See your GP if you're having problems with your hearing. They'll examine your ears and carry out some simple hearing tests.

You may also want to visit the Action on Hearing Loss website for an online hearing test.

Ear examination

During an ear examination, an instrument with a light at the end called an auriscope (or otoscope) is used to look for anything abnormal, including:

• a blockage caused by earwax, fluid or an object
• an ear canal infection
• a bulging ear drum – indicating an infection inside the middle ear
• fluid behind the ear drum – known as glue ear
• a perforated ear drum 
• a collapsed ear drum
• skin collected in the middle ear (cholesteatoma)

Your GP will ask if you have any pain in your ear and when you first noticed the hearing loss.

Referral to a specialist

Your GP may refer you to an ear, nose and throat (ENT) specialist or an audiologist (a hearing specialist). The specialist will carry out further hearing tests to help determine what's causing your hearing loss and recommend the best course of treatment.

Some of the hearing tests you may have include a:

• tuning fork test (sometimes performed by your GP)
• pure tone audiometry
• bone conduction test

These tests are described below.

Tuning fork test

A tuning fork is a Y-shaped, metallic object. It produces sound waves at a fixed pitch when it's gently tapped and can be used to test different aspects of your hearing.

The tester taps the tuning fork on their elbow or knee to make it vibrate, before holding it at different places around your head.

This test can help determine if you have conductive hearing loss, which is hearing loss caused by sounds not being able to pass freely into the inner ear, or sensorineural hearing loss, where the inner ear or hearing nerve isn't working properly.

Pure tone audiometry

Pure tone audiometry tests the hearing of both ears. During the test, a machine called an audiometer produces sounds at various volumes and frequencies (pitches). You listen to the sounds through headphones and respond when you hear them, usually by pressing a button.

Bone conduction test

A bone conduction test is often carried out as part of a routine pure tone audiometry test in adults. It's used to check if you have sensorineural hearing loss, by testing how well your inner ear is working.

Bone conduction involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard.

Bone conduction is a more sophisticated version of the tuning fork test, and when used together with pure tone audiometry, it can help to determine whether hearing loss comes from the outer and middle ear (conductive hearing loss), the inner ear (sensorineural hearing loss), or both.

Read about how hearing tests are performed.

Newborn hearing screening

All newborn babies are offered a hearing test in the first few weeks after birth as part of the NHS Newborn Hearing Screening Programme.

The tests helps to identify babies who have permanent hearing loss as soon as possible so that parents can get the support and advice they need.

Read more about the newborn hearing test. 

Levels of hearing loss

Very few people with hearing loss hear nothing at all. There are four different levels of hearing loss, which are defined by the quietest sound you're able to hear, measured in decibels (dB). These are described below.

Mild deafness

If you're mildly deaf, the quietest sound you can hear is 21 to 40dB. Mild deafness can sometimes make hearing speech difficult, particularly in noisy situations.

Moderate deafness

If you're moderately deaf, the quietest sound you can hear is 41 to 70dB. You may have difficulty following speech without using a hearing aid and may find it difficult to hear announcements, for example.

Severe deafness

If you're severely deaf, the quietest sound you're able to hear is 71 to 90dB. People who are severely deaf usually need to lip-read or use sign language, even with the use of a hearing aid.

Profound deafness

If you're profoundly deaf, the quietest sound you can hear is more than 90dB. People who are profoundly deaf can benefit from a cochlear implant. Other forms of communication include lip reading and British sign language or signed English.

Read more about treating hearing impairment, including different types of hearing aids and sign language.