“Are you deaf?” It’s a phrase tossed around so often, usually as a joke, and sometimes in a more offensive manner. No wonder it’s easy to forget that deafness, or hearing loss, is a real disability that many people live with every day. Imagine not being able to hear the faint sounds from your neighbour in the next room, the lecturer addressing a class, or the market woman you want to haggle with.
The rustle of leaves underfoot – that soft crunch when walking across a path – is about 20 decibels (dB). That is the normal average hearing level. According to the World Health Organisation, a person with hearing loss cannot hear sounds at this level. Instead, their threshold begins at about 35 dB or higher. This means any sound must be nearly twice as loud before they can pick it up, if they can hear it at all.
What causes it?
Think of the ear as having three parts and one pathway. The three parts are the outer ear, middle ear, and inner ear. The pathway is that through which sounds are conducted to the brain. Hearing loss or deafness can result from damage to any of these.
- Outer ear: Problems arise when the small tunnel leading to the eardrum is blocked or the eardrum itself is damaged. Causes include earwax buildup (worsened by cotton buds or foreign objects), ear infections (often from swimming in dirty water), and eardrum perforation.
- Middle ear: This is a tiny chamber with three small bones that pass vibrations from the eardrum to the inner ear. Hearing loss occurs if fluid fills this space, the bones stiffen, or they are damaged, for example, by chronic ear infections, allergies affecting the Eustachian tube, or head injury.
- Inner ear: This delicate snail-shaped structure contains sensory cells that convert vibrations into nerve signals. Damage here means the brain cannot receive clear sound information. Causes include loud noise (Noise-Induced Hearing Loss), ageing, genetic conditions, infections during pregnancy, meningitis, ototoxic drugs (like some antibiotics and chemotherapy drugs), and severe malaria or high fever.
- Auditory pathway: This is the “cable” carrying signals from the inner ear to the brain. If it is damaged or if the hearing centre of the brain is affected, sound can reach the ear but not be processed correctly. Causes include acoustic neuroma (a rare benign tumour), stroke, head injury, or meningitis.
In Nigeria, the most common causes of hearing loss are earwax impaction, chronic ear infections from untreated colds or poor ear hygiene, noise exposure, meningitis in children, and ototoxic drugs. In a room of 15 Nigerians, at least one is likely to have disabling hearing loss. With a population of about 230 million, that is roughly 15.3 million people:
- about 6,100 per 100,000 persons among the elderly, and
- 196 per 1,000 among children.
When it comes to noise-induced hearing loss, the figures are even more striking in certain occupations:
- 145 per 1,000 motorcycle riders
- 850 per 1,000 flour-mill workers
- 330 per 1,000 rice-mill workers
These are not just numbers — they are people with families, jobs, and futures shaped by the sounds they can no longer hear. Hearing is one of the five senses that connect us to the world. Losing it can reshape life entirely: making conversations harder, slowing children’s learning, limiting job opportunities, straining relationships, and, in older adults, even speeding up memory decline.
Treatment and cost
Treatment begins with a diagnosis to identify the underlying cause and whether the loss can be reversed. The plan may involve medical management, surgery, rehabilitation, or a combination of these. Services are provided by Ear, Nose, and Throat (ENT) specialists, also called otolaryngologists.
But the cost is where the struggle begins.
Take the case of a flour mill worker, Mr. X, who earns ₦14,000 monthly. He notices he often asks his wife to repeat herself, and eventually she advises him to seek medical help. His first check-up costs ₦5,000. Another patient’s advanced diagnostic test costs ₦50,000. He breathes a sigh of relief. “Thank God it isn’t him.” Basic treatments, like earwax removal or infection treatment, are about ₦5,000. A mastoidectomy (surgery to remove infected bone) can cost hundreds of thousands. Advanced options, like cochlear implants, range between ₦4.5 million and ₦9 million. And even after surgery, there are continuous costs for hearing aids, batteries, servicing, and speech therapy.
Now, imagine Mr. X requires a mastoidectomy after diagnosis. How can someone earning ₦14,000 a month afford this?
In a country where the minimum wage is ₦75,000 — and many earn far less — these figures place treatment out of reach for most. Health insurance coverage is minimal, so almost all costs are paid out-of-pocket.
For many Nigerians, the question isn’t whether a cure exists, but whether they can afford it. Medical treatment exists in a different world, not because people don’t know about it, but because the money they barely manage to feed themselves cannot buy back their hearing.
Hearing loss in Nigeria is not just a medical issue. It is a social and economic one. Until awareness, prevention, and affordable care become national priorities, the silence will keep spreading — one person, one family, one community at a time.