Hearing Loss

Over 30 million Americans suffer from hearing loss.  Learn more about the types of hearing loss in both children and adults, causes and prevention, symptoms and diagnosis, and whether you may need a hearing test.


There are four types of hearing loss:

  • Conductive Hearing Loss - Hearing loss caused by something that stops sounds from getting through the outer or middle ear. This type of hearing loss can often be treated with medicine or surgery.
  • Sensorineural Hearing Loss - Hearing loss that occurs when there is a problem in the way the inner ear or hearing nerve works.
  • Mixed Hearing Loss - Hearing loss that includes both a conductive and a sensorineural hearing loss.
  • Auditory Neuropathy Spectrum Disorder - Hearing loss that occurs when sound enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound isn't organized in a way that the brain can understand.

The degree of hearing loss can range from mild to profound:

  • Mild Hearing Loss - A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.
  • Moderate Hearing Loss - A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.
  • Severe Hearing Loss - A person with severe hearing loss will hear no speech when a person is talking at a normal level and only some loud sounds.
  • Profound Hearing Loss - A person with a profound hearing loss will not hear any speech and only very loud sounds.

Hearing loss can also be described as:

  • Unilateral or Bilateral - Hearing loss is in one ear (unilateral) or both ears (bilateral).
  • Pre-lingual or Post-lingual - Hearing loss happened before a person learned to talk (pre-lingual) or after a person learned to talk (post-lingual)
  • Symmetrical or Asymmetrical - Hearing loss is the same in both ears (symmetrical) or is different in each ear (asymmetrical).
  • Progressive or Sudden - Hearing loss worsens over time (progressive) or happens quickly (sudden).
  • Fluctuating or Stable - Hearing loss gets either better or worse over time (fluctuating) or stays the same over time (stable).
  • Congenital or Acquired/Delayed Onset - Hearing loss is present at birth (congenital) or appears sometime later in life (acquired or delayed onset).

Infant and Childhood Hearing Loss

Hearing loss can affect a child’s ability to develop speech, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. If you think that a child might have hearing loss, ask the child’s doctor for a hearing screening as soon as possible.  Don’t wait! 

The signs and symptoms of hearing loss are different for each child. If you think that your child might have hearing loss, ask the child’s doctor for a hearing screening as soon as possible. Don’t wait!

Even if a child has passed a hearing screening before, it is important to look out for the following signs.

Signs in Babies

  • Does not startle at loud noises.
  • Does not turn to the source of a sound after 6 months of age.
  • Does not say single words, such as “dada” or “mama” by 1 year of age.
  • Turns head when he or she sees you but not if you only call out his or her name. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
  • Seems to hear some sounds but not others.

Signs in Children

  • Speech is delayed.
  • Speech is not clear.
  • Does not follow directions. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
  • Often says, “Huh?”
  • Turns the TV volume up too high.

Babies and children should reach milestones in how they play, learn, communicate and act. A delay in any of these milestones could be a sign of hearing loss or other developmental problem.

Adult-onset Hearing Loss

Hearing loss is one of the most common conditions affecting older adults. Roughly one-third of Americans 65 to 74 years of age and 47% of those 75 and older have hearing loss. People with hearing loss find it difficult to talk with friends and family. They may also have trouble understanding a doctor's advice, responding to warnings, and hearing doorbells and alarms.

Hearing loss comes in many forms. It can range from a mild loss in which a person misses certain high-pitched sounds, such as the voices of women and children, to a total loss of hearing. It can be hereditary or it can result from disease, trauma, certain medications, or long-term exposure to loud noise.

There are two general categories of hearing loss. Sensorineural hearing loss occurs when there is damage to the inner ear or the auditory nerve. This type of hearing loss is permanent. Conductive hearing loss occurs when sound waves cannot reach the inner ear. The cause may be earwax build-up, fluid, a perforated eardrum, or a problem with the middle ear bones (ossicles). Medical or surgical treatment can usually restore conductive hearing loss.

One form of hearing loss, presbycusis, comes on gradually as a person ages. Presbycusis can occur because of changes in the inner ear, auditory nerve, middle ear, or outer ear. Some of its causes are aging, loud noise, heredity, head injury, infection, illness, certain prescription drugs, and circulation problems such as high blood pressure. Presbycusis commonly affects people over 50, many of whom are likely to lose some hearing each year. Having presbycusis may make it hard for a person to tolerate loud sounds or to hear what others are saying.

Tinnitus, also common in older people, is the ringing, hissing, or roaring sound in the ears frequently caused by exposure to loud noise or certain medicines. Tinnitus is a symptom, not a disease, so it can accompany any type of hearing loss. Tinnitus can also be a sign of other important health problems, such as allergies and problems in the heart and blood vessels. Tinnitus can come and go, or it can persist or stop altogether.

Some people may not want to admit they have trouble hearing. Older people who can't hear well may become depressed or withdraw from others to avoid feeling frustrated or embarrassed about not understanding what is being said. It is easy to mistakenly call older people confused, unresponsive, or uncooperative just because they don't hear well. Hearing problems that are ignored or untreated can get worse. If you have a hearing problem, you can get help. See your doctor. Hearing aids, special training, certain medicines, and surgery are some of the choices that can help people with hearing problems.

Causes and Prevention

Hearing loss happens for many reasons. Some people lose their hearing slowly as they age. This condition is called presbycusis. Doctors do not know why presbycusis happens, but it seems to run in families. Another cause is the ear infection otitis media, which can lead to long-term hearing loss if it is not treated.

Hearing loss can also result from taking certain medications. "Ototoxic" medicines damage the inner ear, sometimes permanently. Some antibiotics are ototoxic. Even aspirin can cause problems, but usually temporarily. Check with your doctor if you notice a problem while taking a medication.

Heredity also is a cause of hearing loss, but not all inherited forms of hearing loss take place at birth. Some forms can show up later in life. In otosclerosis, which is thought to be a hereditary disease, an abnormal growth of bone prevents structures within the ear from working properly. A severe blow to the head also can cause hearing loss.

One of the most common causes of hearing loss is loud noise. Loud noise can permanently damage the inner ear. Loud noise also contributes to presbycusis, or age-related hearing loss, and tinnitus, which is a ringing, buzzing, or roaring sound in the ears. More than 30 million Americans are exposed to damaging noise levels every day. Already, 22 million American adults between 20 and 69 years of age have permanently damaged their hearing due to exposure to loud noise. Noise-induced hearing loss is 100 percent preventable. You can protect your hearing by paying attention to noises above 85 decibels in loudness, which can damage your ears. These include gas lawnmowers, snowblowers, motorcycles, firecrackers, and loud music. Lower the volume on portable stereos and televisions. When you are involved in a loud activity, wear earplugs or other hearing protective devices. Be sure to protect children as well. Although awareness of noise levels is important, you should also be aware of how far away you are from loud noise and how long you are exposed to it. Avoid noises that are too loud, too close, and that last too long.

There are other ways to prevent hearing loss. If earwax blockage is a problem for you, ear, nose, and throat doctors recommend using mild treatments such as mineral oil, baby oil, glycerin, or commercial ear drops to soften earwax. If you suspect that you may have a hole in your eardrum, however, you should consult a doctor before using such products. 

The ear infection otitis media is most common in children, but adults can get it, too. You can help prevent otitis media by washing your hands frequently. Also, get a flu shot every year to help stave off flu-related ear infections. If you still get an ear infection, see a doctor immediately before it becomes more serious.

Symptoms and Diagnosis

Some people may have a hearing problem without realizing it. Others might think they have a problem, but are too embarrassed to tell their doctor, friends, or family. You can help identify a possible hearing problem by asking yourself some key questions and, if necessary, having your hearing checked by a doctor. If a hearing loss is ignored or untreated, it can get worse. But a hearing loss that is identified early can be helped through treatment, such as hearing aids, certain medicines, and surgery.

Do I Need a Hearing Test?

If you are 18 to 64 years old, the following questions will help you determine if you need to have your hearing evaluated by a health professional.

1. Does a hearing problem cause you to feel embarrassed when you meet new people? 

2. Does a hearing problem cause you to feel frustrated when talking to members of your family? 

3. Do you have difficulty hearing or understanding co-workers, clients, or customers? 

4. Do you feel slowed down by a hearing problem? 

5. Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors? 

6. Does a hearing problem cause you difficulty in the movies or in the theater? 

7. Does a hearing problem cause you to have arguments with family members? 

8. Does a hearing problem cause you difficulty when listening to TV or radio? 

9. Do you feel that any difficulty with your hearing limits or hampers your personal or social life? 

10. Does a hearing problem cause you difficulty when in a restaurant with relatives or friends? 

If you answered “yes” to three or more of these questions, you may want to visit Physicians Hearing Center for a hearing evaluation.