Hearing Loss Treatment In Singapore

What is Hearing Loss

Hearing loss, a condition where one’s capacity to perceive sound is diminished or entirely absent, can often feel like listening to a radio that’s gradually losing its signal. It can present as a sense of muffled sounds or a blockage in the ear, making it challenging to discern speech and sounds at regular volume levels. Sometimes it is accompanied by a buzzing or ringing sound (tinnitus) – similar to a faulty radio giving off static sounds.

Engaging in conversations, particularly in noisy settings, or using the phone can become increasingly difficult for those experiencing hearing loss. The progression of hearing loss can be slow and subtle, often going unnoticed until it reaches a significant level, causing the symptoms mentioned.

Moreover, hearing loss can lead to auditory fatigue, a condition where prolonged periods of deliberate or effortful listening lead to tiredness and reduced concentration. This can further impact cognitive functions, affecting memory and the ability to process information.

Therefore, it’s crucial to pay attention to these signs. If you notice any symptoms of hearing loss, don’t hesitate to consult with an Ear surgeon or an Audiologist.

Remember, early detection and intervention can significantly improve the quality of life. Don’t let the world of sound fade away. Take action today. Because your hearing matters.

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Common Types of Hearing Loss in Singapore

Hearing loss is commonly considered in three main types or categories: conductive, sensorineural or mixed hearing loss.

Conductive hearing loss occurs when the transmission process of sound from the environment into the ear canal, via the tympanic membrane (eardrum), through the ossicles (hearing bones) is obstructed or interrupted.

What causes conductive hearing loss?

Conductive hearing loss can occur with conditions like ear wax, , external ear infection (otitis externa), middle ear infection (otitis media), fluid in the middle ear (otitis media with effusion), tympanic membrane perforation with infection (chronic suppurative otitis media), fixation of ossicles (otosclerosis), abnormal ossicles due to erosion from middle ear infection like cholesteatoma, and scarring of the external ear canal (medial canal fibrosis) due to repeated trauma from ear picking.

Sensorineural hearing loss occurs when the sensory (inner ear hearing organ – hair cells in the cochlea) or neural (‘nerve’ – hearing nerve or the hearing part of the brain) component of the hearing process undergo damage or degeneration.

What causes sensorineural hearing loss?

Sensorineural hearing loss may be due to various factors such as:

  • Aging (presbycusis)
  • Inner ear infections (labyrinthitis)
  • Inflammatory conditions (Meniere’s disease)
  • Noise-induced hearing loss
  • Compromised blood supply to the inner ear
  • Ototoxicity (hearing loss associated with use of certain antibiotics e.g. aminoglycosides, high dose of aspirin)
  • Inner ear tumors (schwannoma)

Mixed hearing loss occurs when there is combination of conductive and sensorineural components.

Hearing Loss Symptoms & Early Signs

Hearing loss is often gradual, progressive and asymptomatic until it is significant. Early symptoms include:

In other cases, hearing loss might be sudden and acute. This can happen due to causes like sudden sensorineural hearing loss, or labyrinthitis (usually accompanied with giddiness).

Sudden Sensorineural Hearing loss

Sudden Sensorineural Hearing Loss (SSHL), commonly known as sudden deafness, is an unexplained, rapid loss of hearing. It occurs due to a problem with the sensory organs in the inner ear known as the cochlear.

  • Rapid hearing loss in one ear (often noticed upon waking up).
  • Feeling of ear fullness.
  • Dizziness.
  • Ringing in the ears (tinnitus).
  • Consider SSHL symptoms a medical emergency.
  • Visit an ENT doctor immediately.
  • Timely treatment increases chances of recovery.

Remember, SSHL can happen to people of any age, we do not completely understand the exact causes of SSNHL but time is of essence when it comes to managing SSNHL.

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Hearing Loss Treatment In Singapore

Treatment for hearing loss depends on the underlying cause. Conductive hearing loss is easily reversed with simple procedures to correct the causes, e.g. removal of ear wax, treating ear infection, release of fluid from middle ear. These procedures are done in the outpatient clinic.

One of the most common causes of hearing loss is chronic otitis media (COM). This is a chronic ear disease consisting of a series of infections of the middle ear. It is commonly known as “chronic ear infection”, or “draining ear”.

In this condition, fluid build-up prevents the ossicles (hearing bones) and the ear drum from moving effectively. Sometimes there may be a tear in the eardrum causing hearing loss.

Hearing Loss Treatment – Hearing Aids
Hearing-Aids

Other procedures like repair of eardrum perforation, stapes surgery (for otosclerosis), canaloplasty (for stenosis of ear canal), or reconstruction of hearing bones (ossiculoplasty) can improve hearing significantly.

These procedures are usually performed under general anesthesia in the operating room. In skilled hands of our Ear Surgeons, the success rate for these procedures can reach 80 – 90%.

Sensorineural hearing loss is less easily reversed. It is usually treated with medication (particularly steroids) in the first instance. This is critical especially for sudden sensorineural hearing loss (SSNHL).

Studies have shown that spontaneous recovery (chance of up to 65%) is possible for patients suffering from SSNHL. Treatment with systemic steroids potentially provide additional benefits to recovery.

Intratympanic (I/T) steroid injection (whereby steroid is instilled through a puncture of the eardrum into the middle ear; the steroid then diffuses into the inner ear) is a viable option as steroid treatment in those who are at high risk for systemic steroids (e.g. bleeding gastric ulcer, poorly controlled diabetes, active hepatitis infection, etc).

I/T steroid is also an important consideration when patients initially respond poorly to oral steroids. There are very few potential complications of I/T steroid injection. These include: giddiness, legacy perforation of the eardrum, and pain). Steroid therapy in whatever form (oral, systemic or I/T) is best given within the first two weeks of onset of SSNHL.

Recent guidelines from the American Academy of Otolaryngology-Head & Neck Surgery on treatment of patients with SSNHL have included the option of hyperbaric oxygen therapy.

Sensorineural hearing loss can be permanent and hearing devices might be required. Hearing devices include hearing aids and hearing implants (also see section on hearing implants).

Hearing Aids

Hearing aids are the simplest, least invasive yet very effective solutions for different types of hearing loss. At its heart, a hearing aid is an amplifier that makes sounds louder for better hearing. However, because everybody’s hearing loss is different, the amplification must be individualized according to the hearing levels of the person.

Just as eye glasses are not one size fits all, hearing aids must be customized and tuned for each person. This is usually conducted together with an audiologist – who are highly trained professionals experienced in managing hearing loss with hearing aids.

Advances in technology have enable hearing aids to overcome many past problems such as reduction of feedback (screeching noise), noise cancellation, improved aesthetics (small size of hearing aids).

Other technology such as Bluetooth, direct streaming, rechargeable batteries have made hearing aids very convenient and useful to those with hearing loss.

Hearing Implants

Hearing implants are hearing solutions for those with hearing loss but yet unable to derive full benefit from their hearing aids. This is usually due to the severity of their hearing loss; even with the most powerful hearing aids, these patients do not hear clearly.

Another reason for needing a hearing implant is: unable to wear hearing aids (e.g. ear canal problems such as stenosis or recurrent infection).

There are various types of hearing implants that are suitable for different types and severity of hearing loss. For conductive hearing loss that is not amenable to hearing aids, bone conduction implants are very effective devices for restoration of hearing.

Hearing Loss Treatment using Implants

Types of hearing implants:

Bone conduction implants have two components: external sound processor that captures sound with microphones. It turns sound into signals that are sent through an abutment or magnetic connection to an implanted component under the skin in the area behind the ear.

The signal is conducted via vibration through the bone directly into the inner ear. These signals are then interpreted by the brain as sound.

For sensorineural hearing loss not able to benefit from hearing aids, middle ear implants and cochlear implants are extremely effective solutions.

Bone Conduction Hearing Implants

Middle ear implants (MEIs) work on similar principles as bone conduction implants, with an external removable and internal implanted component. However, MEIs function to accentuate the movement of the ossicles to increase the transmission of sound into the inner ear.

Both the bone conduction and middle ear implants require that the patients have at least sufficient (even if not normal) inherent hearing abilities (cochlear function), otherwise known as adequate cochlear reserve. When the cochlear reserve is very poor, a cochlear implant would be an option.

Middle Ear Hearing Implants

Cochlear implants similarly have two components – but its role is to replace the function of the cochlea that is the most common site of damage or degeneration in severe to profound sensorineural hearing loss.

In other words, when hearing loss is so bad that hearing aids are no longer useful, cochlear implants will be able to restore hearing in most cases. It is suitable for both children and adults with severe to profound hearing loss, and can be implanted for such hearing loss in one or both ears.

More information is available in the section on cochlear

When and Why Should I See An ENT Specialist For Hearing Disorder?

When hearing loss is suspected, one should see an ENT specialist for diagnosis and treatment. Suspicion of hearing loss include symptoms and signs mentioned above. If hearing loss is not corrected, there are many adverse consequences.

In children, hearing loss can result in delayed language skills, academic difficulties, behavioral problems or increased social isolation. In adults, hearing loss is the number one modifiable risk factor for onset of cognitive decline and dementia.

By improving or restoring hearing with hearing aids or implants, the risk of suffering from cognitive decline and dementia subsequently is reduced significantly.

People with hearing loss frequently suffer from social disengagement and isolation. This can result in various family and societal problems, frustration and irritability. It can also lead to anxiety, depression and other mental and psychological conditions. At the same time, evidence from research is increasingly showing a link between hearing loss and mortality.

Selecting the right treatment requires a comprehensive ENT and audiological evaluation and consultation with our Otolaryngologist (ENT doctor) and audiologist. Special tests may be performed to determine the specific treatment option for each patient.

Each option has its own set of advantages and considerations, and what works for one person may not be as effective for another.

How our ENT Doctors Conduct Hearing Test?

Patients with hearing loss are assessed with a thorough history taking and examination with a microscope and endoscope. Hearing tests are done in the clinic on the spot with a dedicated and certified audiometry booth and trained audiological professionals.

Hearing Loss Test Conducted in ENT Clinic

Why Choose Our ENT Clinic?

Our ENT clinic is widely recognised for our expertise in managing ear, balance conditions and hearing implants. It is one of very few clinics that provide one-stop service for investigation, diagnosis and treatment of all ear conditions and balance conditions.

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Hearing Loss Treatment FAQs

Hearing loss is very common. The World Health Organization (WHO) World Report on Hearing 2021 estimates that more than 1.5 billion people worldwide experience some degree of hearing loss – this could increase to 2.5 billion by the year 2050.

In addition, it is estimated that 1.1 billion young people are at risk of permanent hearing loss from listening to music at loud volumes over prolonged perioids of time. Hearing loss has been labelled as the silent and invisible epidemic – silent for the sufferers, invisible to others.

In Singapore, 1 in every 1000 child born has hearing impairment. Similar to the global situation, almost 20% of persons above 65 years of age in Singapore suffer from some degree of hearing loss.

Hearing loss from many causes can be prevented. For example, noise-induced hearing loss (NIHL) are common in people who work in noisy environment e.g. construction and heavy industry, airports, music and entertainment industry, etc.

NIHL is of the sensorineural type and usually not reversible (see above). Limiting the duration of exposure to loud sounds, as well as good hearing protection (earplugs or ear muffs) are effective in preventing NIHL.

Another common cause of hearing loss is chronic ear infection. Chronic ear infection can result in degeneration of the hearing hair cells in the inner ear. Early diagnosis and treatment of ear infection can prevent hearing loss from this cause.

Yes, many causes of hearing loss are amenable to treatment. In particular, conductive hearing loss is frequently easily treatable with minor procedures. As mentioned above, most of these procedures are day surgical procedures and can potentially reverse hearing loss completely.

Surgical treatment are advised whenever appropriate as surgery aims to restore the natural hearing pathway. When successful, hearing via the natural hearing pathway is more natural and comfortable than using devices. However, better outcomes are associated with experience and sub-specialization in ear conditions and treatment.

There is no specific level of hearing loss or time when a person with hearing loss should get a hearing aid. Any time a person is diagnosed with hearing loss (after thorough evaluation by an ENT surgeon or Audiologist), a hearing aid should be considered.

Hearing loss can be very subtle and not noticeable until a person is in a hearing situation e.g. noisy environment before it is ‘perceived’ to be significant. Studies have shown that by that time, there are changes in the brain that might predispose a person with hearing loss to cognitive decline and dementia.

Hearing devices are very individualized products that are carefully customised to each patient. A correct diagnosis from an expert healthcare professional is necessary to determine which hearing device is suitable and optimal for the different and specific types and severity of hearing loss.

Not every patient with hearing loss may benefit from hearing aids; when the hearing aids are not providing optimal benefits, hearing implants may be necessary.

Hearing aids have a range of prices depending on power, function, and other specifications. Each type of hearing aid is designed to suit different severity of hearing loss, as well as the needs and requirements of individual patients. Less pricey hearing aids might not work for some patients, while more expensive ones might not be necessary in others.

Our clinic works with different partners to provide the most cost-effective hearing aid to suit the specific needs of each patient. Feel free to speak to our ENT doctors and audiologists to find the best solution to fulfil your hearing needs.

Hearing implants do cost more than hearing aids due to the cost of development and the advanced technology embedded in them. However, our clinic works closely with different partners to provide the most cost-effective implant solution for each individual patient. We also do our best to ensure every patient who needs a hearing solution will not be denied because of cost.

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