We spoke with Dr Yuen Heng Wai, Ear, Nose and Throat (ENT) specialist, and RadLink Consultant Radiologists Dr Yong Yan Rong and Dr Choong Chih Ching to discuss hearing loss, from early warning signs to the advanced scans that help pinpoint the cause.
Dr Yuen Heng Wai: Hearing loss means you are not hearing as well as you should. It can be mild, where you miss softer sounds, or complete, where you cannot hear at all. Sound normally travels into your ear canal, makes your eardrum vibrate, and passes through three tiny bones in your middle ear to the cochlea. The cochlea changes those vibrations into nerve signals your brain understands. If any part of this system is damaged or blocked, your hearing is affected.
Dr Yuen Heng Wai: Often, it sneaks up on people. You might notice you are asking others to repeat themselves, turning up the TV volume, or struggling to follow conversations in noisy restaurants. Some people think everyone is mumbling. Other signs include ringing in the ears, ear pain or discharge, and even dizziness.
Dr Yuen Heng Wai: There are two main types.
Dr Yuen Heng Wai: Not exactly. Hearing loss has different levels which are mild, moderate, severe, and profound. Mild to severe loss is often called “hard of hearing.” Profound loss is what most people think of as “deaf.”
Dr Yuen Heng Wai: Yes. The Lancet Commission reports in 2020 and 2024 both identify hearing loss as a modifiable risk factor for dementia. Reduced hearing means less stimulation for the brain, which can speed up cognitive decline. Untreated hearing loss can also affect mental health. People may feel isolated, frustrated, and even depressed.
Dr Yong and Dr Choong: Besides standard hearing tests done by the ENT specialist, imaging can give us a detailed look inside the ear and along the hearing nerve to help find the cause.
Dr Yong and Dr Choong: Contrast-enhanced MRI involves injecting a safe dye into the bloodstream before the scan. This makes certain tissues and blood vessels appear clearer on the images. lt is especially helpful in detecting inflammation of the inner ear or nerves, identifying infections, and spotting small tumours such as vestibular schwannomas that might press on the hearing or balance nerves. This level of detail allows for a more accurate diagnosis and helps the ENT specialist plan the best treatment.
Dr Yong and Dr Choong: Prospective studies assessing HRCT accuracy reported sensitivity of approximately 81% in identifying benign lesions and inflammatory conditions, 91% for detecting otosclerosis in conductive hearing loss, and nearly 100% for malignancy. However sensitivity can drop for small or early lesions. In sensorineural hearing loss, MRI is the preferred modality for nerve imaging as CT often misses small tumours. In patients with sudden hearing loss MRI is preferred in most cases, unless there are features of chronic ear disease. Dr Yuen will recommend which is the most suitable imaging modality for your condition during your consultation.
Dr Yuen Heng Wai: Do not ignore the signs. Hearing connects you to people, experiences, and the world around you. If you notice changes, get checked early. Protecting your hearing can also protect your brain and your quality of life.
This article was developed with contributions from Dr Yuen Heng Wai (Ear Nose Throat, Head & Neck Surgery) and the radiologists at RadLink.
Ear Nose Throat, Head & Neck Surgery
Website: www.earnosethroat.com.sg
Tel : 6735 9688
Email : info@earnosethroat.com.sg
