The Complete Hearing Loss Guide

senior woman with hearing loss at the doctor's office

If you’re struggling with hearing, you’re not alone. The World Health Organization estimates that 1.5 billion people worldwide experience some degree of hearing loss, and 430 million have a debilitating impairment.

This comprehensive guide will tell you about hearing loss symptoms, types, causes, and treatments.

Hearing Loss Symptoms

There are a few telltale signs that you are losing your hearing. The most conspicuous is a diminished ability to hear, but you may also have other symptoms.

Signs of Hearing Impairment

The most obvious sign of hearing loss is that you or your loved ones notice a change in your hearing ability. Here are some things to look for:  

  • Sounds are muffled.
  • Friends and relatives point out that your TV or stereo volume is too high.
  • You have trouble understanding conversations on the phone or in-person.
  • You frequently ask the other person to repeat what they’re saying.
  • People often ask you to lower your voice.

Other Symptoms

In addition to difficulty hearing, some forms of hearing loss produce additional symptoms, such as:

  • Tinnitus
  • Dizziness and a loss of balance
  • Fluid discharge from the ear
  • Ear pain
  • A feeling of fullness or pressure in the ears
  • Facial paralysis

Symptoms in Newborns and Infants

The signs of hearing impairment look different in newborns and babies. Your child might be hearing impaired if:

  • Their facial expression doesn’t change when you talk to them
  • They aren’t startled by sounds
  • They do not turn their heads toward sounds at six months old or beyond
  • They aren’t making pre-speech sounds by age 1

Types Of Hearing Loss

Hearing loss is classified according to where the problem occurs. The main types of hearing loss are:

In the following few sections, we’ll look at each hearing loss category in greater depth.

Conductive Hearing Loss

This form of hearing loss occurs when sounds can’t pass through the outer and middle ear into the inner ear.

In most cases, this form of hearing loss can be reversed through medical treatment.

Hearing loss occurs when sound transmission from the ear to the brain is disrupted, either before or after the cochlea.

Causes

Conductive hearing impairment is often caused by a blockage in the ear canal or abnormalities in middle or outer ear structures due to disease or trauma.

Typical causes include:

  • Earwax impaction
  • Obstruction by foreign objects
  • Genetic disorders
  • Trauma
  • Middle or outer ear infections  
  • Sinus infections
  • Benign tumors

Sensorineural Hearing Loss

This type of hearing impairment refers to a problem in the auditory nerve or the inner ear. It’s caused by damage to the parts of the ear that detect sound waves, convert vibrations into electrical signals, or transmit sound information to the brain.

Sensorineural hearing loss is typically irreversible, but it’s treatable in most cases.

The most common causes of sensorineural hearing loss are age and noise.

Noise-Induced Hearing Loss

Prolonged exposure to sounds louder than 85 decibels can damage the tiny hairs inside the inner ear, causing hearing loss.

Noise-induced hearing loss is most common in certain occupations, such as:

  • Heavy manufacturing
  • Bars and clubs
  • The military
  • Construction

Overuse of headphones is also driving an increase in hearing loss cases, especially among teens.

The WHO estimates that 1 in 5 teens are at risk of permanent hearing loss due to unsafe listening practices.

Many devices produce sound waves at volumes as high as 130 decibels, which is far above the recommended level.

Sudden bursts of sound rupture the eardrum or damage the ossicles, resulting in hearing loss .

Age-Related Hearing Loss

Hearing declines as people age because the inner ear’s sensory cells start to break down, affecting the ability to hear high-pitched sounds first and lower frequencies later on.

The National Institute on Deafness and Other Communication Disorders estimates that a third of adults over 65 and half of those over 80 have age-related hearing loss.  

Age-related hearing loss is progressive and irreversible. For people who have a genetic predisposition, it’s likely inevitable, but avoiding loud noises and taking good care of yourself can reduce your risk factors.

Other Causes of Sensorineural Hearing Loss

In addition to age and noise exposure, other things can cause sensorineural hearing loss, such as:

  • Certain medications with toxic effects
  • Chemicals that harm the inner ear
  • Head trauma
  • Viral infections like rubella and cytomegalovirus
  • Autoimmune disorders

Mixed Hearing Loss

Hearing loss that affects the various parts of the hearing pathway from the outer or middle ear to the inner ear is mixed.

Typically, this occurs when a person with one type of chronic hearing loss develops the other. For example, a person with noise-induced hearing loss might get impacted earwax from a dirty hearing aid.

When wax builds up too much, it can become stuck in place, and acts as a barrier that stops sound from traveling into the inner ear as it normally would.

Conversely, a person who has diminished hearing due to abnormalities in the middle ear could later suffer inner ear damage from constant exposure to loud noise.

In rare cases, a person might develop both types of hearing loss simultaneously due to:

  • Congenital conditions
  • Tumors
  • Genetic disorders
  • Head trauma

Characteristics of Hearing Loss

Hearing specialists further categorize hearing loss based on onset, severity and whether the condition is more pronounced or only present in one ear.

Severity

Audiologists quantify hearing impairment in units called decibels of hearing loss (dB HL).

Hearing loss is diagnosed when a person has a score of more than 20 dB HL on a hearing test.

Medical professionals break this down into four categories based on the degree of impairment:

  • Mild (26-40 dB HL): People with mild hearing loss can generally understand speech in a quiet room without background noise, but they cannot hear certain sounds.
  • Moderate (41-55 dB HL): If you have moderate hearing loss, you may have trouble hearing everyday sounds and carrying on regular conversations without a hearing aid.
  • Severe (56-70 dB HL): Those with severe hearing loss can only hear loud sounds and will find it impossible to function without a hearing aid.
  • Profound (71-90 dB) People with profound hearing loss can only hear extremely loud sounds. Once the condition has reached this stage, a hearing aid may no longer be effective and the person may need a cochlear implant or sign language to function.
graph outlining the severity of hearing loss

What is a Normal Human Hearing Range?

Laterality and Symmetry

A crucial part of hearing loss diagnosis is determining whether it occurs in one or both ears. This helps medical professionals identify the underlying cause. For example, a toxic reaction to medications typically affects both ears, but an earwax impaction usually only occurs in one.

Hearing loss is considered unilateral if only one of the ears is affected and bilateral if it’s present in both. It is deemed asymmetrical if it is present in both ears but more pronounced in one. If both ears are impacted equally, it’s called symmetrical.  

Onset

Hearing loss is categorized based on when it develops:

  • Congenital: A person has hearing problems from birth due to genetic disorders or prenatal infection.
  • Delayed onset: A person has a congenital condition, but the symptoms do not appear at birth.
  • Acquired: A person has normal hearing at birth but later develops hearing impairment due to environmental factors or as a secondary effect of another condition.

It’s is also classified based on the speed of onset:

  • Progressive: Symptoms progressively get worse over a long period. Noise-induced and age-related hearing loss are types of progressive hearing loss.
  • Sudden: Symptoms appear instantly or over a few days. Sudden hearing loss may signify a medical emergency if it’s not caused by something harmless like earwax blockage. Contact a doctor immediately.

Around 50% of people with sudden hearing loss can recover within two weeks, but having a doctor’s check-up is still recommended.

Stability

In rare cases, hearing problems will come and go. They’ll improve for a period and then get worse. That’s called fluctuating hearing loss. Most hearing loss is stable, meaning the severity is relatively consistent.

Diagnosing Hearing Loss

Hearing loss has multiple potential underlying causes, so you may need to see several medical professionals before you can zero in on the correct one. The first step is typically a visit to a general practitioner or an ear, nose and throat doctor.

Physical Examination

Your doctor will do a basic exam to gauge your hearing loss and identify any factors causing or contributing to it.

This will likely include:

  • Reviewing your medical history and medications
  • Asking you questions about your lifestyle, occupation and symptoms
  • Looking inside your ear canal for signs of obstruction or infection
  • Conducting preliminary hearing tests

In some cases of acute hearing loss, such as earwax or ear infection, the doctor may prescribe medications to address the cause. If they believe you have permanent hearing loss, they’ll refer you to a specialist for more testing.

Hearing Tests

An audiologist can determine the type and severity of your hearing loss using a battery of hearing tests:

  • Pure-tone audiometry: The audiologist plays a series of tones at various volumes and frequencies into each ear and asks if you can hear them. They’ll note the lowest sound you can hear—the audiometric threshold—on a chart called an audiogram.
  • Bone-conduction test: Using a tone generator or a tuning fork, the audiologist sends sound waves through the air and directly into the bone to see which one you can hear better. If it sounds louder through the bone, your hearing loss is conductive.
  • Speech audiometry: If the audiologist determines you have hearing loss, they might further test your impairment by testing how well you can understand spoken language at different volumes.
  • Middle ear tests: If you’re showing signs of conductive hearing loss, a hearing specialist may check the health of your eardrum with tests like tympanometry and the static acoustic impedance test.

An audiologist determines the type and severity of your hearing loss based on a variety of different hearing tests.

Other Testing

Most hearing loss can be diagnosed through the tests mentioned above. However, when doctors can’t definitively determine the underlying cause, they may order additional tests to screen you for contributing health conditions:

  • Magnetic Resonance Imaging (MRI):  An MRI can show what’s going on inside the inner ear. It helps diagnose benign growths like acoustic neuromas that can form around the auditory nerve, causing sensorineural hearing impairment.
  • CT scans: If your hearing tests show that you have conductive hearing loss and parts of the outer ear have been ruled, your doctor may order a CT scan to get a 3D visualization of your middle ear.

Treating Hearing Loss

Your hearing loss treatment options vary depending on the diagnosis. While some forms of hearing loss can be reversed through medical treatment, others are permanent and can only be addressed using hearing aids or cochlear implants.

Removing Obstructions

Hearing loss caused by an ear canal blockage is easily reversed.

  • Earwax can be flushed out with medicated drops and warm water. See a doctor if at-home methods don’t work. They can remove it using suction or other tools.  
  • Foreign bodies may fall out on their own if you tilt your head to one side. If not, your doctor can use an otoscope to look inside your ear and pull the object out.
  • Fluids like water often evaporate eventually or you can tilt your head to get them to drain out. You may need to see a doctor to get the fluid drained in some cases.

Ear Surgery

Surgery can reverse many of the conductive causes of chronic hearing loss and a few types of sensorineural hearing impairment.

Here are some surgical procedures that can correct hearing loss:

  • Stapedectomy: When hearing loss is caused by a hardening of the middle ear bones, a surgeon can replace one with an artificial bone that allows them to vibrate normally.
  • Tympanoplasty and myringoplasty: A severe rupture of the eardrum that doesn’t heal can be repaired with a pair of surgeries.
  • Pressure Equalizer tubes: People who suffer recurring middle ear infections can have tubes surgically implanted to address fluid buildup.
  • Bone-anchored hearing aid (BAHA):  As the name suggests, BAHA are hearing aids that are surgically implanted directly into the bone, allowing sound to bypass the damaged parts of the ear.
  • Removing growths: Surgeons can remove noncancerous tumors and growths around the hearing nerve or in the middle and inner ear, which cause hearing loss if allowed to grow unchecked.

Hearing Aids

If your hearing loss is irreversible, hearing aids are your best bet. While they won’t magically restore your hearing, a good set of hearing aids makes living with hearing loss a lot easier. You’ll hear sounds louder and voices clearer. It’s an excellent option for people with mild or moderate hearing loss.

Many hearing aids can be custom programmed according to your hearing test results.

For example, if you have trouble hearing high-pitched sounds, they can boost higher frequencies.  Some have special features like the ability to filter out background noise or interface with phones and media devices.

At the same time, hearing aids aren’t cheap. They’ll set you back at least $1,000 on the lower end, while advanced models can cost up to $5,000. Many standard health insurance plans do not cover them, so you may need to invest in supplemental insurance.

The National Institute on Deafness and Other Communication Disorders recommends working with your audiologist to find hearing aids that are suitable for you. They suggest taking price into account but warn against assuming that a more expensive device is better.

Cochlear implants

Hearing aids will not help many people with severe or profound hearing loss, but a cochlear implant can help some people hear sounds and understand conversations.

Sometimes called a “bionic ear,” a cochlear implant doesn’t amplify sound like a hearing aid. Instead, it captures sound through a microphone, transforms it, and stimulates the auditory nerve directly.

An audiologist will work alongside your ENT if this is your option.

Preventing Hearing Loss

Hearing loss is sadly unavoidable for some people due to genetics. However, many common forms of hearing loss are preventable. Here are a few steps you can take to reduce your risk.

Limit Noise Expousure

Prolonged exposure to sounds louder than 85 dB can permanently damage the delicate hair cells of the inner ear.

Follow these tips to limit your risk of noise-induced hearing impairment:

  • Avoid spending a long time in noisy areas if possible. If you’re unsure about the ambient noise level, you can download a smartphone app to check. Take breaks and periodically go outside if you’re at a bar or club.
  • Wear hearing protection approved by the Occupational Safety and Health Administration (OSHA) if you work in construction, manufacturing or any other industry that exposes you to loud noise daily.
  • Reduce your device volume and don’t listen to music on headphones for an extended period. Some devices produce volumes up to 130 dB. Health experts recommend the “60-60 rule,” which means 60 percent volume for only an hour at a time.
  • Protect your ears off the job. Wear earplugs or other hearing protection when you go to a concert. You’ll still be able to enjoy the music. Many musicians wear them.

OSHA requires your employer to provide hearing protection if you work in construction, manufacturing or any other industry that exposes you to loud noise daily.

Screen Regularly

Early detection and intervention are crucial. You should get your hearing tested at regular intervals, even if you have normal hearing.

The Hearing Loss Association of America recommends testing every three to five years for people between 18 and 40 with no apparent signs of hearing loss.

Get tested annually if you:

  • Are over 60
  • Have high exposure to noise or substances that harm the ear
  • Frequently listen to loud music or engage in noisy hobbies like hunting or working with power tools
  • Have a family history of hearing loss at an early age

Treat Ear Infections

If your symptoms are tolerable, you may be tempted to wait until they go away, but ear infections can cause fluid buildup and inflammation that can harm your ear.

See a doctor immediately if you have the following symptoms:

  • Ear pain
  • Fever
  • Fluid discharge
  • Ear pressure or fullness
  • Tinnitus  

The doctor will prescribe antibiotics, antifungals or antivirals as needed. Don’t stop using them once the symptoms ease. Be sure to take them for the entire recommended period.

Take Care of Yourself

Living a healthy lifestyle will reduce your risk of hearing loss. Your cardiovascular and nervous systems play a vital role in hearing, so health problems in one part of your body might also affect your ears.

The following conditions are associated with hearing loss:

  • Diabetes
  • Hypertension
  • Cardiovascular disorders
  • Anxiety and depression
  • Nutritional deficiencies

Take care of your mental and physical health by taking your medications, eating well, exercising, managing stress and getting enough sleep.

Living With Hearing Loss

Hearing aids and other treatments can substantially reduce the impact of hearing loss on everyday life, but they work best when coupled with a few coping techniques.

  • Tell the people in your life about your hearing loss. Your acquaintances can better accommodate you if you’re open about your condition.
  • Orient your body toward the speaker when having a conversation. It will help your ears better.
  • Look directly at the speaker. Visual cues will help you understand better. You can even learn some basic lip-reading skills.
  • Choose quiet surroundings to talk with or meet people. Pick a place with less noise when scheduling meetings and events.
  • Reduce background noise when you’re on the phone. Turn off the television and close the windows.
  • If you miss a word or a phrase, politely ask people to repeat it. Explain your condition and ask them to enunciate instead of talking louder.

Summary

Hearing loss affects tens of millions in the United States and billions worldwide. It’s most commonly caused by age and noise exposure, but it’s also tied to a host of other medical conditions. Schedule an appointment with your doctor today if you have hearing loss symptoms.

If your hearing is normal and you want to keep it that way, avoid loud noises and other sounds, take care of your health, and get tested regularly.

Citations

2.     Borg E. Perinatal asphyxia, hypoxia, ischemia, and hearing loss. An overview. Scand Audiol. 1997;26(2):77-91. doi: 10.3109/01050399709074979. PMID: 9187000.

3.     Jung SY, Kim SH, Yeo SG. Association of Nutritional Factors with Hearing Loss. Nutrients. 2019;11(2):307. Published 2019 Feb 1. doi:10.3390/nu11020307

4.     Moore DR. Editorial: Auditory Processing Disorder. Ear Hear. 2018;39(4):617-620. doi:10.1097/AUD.0000000000000582

5.     Lieu JEC, Kenna M, Anne S, Davidson L. Hearing Loss in Children: A Review. JAMA. 2020 Dec 1;324(21):2195-2205. doi: 10.1001/jama.2020.17647. PMID: 33258894.