Age-related hearing loss (presbycusis): signs, causes and treatment

What age-related hearing loss is

Age-related hearing loss, also called presbycusis, is hearing loss that comes on gradually as people get older. It is one of the most common conditions of aging ^[1]. It usually affects both ears, and because it's so gradual, many people don't realize they've lost hearing ^[1].

The main damage happens in the inner ear. Tiny hair cells there turn sound vibrations into signals for the brain. When they're damaged or die, they don't regrow, so the loss is permanent ^[4]. Changes in the middle ear and along the nerve pathways to the brain can also play a part ^[1].

How common it is, by age

The answer depends on how you measure it. Asking people whether they have trouble hearing gives lower numbers than testing them, because people with mild loss often don't notice it.

Age	Report some trouble hearing (survey, 2018) [7]	Disabling hearing loss on a hearing test (2015-2020) [2]
18 to 44	6.1%	Not reported
45 to 54	17.8% (ages 45 to 64)	About 5%
55 to 64	17.8% (ages 45 to 64)	About 10%
65 to 74	31.6%	About 22%
75 and older	47.2%	About 55%

"Disabling" here means a loss of 35 decibels or more in the better ear ^[2]. Milder loss is far more common. In a national study that gave hearing tests to 2,803 adults aged 71 and older in 2021, 65.3% had at least some hearing loss: 37.0% mild, 24.1% moderate and 4.2% severe ^[3]. Among adults 90 and older, 96.2% had hearing loss ^[3].

NIDCD's plain-language summary: about one in three people aged 65 to 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing ^[1].

How it progresses

Presbycusis usually gets worse slowly over years ^[4]. It can't be reversed ^[4]. Most people start with mild loss. A national analysis found that most Americans with hearing loss have mild loss, but among people 80 and older, moderate loss is more common than mild ^[8].

FDA's labeling for over-the-counter hearing aids gives a useful way to gauge where you are ^[6]:

What you notice	What it usually points to [6]
Trouble following speech in noisy places or groups; trouble on the phone; listening feels tiring; you want the TV louder than others do	Perceived mild to moderate hearing loss
Trouble hearing speech even in a quiet room; loud sounds like music, power tools or engines seem faint	More than mild to moderate loss; see a hearing professional

MedlinePlus lists the common symptoms: difficulty hearing people around you, frequently asking people to repeat themselves, trouble telling apart sounds like "s" and "th", difficulty understanding higher-pitched voices, some sounds seeming overly loud, trouble in noisy areas, and ringing in the ears ^[4]. For the full checklist, see our guide to early signs of hearing loss.

What causes it

There's no single cause ^[4]. NIDCD and MedlinePlus list these contributors ^[1][4]:

• Aging changes in the inner ear, the most common cause
• Long-term noise exposure from work, hobbies or music
• Genes and family history
• Medical conditions, including high blood pressure and diabetes
• Some medicines that are toxic to the ear's hair cells, such as certain chemotherapy drugs
• Smoking
• Less commonly, middle-ear problems such as otosclerosis

Scientists don't yet know how to prevent age-related hearing loss ^[1]. What you can control is noise. NIDCD's advice is to avoid loud noises, reduce how long you're exposed, and wear earplugs or earmuffs ^[1].

When it's probably not just age: hearing loss in one ear only, a sudden drop, or hearing loss with headache, vision changes or dizziness. MedlinePlus says to contact a provider right away in those cases ^[4].

Treatment options

There is no cure, but treatment helps people hear better and stay involved ^[4].

Option	Who it's for	Notes
Over-the-counter (OTC) hearing aids	Adults 18 and older with perceived mild to moderate loss [6]	Sold in stores and online without an exam since October 17, 2022 [6]. Compare options in our OTC hearing aids guide.
Prescription hearing aids	Any degree of loss, including more than mild to moderate [6]	An audiologist measures your hearing and provides the devices [1]
Cochlear implants	Severe or profound loss [1]	Surgically implanted; helps people perceive sound but doesn't restore normal hearing [4]
Assistive listening devices	Anyone, alone or with hearing aids	Phone amplifiers, smartphone apps and hearing loop systems in some public venues [1]
Communication habits	Families and caregivers	Face the person so they can see expressions and lip movements [1]

OTC or professional? FDA's labeling says OTC devices fit people who have trouble understanding speech in noise or groups, trouble on the phone, or need the TV louder than others like it. If you have trouble hearing speech even in a quiet room, or can't hear loud sounds well, FDA says to see a hearing professional ^[6].

Who to see. NIDCD lists three starting points: your primary care doctor, who can check for medical causes and refer you; an otolaryngologist (ENT), a doctor who treats ear disorders; and an audiologist, who measures hearing loss and fits hearing aids ^[1]. A primary care visit can also catch earwax, which can block the ear canal and muffle hearing ^[4].

Why so many people wait, and why it costs them

Most people with age-related hearing loss don't treat it.

• Among adults 70 and older with hearing loss who could benefit from hearing aids, fewer than one in three (30%) has ever used them ^[2].
• Among adults 20 to 69 who could benefit, only about 16% have ever used them ^[2].
• In the 2021 national study of adults 71 and older, only 29.2% of those with hearing loss used hearing aids, with lower use among Black, Hispanic and low-income older adults ^[3].

The average delay is close to nine years. A study that followed adults for 28 years found an average of 8.9 years between when people met the hearing test criteria for hearing aids and when they got them ^[5]. People with worse hearing, and those who felt it was hurting their social lives, got them sooner ^[5].

Why the wait? Part of it is that the loss is gradual, so people adapt without noticing ^[1]. Cost and coverage matter too. Our guides on hearing aid costs and Medicare coverage explain what to expect.

Waiting has costs. NIDCD notes that untreated hearing loss can make it hard to follow a doctor's advice, respond to warnings, and hear doorbells and smoke alarms, and can lead to feelings of isolation ^[1]. Hearing loss is also a leading modifiable risk factor for dementia, though whether treating it lowers that risk is still being studied. See hearing loss and dementia for what the research shows.

What to do next

1. Notice the signs. Trouble in groups, turning up the TV and asking for repeats are the classic early ones ^[4].
2. Get a hearing test. It tells you the type and degree of loss and whether OTC devices are a reasonable fit.
3. Rule out quick fixes. Ask whether earwax is part of the problem ^[4].
4. Pick a treatment and follow up. Go back to your provider if devices sound wrong or aren't helping.
5. Bring family in. Small changes, like facing the person when you talk, make a real difference ^[1].

When you're ready, find a hearing provider near you.