Why Your Hearing Gets Worse as You Age and What to Do About It

Age-related hearing loss is common, but limiting your exposure to loud noises can help keep your ears healthy for longer.
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Do you find yourself straining to hear certain sounds, turning up the volume on the radio or missing out on snatches of conversation?


Age-related hearing loss — also known as presbycusis — happens to most of us as we get older. In fact, nearly a third of American adults between the ages of 65 and 74 experience hearing loss, and almost half of those above 75 have trouble hearing, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).

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But is this loss of listening ability inevitable?

Here, Maura Cosetti, MD, director of the Ear Institute at the New York Eye and Ear Infirmary of Mount Sinai, explains how your hearing may become hampered in later stages of life and what you can do to manage (and possibly even minimize) it.

First, What Causes Age-Related Hearing Loss?

“Age-related hearing loss or ‘presbycusis’ is a type of sensorineural hearing loss that affects the inner ear, specifically the hair cells within the cochlea,” the spiral-shaped structure that contains the organ of Corti, aka the organ for hearing, Dr. Cosetti says.

“The cochlea is organized by frequency [a principle called tonotopic organization],” Dr. Cosetti says. That means that different frequencies stimulate different hair cells.

And with age, some hair cells may degrade earlier than others, producing problems with hearing loss, Dr. Cosetti says.

So why do these changes in the inner ear happen as we grow older? Here are some of the most common causes of age-related hearing loss, per the NIDCD.

  • Medical conditions‌: Health issues like high blood pressure and diabetes (which are more common in older people) can affect your hearing.
  • Ototoxic medications‌: Certain medications, such as drugs to treat cancer, heart disease, infections and autoimmune disease — which are more often prescribed to older folks — can be toxic to the sensory cells in your ears and contribute to hearing loss.
  • Abnormalities of the outer or middle ear‌: While rare, abnormalities in the ear structures that carry sound waves from the eardrum to the inner ear can lead to age-related hearing loss.
  • Long-term noise exposure:‌ Prolonged exposure to loud noise (think: you work in construction or in a factory) can damage the sensory hair cells in your ear and diminish your hearing over time.

4 Ways Your Hearing Changes as You Age

Usually affecting both ears, age-related hearing loss is often slow and insidious, and the symptoms may be quite subtle, Dr. Cosetti says. Here are a few signs to look out for:


1. You Have Trouble Hearing Higher-Pitched Sounds

"In both age-related hearing loss and noise-induced hearing loss, the high frequencies are affected first," Dr. Cosetti says. Which is why "some individuals report difficulty hearing the voices of young children and others with high-pitched voices," she says.

In addition, "consonants such as s, f and h, which help distinguish words, fall in the high frequencies," Dr. Cosetti says. So the "loss of these key sounds leads to difficulty with speech understanding" as well.


2. You Find It Difficult to Follow Conversations When There Is Background Noise

Anyone at any age will find it challenging to hear a conversation crystal clear at a boomingly loud rock concert. But if you're noticing that everyday background noise is limiting your listening skills, you're likely dealing with age-related hearing loss.

People with age-related hearing loss "often report a lack of clarity or inability to understand or make out what is being said," Dr. Cosetti says.


"Typically, this is most noticeable in difficult-to-hear environments where there is a significant amount of background noise, such as restaurants, sporting events or public transportation," she adds.


3. You Hear Ringing, Buzzing or Hissing Sounds in One or Both of Your Ears

Tinnitus is a common symptom of age-related hearing loss.


"Tinnitus may be tonal, with a ringing sound, but it also may sound like buzzing, hissing, sizzling, wind or a shushing sound, and it can be present in the quiet only or all the time," Dr. Cosetti says.

"Many people report they might hear better if only the noise or tinnitus would abate, not recognizing that the tinnitus itself may be a manifestation of hearing loss," she adds.


4. Certain Sounds Seem Very Loud

Does the sound of the air conditioner suddenly seem shockingly loud? This perception of exaggerated sound is called recruitment, and it's another common symptom of age-related hearing loss, Dr. Cosetti says.

"This phenomenon results from the uneven distribution of hearing loss across the various frequencies in the cochlea," she says.


"As mentioned earlier, in age-related hearing loss, some hair cells degrade earlier than others," Dr. Cosetti says. But the remaining functioning hair cells may respond rapidly to certain sounds, leading you to experience these noises as startlingly loud.

How to Maintain Healthy Hearing as You Age

"In general, hearing loss is underrecognized and under-treated," Dr. Cosetti says. But your hearing has a wide-ranging effect on your overall health and ability to function in older age.

Indeed, "a large amount of data has accumulated in the scientific community linking hearing loss to a number of other important markers of health, including cognitive function, balance and falls, physical functioning, depression and social isolation," Dr. Cosetti says. "The data suggests that those with more hearing loss are at a greater risk of significant health problems in each of these domains."


That's why protecting your hearing is hugely important. Here are some smart strategies to safeguard your hearing into your golden years.

1. Limit Loud Noise Exposure

Use ear protection such as earplugs or earmuffs "to protect your hearing from loud noises, even those you may find routine, such as the lawn mower, home power tools, indoor exercise classes and home speaker systems," Dr. Cosetti says.

2. Steer Clear of the Sound Source

"When at public events, try to avoid or keep your distance from the sound source, such as a loudspeaker at concerts or sporting events," Dr. Cosetti says.

And, once again, when in loud environments, "wear ear protection and try to take intermittent breaks from the noise," she adds.

3. Measure the Noise Level

"Many smartphones have free 'sound level meter' apps that can measure the noise level of your environment," Dr. Cosetti says. "Take the opportunity to become more familiar with the loudness level of your common activities."

Levels at or above 85 dB may put you at risk for hearing loss, she says.

4. Follow a Healthy Lifestyle

Remember: "Hearing loss is associated with tobacco use, heart disease and diabetes as well as a variety of medications," Dr. Cosetti says. Thus, "eating well, exercising and generally living a healthy lifestyle are some of the best things you can do to lower your risk of hearing loss."

5. Ask for a Hearing Test

"Age-related hearing loss may begin in mid-life, around age 50, though the serious symptoms may not manifest for years," Dr. Cosetti says. "Talk to your doctor about hearing loss and ask for a hearing test to understand your hearing level and potential risk."

See a Doctor About Hearing Loss if:

  • You have difficulty understanding conversations
  • Others report that you always have the TV or music set at a high volume
  • You have tinnitus in one or both ears
  • You have a history of noise exposure, either occupational (such as military, construction, music, etc.) or recreational (such as firearms, motorcycling, carpentry, etc.)
  • You have a history of prior ototoxic medication usage
  • You have a strong family history of hearing loss
  • You have a history of prior ear infections, ear surgery or treatment for ear or neurologic diseases
  • You have a history of falls or imbalance
  • You experience rapid or sudden hearing loss (this could be a sign of a non-age-related issue)




Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.

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