Persistent or reversible?

The most common causes of persistent hearing loss are ageing and exposure to excessive noise, such as occupational noise and personal audio devices and smartphones used at loud volumes for long periods.

In a small number of cases, past infection may have damaged the eardrum or middle ear and caused persistent conductive hearing loss. Other causes of persistent deafness include exposure to ototoxic substances and a wide variety of genetic, systemic and infectious conditions.

Reversible conductive hearing loss is commonly caused by impacted earwax (cerumen). Occasionally the problem may be exacerbated by foreign bodies such as cotton bud tips and other items inappropriately used to clean the ear.

Infection due to otitis media or otitis externa (OE) may also cause or aggravate hearing loss and these conditions are usually associated with pain, alongside other symptoms such as itch or discharge.

Ear canal occlusion is not common with OE and is mainly due to swelling caused by cellulitis, which can be very painful and needs urgent referral. The build-up of squamous debris caused by OE may contribute to impaction of earwax.

Worried patients

Patients may come to the pharmacy concerned that they are ‘going deaf’. Signs include difficulty hearing other people clearly and misunderstanding what they say, especially in noisy places, having to ask people to repeat themselves, listening to music or watching TV with the volume high enough to annoy other people, and difficulty hearing on the phone.

The pharmacy team will be aware of patients who they may suspect are ‘hard of hearing’ and with whom they have to raise their voice in order to communicate. Simple communication tips include:

• Before speaking, get the person’s attention
• Make eye contact with face and lips visible
• Use facial expressions and gestures
• Where possible, avoid background noise
• Get used to not looking away when talking
• Repeat the sentence once if necessary, then rephrase if needed
• Write down important facts or use a leaflet to point them out
• A longer consultation time may be needed.

Patient could try an online hearing test such as that provided by the RNID (rnid.org.uk/information-and-support/take-online-hearing-check/). There are also hearing test features provided by some mobile phones, such as on Apple devices.