to help you or, more often, refer you to an audiology department in a hospital or private audiologist or ENT (Ear, Nose & Throat) specialist, if you prefer.
Audiology & Hearing Tests
The purpose of initial audiology testing is to establish some facts, to document the extent and nature of your hearing loss.
These tests will include:
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Listening to you describing the impact of the loss on your life
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Asking you questions
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Examining your ears for blockages or infection
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Checking the pressure in your middle ear
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Doing a hearing test on what you can hear or feel. Here are examples of audiograms.
How To Read Your Audiogram
Example Audiogram Audiogram Hearing Loss Levels 
Normal hearing
Mild hearing loss
Moderate hearing loss
Severe hearing loss
Profound hearing loss
The above audiogram represents the hearing of an individual with normal hearing in the low frequencies (pitch) sloping to a severe high frequency hearing loss in the left ear and a moderate to severe hearing loss in the right ear.
The blue Xs indicate the thresholds for the left ear and the red Os indicate the thresholds for the right ear
The softest sound you are able to hear at each pitch is recorded on the audiogram. The softest sound you are able to hear is called your threshold. Thresholds of 0-25 dB are considered normal (for adults). The audiogram above demonstrates the different degrees of hearing loss Doing a speech discrimination test will assess how well you are processing the sound that you hear.
