Age-Related Hearing Loss

Overview

Age-related hearing loss occurs gradually for many people as they grow older. It is one of the most common conditions affecting adults as we age.

Hearing loss is a common problem caused by noise, aging, disease, and heredity. Hearing is a complex sense involving both the ear’s ability to detect sounds in the environment and the brain’s ability to interpret the sounds of speech.

Having trouble hearing can make it hard to understand and follow a doctor’s advice, respond to warnings, and hear phones, doorbells, and smoke alarms. Hearing loss can also make it hard to enjoy talking with family and friends, leading to feelings of isolation. Untreated hearing loss has been associated with serious conditions such as depression, anxiety, low self-esteem, dementia, reduced mobility, and falls.

Hearing loss typically occurs in both ears as we age. Because the loss is gradual, you may not realize that you’ve lost some of your ability to hear.

Signs and Symptoms

Using the Revised Hearing Handicap Inventory and Screening Tool, you may have age-related hearing loss if you notice any of the following:

• Speech or other sounds seem muffled.
• You have trouble hearing when you’re in a group, in a noisy area, on the phone, or when you can’t see who is talking.
• You have to ask others to speak more slowly or clearly, to talk louder, or to repeat what they said.
• You turn up the volume higher than other people prefer when watching TV or listening to the radio or music.

Associated symptoms can include:

• Tinnitus (ringing, roaring, or buzzing in the ears or head)
• Hyperacusis (intolerance to normal environmental sounds)
• Recruitment (when loud sounds are suddenly uncomfortable)

Self-Screening Questions

Ask yourself the following questions. If you answer “yes” to two or more, or “sometimes” to three or more, you could have hearing loss and should consider having your hearing checked:

• Does a hearing problem cause you difficulty when listening to TV or radio?
• Does a hearing problem cause you difficulty when attending a party?
• Does a hearing problem cause you to feel frustrated when talking to members of your family?
• Does a hearing problem cause you to feel left out when you are with a group of people?
• Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?
• Do you feel challenged by a hearing problem?
• Do you feel that any difficulty with your hearing limits or hampers your personal or social life?
• Does a hearing problem cause you to feel uncomfortable when talking to friends?
• Does a hearing problem cause you to avoid groups of people?
• Does a hearing problem cause you to visit friends, relatives, or neighbors less often than you would like?

When to See a Doctor Promptly

Some ear problems need medical treatment right away. See a licensed physician if you have any of the following:

• Fluid, pus, or blood coming out of your ear within the previous 6 months
• Pain or discomfort in your ear
• A history of excessive ear wax or suspicion that something is in your ear canal
• Episodes of vertigo (severe dizziness) with hearing loss
• Sudden hearing loss or quickly worsening hearing loss
• Hearing loss that has gotten more and then less severe within the last 6 months
• Hearing loss or tinnitus (ringing) in only one ear, or a noticeable difference in how well you can hear in each ear

Causes and Risk Factors

Many things affect hearing as we age. Causes and risk factors include:

• Age-related changes in the middle and inner ear and complex changes along the nerve pathways from the ear to the brain
• Long-term exposure to noise
• Certain medical conditions such as high blood pressure and diabetes, which are more common in older people, are associated with hearing loss
• Genes make some people more susceptible to hearing loss as they age
• Some medicines that are toxic to the sensory cells in the ears, such as some antibiotics and chemotherapy drugs
• Disease
• Genetic factors

Diagnosis

Mild losses may not be noticed and even moderate losses may not cause a problem for people with excellent perceptual abilities and good coping skills. 

If you think you might have hearing loss, knowing where to turn for help may be hard. Start by talking with your primary care provider, who may refer you to an otolaryngologist or audiologist for more specific tests and treatment. For more information about the types of hearing health professionals, visit the Healthy Hearing page.

Formal Audiometric Testing

Formal audiometric testing is the gold standard for diagnosing hearing loss and monitoring treatment. It provides precise information about hearing ability in each ear, based on how loud a sound at different frequencies have to be to detect it (thresholds). Testing may be done at any age.

A convenient summary of the audiogram for each ear is the pure-tone average (PTA) of thresholds measured at specific frequencies. The most common PTA definition found in population-based studies is the four-frequency average of 500, 1000, 2000, and 4000 Hz. As the PTA increases, the hearing ability decreases. Normal hearing for speech is observed in adults with PTAs of 25 dB HL or less.

A PTA greater than 25 dB HL generally requires adaptive listening strategies, such as sitting closer to the source of sound. At a PTA of around 40 dB HL in both ears, most people are considered functionally impaired and could benefit from amplification. Severe to profound losses are present when PTAs are greater than 70 dB HL.

An accurate assessment of hearing includes:

• Laterality (one or both ears affected)
• Degree and pattern of threshold loss across frequencies
• Best ability to understand speech, either with hearing aids or loud speaking levels

Other factors to determine include:

• The speed of onset or progression of hearing loss
• Associated symptoms such as tinnitus and dizziness, hyperacusis (intolerance to normal environmental sounds), and recruitment (when loud sounds are suddenly uncomfortable)

Self Report

Hearing loss may also be identified through self-report or by friends and family. Self-report and family report are important because they are relatively simple to determine and provide a global assessment of the impact of the problem on the individual.

Treatment and Management

Treatment depends on the severity of your hearing loss, so some treatments or devices will work better for you than others. Options include:

• Hearing aids (prescription or over the counter): Small electronic devices you wear in or behind your ear that make sounds louder
• Cochlear implants: Small electronic devices that are surgically implanted in the inner ear that help provide a sense of sound to people who are profoundly deaf or have severe hearing loss
• Assistive listening devices: Any device that helps a person hear better, especially in certain situations
• Captions and telecommunications: Words displayed on device that describe the audio or sound

Hearing aids are particularly good options for people with age-related hearing loss, or a combination of age-related and noise-induced hearing loss.

Living With Age-Related Hearing Loss

The impact of hearing loss on a person depends on several factors:

• The degree of hearing loss: Mild hearing loss may not be noticed, and even moderate losses may not cause a problem for some people.
• The speed at which hearing loss develops: People often adapt better to slowly progressive losses than to sudden losses.
• The pattern of hearing loss across sound frequencies
• Whether one or both ears are affected
• The area of abnormality in the auditory system: such as the middle ear, inner ear, auditory neural pathways, or brain
• Speech recognition ability

You and your family can work together to make living with hearing loss easier. Here are some things you can do:

• Tell your friends and family about your hearing loss. Explain which listening situations are hard for you.
• Ask your friends and family to face you when they talk so that you can see their expressions and lip movements.
• Ask people to speak louder but not shout. You may need to ask them to slow down and look at you while speaking as an aid to lip reading.
• Turn off or turn down background noise, such as the TV, when you’re trying to have a conversation.
• Be aware of noise around you that can make hearing more difficult. When you go to a restaurant, don’t sit near the kitchen or near a band playing music. Ask for seating in a quiet area. Sitting in a booth near ceiling to floor curtains can help to soften echoes and block other noises.

In the event of an emergency:

• TTY or TDD users can call 911 directly and do not need to make a telecommunications relay service call via 711.

Adjusting to Hearing Aids

Hearing aids take time and patience to use successfully. Wearing your aids regularly will help you adjust to them.

Become familiar with your hearing aid’s features. Practice putting in and taking out the aid, cleaning it, identifying right and left aids, and replacing the batteries. Learn to adjust the aid’s volume and to program it for sounds that are too loud or too soft.

Common adjustment challenges include:

• Discomfort: Some people find a hearing aid slightly uncomfortable at first. Ask your audiologist how long you should wear your hearing aid while adjusting to it.
• Voice sounds too loud: The “plugged-up” sensation that causes a hearing aid user’s voice to sound louder inside the head is called the occlusion effect and is very common for new hearing aid users.
• Feedback: A whistling sound can be caused by a hearing aid that does not fit or work well or is clogged by earwax or fluid.
• Background noise: A hearing aid does not completely separate the sounds you want to hear from the ones you do not want to hear.
• Cell phone buzzing: Some people who wear hearing aids experience problems with radio frequency interference caused by digital cell phones, though these problems are occurring less often as both hearing aids and cell phones improve.

To extend the life of your hearing aid:

• Keep hearing aids away from heat and moisture.
• Clean hearing aids as instructed, as earwax and ear drainage can damage a hearing aid.
• Avoid using hairspray or other hair care products while wearing hearing aids.
• Turn off hearing aids when they are not in use.
• Replace dead batteries immediately.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on Age-Related Hearing Loss.

Community Support

For information on telecommunications relay services, visit the Federal Communications Commission website. They have information on closed captioning rules and the complaint process. 

• Toll-Free Voice: 1-888-CALL-FCC (1-888-225-5322)
• Toll-Free TTY: 1-888-TELL-FCC (1-888-835-5322)

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH supports research on the causes of age-related hearing loss, including genes that may make this type of hearing loss more likely. NIH-funded scientists are working to understand what happens as we age that interferes with our ability to hear speech in a noisy environment. NIH also funds research that explores changes in how the brain processes sound when we lose our hearing. The research to date supports the use of hearing aids to maintain the brain’s sound-processing capabilities.

NIH-supported research provided critical data that contributed to the FDA’s decision to make hearing aids available over the counter, without a prescription or healthcare examination, for adults who believe they have mild to moderate hearing loss. NIH continues to support research on ways to make adult hearing healthcare more accessible and affordable.

Researchers are also looking at ways to apply new signal processing strategies to the design of hearing aids. NIH-funded researchers are studying how hearing aids can enhance speech signals to improve understanding. Researchers are also investigating the use of computer-aided technology to design and manufacture better hearing aids and seeking ways to improve sound transmission and reduce noise interference, feedback, and the occlusion effect.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.