What every adult needs to know about hearing loss

Many of us will eventually experience hearing loss to some degree. After age 60, roughly two-thirds of people experience age-related hearing loss called presbycusis (prez-buh-KYOO-sis).^1,2

But take heart: If you’ve already lost some hearing, the latest treatments are better and easier to use than ever. Here’s what you need to know about hearing loss.

How we hear

How we hear and process sounds is a complex process. And it depends on many different parts of the ear working optimally.

Imagine, for example, that you’re talking to a friend while walking down a busy street. Loud cars and trucks whiz by, sometimes honking their horns. These sounds are picked up by the ears and move into the ear canal. This is the tube that runs from the outer ear to the eardrum, or middle ear.^3,4

Once these sound waves reach the eardrum, they cause it to vibrate. It’s these vibrations that then cause fluid and hair-like cells to ripple and sway — all inside a tiny snail-shaped structure called the cochlea.^3,5

All this movement activates tiny nerves in the ear, which then send electrical signals to the brain. The brain interprets those signals as either noise or words, and hearing happens.³

“One of the jobs of our brain is to take the sounds that we are hearing and give them meaning and context,” says Erich P. Voigt, M.D., a head and neck surgeon at NYU Langone Health in New York City.

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How do you know if you have hearing loss?

Hearing loss may initially appear as an inability to hear what someone is saying when there is background noise, such as traffic in the street. Over time, you may lose your ability to hear higher frequencies (such as children’s voices) and certain consonants — especially s, f and th.⁴

According to the National Institute on Aging (NIA), you may have hearing loss if you have:⁵

• Trouble understanding someone while on the phone
• Difficulty following conversations when two or more people are talking
• Problems understanding discussions when there’s background noise
• A frequent need to ask people to repeat what they said
• Regularly needing to turn up the TV or radio
• Thinking that other people are mumbling

How is hearing loss diagnosed?

If you suspect you have hearing loss, you can have your primary care provider check for anything physical that could be affecting your hearing. “It’s helpful to have a provider take a look in your ears to rule out earwax impaction or fluid buildup in the ear,” says Dr. Voigt. Both can muffle hearing.^6,7 

If that’s not the issue, then request an appointment with a hearing care professional for a comprehensive hearing exam and consultation.

Your hearing care professional will do a series of tests to help determine:⁸

• Your hearing sensitivity
• Your type of hearing loss
• How well you understand speech
• Your communication limits

You can also take a preliminary online hearing test. While it may not give you official results, it might help you decide whether to get a comprehensive exam.

What causes hearing loss?

All of us lose some hearing over time, says Dr. Voigt. But there are certain things that can speed up hearing loss.

• Loud sounds: This is the most common cause of hearing loss. Loud sounds can permanently damage the tiny antenna-like hairs and other sensory cells in the cochlea.⁹ Along with age-related hearing loss, loud noises can lead to tinnitus. This is a health problem marked by ringing or buzzing in the ears, which can make it hard to hear.⁹
  
  As a result, you’ll want to protect yourself from noises above 70 decibels (dB), a unit used to measure sound. That means, for example, that you’ll want to wear hearing protection when:^9,10
  • Mowing the lawn (80 to 100 dB)
  • Riding a motorcycle (80 to 110 dB)
  • Watching fireworks (140 to 160 dB)
  To help determine what’s harmful to your ears, you can download apps on your smartphone or tablet that measure the decibel level of the sounds around you.¹⁰

• Certain diseases: High blood pressure, heart disease and diabetes are all linked to an increased chance of hearing loss, says Dr. Voigt. That’s likely because those conditions erode the health of your blood vessels, including the ones in your ears, he says.

• Smoking: Like high blood pressure, smoking can damage the blood vessels in your ears, says Dr. Voigt. That can affect your hearing.¹¹

• Certain medicines: Some medicines are “ototoxic” or ear-toxic — meaning they may damage tissues in the ear. This includes some medications used to treat cancer, like cisplatin, or infections, such as gentamicin.¹² Don’t stop these medications, but do talk to your provider. “If you’re taking something that has the potential to be ototoxic, you’ll want to have your hearing monitored while you’re on those drugs,” says Dr. Voigt.
   
• Genetics: Some inherited forms of hearing loss can show up later in life, according to the NIA.⁹

Can hearing loss affect my health?

Hearing loss isn’t an isolated medical problem of the ears. It’s linked to an increased chance of other health-related issues.¹³ These include:

• Social isolation: It’s no fun to continually ask the people around you, “Could you repeat that?” That's why people with hearing loss tend to isolate themselves. Social isolation can lead to many other health problems, including depression.¹⁴

• Dementia: Hearing loss is linked to an increased chance of memory problems.¹⁵
  
  “With hearing loss, speech and sound are garbled by the time they reach the brain, which requires the brain to use extra effort for processing the signals that come from the ear,” says Frank Lin, M.D., Ph.D. He is a professor of otolaryngology, medicine, mental health and epidemiology at Johns Hopkins School of Medicine. “The brain then has fewer resources for supporting thinking and memory abilities.”
  
  What’s more, Dr. Lin says that the parts of the brain that are stimulated by speech and sound are now understimulated, which can lead to atrophy. That means those unused parts of the brain start to waste away.^{16, 17}
  
  The good news? Hearing aids have been shown to lower your risk of thinking and memory problems by as much as 48% over three years.¹⁸
   
• Accidents: Even small changes in hearing are linked to an increased fall risk.¹⁹ Experts don’t know why for sure. But they think that hearing loss may either affect the brain’s ability to keep the body balanced or drain someone’s ability to pay attention, causing them to trip more easily.

Ready to get your hearing checked? Early treatment may help lower your risk of other conditions like depression and memory loss. Find a provider.

What can you do about hearing loss?

Many people notice hearing loss in their 50s, 60s and 70s but put off getting evaluated and treated. That’s a mistake, says Dr. Voigt.

The reason: The brain is a use-it-or-lose-it organ. As your ears send fewer frequencies, brain pathways lose their ability to understand them. Years later, hearing aids can amplify sounds, but your brain may no longer be able to interpret them.²⁰

“The earlier you start using hearing aids, the better function you’ll have long term,” he says. “You want to keep stimulating the auditory pathways.”

You have two choices when shopping for a hearing aid: prescription hearing aids and over-the-counter hearing aids.

Prescription hearing aids: A hearing care professional can custom fit you with the right hearing aid for your hearing loss, notes Dr. Voigt. These hearing aids will amplify the frequencies that you’re missing.

“Hearing does change over time,” he says. “Prescription hearing aids can be programmed to match these individual changes.”

Over-the-counter (OTC) hearing aids: Since 2022, the U.S. Food and Drug Administration has allowed companies to sell hearing aids without a doctor visit or prescription.²¹

It's important to know that these hearing aids are meant for people with perceived mild to moderate hearing loss. They can be worn all day, if necessary, or in certain situations where you may find it hard to hear.²²

If you suspect you have hearing loss, the first step is a hearing exam. No matter what your level of hearing loss, if any, you can take comfort in knowing that there are treatments that can help.

Sources

1. World report on hearing World Health Organization. Published March 2021.
2. Age-related hearing loss (presbycusis) National Institute on Deafness and Other Communication Disorders. Last updated March 17, 2023.
3. How do we hear? National Institutes on Deafness and Other Communication Disorders. Last updated March 16, 2022.
4. Parts of the ear Centers for Disease Control and Prevention. Last reviewed August 7, 2023.
5. Six signs of hearing loss National Institute on Aging. Accessed December 14. 2023.
6. Ear wax Medline Plus. Last reviewed May 30. 2022.
7. Fluid in the ear (secretory otitis media) Merck Manual Consumer Version. Last reviewed July 2022.
8. Hearing tests for adults Medline Plus. Last updated October 25, 2023.
9. Hearing loss: a common problem for older adults National Institute on Aging. Last reviewed January 19, 2023.
10. Hearing protectors National Institute on Deafness and Other Communication Disorders. Last reviewed October 21, 2022.
11. Association of cigarette smoking patterns over 30 years with audiometric hearing impairment and speech-in-noise perception: The atherosclerosis risk in communities study JAMA Otolaryngology-Head & Neck Surgery. Published January 27, 2022.
12. Prevention and management of hearing loss in patients receiving ototoxic medications Bulletin World Health Organization. Published December 1, 2022.
13. Hidden hearing loss National Institutes of Health. Last updated July 26, 2022.
14. “The worse my hearing got, the less sociable I got:” a qualitative study Age and Ageing. Published February 2022.
15. Hearing loss and dementia prevalence in older adults in the U.S. JAMA. Published January 10, 2023.
16. The Effects of Age-Related Hearing Loss on the Brain and Cognitive Function Trends in Neurosciences. Published August 19, 2020.
17. Hearing impairment is associated with cognitive decline, brain atrophy and tau pathology ebio Medicine. Published December 2022.
18. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial The Lancet. Published July 17, 2023.
19. Falls and fractures in older adults: Causes and prevention National Institute on Aging. Last reviewed September 12, 2022.
20. Hearing loss and cognition: What we know and where we need to go Frontiers in Aging Neuroscience. Published February 2022.
21. OTC hearing aids: What you should know U.S. Food and Drug Administration. Last reviewed May 3, 2023.
22. Consumers and OTC hearing aids: FAQ’s consumers need to know American Academy of Audiology. Accessed December 13, 2023.

Information is for educational purposes only and is not a substitute for the advice of a licensed medical provider. Consult your provider prior to making changes to your lifestyle or health care routine.

The online hearing test is not intended to act as a substitute for professional medical advice, diagnosis, or treatment. Talk with your healthcare provider with any question about a medical condition.