All About Hearing Loss: Types, Causes, Symptoms and Treatment Options in Singapore

Hearing loss is more than just difficulty picking up sounds; it can affect conversations, relationships and overall quality of life. It refers to a partial or complete inability to hear in one or both ears, and can range in severity from mild to profound.

In Singapore, around 500,000 people live with hearing loss¹. Additionally, national health surveys show that the prevalence of self-reported hearing loss among adults aged 18 to 74 has risen sharply from 1.3% in 2013 to 9.2% in 2023, with the steepest increase seen in those aged 60 years and above².

Yet, while many people associate hearing loss with ageing, it can affect individuals at any stage of life. In this article, we’ll explore the different types of hearing loss and their causes, and share the signs to look out for. We’ll also discuss available options for diagnosis, treatment and prevention.

• What Are the Different Types of Hearing Loss?
• What Causes Hearing Loss?
• What Are the Common Signs and Symptoms of Hearing Loss?
• What Are the Different Degrees/Levels of Hearing Loss?
• When Should You Seek Help for Hearing Loss?
• What Are Some Potential Complications of Hearing Loss?
• What Are the Options for Hearing Loss Management and Treatment in Singapore?
• How to Prevent Hearing Loss
• FAQs About Hearing Loss in Singapore

There are three main types of hearing loss, and each relates to a specific part of the hearing system where damage has occurred.

Sensorineural hearing loss occurs when there is damage to the inner ear, specifically the cochlea, or to the auditory nerve that transmits signals from the ear to the brain. This type of hearing loss often results in sounds being distorted or unclear. Even when speech or music is made louder, the clarity does not fully return, making it particularly difficult to follow conversations in noisy environments.

Conductive hearing loss happens when sound waves fail to pass efficiently through the outer or middle ear to reach the inner ear. This may be due to blockages such as earwax, infections, fluid buildup, or damage to the eardrum or middle ear bones.

The primary impact on hearing is a reduction in loudness, with voices and everyday sounds sounding faint or muffled, as if hearing through a blocked or covered ear. Unlike sensorineural loss, clarity is usually preserved once the obstruction is treated.

Mixed hearing loss is a combination of both sensorineural and conductive hearing loss. This means there are problems in the outer or middle ear and the inner ear or auditory nerve. As a result, individuals with mixed hearing loss may find that sounds are not only softer but also distorted. This dual effect can make communication particularly challenging, since amplification alone may not restore clarity.

Hearing loss can develop for many reasons, and the cause often depends on the part of the ear that is affected. Some of the most common causes include:

Hearing loss can occur when the delicate hair cells in the cochlea become damaged. These cells are essential for sending sound signals to the brain, but once lost, they cannot regenerate. Two of the most common causes are presbycusis, or age-related hearing loss, and noise-induced hearing loss from repeated exposure to loud sounds. Both conditions often make higher-pitched sounds seem muffled and can make it especially difficult to follow conversations in noisy environments.

A gradual accumulation of earwax can block the ear canal, preventing sound waves from passing through normally. Fortunately, this type of hearing loss is usually temporary and can be resolved with proper earwax removal.

Outer ear infections, middle ear infections, or fungal ear infections, as well as abnormal growths such as tumours, can interfere with the transmission of sound to the inner ear. Depending on the severity, this may cause partial or complete hearing loss in the affected ear.

The eardrum can tear as a result of sudden loud noises, abrupt changes in air pressure, accidental injury (such as poking the ear with a cotton swab), or infection. A ruptured eardrum disrupts the normal transmission of sound and can lead to temporary or even lasting hearing loss.

Some common signs of hearing loss include (but are not limited to):

• Difficulty hearing soft or distant speech
• Difficulty understanding the speaker in noisy environments
• Needing to read someone’s lips to understand what is being said
• Speaking louder than usual
• Tinnitus
• Turning the television volume higher than usual
• Imbalance

The degree/severity of your hearing loss can range from mild to moderate, severe and profound.

• Mild (21–40dB): Speech may be unclear in noisy environments; the television volume may also be turned higher than normal
• Moderate (41–69 dB): Communication may be challenging without a hearing aid; most individuals would notice an increased need for loud speech and/or frequent repetition to follow conversations.
• Severe (70–94 dB): Speech and sounds in the environment become difficult to hear; communication strategies like lip-reading, sitting close to the speaker and requesting the speaker to speak slowly and clearly may be necessary to facilitate a conversation, even with a hearing aid
• Profound (95 dB and above): Listening is difficult even with a hearing aid in quiet environments; communication strategies similar to those employed by individuals with severe hearing loss are necessary to facilitate a conversation

Hearing changes often develop gradually, so it’s not always easy to recognise when professional help is needed. If you notice any of the following signs, it may be time to schedule a hearing check:

• Persistent ringing in the ears: You hear ringing, buzzing, or humming noises that aren’t coming from an external source.
• Struggling with conversations: Following discussions in groups or noisy environments feels challenging.
• Frequent requests to repeat: You frequently ask others to repeat what they’ve said, as speech may sound unclear or like mumbling.
• Unclear phone calls: Voices over the phone often sound muffled or hard to follow, whether you’re in a quiet or busy place.
• Turning up the volume: Family or friends comment that your television, radio, or music is set too loud.
• Trouble pinpointing sounds: Identifying where a sound is coming from, such as traffic or someone calling your name, becomes more difficult.

Paying attention to these signs can help you identify hearing loss early and seek the right support.

Left unmanaged, hearing loss can affect many aspects of daily life. When conversations become hard to follow, some individuals may start to withdraw from social interactions. Over time, this can lead to social isolation and a sense of disconnection from loved ones and the community.

Struggling to hear can also be emotionally taxing. The extra effort needed to understand speech may cause frustration, stress or low mood, and for some, this can contribute to feelings of depression.

In addition, hearing loss may make it more challenging to stay engaged in conversations, concentrate in noisy settings or keep up with group discussions. This can affect the individual’s cognitive functions and speeds, e.g. how easily someone thinks, focuses, recalls information, and interacts with others in day-to-day life.

Depending on the type and cause of hearing loss, different types of hearing loss treatment and management may be recommended.

Suitable for: Sensorineural and conductive hearing loss

Hearing aids are devices that detect and amplify sounds in the environment to allow the user to hear better and more clearly. The 2 main types of hearing aids are behind-the-ear (BTE) and in-the-ear (ITE), where the device casing can be worn either behind the ear or inside the ear canal. These devices are suitable for varying degrees of hearing loss, from mild to profound.

Suitable for: Sensorineural hearing loss

Cochlear implants are hearing devices that are surgically inserted into the inner ear. They’re designed to take on the function of the damaged hair cells of the cochlea and directly stimulate the auditory nerves that aren’t damaged.

Cochlear implants are suitable for those experiencing severe to profound sensorineural hearing loss and can be worn by both children and adults. To be eligible for this procedure, the individual must experience limited benefits from wearing hearing aids and have poor speech intelligibility scores.

Suitable for: Conductive hearing loss

Individuals who suffer from hearing loss due to ear infections may be prescribed topical antibiotics. In some cases, medications may also be stopped or switched out for an alternative if they’re the potential cause of hearing loss.

Suitable for: Conductive hearing loss

Surgery may be the recommended treatment option for hearing loss resulting from:

• Perforated eardrums
• Bony growths in the ear canal
• Ear bone fixations or deformities
• Recurring middle ear infections
• Growth in the middle ear (cholesteatoma)

While options for treating and managing hearing loss are available, prevention is always better than cure. Here are some ways to prevent hearing loss from occurring:

You can prevent hearing loss by incorporating good habits into your daily life. This includes:

• Consuming a nutritious diet to improve your ear function
• Engaging in physical exercises to reduce the risk of age-related hearing loss and to maintain the auditory function of the cochlear
• Engaging in hearing exercises to sharpen your skills in listening and identifying sounds
• Keeping your ears dry to prevent ear infections and earwax buildup

Certain habits can be harmful to your hearing health. To maintain good hearing, it’s important to avoid these habits:

• Placing small objects in your ear as this can damage your eardrums
• Smoking – it increases the risk of hearing loss and tinnitus
• Listening to loud sounds frequently as this can lead to noise-induced hearing loss (NIHL) and tinnitus

In general, you’re advised to limit your exposure to sounds over 85 decibels* to 8 hours a day. If you’re unable to avoid prolonged exposure to such sounds, wearing ear protection and resting your ears periodically can help to mitigate the effects.

*This includes noise from a food blender, lawnmower and heavy traffic. Additionally, if you have to raise your volume to speak to another person standing approximately 0.9m away from you, the ambient noise level may be over 85 decibels.

Take a hearing test periodically to monitor your hearing health. This can allow you to detect any early signs of hearing loss and take the appropriate actions to manage it.

¹Retrieved from the Singapore Association for the Deaf (SADeaf)
²Retrieved from the Ministry of Health
³Retrieved from Statista
⁴Retrieved from Enabling Guide Singapore