Understanding hearing loss: types, symptoms, causes and treatment
In This Article
Introduction
Hearing loss affects approximately 3.6 million Australians — that is around one in six people — making it one of the most common health conditions in the country. Despite its prevalence, many people wait an average of seven years before seeking help. Often this is because hearing changes develop so gradually that they are easy to dismiss, attribute to other people's mumbling, or simply push to the back of the mind.
If you have been asking people to repeat themselves more frequently, struggling in noisy restaurants, or noticing that the television volume keeps creeping up, you are not alone. These are among the most common early signs that hearing has changed.
Understanding hearing loss — its types, causes, symptoms, and the support available — is the first step toward better hearing health. At Hearing Care on the Sunshine Coast, qualified hearing aid audiometrist Linda Whittaker brings over 20 years of experience helping Queenslanders understand and manage their hearing health. As a member of the Australian College of Audiology (ACAud), Linda emphasises that early identification and professional assessment are key to maintaining quality of life and staying connected with the people and activities you value.
Understanding hearing loss
Hearing loss occurs when any part of the auditory system — from the outer ear to the auditory nerve — is damaged or no longer functions as it should. The result is a reduced ability to detect sounds, understand speech, or distinguish between different frequencies.
How the hearing system works
Sound travels through several key structures before you perceive it as recognisable audio:
- Outer ear — collects sound waves and funnels them through the ear canal
- Middle ear — the eardrum and three tiny bones (ossicles) amplify and transmit sound vibrations
- Inner ear (cochlea) — converts vibrations into electrical signals
- Auditory nerve — carries those signals to the brain for interpretation
Hearing loss can occur when any part of this pathway is affected by damage, disease, obstruction, or the natural ageing process.
Measuring hearing loss
Audiometry measures hearing loss in decibels (dB), indicating the volume at which you can reliably detect sounds. Results are plotted on an audiogram showing your hearing thresholds across a range of frequencies.
Classification Threshold range **What You Might Notice** ———————– ———————– ———————– Mild 26–40 dB Difficulty with soft speech in noisy environments
Moderate 41–55 dB Regular speech becomes hard without amplification
Moderately severe 56–70 dB Louder speech is needed; groups are challenging
Severe 71–90 dB Very loud speech or amplification required
Profound 91+ dB Little to no functional hearing without assistance ———————————————————————–
Types of hearing loss
Hearing loss is categorised based on which part of the auditory system is affected. Identifying the type is essential for determining the most appropriate management approach.
Sensorineural hearing loss
Sensorineural hearing loss is the most common type, accounting for approximately 90% of all cases. It occurs when the inner ear (cochlea) or the auditory nerve pathways to the brain are damaged.
The cochlea contains thousands of tiny hair cells that convert sound vibrations into electrical signals. These cells can be damaged by ageing, noise exposure, certain medications, viral infections, or other factors. Once damaged, cochlear hair cells do not regenerate — which is why sensorineural hearing loss is typically permanent.
Common characteristics:
- May affect certain frequencies more than others (high frequencies are usually affected first)
- Can make sounds seem muffled or unclear
- Speech understanding in background noise is often particularly difficult
- May be accompanied by tinnitus
Common causes: natural ageing (presbycusis), prolonged noise exposure, ototoxic medications, viral infections, genetic factors, head trauma.
Conductive hearing loss
Conductive hearing loss occurs when sound cannot efficiently travel through the outer or middle ear to reach the cochlea. Unlike sensorineural hearing loss, it often has a treatable or medically reversible cause.
Common characteristics:
- Sounds seem quieter or muffled
- Your own voice may sound unusually loud (particularly with earwax blockage)
- Tends to affect all frequencies fairly equally
- May respond to medical treatment or surgical intervention
Common causes: earwax buildup (cerumen impaction), ear infections, fluid in the middle ear (glue ear), perforated eardrum, otosclerosis (abnormal bone growth in the middle ear).
Mixed hearing loss
Mixed hearing loss involves both a sensorineural and a conductive component simultaneously. A person might have age-related inner ear changes (sensorineural) alongside a current ear infection or earwax blockage (conductive). Treating the conductive component can improve overall hearing, though the sensorineural component generally remains.
Auditory processing difficulties
Some people have normal hearing sensitivity on an audiogram but still struggle to understand speech — particularly in noisy environments or when multiple people are talking. This reflects differences in how the brain processes auditory information rather than damage to the ear itself. Assessment and management for auditory processing difficulties is a specialist area; your hearing health professional can advise whether referral is appropriate.
Common causes of hearing loss
Hearing loss can develop from a wide range of factors, from natural processes to preventable environmental exposures.
Age-related hearing loss (presbycusis)
Presbycusis is the gradual hearing loss that develops as part of natural ageing. It is the most common cause of sensorineural hearing loss in adults over 50. The cochlea's delicate hair cells deteriorate over time, blood flow to the inner ear changes, and the auditory nerve may show age-related changes.
Presbycusis typically affects both ears equally and progresses gradually. High-frequency sounds — children's voices, birdsong, and consonant sounds like "s", "f", and "th" — are usually affected first. This is why people with age-related hearing loss often report they can hear someone speaking but cannot make out what is being said.
Noise-induced hearing loss
Noise-induced hearing loss results from exposure to loud sounds, whether from a single extremely loud event (acoustic trauma) or prolonged exposure to elevated noise levels over time. Sounds above 85 decibels can cause hearing damage with extended exposure.
High-risk contexts in Queensland: construction, mining, agriculture, manufacturing, entertainment venues, recreational shooting, motorsports, and personal listening devices at high volumes.
The damage accumulates over time. Even if there are no immediate effects, repeated exposure to loud noise gradually damages cochlear hair cells. Once damaged, these cells do not regenerate. Many Queenslanders work or have worked in industries where noise exposure is significant — which is why this cause of hearing loss is particularly relevant in regional and coastal communities like the Sunshine Coast.
Medical conditions
Several health conditions can affect hearing:
- Meniere's disease — fluid imbalance in the inner ear, associated with episodes of vertigo, tinnitus, and fluctuating hearing
- Otosclerosis — abnormal bone growth in the middle ear that impedes the movement of the ossicles
- Acoustic neuroma — a benign tumour on the auditory nerve that can cause gradual one-sided hearing loss or sudden hearing loss
- Chronic ear infections — repeated infections can leave scarring or structural damage
Some general health conditions can affect circulation to the inner ear. Speak with your GP about how any conditions you have may relate to hearing health.
Ototoxic medications
Over 200 medications are known to be potentially ototoxic, meaning they can damage inner ear structures or the auditory nerve. Common examples include certain antibiotics (particularly aminoglycosides), some chemotherapy drugs (platinum-based compounds), high doses of aspirin, and some loop diuretics.
Not everyone who takes these medications will experience hearing changes, and the clinical benefits often outweigh the risks. If you are prescribed medication known to be ototoxic, your healthcare provider may recommend periodic hearing monitoring to detect any changes early.
Genetic and congenital factors
Some people are born with hearing loss or carry genetic predispositions that make them more susceptible to hearing damage. Genetic hearing loss may be present at birth or develop progressively across the lifespan. A family history of early-onset hearing loss may indicate a genetic component worth discussing with your GP.
Physical trauma
Head injuries, skull fractures, or direct trauma to the ear can result in hearing loss. The extent and permanence of trauma-related hearing changes depend on the nature and severity of the injury. Some cases improve with time or medical intervention; others result in permanent change.
Recognising the signs
Hearing loss often develops gradually, making it easy to miss or attribute to other causes. Recognising the early signs matters because earlier intervention generally leads to better outcomes.
Communication challenges
- Frequently asking people to repeat themselves or saying "what?" in conversation
- Difficulty following conversations when multiple people are talking
- Struggling to understand speech when you cannot see the speaker's face
- Finding telephone calls challenging, particularly with unfamiliar voices
- Mishearing words or responding inappropriately due to misunderstanding
- Trouble hearing women's and children's voices (which tend to be higher-pitched)
- Speech sounding muffled even when loud enough
Environmental listening challenges
Restaurants, cafes, and social gatherings with background noise often become exhausting or frustrating. Cars, group conversations, worship services, and meetings where you are not close to the speaker may all become more difficult. If you find yourself withdrawing from social situations that were once enjoyable, this is worth noting — it is one of the most common patterns associated with unaddressed hearing changes.
Media and technology behaviours
- Turning up the television or radio to levels that others find too loud
- Using subtitles or closed captions more frequently
- Difficulty hearing doorbells, phone rings, or alarm clocks
- Struggling to hear clearly at cinemas or theatres
Physical symptoms
- Tinnitus — ringing, buzzing, hissing, or other sounds in the ears not produced by an external source
- Sensation of fullness or pressure in the ears
- Ear pain or discomfort (which may indicate infection or another medical issue requiring attention)
- Dizziness or balance problems, particularly with inner ear conditions
Listening fatigue
The cognitive effort required to fill the gaps in conversation when hearing is reduced is significant. Many people with unmanaged hearing changes describe feeling mentally drained after social interactions, even without fully realising they have been working harder than usual to understand speech. This listening fatigue is real and well recognised.
How hearing loss is assessed
In Australia, you do not need a GP referral to book a hearing assessment with a qualified hearing health professional. You can self-refer.
A comprehensive hearing assessment typically includes:
Case history discussion — your clinician will ask about your hearing concerns, when you first noticed changes, situations where you find hearing difficult, medical history, medications, noise exposure history, and family history of hearing loss.
Otoscopy — a visual examination of your ear canals and eardrums, checking for earwax, signs of infection, eardrum health, and structural concerns.
Pure tone audiometry — the standard hearing test, measuring your thresholds across a range of frequencies through headphones (air conduction) and via a bone vibrator behind the ear (bone conduction).
Speech audiometry — testing how well you understand spoken words at various volumes, providing real-world communication insight.
Tympanometry — a brief, painless test of middle ear function.
Results discussion — your clinician will explain your audiogram, what the results mean for your daily communication, whether referral is recommended, and what management options are available.
A comprehensive assessment typically takes 45 to 60 minutes. It is completely non-invasive.
Treatment options overview
The right approach to managing hearing loss depends on its type, degree, and cause, as well as your lifestyle and communication needs.
Medical and surgical treatments
Some types of hearing loss respond directly to medical intervention. Earwax can be professionally removed. Ear infections are treated with antibiotics or ear drops. Perforated eardrums may heal spontaneously or require surgical repair. Otosclerosis can be addressed with a surgical procedure called a stapedectomy. Middle ear fluid may be managed with pressure equalisation tubes.
If assessment identifies a medically treatable cause, your clinician will refer you to the appropriate medical specialist. In many cases, addressing the underlying cause can improve or restore hearing partially or completely.
Hearing aids
Hearing aids are the primary management approach for sensorineural hearing loss. Modern hearing aids are sophisticated medical devices that amplify sound selectively based on your specific hearing loss pattern. They do not restore normal hearing, but when well-fitted, they can make a meaningful difference to communication and daily life.
Hearing aids come in a range of styles — from behind-the-ear (BTE) and receiver-in-canal (RIC) models to smaller in-the-canal (ITC) and completely-in-canal (CIC) devices — and across a range of technology levels. Features vary by model and manufacturer, and what suits you will depend on your degree of hearing loss, manual dexterity, lifestyle, and listening priorities.
What to expect from the fitting process:
A well-fitted hearing aid requires professional assessment, programming to your specific audiogram, and follow-up fine-tuning based on your real-world experiences. Your hearing health professional will help you work through the adjustment period.
The adjustment period:
When you first start wearing hearing aids, sounds may initially seem different from what you expect. Your brain needs time to relearn how to process sounds it has not been receiving clearly, sometimes for years. Most clinicians recommend starting by wearing hearing aids in quieter environments and gradually increasing wearing time. Many people who persist through the adjustment period report improvements in communication and day-to-day hearing. Individual results vary. A qualified hearing care professional can discuss what you might expect based on your specific audiogram and history.
Cochlear implants
For people with severe to profound sensorineural hearing loss who receive limited benefit from hearing aids, cochlear implants may be an option. Unlike hearing aids (which amplify sound), cochlear implants bypass damaged cochlear hair cells and directly stimulate the auditory nerve with electrical signals. They require surgery and an extended post-implant rehabilitation period. Your hearing health professional and an ENT specialist would assess candidacy.
Bone-anchored hearing systems
For specific types of conductive or mixed hearing loss, or single-sided deafness, bone-anchored hearing systems transmit sound through bone conduction, bypassing the outer and middle ear. These can be surgically implanted or worn on a softband or headband. Candidacy is assessed by your clinician and ENT specialist.
Assistive listening devices
Beyond hearing aids, various assistive devices help in specific situations:
- Amplified telephones with tone control
- Television listening systems that stream audio directly to headphones or hearing aids
- Alerting devices with visual or vibration alerts for doorbells, smoke alarms, and baby monitors
- FM systems and induction loop (telecoil) technology in public venues
Many public venues in Australia — including theatres, churches, and government buildings — have hearing loop systems installed. If your hearing aids include a telecoil, you may be able to access these systems for clearer sound in those environments.
Communication strategies
Communication strategies benefit both the person with hearing loss and those around them. Practical adjustments — positioning yourself to see the speaker's face, reducing background noise, choosing venues with good acoustics, and being open about your hearing — can meaningfully reduce communication effort. Some clinics offer aural rehabilitation programs that teach these approaches in depth.
Funding and support in Australia
Hearing Services Program (HSP)
The Commonwealth Hearing Services Program provides eligible Australians with access to funded hearing assessments and subsidised or fully funded hearing devices.
Eligible groups include:
- Pensioners with a valid Pensioner Concession Card
- Veterans and war widows/widowers (DVA card holders)
- NDIS participants with hearing goals in their plan
- Children and young people up to age 26 with significant hearing loss
Services are delivered through accredited community providers, including independent clinics.
NDIS
NDIS participants with hearing-related goals in their plan may be funded for hearing devices, assistive technology, and related services. The specifics depend on what is included in each participant's plan.
Department of Veterans' Affairs (DVA)
DVA Gold Card holders are generally eligible for full coverage of hearing assessments and devices. DVA White Card holders may be eligible depending on the conditions recorded on their card. Contact DVA directly to confirm your entitlement.
Private Health Insurance
Most private health extras policies include some hearing aid benefits. Rebate amounts vary considerably between funds and policy levels — contact your insurer directly to confirm your entitlement and any applicable waiting periods.
Payment plans
Many clinics offer interest-free or flexible payment plans to make hearing aids more accessible for people who are not eligible for government programs and do not hold private health extras cover. Ask about this when you contact a clinic.
Take the next step
If you recognise signs of hearing loss in yourself or a loved one, a comprehensive hearing assessment is the logical next step.
At Hearing Care on the Sunshine Coast, qualified hearing aid audiometrist Linda Whittaker provides thorough, unhurried hearing assessments in a supportive environment. With over 20 years of experience and ACAud credentials, Linda takes time to understand your individual concerns and circumstances.
The clinic offers complimentary hearing screenings to identify whether a full assessment is recommended. Comprehensive diagnostic hearing assessments are a separate service — contact the clinic directly for details, pricing, and appointment availability. Eligible patients can also access government-funded hearing services through the Hearing Services Program.
Hearing Care Serving the Sunshine Coast, Queensland
*This article is for educational purposes only and does not replace professional medical advice.*
Key Takeaways
- Hearing loss affects approximately 3.6 million Australians — one in six people
- Three main types exist: sensorineural (inner ear or nerve, typically permanent), conductive (mechanical, often treatable), and mixed
- Common causes include natural ageing, noise exposure, ototoxic medications, medical conditions, and genetic factors
- Early signs include frequently asking for repetition, difficulty in noisy environments, increasing TV volume, and feeling exhausted after conversations
- No GP referral is needed to book a hearing assessment
- Management options include medical treatment, hearing aids, cochlear implants, assistive devices, and communication strategies
- Funding is available through the Hearing Services Program, NDIS, DVA, and private health insurance
- Earlier intervention leads to better adjustment outcomes and supports ongoing communication and social participation
Take the next step
If anything in this guide reflects your own situation, a comprehensive hearing assessment is the most reliable next step. At Hearing Care on the Sunshine Coast, Linda Whittaker — a Senior Clinical Audiometrist with over 20 years of experience and ACAud accreditation — provides unhurried, individualised hearing care in a supportive environment.
We see clients from Caloundra, Maroochydore, Mooloolaba, Buderim, Noosa and across the wider Sunshine Coast region. Eligible patients can access fully funded hearing services through the Australian Government's Hearing Services Program.
Individual results vary. Professional hearing assessment is required to determine the most appropriate management approach for your specific situation.
Frequently Asked Questions
It depends on the type and cause. Conductive hearing loss caused by earwax, infection, or structural problems may be fully or partially reversible with medical treatment. Sensorineural hearing loss — caused by damage to cochlear hair cells or the auditory nerve — is typically permanent, because these cells do not regenerate. It can, however, be effectively managed with hearing aids or, in severe cases, cochlear implants.
Consider a hearing assessment if you frequently ask people to repeat themselves, have difficulty following conversations in noisy places, need to increase television volume, struggle to hear on the phone, find yourself watching people's lips to understand them, or avoid social situations because conversation is too effortful. If you are over 50, work in a noisy industry, or have a family history of hearing loss, a baseline assessment is a sensible step. You do not need a referral — book directly with a qualified hearing health professional.
In Australia, both audiologists and hearing aid audiometrists are qualified to assess adult hearing and fit hearing aids, but their training differs. Audiologists hold university postgraduate degrees in audiology and can assess and manage a wider range of hearing and balance disorders across all age groups. Hearing aid audiometrists complete nationally accredited vocational training with a specific focus on adult hearing assessment and hearing aid fitting. Both are registered practitioners. For complex diagnostic or balance concerns, or for paediatric assessment, an audiologist's broader scope may be appropriate — your GP or hearing health professional can advise.
Yes. Noise-induced hearing loss is permanent because loud noise damages or destroys cochlear hair cells, which do not regenerate. Prolonged exposure to sounds above 85 decibels — common in construction, manufacturing, mining, farming, and entertainment settings — causes gradual damage over time. A single very loud event, such as an explosion or close-range gunshot, can cause immediate permanent hearing damage. Noise-induced hearing loss is largely preventable through consistent use of appropriate hearing protection and limiting exposure to loud environments.
Tinnitus is the perception of sound — ringing, buzzing, hissing, clicking, or roaring — in the absence of an external source. It frequently occurs alongside hearing loss, often because the same cochlear hair cell damage that causes hearing loss also disrupts how the auditory system processes sound. Not everyone with hearing loss has tinnitus, and not everyone with tinnitus has measurable hearing loss. Management strategies include sound therapy, stress management, cognitive behavioural approaches, and, for those with hearing loss, hearing aids (which may reduce tinnitus perception by improving auditory input).
Medicare does not typically cover hearing aids for adults. The Hearing Services Program provides subsidised or funded hearing devices for eligible Australians — pensioners, veterans, NDIS participants, and children up to age 26 with significant hearing loss. Private health extras cover may provide partial rebates; contact your insurer to confirm your specific entitlement. Many clinics also offer payment plans.
Adjustment typically takes several weeks to several months. Initially, sounds may seem sharper or louder than expected, because your brain has to relearn how to process sounds it has not been receiving fully. Most clinicians recommend a gradual approach — starting with a few hours daily in quiet environments and building up over time. Consistent use is key. Ongoing follow-up appointments to fine-tune programming based on your real-world experience are an important part of the process.
This article is for educational purposes only. Individual results may vary. Professional hearing assessment is recommended for personalised advice.
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