What is hearing loss?

Hearing loss is a partial or total inability to hear sounds in one or both ears. It can happen suddenly or gradually and may be temporary or permanent, depending on the cause.

Types of Hearing Loss

1. Conductive Hearing Loss
   Caused by problems in the outer or middle ear (e.g., earwax buildup, ear infections, or damage to the eardrum). Sound doesn't reach the inner ear properly.

2. Sensorineural Hearing Loss
   Results from damage to the inner ear (cochlea) or the auditory nerve. Common causes include aging, loud noise exposure, and certain medications or illnesses.

3. Mixed Hearing Loss
   A combination of conductive and sensorineural hearing loss.

Common Causes

• Aging (presbycusis)

• Repeated exposure to loud noise

• Ear infections

• Earwax blockage

• Genetics

• Certain medications (ototoxic drugs)

• Head injuries or illnesses (e.g., meningitis)

• Viruses/bacterial infections

• Comorbidities linked to hearing loss (here is a short, non-exhaustive list)

  • Diabetes

  • Chronic kidney disease

  • Cardiovascular disease

  • Hypertension

  • Cancer

Symptoms

• Muffled or distorted speech and sounds

• Trouble hearing conversations, especially in noisy environments

• Frequently asking others to repeat themselves

• Needing to turn up the volume on TV or devices

• Hearing better in one ear compared to the other

Prevalence of Hearing Loss in the U.S.

• General Population: Approximately 15% of American adults (37.5 million) aged 18 and over report some trouble hearing.

• Children: About 2 to 3 out of every 1,000 children in the U.S. are born with a detectable level of hearing loss in one or both ears.

  Older Adults:

  • 5% of adults aged 45–54 have disabling hearing loss.

  • 10% of adults aged 55–64.

  • 22% of those aged 65–74.

  • 55% of individuals aged 75 and older.

• Gender Disparities: Men are nearly twice as likely as women to experience hearing loss among adults aged 20–69.

• Racial/Ethnic Differences:

  • Non-Hispanic White adults have a higher prevalence of hearing loss compared to other racial/ethnic groups.

  • Non-Hispanic Black adults have the lowest prevalence among adults aged 20–69.

Severity of Hearing Loss

• Mild Hearing Loss: Approximately 25.4 million individuals aged 12 years or older.

• Moderate Hearing Loss: About 10.7 million.

• Severe Hearing Loss: Approximately 1.8 million.

• Profound Hearing Loss: Around 0.4 million.

Trends and Projections

• The prevalence of hearing loss is expected to rise from 44 million in 2020 to over 73 million by 2060, primarily due to the aging population.

• Despite an increase in the population, the overall annual prevalence of hearing loss among adults aged 20–69 declined slightly from 16% (28 million) in 1999–2004 to 14% (27.7 million) in 2011–2012.

Treatment Options

• Hearing aids

• Cochlear implants

• Osseointegrated auditory devices

• Medications or surgery (in cases of infections or structural issues)

• Assistive listening devices (like amplified phones, FM systems, ear-level amplifiers)

How to test for hearing loss.

Professional Hearing Tests (at a clinic or audiologist's office)

If you begin to notice symptoms of hearing loss (or worse, others are noticing your symptoms)

here is the simple process of how hearing testing is performed.

1. Pure Tone Audiometry

   • You wear headphones in a sound treated booth.

   • You’ll listen for tones at different pitches and volumes.

   • You press a button or raise your hand when you hear a sound, even if it’s very faint.

   • Results are shown on an graph called an audiogram to identify the quietest sounds you can hear at each frequency or pitch.

   • This procedure helps identify whether hearing levels are in a normal hearing range, or if there is hearing loss it determines the degree and type of hearing loss.

2. Speech Audiometry

   • Measures how well you hear (detect) and understand (discriminate) speech at different volumes.

   • Includes:

     • Speech recognition threshold (SRT)

     • Word recognition score (WRS)

3. Tympanometry

   • Tests middle ear function (e.g., eardrum movement).

   • It can detect fluid behind the eardrum caused by allergies, ear infections, or eustachian tube issues.

4. Acoustic Reflex Threshold

   • This reflex occurs when a tiny muscle in the middle ear called the stapedius muscle contracts to reduce acoustic vibrations and protect the inner ear.

   • The test measures the lowest volume level of sound that triggers this reflex.

     • It helps determine whether the middle ear, auditory nerve, and parts of the brainstem involved in hearing are functioning properly.

How Hearing Loss Impacts You

Hearing loss can have wide-reaching effects—not just physically, but also emotionally, financially, socially, and even cognitively. Here’s how it can impact you:

Cognitive Effects

• Increased cognitive load: Your brain works harder to interpret sounds, which can lead to mental fatigue.

• Higher risk of dementia: Studies have linked untreated hearing loss (especially in older adults) to an increased risk of cognitive decline and Alzheimer’s disease. It is a modifiable risk factor by seeking help from an audiologist.

• Trouble with memory or focus: When you’re struggling to hear, it’s harder to absorb and remember information.

Communication & Relationships

• Not hearing clearly can lead to misunderstandings in conversations and sometimes people choose avoidant behavior or simply pretend they understood the message.

• Feeling left out in group settings.

• May lead to arguments or frustration with loved ones.

• Withdrawal from social activities due to embarrassment or fatig

Emotional & Mental Health

• Social isolation: People often avoid situations where they can’t hear well.

• Depression and anxiety: Struggling to connect with others can take a toll on your mental health.

• Lower self-esteem: Especially in younger people, it may cause feelings of insecurity or being “different.”

Day-to-Day Functioning

• Difficulty hearing alarms, sirens, doorbells, or phone calls.

• Trouble understanding speech in noisy places (like restaurants).

• Risk of accidents if you can’t hear warnings or cues

• Higher incidents of falls when hearing loss is present

• Reduced performance at work or school due to missed information

Economic & Career Impact

• People with untreated hearing loss may earn less due to communication challenges at work.

• It may limit job choices, especially in fields that rely heavily on verbal communication.

• But here's the thing: with early detection and proper support (like hearing aids, cochlear implants, or therapy), many of these impacts can be minimized or avoided altogether.

Overall Impact on Health

• People with untreated hearing loss have experience a higher incidence of hospitalizations and overall higher healthcare costs compared to those without hearing loss

Hearing loss treatment

Treating hearing loss depends on the type, cause, and severity of the condition. Here's a breakdown of the most common treatment options:

1. Medically Treatable

Earwax buildup: Earwax impaction can cause a temporary “conductive” type of hearing loss and sometimes it can also cause temporary tinnitus (ringing in the ear). Removal by an audiologist, physician or nurse practitioner is recommended.

• Methods of earwax removal include: irrigation, suction, or curettage.

Ear Infections: Antibiotics or antifungal medications; sometimes minor surgery if infections are chronic.

Middle ear diseases: Surgical procedures or pressure equalization (PE) tubes for fluid drainage.

2. Sensorineural Hearing Loss (Usually Permanent)

This is the most common type—damage to the inner ear (cochlea) or auditory nerve. Treatment focuses on managing the loss:

Hearing Aids

• Amplify sounds; best for mild to moderate loss.

• Customized and programmed to match your hearing levels using real ear verification measures for proper fitting.

Cochlear Implants

• For severe to profound hearing loss when hearing aids aren't enough.

• Surgically implanted device that bypasses damaged hair cells in the cochlea and directly stimulates the auditory nerve.

Assistive Listening Devices

• Amplified phones, TV headsets, personal amplifiers, and FM systems

• Great for specific environments (like classrooms or theaters)

Speech and Auditory Training

• Helps retrain the brain to interpret sounds, especially useful after cochlear implantation or long-term untreated loss

3. Genetic or Congenital Hearing Loss

• Often addressed with early intervention (like cochlear implants in infants)

• Support includes speech-language therapy, sign language, or a bilingual approach (spoken + sign language)

4. Other Treatments

• Steroids: Sometimes used in cases of sudden sensorineural hearing loss (SSHL) if caught early.

• Bone-anchored hearing systems (BAHA): For conductive hearing loss or single-sided deafness.

• Auditory brainstem implants (ABI): In rare cases of nerve absence or damage.

Early Intervention Matters

The sooner hearing loss is addressed, the better the outcomes for communication, mental health, and brain health. Untreated hearing loss can worsen over time and impact quality of life significantly.