Hearing Loss in Nepal: Types, Causes and When to See a Specialist
Hearing loss is Nepal’s most common sensory disability, yet the majority of people with clinically significant hearing impairment never receive a diagnosis or treatment. In rural and semi-urban settings, including many communities around Pokhara, progressive hearing loss is accepted as an inevitable consequence of aging or past infections — not as a treatable medical condition. This is a missed opportunity, because many causes of hearing loss are treatable and all causes are manageable.
What Are the Three Types of Hearing Loss?
Hearing loss is classified as conductive, sensorineural, or mixed, based on where in the auditory system the problem lies.
Conductive hearing loss is caused by a problem in the outer or middle ear that prevents sound waves from reaching the inner ear efficiently. Common causes include cerumen (earwax) impaction, otitis media with effusion (fluid in the middle ear), a perforated eardrum, and ossicular chain disruption (damage to the three small bones of the middle ear — the malleus, incus, and stapes). Conductive hearing loss reduces the volume of sound but preserves sound clarity — the person hears as if there is cotton wool in their ear. This type is often reversible or surgically correctable.
Sensorineural hearing loss is caused by damage to the cochlear hair cells or the auditory nerve. Hair cells do not regenerate in humans. Once lost, the hearing loss is permanent. However, it is manageable with hearing aids or cochlear implants. Sensorineural loss typically affects high-frequency sounds first, making it difficult to understand speech even at conversational volume — particularly in noisy environments.
Mixed hearing loss has both conductive and sensorineural components. It requires both types of treatment consideration.
What Are the Main Causes of Hearing Loss in Nepal?
Chronic suppurative otitis media (CSOM) — persistent middle ear infection with a perforated eardrum — is the leading cause of preventable hearing loss in Nepal. Studies in Nepalese schoolchildren have found CSOM prevalence rates of 4–8%, far above the WHO threshold of 1% that designates a public health problem. CSOM causes progressive conductive hearing loss through continued damage to the eardrum and ossicular chain, and risks serious complications if it is not treated.
Noise-induced hearing loss is a sensorineural condition affecting those with prolonged occupational exposure to loud noise. This includes military personnel (firearms, explosions, helicopter noise), factory workers, and farmers using machinery. The WHO estimates that 1.1 billion young people are at risk of noise-induced hearing loss from recreational sound exposure. In Nepal’s veteran community, noise-induced hearing loss is a common but under-recognised condition.
Age-related hearing loss (presbycusis) is the natural decline in hearing function that begins in the fifth and sixth decades, affecting high frequencies first. It is bilateral, slowly progressive, and sensorineural. It is not reversible but responds well to hearing aid fitting.
Meningitis — particularly bacterial meningitis in children — can damage the cochlea directly, causing profound or total sensorineural hearing loss. This is why hearing testing after bacterial meningitis in children is standard practice.
Ototoxic drugs — certain antibiotics (aminoglycosides such as gentamicin), chemotherapy agents (cisplatin), high-dose loop diuretics — can damage cochlear hair cells. In settings where aminoglycosides are used liberally for serious infections, ototoxicity is a real risk, and monitoring is important.
How Is Hearing Loss Tested? Understanding Audiometry
Audiometry is the standard diagnostic test for hearing loss. Pure tone audiometry measures the quietest sound a person can detect at frequencies from 250 Hz to 8,000 Hz. The results are plotted on an audiogram — a graph showing hearing level across frequencies. Normal hearing is defined as detecting sounds at 25 dB or better across frequencies.
Tympanometry measures middle ear function — it assesses the movement of the eardrum and can identify middle ear fluid (otitis media with effusion) and eardrum perforation. It does not require patient response and is therefore useful for testing young children and those who cannot cooperate with standard pure tone testing.
Speech audiometry tests the ability to understand words at various volumes, providing functional information beyond the pure tone thresholds.
The combination of these tests, interpreted alongside the clinical history and examination, allows accurate classification of the type and degree of hearing loss and guides treatment decisions.
What Surgical Options Are Available for Conductive Hearing Loss?
Myringoplasty is the surgical repair of a perforated eardrum, using a graft of temporalis fascia (connective tissue from behind the ear) to close the hole. It is most commonly performed for CSOM. Success rates are high (75–90%) and the procedure can restore near-normal hearing if the ossicular chain is intact.
Tympanoplasty includes eardrum repair plus reconstruction of the ossicular chain. It is performed when the middle ear bones have been damaged or destroyed by chronic infection or cholesteatoma (an abnormal skin growth in the middle ear that can cause progressive destruction).
Stapedectomy is the surgery for otosclerosis — a condition in which the stapes (the innermost of the three middle ear bones) becomes abnormally fixed, causing progressive conductive hearing loss. The fixed stapes is replaced with a prosthesis. It is highly effective when appropriately selected.
Grommets (ventilation tubes) are tiny tubes inserted through the eardrum to allow air into the middle ear, bypassing a blocked Eustachian tube. They are used for persistent otitis media with effusion (glue ear) in children and adults. They fall out spontaneously over months and the eardrum heals.
How Do Hearing Aids Work and What Is Available in Pokhara?
Hearing aids amplify and process sound, compensating for sensorineural hearing loss that cannot be surgically corrected. Modern hearing aids are digital, highly programmable, and can distinguish speech from background noise. They come in several configurations: behind-the-ear (BTE), receiver-in-canal (RIC), and in-the-ear (ITE) styles.
Hearing aids are fitted after audiometry by an audiologist or trained ENT technician. The fitting is adjusted to match the audiogram — the pattern of frequencies at which hearing is impaired. Regular follow-up ensures the programming remains optimal as hearing changes over time.
A common barrier to hearing aid uptake in Nepal is cost. Basic digital hearing aids are available in Pokhara at various price points. ECHS coverage may be applicable for hearing aids for eligible veterans — the A&B ENT team can advise on this.
How Should I Communicate With a Family Member Who Has Hearing Loss?
Face them directly when speaking, at eye level. Ensure the environment is well lit so they can use lip reading to supplement hearing. Reduce background noise. Speak clearly at a moderate pace — shouting distorts lip patterns and adds to communication difficulty. If they do not understand, rephrase using different words rather than simply repeating louder. Use written notes for important information.
Untreated hearing loss is associated with cognitive decline, social isolation, and depression. Addressing hearing loss is therefore not only about communication — it is a health intervention with broad systemic benefits.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
If you or a family member is experiencing hearing loss, regular ear discharge, or difficulty understanding speech, an audiometry assessment and ENT consultation at A&B International Hospital is the appropriate first step. ECHS polycards accepted for eligible veterans.
