What is hearing loss?
Hearing loss is a partial or total inability to hear sound in one or both ears. It can develop gradually over time or occur suddenly due to trauma or illness. More than 48 million Americans experience some degree of hearing loss, making it one of the most common chronic conditions in older adults.
There are many reasons hearing may become impaired — from age-related wear on the inner ear to prolonged exposure to loud sounds, or even complications from infections or medications. Hearing loss can affect your ability to follow conversations, participate socially, and maintain emotional well-being. The good news is that many options are available to treat or manage hearing loss, including hearing aids and hearing protection.
Key takeaways
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There are three main types of hearing loss: conductive, sensorineural, and mixed.
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Common causes include aging, noise exposure, ear infections, and certain medications.
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Hearing aids, cochlear implants, and protective strategies can help manage or prevent hearing decline.
Types of hearing loss
Conductive hearing loss
This type of hearing loss occurs when sound waves are blocked from reaching the inner ear. Causes include earwax buildup, infections in the middle ear (otitis media), fluid buildup, perforated eardrums, and structural abnormalities. Conductive hearing loss often leads to a feeling of fullness in the ear and sounds may seem muffled. Fortunately, it is often treatable through medical intervention such as earwax removal, antibiotics, or minor surgery.
Sensorineural hearing loss
Sensorineural hearing loss results from damage to the inner ear or the auditory nerve that connects the ear to the brain. Common causes include age-related degeneration (presbycusis), long-term noise exposure, certain medications (ototoxic drugs), head trauma, and illnesses like Meniere’s disease. This type of hearing loss is usually permanent, but hearing aids or cochlear implants can significantly improve hearing.
Mixed hearing loss
When both the conductive and sensorineural systems are affected, it's referred to as mixed hearing loss. For example, someone might have age-related nerve damage along with a blockage from earwax or an infection. Treatment for mixed hearing loss typically involves a combination of medical and audiological interventions.
Common symptoms of hearing loss
Hearing loss can develop so gradually that many people are unaware they’re experiencing it. Recognizing symptoms early can make a significant difference in treatment outcomes. Common signs include:
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Difficulty hearing speech, especially in noisy settings like restaurants or family gatherings
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Frequently asking people to repeat themselves or speak louder
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Turning up the volume on the TV or phone more than others in the room
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Trouble hearing certain sounds, such as high-pitched voices, doorbells, or birdsong
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A sensation of ringing or buzzing in the ears (tinnitus)
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Withdrawing from social situations due to difficulty understanding conversations
In children, signs may include delayed speech development, inattentiveness, or a lack of response to sound. Pediatric hearing loss can affect learning and should be evaluated promptly.
Causes of hearing loss
Hearing loss can be caused by a wide variety of factors, both temporary and permanent. Understanding the root cause can guide appropriate treatment.
Age-related hearing loss (presbycusis)
Presbycusis affects nearly one in three people over the age of 65. It is caused by gradual degeneration of the hair cells in the cochlea, which are responsible for converting sound waves into nerve signals. This condition usually affects both ears and makes it difficult to hear high-frequency sounds or follow conversations.
Prolonged noise exposure
Noise-induced hearing loss (NIHL) is one of the most preventable causes of hearing damage. It results from long-term exposure to loud sounds, such as concerts, power tools, or headphones at high volumes. The louder the noise and the longer the exposure, the greater the risk. Even short bursts of very loud noise, like gunfire or fireworks, can cause permanent hearing damage.
Ear infections and blockages
Middle ear infections and impacted earwax can obstruct the transmission of sound waves. These conditions are typically treatable, but if left unresolved, they can lead to longer-term damage. Swimmer’s ear, fluid buildup behind the eardrum, or structural abnormalities like otosclerosis can also contribute.
Medications and illness
Some medications are known to be ototoxic, meaning they can harm the ear’s inner structures. These include certain chemotherapy drugs, loop diuretics, and large doses of aspirin. Chronic conditions such as diabetes, cardiovascular disease, or autoimmune disorders can reduce blood flow to the inner ear, increasing the risk of sensorineural damage.
Genetic factors and birth conditions
Hearing loss may be inherited or the result of complications during pregnancy and birth. Babies exposed to infections in utero (like rubella or cytomegalovirus), or those born with low birth weight or oxygen deprivation, may experience early-onset hearing issues. Inherited conditions like Usher syndrome or Pendred syndrome can also be responsible.
How hearing loss is diagnosed
Diagnosing hearing loss involves a step-by-step process starting with a physical exam and review of your health history. Your primary care doctor may refer you to an audiologist or ENT specialist for further evaluation.
Hearing tests include:
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Pure-tone audiometry: Measures your ability to hear tones at various pitches and volumes.
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Speech audiometry: Assesses how well you understand spoken words at different sound levels.
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Tympanometry: Evaluates the movement of the eardrum in response to air pressure changes, which can help detect fluid or blockages.
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Otoacoustic emissions (OAE): Used to assess inner ear function, especially in infants or people who can’t respond to conventional tests.
These tests not only determine whether hearing loss exists but also help identify its type, location, and severity.
Degrees and stages of hearing loss
Hearing loss is classified into degrees based on the softest sound you can hear, measured in decibels (dB). Understanding these stages helps guide the choice of hearing devices or treatment.
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Slight (16–25 dB): May have difficulty hearing soft speech or distant sounds
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Mild (26–40 dB): Trouble hearing in noisy environments; may miss some conversation
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Moderate (41–55 dB): Regular conversations become difficult without hearing aids
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Moderately severe (56–70 dB): Struggles with group conversations and most daily sounds
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Severe (71–90 dB): Only loud sounds are audible; communication without aids is challenging
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Profound (91+ dB): Minimal or no hearing; may rely on visual communication and assistive devices
Treatment options for hearing loss
Hearing aids
Hearing aids are one of the most common and effective ways to manage hearing loss. These small devices amplify sound and can be customized based on the type and degree of loss. Today’s models are often nearly invisible and offer Bluetooth streaming, background noise reduction, and rechargeable batteries.
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Cochlear implants
Cochlear implants are suitable for individuals with severe to profound sensorineural hearing loss who receive little benefit from traditional hearing aids. A small device is surgically implanted behind the ear and bypasses the damaged inner ear structures to directly stimulate the auditory nerve.
Surgery or medication
Medical treatments may include antibiotics for ear infections, removal of tumors, or surgical repair of the eardrum or middle ear bones. For some conditions, such as otosclerosis or cholesteatoma, surgical options offer significant improvement.
Assistive listening devices
For those who need added help in specific situations, devices like TV streamers, personal amplifiers, captioned phones, and vibrating alarm clocks can improve independence and communication. Many of these are compatible with hearing aids and cochlear implants.
Preventing hearing loss
While not all hearing loss is preventable, taking proactive steps can preserve your hearing for longer.
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Limit exposure to loud environments: Use earplugs at concerts, construction sites, or while using power tools.
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Practice safe listening: Keep headphones at 60% volume or lower, and avoid listening for more than 60 minutes at a time.
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Monitor your health: Control blood pressure, manage diabetes, and avoid smoking, all of which can affect hearing.
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Avoid inserting objects into the ear: Cotton swabs and other tools can cause damage.
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Schedule regular hearing tests: Early detection allows for quicker intervention and better outcomes.
Living with hearing loss
Adjusting to hearing loss can be emotionally and socially challenging. Many individuals experience frustration, embarrassment, or withdrawal from conversations. Acknowledging hearing loss and seeking support can dramatically improve your quality of life.
Communication strategies, such as facing the speaker, reducing background noise, and using assistive devices, can make a big difference. Support groups, both online and in-person, offer shared experiences and encouragement. Hearing specialists can also guide you through rehabilitation services, which may include auditory training and counseling.
Living well with hearing loss is possible — especially when you stay informed and take an active role in your hearing health.
FAQs about hearing loss
What are the first signs of hearing loss?
You may begin to miss high-pitched sounds, struggle to follow conversations in noisy places, or frequently ask others to repeat themselves. You might also find yourself turning up the TV or phone volume more than usual.
Can hearing loss be reversed?
It depends on the cause. Hearing loss from infections or earwax may be temporary, while damage to the inner ear from age or noise exposure is often permanent. Treatment can significantly improve communication even if hearing itself isn’t fully restored.
How do I know if I need hearing aids?
If hearing loss affects your daily life — whether in conversations, on the phone, or while watching TV — it’s a good idea to get your hearing tested. An audiologist can determine if hearing aids will help.
Is hearing loss the same as deafness?
No. Hearing loss ranges in severity, while deafness usually refers to profound hearing loss with minimal or no sound perception. People with hearing loss may benefit from hearing aids, while those who are deaf may use sign language or other forms of communication.
How can I protect my hearing in daily life?
Wear ear protection in loud settings, use headphones at safe volumes, avoid inserting objects into your ears, and get regular hearing screenings, especially if you’re over 60 or have risk factors.
Note: This article is for informational purposes only and is not intended to provide medical advice. Always consult a healthcare provider or audiologist for personalized recommendations.
