Everyone has, at one time or another, experienced variations in their sensitivity to sounds. These changes are part of everyday life. You may have found yourself speaking louder, even shouting unintentionally, or wondering, in a room, why everyone was speaking so softly.
Hearing loss is nothing to be ashamed of: it’s an experience many people go through. So, how do you know if your changes in hearing are a real medical problem?
Most likely, you’re missing something. Either you don’t hear certain sounds because of their low intensity, or you miss others — like voices in noisy environments — due to hearing loss at certain frequencies. Not being able to hear can quickly lead to isolation.
What is hearing loss?
Hearing loss, hearing impairment, or deafness refers to the partial or total inability to hear sounds, in one or both ears.
Depending on the cause and degree of your hearing loss, the symptoms experienced can be mild, moderate, severe, or profound.
The severity of your hearing loss is measured by the volume or pitch a sound must reach for you to perceive it.
For example, if your hearing impairment is mild, you will have difficulty hearing or understanding speech when there are high-pitched sounds around you. If your hearing loss is moderate, you can still communicate with the help of a hearing aid.
People with severe hearing loss or deafness do not hear sounds, even when amplified. They primarily rely on sign language, lip-reading, or very loud speech to communicate. Similarly, patients with profound deafness perceive no sound and depend on lip-reading or sign language.
While most people group mild and moderate hearing loss together, severe hearing loss and profound deafness are at the extreme end of the auditory spectrum. The human ear perceives frequencies between 20 Hz (the lowest sound) and 20 kHz (the highest): any patient who hears no sound in this range suffers from profound deafness.
How common is hearing loss?
The World Health Organization states that hearing loss is among the most prevalent health problems in humans, affecting over 450 million people worldwide.
Hearing gradually deteriorates with age: almost one in three people over 65 have measurable hearing loss. This is known as presbycusis, a natural phenomenon.
As a result, hearing loss often remains underdiagnosed and undertreated. Most types of hearing loss are irreversible. However, consulting a healthcare professional allows for managing symptoms as early as possible and preventing further damage.
Some hearing losses can be corrected with relatively simple solutions, such as removing a cerumen plug. It is best to have your treatment options determined by a healthcare professional.
Wearing hearing aids can also significantly improve your sensitivity to sounds and your overall quality of life.
Types of hearing loss
Hearing loss is primarily classified according to the part of the ear and the stage of the auditory process concerned. There are three main types:
Sensorineural hearing loss
Conductive hearing loss
Mixed hearing loss
Sensorineural hearing loss
Sensorineural hearing loss
Sensorineural hearing loss (also known as nerve-related hearing loss) is the most common and usually results from a problem in the inner ear.
This type of hearing loss occurs when the auditory nerves are broken or damaged. Since these nerves carry sound frequencies as well as information about the volume and clarity of sounds, their damage leads to a gradual disappearance of nerve endings and sound receptors.
In severe cases, this damage weakens or blocks the transmission of nerve signals to the brain and results in total deafness.
Conductive hearing loss
Conductive hearing loss is less common and less severe than sensorineural hearing loss. Affected patients sometimes hear better when the sound is loud or during phone conversations.
It occurs as a result of damage to the ear canal, outer or middle ear, or eardrum. This obstruction prevents sound waves from reaching the inner ear.
Depending on the cause, conductive hearing loss can be temporary or permanent. However, it is very rare for it to lead to total deafness. Hearing aids or corrective surgery can sometimes improve hearing.
Here are some common causes of conductive hearing loss:
Obstruction of the external auditory canal
Fusion or blockage of the ossicles of the ear (malleus, incus, and stapes)
Ear infections and diseases
Perforated eardrum
Mixed hearing loss
Mixed hearing loss combines a sensorineural and a conductive component. It usually occurs when the ear suffers trauma affecting both the cochlea (inner ear), the auditory nerves, and the outer or middle ear.
Mixed hearing loss can be temporary or worsen over time. For example, if you have conductive hearing loss due to an ear infection, you can still develop presbycusis as you age. Similarly, excess earwax or a plug can further worsen your hearing loss.
What are the causes of hearing loss?
The causes of hearing loss are either congenital or acquired. Congenital causes result in hearing loss present from birth, while acquired causes appear later in life.
Congenital causes of hearing loss
Several studies have shown that hearing loss can be hereditary and triggered by genetic mutations.
Concretely, this means that some people are more predisposed to it than others. For example, infants whose parents have hearing disorders are at higher risk.
The American Centers for Disease Control and Prevention attribute 50 to 60% of infant hearing loss to genetic causes. Maternal infections and pregnancy and birth complications account for about 25% or more.
During pregnancy and childbirth, complications that can cause congenital hearing loss include:
Diseases and infections during pregnancy, such as maternal rubella, cytomegalovirus, syphilis, and toxoplasmosis
Improper use of medications, prescription or non-prescription, during pregnancy: aminoglycosides, cytotoxic drugs, antimalarials, and diuretics
Low birth weight
Perinatal or neonatal asphyxia
Severe jaundice during the neonatal period
Acquired causes of hearing loss
In this section, we focus on acquired causes of hearing loss. In adults, all hearing losses are acquired.
1. Ototoxic medications
Ototoxic medications treat certain pathologies but can impair your hearing as a side effect. Many over-the-counter and prescription medications are ototoxic.
These medications damage the cochlea and hearing loss sets in rapidly. Other symptoms, such as dizziness and tinnitus, often accompany it. Hearing often returns to normal when treatment is stopped.
Common examples of ototoxic medications include loop diuretics like furosemide or bumetanide, used for heart failure and hypertension, high-dose aspirin, and anti-inflammatory drugs like naproxen and ibuprofen.
Certain antibiotics such as gentamicin, neomycin, or streptomycin, as well as anticancer drugs such as bleomycin, cyclophosphamide, and cisplatin, can also cause hearing loss.
2. Exposure to loud noises
Sudden or continuous exposure to loud noises can lead to hearing loss. Your ears tolerate a certain sound level; beyond that, your hearing can be instantly damaged.
Loud noise can rupture your eardrum or destroy the hair cells in your inner ear. This is called acoustic trauma.
Hearing loss due to a ruptured eardrum is reversible if the tear heals. Most of these perforations heal spontaneously, with no treatment other than keeping the ear dry.
However, hearing loss caused by damage to the hair cells of the inner ear is irreversible, as these cells cannot be repaired or replaced.
3. Aging
Aging is another cause of hearing loss in adults. With age, your body's organs and the hair cells in your inner ear deteriorate, causing hearing loss.
Age-related hearing loss develops gradually. Over time, it worsens until it becomes profound and permanent. It is not reversible: the only way to continue hearing is through hearing aids.
4. Earwax buildup
Earwax is produced in the ear canal to protect the ear from particles, water, and bacteria that cause infections. When the ear produces a normal amount, it clears naturally and disappears with washing.
In some cases, the ear produces more earwax than necessary. The excess becomes difficult to remove and accumulates.
As it accumulates, earwax hardens and grows. Over time, it eventually forms a plug that obstructs the ear canal.
This plug prevents sound from the outer ear from reaching the inner ear: this is how conductive hearing loss appears. Hearing returns to normal once the excess earwax is removed.
5. Perforated eardrum
The eardrum, or tympanic membrane, is a thin membrane located between the outer and middle ear. It plays an essential role in transmitting sound from one to the other.
A tear or hole in the eardrum constitutes a tympanic perforation, and several factors can be responsible.
Sudden exposure to loud noise can rupture the eardrum instantly. Sudden pressure changes, a direct blow to the ear, head trauma, or the introduction of objects into the ear can also perforate it.
Ear infections that cause fluid buildup behind the eardrum can also cause it to rupture: the pressure exerted by the fluid eventually tears it.
Perforated eardrums usually heal within a few weeks without medical intervention. When healing does not occur spontaneously, surgery may be necessary, either in the office or operating room. Hearing returns to normal once the tear closes.
6. Ear infections and diseases
Ear infections, such as autoimmune inner ear disease and otitis media, can cause hearing loss.
Autoimmune inner ear diseases occur when antibodies in the inner ear begin to destroy hair cells. If the condition is not treated promptly, all hair cells can disappear, leading to permanent hearing loss.
Other infections such as swimmer's ear, otitis externa, and otitis media with effusion can also cause hearing loss.
7. Other factors
Several other factors can cause hearing loss in adults.
Here are some examples:
Otosclerosis
Eustachian tube dysfunction
Ménière's disease
Head injuries
Tumors
Certain diseases like meningitis and high fevers
How does hearing loss affect patients?
When you lose your hearing, life changes: communicating suddenly becomes difficult, and you start to lose essential connections. The constant effort of adaptation can itself lead to cognitive decline, which can worsen the situation.
Let's see how hearing loss can affect different aspects of your life.
Functional consequences
Hearing loss impairs one of the most essential functions of life: your ability to communicate with others. Often, it also limits access to education and professional opportunities.
In children, hearing loss is accompanied by speech and language delays. If poorly managed, whether due to ear infections or genetic causes, it results in lower academic performance and a withdrawn social life.
Affected children need adapted educational support to improve their learning, experiences, and results.
Below is additional information on the functional consequences of hearing loss in adults.
1. Communication difficulties
Most people with hearing loss don't realize it until they struggle to follow everyday conversations.
Since this is one of the very first signs, they usually don't immediately suspect hearing loss.
Here are some of the difficulties encountered during conversations:
Muffled hearing: voices and sounds seem faint, indistinct, or dull
Difficulty locating the source of a sound
The constant need to ask for repetition
Asking others to speak louder or turning up the volume of the TV or radio
Asking others to speak slower
Inability to hear distant sounds
Difficulties participating in group conversations
Most often, it is the person's relatives who first notice their hearing impairment.
Hearing loss can cause them to misunderstand or not hear what you are saying. If only one ear is affected, they may turn their "good" ear towards you to follow you better.
An audiologist can assess speech understanding through the speech discrimination test reported on your audiogram. This measure is sometimes more meaningful than frequency-by-frequency hearing thresholds, as it reflects usable hearing in daily life.
Communicating with a hard-of-hearing person can be frustrating, but a few simple strategies greatly facilitate exchanges.
Here are some tips to apply:
Face your hard-of-hearing interlocutor
Ensure that the speaker's face is well lit
Do not speak from another room or at a distance
Say the person's first name before starting the conversation, to give them time to be available
Avoid complex sentences
Speak slowly, distinctly, and clearly
Avoid shouting: shouting distorts speech sounds.
Pause between sentences and groups of words to ensure the person has understood
Take turns speaking and avoid abrupt topic changes
2. Difficulties understanding speech in noise
Difficulty hearing well in ambient noise is another major sign of hearing loss. Background noise refers to any sound other than the one you are trying to listen to.
This can include the sound of electrical appliances like air conditioners, engines, or refrigerators, as well as animals, traffic, water, or any other environmental noise.
Hard-of-hearing adults hear correctly in quiet environments but struggle as soon as background noise is added.
This difficulty is explained by the fact that ambient noise masks fine speech sounds, such as high-pitched consonants. These subtle sounds facilitate understanding; once masked, listening becomes an effort.
When masked, the brain cannot always fill in the gaps they leave, especially since it is already busy separating speech from background noise.
These blanks left by masked sounds prevent the hard-of-hearing person from understanding what you are saying.
And if the brain manages to reconstruct the missing sounds thanks to the context, this often comes at the cost of fatigue related to the effort made during the conversation.
Furthermore, the inner ear's auditory system functions differently in hard-of-hearing individuals. This system distributes sounds into channels tuned to distinct frequencies.
In people with normal hearing, these channels are clear and precise. In hard-of-hearing people, they are wide and dispersed. In the presence of background noise, the neurons of the inner ear must redouble their efforts, because the channels are too spread out.
This phenomenon, combined with the fact that neurons are also disturbed by ambient noise, makes the perceived sound blurry.
If your hearing loss is due to damage to the hair cells in the inner ear, you will also have difficulty hearing in noise. In addition to determining the volume needed to perceive a sound, these cells help understand speech in noise. When they are damaged, listening becomes laborious.
3. Difficulties hearing children's voices
Another common sign of hearing loss in adults is difficulty hearing female and children's voices. When you perceive them, they sound muffled or unclear.
This is because these voices are high-pitched sounds, and the first cells to give out in case of hearing loss are precisely those responsible for detecting high-pitched sounds.
Beyond female and children's voices, you may also have trouble hearing beeps from phones and appliances, birds and animal cries, doorbells, and certain consonants, such as "s," "h," or "f."
4. Auditory Fatigue
Auditory fatigue is the feeling of weariness that appears after listening to someone speak for a certain period. People with normal hearing can experience it, but it manifests differently in people with hearing loss.
It occurs earlier in them, and more frequently or intensely, due to the extra work the brain has to do to interpret sounds.
The hair cells in the inner ear convert sound waves into electrical energy, which the brain then interprets as sound. When they are damaged, the ear can no longer perform this conversion.
As a result, the brain receives raw, unconverted sound waves. It then has to work much harder to make sense of what the inner ear transmits to it.
Moreover, each hair cell translates a precise frequency; when they are damaged, the auditory system can no longer reproduce the missing frequencies. Your brain must therefore constantly fill in the gaps left by these lost frequencies when others speak.
If several people speak at the same time, the burden becomes even heavier. Hence the great fatigue felt at the end of a social event.
Auditory fatigue can cause people with hearing loss to withdraw from social activities and fall into depression. This withdrawal is due to the difficulty of following conversations and the embarrassment of constantly having to ask people to repeat themselves.
5. Pathologies associated with hearing loss
Here are some pathologies frequently present in people diagnosed with hearing loss.
The link between hearing loss and the mentioned condition is not necessarily obvious, nor causal:
Falls: Dizziness, missteps, balance disorders, and falls are often associated with hearing loss. It is important to be aware of the risk of falls if you or a loved one are affected. Hearing and balance are closely linked, both anatomically and in daily life.
Cardiovascular diseases: Hearing loss and cardiovascular diseases are both linked to aging and the accompanying degeneration.
Diabetes: Hearing loss and diabetes are also considered age-related degenerative conditions.
Cognitive disorders and dementia: Hearing loss, cognitive disorders, and dementia are all linked to aging and the degeneration it causes.
The emotional consequences of hearing loss
Hearing loss can be disabling. It therefore affects the health and social well-being of those concerned.
Although it is a natural process, losing hearing can be a source of embarrassment. Social situations become more difficult to manage and daily life more challenging. You may not know anyone else with hearing problems, but chances are others around you are experiencing the same thing.
Most often, hearing loss disrupts your social or professional life and can cause you to lose self-confidence or damage your self-esteem. People with hearing loss frequently report:
Frequent mood swings
Depression
Distress
Anxiety
Social isolation and loneliness
Furthermore, some people find hearing aids uncomfortable or aesthetically unpleasing: the social and emotional barriers to seeking treatment can therefore be significant.
The best thing to do is consult a healthcare professional at the slightest doubt about your hearing. The only way to know if you have significant hearing loss is to have your ears examined and your hearing checked.
The good news is that current treatments help you manage the emotional and psychological effects of hearing loss.
Economic and financial consequences
The financial and economic repercussions of hearing loss are considerable. According to the World Health Organization, the global cost of unaddressed hearing loss amounts to approximately $750 billion per year. This estimate includes:
Healthcare sector costs (excluding the cost of hearing aids and devices)
Productivity losses
School support costs
Social costs
Unfortunately, the situation is even more serious in developing countries. Children with hearing loss rarely receive educational and social support there. And even in some countries that provide for them, structures are poorly equipped and poorly managed.
Adults with hearing loss have difficulty finding employment. Among those who work, a significantly larger proportion hold less skilled positions than people of equivalent educational level.
Efforts are being made to raise public awareness, improve access to education, develop vocational support services, and create jobs, but much remains to be done.
Symptoms of hearing loss
The signs of hearing loss you may experience depend on several factors, including the type and cause of deafness. Some people are born deaf, others lose their hearing with age or as a result of trauma.
Hearing loss can also be a symptom of an underlying condition, such as tinnitus or an infectious disease. Early screening and diagnosis are therefore essential to decide on the next steps.
Newborns
Here are common signs to watch for in newborns:
The child does not turn their head towards a sound or noise before the age of four months
The baby has not spoken or made sounds by the age of one year
Your child does not seem to react to a loud noise
The baby only responds to you when they see you, but not when you call them out of their line of sight
The child reacts only to a small number of sounds
Among the symptoms that may indicate a hearing disorder in toddlers and children are:
The child has difficulty communicating with children their age
The child constantly asks you to repeat yourself
The child speaks or makes high-pitched sounds louder than normal
The child speaks in a muffled and indistinct way
Some of these symptoms may worsen as your children grow.
Adults
The Mayo Clinic lists common symptoms of hearing loss:
Muffled hearing of sounds
Difficulty understanding words in normal conversation
Asking others to speak louder, slower, or more distinctly
Using electronic devices (television, phone, radio, headphones) at a high volume
Withdrawing from conversations
Avoiding social situations due to embarrassment
Diagnosis of hearing loss
As hearing loss develops slowly, many people delay between the first symptoms and their first audiometric examination by a healthcare professional. A recent survey showed that patients waited an average of seven years before their first hearing test.
This is not surprising: initially, the degree of hearing loss does not really affect the quality of life. But as with any pathology, the earlier the screening, the better the prognosis.
By acting early, you can take the necessary precautions to prevent your hearing from worsening and benefit from the right treatment. In some cases, surgery on the eardrum or the ossicles behind it can even restore hearing.
We advise you to have your ears examined and your hearing tested as soon as the first symptoms appear.
Where to get a hearing test?
Getting screened can seem complicated, but there are several ways to find the right care for your needs. You can consult your general practitioner, an ENT (ear, nose, throat) specialist, an otologist, or an audiologist.
Keep other factors in mind when choosing. Consider your medical history, health coverage, and family history to determine the practitioner who will best suit you. Hearing loss and diseases affecting the ear, hearing, or balance can be familial.
During the consultation, the doctor will ask you about your history and symptoms. Based on this information, they will perform a physical examination using instruments such as an otoscope. This will allow them to detect an ear infection, an earwax plug, or fluid in the ear canal.
If nothing is found on physical examination, they will prescribe a series of tests to refine the diagnosis:
Audiometric tests: During audiometry, your audiologist uses an audiometer to determine your hearing thresholds, your ability to recognize pitches, distinguish different intensities, or separate speech from background noise.
Tuning fork tests: These allow for early diagnosis, especially when audiometry is not accessible. Tuning forks are metal instruments that produce a sound when struck. These tests help detect unilateral or conductive hearing loss.
App-based hearing tests: If you do not have access to a medical consultation, mobile applications allow you to get a quick screening.
Bone vibrator tests: This examination allows the doctor to identify the type and severity of hearing loss. A bone vibrator is placed against the mastoid; it vibrates and transmits a pure sound to the cochlea, i.e., the inner ear. The goal is to evaluate how vibrations travel through the ossicles and to test the functioning of the nerve that transmits these signals to the brain.
How to prevent hearing loss
You cannot prevent hearing loss of genetic origin, related to birth complications, or an accident. However, here are some preventive measures to avoid acquired hearing loss.
1. Stay away from noisy places
Both adults and children are at risk of noise-induced hearing loss. If you have to shout to be heard, the noise level is sufficient to damage your hearing. At home and in the car, keep the radio and television volume at a moderate level to protect your ears.
When using headphones or earbuds, keep the volume at a reasonable level and take regular breaks.
2. Wear hearing protection at noisy events
If you attend noisy events — concerts, nightclubs, car races — you can wear earplugs to reduce the sound intensity. Also, remember to move away from the source of the noise at intervals.
3. Strictly follow hearing safety instructions
If you work in a noisy environment — nightclub, factory, construction site — wear hearing protection such as earmuffs or earplugs, and move away from the noise regularly.
4. Have your hearing tested regularly
Again, if you are frequently exposed to loud sounds, consult an audiologist for an examination and hearing tests. Early identification and diagnosis will help you better manage the situation.
Treatments for hearing loss
There are different treatments for hearing loss. The best one depends on the type, cause, and severity of the deafness. In cases of sensorineural hearing loss, however, treatment does not cure deafness: it helps you live with it.
Let's review the main options available.
Wearing hearing aids
Hearing aids and other assistive devices do not cure hearing loss. They are designed to improve your hearing and quality of life. The device amplifies sound vibrations entering your ear and makes the sound audible.
Hearing aids come in different sizes and capabilities. They consist of a microphone, a speaker, an amplifier, and a battery. Ask your doctor to recommend one suitable for your case.
Cochlear implants
Cochlear implants are suitable for patients with severe hearing loss. The device is inserted into the cochlea and directly stimulates the auditory nerves. It improves hearing, speech comprehension, and communication.
Recent advances in cochlear implant technology allow patients to understand speech even in noise, enjoy music, and use their implant while swimming.
Removal of obstructions and earwax plugs
An ear obstruction due to excess earwax can cause temporary hearing loss. Removing this obstruction restores hearing. It is advisable to have an earwax plug removed by a healthcare professional.
Surgical interventions and medications
Surgery can improve your hearing if your hearing loss is due to abnormal bone growths, tumors, or chronic ear infections such as otitis media.
For example, in cases of infection or fluid accumulation in the ear, the insertion of small tubes (ventilating tubes) drains the fluid and restores hearing.
Lip-reading and sign language
Lip-reading and sign language are alternative communication methods for people with profound deafness.
In lip-reading, the person observes the lips, tongue, and facial movements of their interlocutor. They then rely on these clues and context to understand what is being said.
Sign language relies on hand signs, facial expressions, and body postures. It is primarily used by people with permanent hearing loss.
Conclusion
If you suspect hearing loss, we recommend having your hearing tested. You can take a free online test or visit a hearing center for an assessment by an audiologist. Keep in mind that results obtained online are more difficult to interpret.
In cases of severe to profound hearing loss, we advise you to consult an audiologist. At this level of hearing loss, you will likely need a more advanced solution.
In cases of mild to moderate hearing loss, less extensive solutions may be sufficient to significantly improve your daily life. CLARIA rechargeable hearing aids are among the most affordable on the market: starting from only $89 a pair for our EV1 hearing aids, and $249 a pair for our EV3, our top-of-the-range model.
The treatment that is right for you depends on your level of hearing loss and your budget. Keep these two criteria in mind, and if you don't need an ultra-sophisticated or overpriced solution, try us! With a 30-day money-back guarantee, there's no reason to wait.
Thank you for reading, and happy journey to better hearing!
“The senses of hearing and balance are complex, poorly understood, and too often neglected. CLARIA hearing aids offer an affordable solution to many people.” - Drew Sutton, MD, board-certified otorhinolaryngologist.
CLARIA offers the OTC hearing aid adapted to your situation; we offer:
Affordable hearing aids
Stylish hearing aids
Online hearing aids
The best OTC hearing aids
Sources:
About Sensorineural Hearing Loss | ASHA
Age-Related Hearing Loss (Presbycusis) — Causes and Treatment | NIDCD
Genetics of Hearing Loss | CDC
