Hearing Health

Hearing Loss – Symptoms and Causes

Hearing loss is a common condition that affects people of all ages, yet it often goes overlooked and undiagnosed. Approximately 15% of American adults report having some trouble hearing, making hearing loss one of the most prevalent chronic health conditions in the United States. The implications of leaving hearing loss untreated can be significant – it can lead to social isolation, depression, cognitive decline, and even dementia. However, with proper diagnosis and treatment, many people with hearing loss can improve their hearing, communication, and quality of life.

In this comprehensive guide, we will cover the fundamentals of hearing loss, including the different types, causes, symptoms, diagnosis methods, treatments, and prevention strategies. With a deeper understanding of the mechanisms underlying hearing loss and the available management techniques, people can become better advocates for their own hearing healthcare. Our aim is to empower readers with the knowledge and resources to recognize signs of hearing loss, seek professional help when needed, and implement lifestyle changes to prevent unnecessary deterioration of hearing over time. Drawing on decades of clinical experience in audiology and up-to-date medical research, we will explore this important health topic in a way that is accessible and actionable for any reader concerned about their hearing.

Causes of Hearing Loss

There are a number of potential causes of hearing loss, both acquired and congenital. These include:

Congenital hearing loss – Some babies are born with impaired hearing due to genetic factors or complications at birth. This type of hearing loss can vary from mild to profound and may affect one or both ears. Approximately 1-3 of every 1,000 babies are born with some level of hearing loss.

Noise-induced hearing loss – Prolonged exposure to loud noises, like heavy equipment, gunfire, or loud music, can damage the delicate hair cells in the inner ear that transmit sound to the brain. This is one of the most common causes of preventable hearing loss. Use of hearing protection is key to prevention.

Age-related hearing loss (presbycusis) – As we age, changes in the inner ear that affect hearing sensitivity occur. The cumulative effects of aging as well as noise exposure lead to age-related hearing decline, which generally impacts higher frequencies first.

Ear infections – Chronic ear infections or a particularly severe ear infection can damage the middle ear and cause conductive hearing loss. Prompt treatment of infections can prevent permanent damage.

Head trauma – Injuries to the head or ear can sometimes lead to sensorineural hearing loss. The extent of damage depends on the nature and force of the trauma.

Certain medications – There are over 200 prescription and OTC medications that have ototoxic effects, meaning they can damage hearing. Some common culprits are aspirin, NSAIDs, certain antibiotics, diuretics, and chemotherapy drugs.

Genetic factors – Although many genetic causes of hearing loss have yet to be identified, there are some known inherited syndromes and genetic mutations that can predispose individuals to early-onset hearing loss.

Types of Hearing Loss

There are three main types of hearing loss, categorized by which part of the auditory system they affect.

Conductive hearing loss – This occurs when there is a problem conducting sound waves anywhere along the path through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). It is often medically treatable through antibiotics or surgery. Conductive loss causes decreased loudness of sounds.

Sensorineural hearing loss – This results from damage to the inner ear (cochlea) or auditory nerve pathways to the brain. It is most often irreversible. Sensorineural hearing loss impacts sound clarity more than loudness.

Mixed hearing loss – This refers to a combination of conductive and sensorineural loss, with both outer/middle ear and inner ear involvement. Those with mixed loss experience decreases in both loudness and clarity.

The type of hearing loss present has implications for treatment approaches. Conductive loss can often be restored through medical intervention, while sensorineural loss may require hearing aids or cochlear implants to amplify sounds electronically. Identifying the subtype and degree of loss through audiometric testing is necessary to determine appropriate therapies.

Symptoms of Hearing Loss

Hearing loss can develop gradually over time, so many people may not realize their hearing ability is declining at first. There are several common symptoms that indicate someone should get their hearing evaluated by a professional:

  • Difficulty hearing conversations, especially in noisy environments or when speakers are at a distance
  • Frequently needing to ask others to repeat themselves, or responding inappropriately because part of the conversation wasn’t heard
  • Turning up the volume on the TV, radio, or phone to louder levels than others need
  • Avoidance of group settings, public spaces, or conversations due to difficulty understanding speech
  • Social isolation or withdrawal from friends and family due to communication challenges
  • Tinnitus (ringing, buzzing, roaring, or hissing in the ears)
  • Favoring one ear over the other when listening, or having more trouble hearing out of one ear
  • Regular ear pain, itching, or discomfort
  • Poor speech development in children
  • Increased clumsiness or imbalance

Any notable changes in hearing ability that persist over time, especially the need for increased volume or difficulties hearing conversation, warrant a professional audiologic evaluation. The sooner hearing loss is diagnosed, the sooner treatment can begin.

Diagnosing Hearing Loss

If hearing loss is suspected, it is important to get a professional diagnosis so that the type, severity, and configuration of loss can be identified. This guides treatment recommendations. There are several tests audiologists use to diagnose hearing loss:

Routine Hearing Screenings – Basic pure tone testing can identify potential red flags for hearing loss that warrant further evaluation. Many schools and workplaces offer periodic hearing screenings.

Comprehensive Audiometric Testing – This thorough assessment maps out the softest sounds one can hear across different pitches. Results are plotted on an audiogram showing the degree, type, and pattern of hearing loss.

Tympanometry – This test assesses middle ear function by measuring eardrum mobility and air pressure in the ear canal. It can identify conductive hearing issues.

Acoustic Reflex Testing – Loud tones are emitted to trigger an involuntary reflex contraction of the stapedius muscle in the middle ear. Absent or elevated reflex thresholds may indicate hearing loss.

Auditory Brainstem Response (ABR) – Electrodes measure the brain’s response to clicks and tones. It can identify auditory nerve damage and neurological hearing issues.

Otoacoustic Emissions Testing – A small probe emits tones into the ear canal to measure emission echoes coming from outer hair cells. This tests inner ear function.

Getting baseline hearing tests allows hearing loss to be monitored over time. Testing may need to be repeated periodically to guide ongoing management.

Treating Hearing Loss

Once hearing loss is diagnosed, the main treatment options include:

Hearing Aids – These electronic amplification devices are the most common treatment for hearing loss. They fit in or behind the ear and make sounds louder and clearer. Hearing aids can address mild to profound sensorineural or mixed hearing loss.

Cochlear Implants – For those with severe to profound sensorineural hearing loss, cochlear implants can bypass damaged areas and directly stimulate the auditory nerve. They involve surgical implantation of a receiver behind the ear with electrodes in the inner ear.

Assistive Listening Devices – These enhance speech in challenging environments by transmitting sound signals directly to the listener’s ears. Devices include FM systems, Bluetooth streamers, TV amplifiers, and more.

Speech Therapy – Working with a speech-language pathologist helps people with hearing loss practice speech, language, and listening skills for improved communication. Certain exercises may also help maximize hearing aid use.

Surgery – For conductive hearing loss caused by earwax blockage, otosclerosis, or other anatomical issues, surgery can sometimes successfully restore hearing.

Hearing loss treatment should be customized to each patient’s audiogram results, lifestyle, and preferences. Combining technologies like hearing aids and assistive devices often provides the most benefit. Ongoing adjustment and rehabilitation is key to ensuring maximal results.

Coping with Hearing Loss

Learning to live with hearing loss presents many challenges, but there are helpful strategies and resources for coping:

Communication Strategies – Face the person speaking, request they speak slowly and clearly, and don’t be afraid to ask for repetition. Let conversation partners know what they can do to make understanding easier.

Hearing Assistive Technology – Take advantage of alerting devices, amplified phones, hearing aid compatible headphones, TV listeners, and more. Customize your environment.

Support Groups – Connecting with other people experiencing hearing loss helps build understanding and techniques for self-advocacy. Organizations like HLAA provide support groups.

Stay Socially Engaged – Continue participating in satisfying activities and relationships. Let friends and family know how they can best communicate with you.

Cognitive-Perceptual Training – Speechreading classes, auditory training programs, and cognitive skills practice can boost communication ability.

Manage Fatigue – Hearing loss can be mentally and physically exhausting. Allow yourself rest breaks and treat hearing efforts as “work.”

Address Associated Conditions – Seek treatment for conditions like tinnitus, balance issues, or depression that may accompany hearing loss.

Coping with hearing loss involves patience, self-advocacy, support, and maintaining an engaged lifestyle. Counseling and educational programs allow people to gain skills to successfully manage their hearing health.

Preventing Further Hearing Loss

While some degree of age-related hearing decline is inevitable, there are ways to minimize unnecessary further damage to hearing:

  • Use hearing protection when exposed to loud noise above 85 decibels. This includes concerts, machinery, power tools, sporting events, etc. Earplugs, earmuffs, or noise-cancelling headphones can all help block hazardous volumes.
  • Promptly treat any ear infections with the full course of prescribed antibiotics to prevent chronic ear fluid issues that could lead to conductive loss.
  • Have medications reviewed by a doctor or pharmacist to discuss any potential ototoxicity issues, and inquire about alternative options as needed.
  • Limit use of damaging agents like solvents and paint thinners which can contain ototoxins. Be aware of any occupational exposures.
  • Discuss hearing health risks with your doctor if planning pregnancy, since some prenatal infections can cause congenital hearing loss.
  • Abstain from inserting foreign objects in the ear like cotton swabs or hair pins, which can damage the delicate eardrum.
  • Wear protective headgear and reduce head trauma risks through activities like cycling, contact sports, construction work, etc.
  • Get regular hearing evaluations to monitor age-related decline and promptly address sudden changes in hearing ability that could signify a medically treatable problem.

With some basic precautions and proactive monitoring, many cases of preventable hearing damage can be reduced. Preservation of hearing health remains an important quality of life factor as we age.


Hearing loss is a prevalent condition that affects people of all ages, yet it is often overlooked or accepted as an inevitable part of aging. However, untreated hearing loss carries significant consequences – it can negatively impact social functioning, cognitive processes, physical safety, and overall wellbeing. The good news is that with today’s increasing treatment options and hearing assistive technologies, people with hearing impairment can improve their communication abilities and mitigate the downstream effects of ongoing auditory deprivation.

From routine hearing protection to emerging drug therapies that may reverse noise-induced hearing loss, there are more prevention and treatment tools available than ever before. But the first step is proactively monitoring hearing health and seeking professional care when needed. Hearing loss should not just be “lived with” given the progress made in audiological interventions. Through greater public awareness, we can ensure that people recognize the signs of hearing decline in themselves and loved ones, and obtain appropriate support. If you or someone you know is showing symptoms of hearing loss, encourage them to get a hearing evaluation. Taking action early is key to successfully managing hearing health over the long term.

About the Author

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Ben Horlock Audiologist

Ben Horlock RHAD MHSAA, is an accomplished audiologist deeply committed to delivering remarkable audiological services.

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