Hearing loss that occurs gradually as you age (presbycusis) is common. According to the National Institutes of Health, an estimated one-third of people in the United States between the ages of 65 and 75 and close to one-half of those older than 75 have some degree of hearing loss.

Doctors believe that heredity and chronic exposure to loud noises are the main factors that contribute to hearing loss over time. Other factors, such as earwax blockage, can prevent your ears from conducting sounds as well as they should.

You can't reverse hearing loss. However, you don't have to live in a world of muted, less distinct sounds. You and your doctor or hearing specialist can take steps to improve what you hear.

Signs and symptoms of hearing loss may include:

  • Muffling of speech and other sounds
  • Difficulty understanding words, especially against background noise or in a crowd of people
  • Frequently asking others to speak more slowly, clearly and loudly
  • Needing to turn up the volume of the television or radio
  • Withdrawal from conversations
  • Avoidance of some social settings

When to see a doctor

Talk to your doctor if difficulty hearing is interfering with your daily life. Your hearing may have deteriorated if you find that it's harder to understand everything that's said in conversation, especially when there's background noise; if sounds seem muffled; or if you find yourself having to turn the volume higher when you listen to music, the radio or television.

Some causes of hearing loss include damage to the inner ear, a buildup of earwax, infections and a ruptured eardrum. To understand how hearing loss occurs, it can be helpful to understand how you hear.

How you hear

Hearing occurs when sound waves reach the structures inside your ear, where the sound wave vibrations are converted into nerve signals that your brain recognizes as sound.

Your ear consists of three major areas: outer ear, middle ear and inner ear. Sound waves pass through the outer ear and cause vibrations at the eardrum. The eardrum and three small bones of the middle ear — the hammer, anvil and stirrup — amplify the vibrations as they travel to the inner ear. There, the vibrations pass through fluid in the cochlea, a snail-shaped structure in the inner ear.

Attached to nerve cells in the cochlea are thousands of tiny hairs that help translate sound vibrations into electrical signals that are transmitted to your brain. The vibrations of different sounds affect these tiny hairs in different ways, causing the nerve cells to send different signals to your brain. That's how you distinguish one sound from another.

How hearing loss can occur

Causes of hearing loss include:

  • Damage to the inner ear. Aging and prolonged exposure to loud noise may cause wear and tear on the hairs or nerve cells in the cochlea that send sound signals to the brain. When these hairs or nerve cells are damaged or missing, electrical signals aren't transmitted as efficiently, and hearing loss occurs. Higher pitched tones may become muffled to you. It may become difficult for you to pick out words against background noise. Heredity may make you more prone to these changes. This type of hearing loss is known as sensorineural hearing loss, which is permanent.
  • A gradual buildup of earwax. Earwax can block the ear canal and prevent conduction of sound waves. Earwax blockage is a cause of hearing loss among people of all ages. This causes conductive hearing loss, which usually can be restored with earwax removal.
  • Ear infection and abnormal bone growths or tumors. In the outer or middle ear, any of these can cause hearing loss.
  • Ruptured eardrum (tympanic membrane perforation). Loud blasts of noise, sudden changes in pressure, poking your eardrum with an object and infection can cause your eardrum to rupture and affect your hearing.

Factors that may damage or lead to loss of the hairs and nerve cells in your inner ear include:

  • Aging. Exposure to sounds over the years can damage the cells of your inner ear.
  • Heredity. Your genetic makeup may make you more susceptible to ear damage.
  • Occupational noises. Jobs where loud noise is a regular part of the working environment, such as farming, construction or factory work, can lead to damage inside your ear.
  • Recreational noises. Exposure to explosive noises, such as from firearms and fireworks, can cause immediate, permanent hearing loss. Other recreational activities with dangerously high noise levels include snowmobiling, motorcycling or listening to loud music. Personal music players, such as MP3 players, can cause lasting hearing loss if you turn the volume up high enough to mask the sound of other loud noises, such as those from a lawn mower.
  • Some medications. Drugs, such as the antibiotic gentamicin and certain chemotherapy drugs, can damage the inner ear. Temporary effects on your hearing — ringing in the ear (tinnitus) or hearing loss — can occur if you take very high doses of aspirin, other pain relievers, antimalarial drugs or loop diuretics.
  • Some illnesses. Diseases or illnesses that result in high fever, such as meningitis, may damage the cochlea.

Comparing loudness of common sounds

What kind of decibel levels are you exposed to during a typical day? To give you an idea, compare noises around you to these specific sounds and their corresponding decibel levels:

Decibels Noise source
Safe range
30 Whisper
60 Normal conversation
70 Washing machine
Risk range
85 to 90 Heavy city traffic, power lawn mower, hair dryer
95 Motorcycle
100 Snowmobile, hand drill
110 Chain saw, rock concert
Injury range
120 Ambulance siren
140 (pain threshold) Jet engine at takeoff
165 12-guage shotgun blast
180 Rocket launch

Adapted from National Institute on Deafness and Other Communication Disorders, 2008; the National Institute for Occupational Safety and Health, 2009; and American Tinnitus Association, 2009

Maximum sound-exposure durations

Below are the maximum noise levels on the job to which you may be exposed without hearing protection, and for how long.

Maximum job-noise exposure allowed by law
Sound level, decibels Duration, daily
90 8 hours
92 6 hours
95 4 hours
97 3 hours
100 2 hours
102 1.5 hours
105 1 hour
110 30 minutes
115 15 minutes or less

Source: Department of Labor's Occupational Safety & Health Administration, 2005

Hearing loss can have a significant effect on your quality of life. Among older adults with hearing loss, commonly reported problems include:

  • Depression
  • Anxiety
  • An often false sense that others are angry with you

Unfortunately, most people affected by hearing loss live with these difficulties for years before seeking treatment — or never seek treatment at all. This also may cause lasting problems for those who love you, if you try to cope by denying your hearing loss or withdrawing from social interactions.

Benefits of treatment

Getting treatment can improve your quality of life dramatically. People who use hearing aids report these benefits:

  • Greater self-confidence
  • Closer relationships with loved ones
  • Improved outlook on life, overall

Family and friends of people who have begun using a hearing aid are even more likely to report these improvements in shared quality of life.

Only a small minority of people with hearing loss seek treatment, but those who do report dramatic improvements in their relationships and quality of life. If you suspect you may have hearing loss, call your doctor. After an initial evaluation, your doctor may refer you to a hearing specialist (audiologist).

Here's some information to help you prepare for your appointment and to know what to expect from your doctor.

  • List any symptoms you're experiencing, and for how long. Ask your loved ones to help you make the list. Friends and family may have noticed changes that aren't obvious to you, but they may be important for your doctor to know.
  • Write down key medical information, especially related to any problems you've had with your ears. Your doctor will want to know about chronic infections, injury to your ear or previous ear surgery. Also list any medications, vitamins or supplements you're taking.
  • Summarize your work history, including any jobs, even those in the distant past, that exposed you to high noise levels.
  • Take a family member or friend along. Someone who accompanies you can help you absorb all the information from the doctor.
  • Write down questions to ask your doctor. Having a list of questions in advance can help you make the most of your time with your doctor.

For hearing loss, some basic questions to ask your doctor include:

  • What are the possible causes of my symptoms or condition?
  • Other than the most likely cause, what else might be causing my symptoms?
  • What tests do you recommend?
  • Should I stop taking any of my current medications?
  • Should I see a specialist?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • How would you describe your symptoms?
  • Did your symptoms come on suddenly?
  • Do you have ringing, roaring or hissing in your ears?
  • Do your symptoms include dizziness or balance problems?
  • Do you have pain in the affected ear?
  • Do you have a history of ear infections, ear trauma or ear surgery?
  • Have you ever worked in a job that exposed you to loud noise, flown airplanes or been in combat in the military?
  • Do you have any close relatives who have been affected by hearing loss?
  • What medications do you take?
  • Does your family complain that you turn up the volume of the television or radio too high?
  • Do you have trouble understanding someone who is talking to you in a low voice?
  • Do you have trouble understanding someone who is speaking to you on the telephone?
  • Do you frequently need to ask others to speak up or repeat themselves during conversation?
  • Do you have trouble hearing someone in a noisy setting, such as a crowded restaurant?
  • Can you follow a conversation in which more than two people are speaking at once?
  • Can you hear a coin hitting the floor?
  • Can you hear a door closing?
  • Can you hear when someone approaches you from behind?
  • How are your hearing problems affecting your life, including your close relationships?
  • Would you be willing to use a hearing aid if needed?

Tests to diagnose hearing loss may include:

  • General screening tests. Your doctor may ask you to cover one ear at a time to see how well you hear words spoken at various volumes and how you respond to other sounds.
  • Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor detect hearing loss. A tuning fork evaluation may also reveal whether hearing loss is caused by damage to the vibrating parts of your middle ear (including your eardrum), damage to sensors or nerves of your inner ear, or damage to both.
  • Audiometer tests. During these more-thorough tests conducted by an audiologist, you wear earphones and hear sounds directed to one ear at a time. The audiologist presents a range of sounds of various tones and asks you to indicate each time you hear the sound. Each tone is repeated at faint levels to find out when you can barely hear. The audiologist will also present various words to determine your hearing ability.

If you have hearing problems, help is available. Treatment depends on the cause and severity of your hearing loss.

Options include:

  • Removing wax blockage. Earwax blockage is a common reversible cause of hearing loss. Your doctor may remove earwax by loosening it with oil and then flushing, scooping or suctioning the softened wax out.
  • Hearing aids. If your hearing loss is due to damage to your inner ear, a hearing aid can help by making sounds stronger and easier for you to hear. An audiologist can discuss with you the potential benefits of using a hearing aid, recommend a device and fit you with it. In some cases, you may be satisfied with an inexpensive, over-the-ear microphone device available at electronic stores. You may need to try more than one device to find one that works well for you.
  • Cochlear implants. If you have severe hearing loss, a cochlear implant may be an option for you. Unlike a hearing aid that amplifies sound and directs it into your ear canal, a cochlear implant compensates for damaged or nonworking parts of your inner ear. If you're considering a cochlear implant, your audiologist, along with a medical doctor who specializes in disorders of the ears, nose and throat (ENT), can discuss the risks and benefits with you.

These tips can help you to communicate more easily despite your hearing loss.

  • Position yourself to hear. Face the person with whom you're having a conversation.
  • Turn off background noise. For example, noise from a television may interfere with conversation.
  • Ask others to speak clearly. Most people will be helpful if they know you're having trouble hearing them.
  • Choose quiet settings. In public, such as in a restaurant or at a social gathering, choose a place to talk that's away from noisy areas.
  • Consider using an assistive listening device. Hearing devices, such as TV-listening systems or telephone-amplifying devices, can help you hear better while decreasing other noises around you.

Hearing loss prevention consists of steps you can take to help you prevent noise-induced hearing loss and avoid worsening of age-related hearing loss:

  • Protect your ears in the workplace. Specially designed earmuffs that resemble earphones can protect your ears by bringing most loud sounds down to an acceptable level. Foam, pre-formed, or custom-molded earplugs made of plastic or rubber also can effectively protect your ears from damaging noise.
  • Have your hearing tested. Consider regular hearing tests if you work in a noisy environment. Regular testing of your ears can provide early detection of hearing loss. Knowing you've lost some hearing means you're in a position to take steps to prevent further hearing loss.
  • Avoid recreational risks. Some activities, such as riding a snowmobile, hunting and listening to extremely loud music for long periods of time, can damage your hearing. Wearing hearing protectors or taking breaks from the noise during loud recreational activities can protect your ears. Turning down the volume when listening to music can help you avoid damage to your hearing.
  • Expertise. Mayo Clinic specializes in treating difficult cases of hearing loss. Each Mayo Clinic location has ear, nose and throat (ENT) specialists (otolaryngologists) and audiologists experienced in treating hearing disorders of all kinds. Mayo has sophisticated diagnostic tools and can offer you virtually every treatment option.
  • Experience. Mayo Clinic doctors treat large numbers of people, and are skilled at performing less common procedures such as surgery for acoustic neuromas, or cochlear implants.
  • Latest technology. Mayo uses the latest technology to accurately diagnose and treat your problem. Mayo Clinic offers a wide selection of hearing aids, many of which are compatible with the latest Bluetooth devices, such as cell phones and other listening devices.
  • Time for you. Doctors at Mayo take time to listen to your problem, explain your options and answer your questions.
  • At Mayo Clinic, you will meet with an ENT doctor who specializes in ear problems (otologist). The doctor will conduct a medical interview and physical exam, assisted by a master's- or doctoral-level hearing specialist (audiologist). You will then undergo a battery of tests to confirm the cause of their hearing loss. Tests may include:

    • Basic audiogram. An audiogram determines whether you have a hearing loss, where it occurs and its type or classification.
    • Tympanometry. This test assesses how well your eardrum and middle ear are working.
    • Stapedial reflexes and reflex decay. Tests how well your auditory nerve is able to transmit hearing signals to the brain.
    • Auditory brainstem response testing. Measures the electrical nerve impulses that carry sound from the inner ear to the brain. An audiologist can determine how sound is transmitted and if nerve impulses are blocked or interrupted.
    • Sentence-in-noise test. Evaluates your ability to understand conversational speech in the presence of background noise. This test will help determine whether you might benefit from a hearing aid or a cochlear implant.
    • Otoacoustic emissions. These are signals generated by the normal inner ear that can be measured by placing a microphone in the ear canal. This test is primarily used in screening newborns for hearing loss.
    • Radiology studies. MRI and CT scans can reveal structural abnormalities or tumors within the ear.
    • Balance testing. Done for people with both hearing and balance difficulties.

    Mayo Clinic offers state-of-the-art treatment to people with hearing loss. If your condition can be helped with medication or surgery, you will be treated by an ENT specialist. If there are no medical or surgical options, or if you chose not to pursue them, an audiologist can provide options that may include hearing aids or other devices.

    Hearing loss conditions and treatments

    Below is an overview of hearing problems and their treatments:

    • Presbycusis. Presbycusis, the most common cause of hearing loss, results from the effects of aging on the inner ear. It is not medically or surgically treatable. Mayo's audiologists can provide education and fit you with hearing aids and other assistive devices, as well as provide strategies to improve your hearing in common situations.
    • Chronic otitis media. Chronic otitis media is a condition of the middle ear that can cause hearing loss and eardrum perforations. Most active infections with perforations can be treated with antibiotics. If not, surgery may be necessary.
    • Mastoiditis. Mastoiditis is an infection that affects the mastoid bone, located behind the ear. Doctors will treat the infection with antibiotics or, if symptoms do not improve, with surgery.
    • Otosclerosis. This is a condition in which a bone growth in the middle ear prevents the small ear bones from working properly. You may benefit from surgery or a hearing aid.
    • Acoustic neuroma. An acoustic neuroma is a noncancerous (benign) tumor that grows on the nerves leading from the inner ear to the brain. Doctors will usually remove or reduce the tumor with microsurgery or stereotactic radiation therapy (radiosurgery).
    • Balance disorders. Dizziness and balance difficulties can be caused by a problem with the vestibular system in the inner ear and can also affect hearing. A team of specialists, including specialists in ENT, audiology, neurology, neurosurgery, physical and occupational therapy, psychiatry and psychology, and physical medicine, works together to help people experiencing balance problems. Specially trained therapists offer vestibular rehabilitation therapy, which may include an exercise program. In cases of Meniere's disease, medical therapy, transtympanic ear injections and surgery can also provide relief from the dizziness.
    • Cholesteatoma. Cholesteatoma (koe-leh-stee-uh-TOE-muh) is a type of skin cyst in the middle ear. Individuals may be born with one or acquire one following repeated ear infections. These growths are not cancerous but can damage the ear and cause hearing loss. The initial treatment is to stop the infection and drainage with antibiotics and eardrops. In some cases, surgery is required.

    Hearing aids

    Audiologists offer hearing aid testing, evaluations and fittings at all three Mayo locations. Many kinds of hearing devices are available, ranging from tiny hearing aids that fit completely within the ear canal, to more traditional, behind-the-ear styles. Styles also range from more basic to sophisticated digital aids with advanced features.

    Bone-anchored hearing aids (Baha system). Baha hearing aids (also called osseointegrated hearing aids) are good for people who have chronic conductive or mixed hearing loss, or single-sided deafness. A small titanium screw is implanted behind your ear into the skull bone and used to conduct sound from a hearing aid to the inner ear. You will need to be evaluated by an ear physician (otologist) to see if the Baha system is right for you. Audiologists can provide a demonstration headband so you can experience the sound from the system.

    Cochlear implants

    These implantable electronic devices can help individuals with severe hearing loss in both ears who do not adequately benefit from hearing aids. This surgery is performed at all three Mayo Clinic locations. Read more about cochlear implants.

    Hearing loss in children

    Mayo Clinic campuses in Minnesota and Arizona offer specialized treatment for children with hearing loss, including evaluation, medication, surgery and a wide variety of hearing devices.

    Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

    Specialists in otolaryngology and audiology at Mayo Clinic in Arizona have extensive experience treating hearing disorders in children and adults. Specialized evaluations of balance disorders are accomplished with a state-of-the-art vestibular laboratory and a balance and dizziness disorders team.

    For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

    Mayo Clinic in Florida has extensive experience treating hearing disorders in adults. Specialized evaluations of balance disorders are accomplished with a state-of-the-art vestibular laboratory. Hearing disorders in adults are treated by specialists in otolaryngology and audiology. The Mayo Hearing Aid Clinic offers the latest selection of hearing devices.

    For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

    Experienced specialists in otolaryngology and audiology at Mayo Clinic in Minnesota diagnose and treat hearing loss in adults and children. Other resources in Minnesota for hearing loss include hearing aid services and the Vestibular and Balance Testing Laboratory.

    For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

    Please refer to the international appointment section to request appointments via phone.

    See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

    To learn about some current research in the Department of Otorhinolaryngology related to hearing loss, see:

    Mayo publications

    See a list of publications by Mayo Clinic doctors on hearing loss on PubMed, a service of the National Library of Medicine.

    Aug. 23, 2011