Age-Related Hearing Loss: Signs, Causes and Treatment

Age-related hearing loss, also called presbycusis, is the slow, gradual loss of hearing that happens to many people as they get older. It usually affects both ears, starts with high-pitched sounds and speech in noisy rooms, and is treated mainly with hearing aids, including over-the-counter hearing aids for mild to moderate loss. It cannot be reversed, but treating it early can help you stay connected, safer and more independent.

Because the change is so slow, family members often notice it first.

This article is for general information and is not medical advice.

Key takeaways

• Roughly one in three people aged 65 to 74 has hearing loss, and nearly half of people over 75 have difficulty hearing.
• Early signs include asking people to repeat themselves, trouble following group conversations and turning the TV up louder than others like.
• Adults 18 and older with perceived mild to moderate hearing loss can buy over-the-counter (OTC) hearing aids without a prescription or exam.
• Hearing loss is linked to a higher risk of dementia and falls, which is a strong reason to get tested and treated.
• Sudden hearing loss, especially in one ear, is a medical emergency. See a doctor right away.

What is age-related hearing loss?

Age-related hearing loss is gradual hearing loss caused by changes in the ear and the nerve pathways to the brain as you age. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), it is one of the most common conditions in older adults.

Most cases are sensorineural hearing loss, which means damage to the inner ear (the cochlea, where tiny hair cells turn sound vibrations into nerve signals) or to the hearing nerve itself. This type is usually permanent. It differs from conductive hearing loss, where something blocks sound from reaching the inner ear, such as earwax, fluid or a damaged eardrum. Conductive loss is often fixable.

NIDCD reports that about 15% of U.S. adults report some trouble hearing, roughly one in three people aged 65 to 74 has hearing loss, and nearly half of those over 75 have difficulty hearing. It often sits alongside other conditions covered in our overview of the most common chronic diseases and how to prevent them.

What are the early signs of hearing loss?

The earliest signs are usually trouble understanding speech in noisy places and needing people to repeat themselves. You may still hear that someone is talking but struggle to make out the words.

The National Institute on Aging (NIA) lists these common signs:

• Trouble understanding phone calls
• Difficulty following a conversation when several people are talking
• Often asking people to repeat what they said
• Needing the TV so loud that others complain
• Difficulty hearing over background noise
• Trouble understanding children and other higher-pitched voices

The U.S. Food and Drug Administration (FDA) adds that finding listening tiring is a sign of mild to moderate loss. If you have trouble hearing speech even in a quiet room, or struggle to hear loud sounds such as power tools, your loss may be more severe.

NIDCD notes that people with hearing loss may also feel left out in groups or start avoiding social activities.

What causes age-related hearing loss?

Age-related hearing loss is caused by a mix of natural aging changes in the ear, lifetime noise exposure, health conditions and genes. Usually no single cause explains it.

NIDCD lists these contributors:

• Aging changes in the inner ear, middle ear and nerve pathways from the ear to the brain
• Long-term noise exposure from work, hobbies, music or traffic
• Medical conditions more common in older age, such as high blood pressure and diabetes
• Ototoxic medicines, meaning drugs that can damage the ear's sensory cells, such as some chemotherapy drugs
• Middle ear problems such as otosclerosis, an abnormal bone growth that stops sound moving through the ear
• Genes that may make some people more likely to lose hearing

NIA adds that some antibiotics and, at some doses, aspirin can damage the inner ear. Ask your pharmacist if any of your medicines can affect hearing, but do not stop one on your own.

How is hearing tested?

Hearing is usually checked first by your primary care doctor and then measured in detail by an audiologist, a health professional who tests and treats hearing loss. You may also be referred to an otolaryngologist, also called an ENT (ear, nose and throat) doctor.

According to Mayo Clinic, common tests include:

Test	What happens	What it shows
Physical exam	A clinician looks inside your ear	Earwax, infection or other visible causes
Whisper (screening) test	One ear is covered while words are spoken at different volumes	A rough idea of how well you respond to sound
App-based hearing test	You screen yourself on a phone or tablet	Whether a full test is worth booking
Tuning fork test	A metal fork is tapped to make a tone near your ear	Hearing loss and where in the ear the damage may be
Audiometer test	An audiologist plays tones and words through earphones at falling volumes	The quietest sound you can hear in each ear

The result is an audiogram, a chart of the softest sounds you can hear at different pitches, which shows how severe your loss is.

What are the treatment options for presbycusis?

The main treatment is hearing aids, which make sounds louder. For severe or profound loss that hearing aids cannot help much, cochlear implants are an option. Assistive listening devices can fill gaps in specific situations.

Over-the-counter hearing aids

Since October 17, 2022, the FDA has allowed OTC hearing aids. Adults 18 and older who perceive mild to moderate hearing loss can buy them in stores or online without a prescription, exam or fitting. The FDA states they are intended only for perceived mild to moderate loss. People with severe or profound loss, and anyone under 18, should see a licensed hearing health professional.

NIDCD advises that if OTC aids do not help, or if loud sounds are hard to hear, you should see a hearing health professional.

Prescription hearing aids

Prescription hearing aids are fitted by an audiologist or hearing aid specialist and suit greater or more complex loss. Mayo Clinic notes that hearing aids help most when inner ear damage is the cause.

Cochlear implants

A cochlear implant is a surgically placed device for people with severe or profound hearing loss. NIA explains that instead of amplifying sound like a hearing aid, it creates electric signals that the brain recognizes as sound. Surgery is followed by hearing therapy so the brain can learn to use the new signals.

Assistive listening devices

NIDCD lists phone amplifiers, smartphone or tablet apps and hearing loop systems in some venues.

Not all hearing loss is age-related. Mayo Clinic notes that earwax blockage is a fixable cause, removed with suction or a small looped tool, and some types of loss can be treated with surgery. That is one reason a proper check is worth it before you buy anything.

How is hearing loss linked to dementia and falls?

Hearing loss is linked to a higher risk of both dementia and falls. Treating it may help some people, though research is still sorting out how much.

NIA reports that older adults with hearing loss have a greater risk of dementia, and their memory and concentration may decline faster. One analysis found hearing devices such as hearing aids and cochlear implants were linked to a lower risk of long-term cognitive decline. You can read more about risk factors in our guide to dementia types, stages and how to lower your risk.

The best evidence comes from the ACHIEVE trial, a randomized study of nearly 1,000 adults aged 70 to 84 with hearing loss. As described by the National Institutes of Health, hearing aids did not change the rate of cognitive decline across all participants over three years. But in a group at higher risk of dementia, hearing aid users had a nearly 50% slower rate of decline than the comparison group. Staying active also supports brain health, as covered in our article on the best exercise for brain health.

For falls, NIA notes that even small hearing losses are linked to a higher risk of falling. If you or a parent is unsteady, pair hearing care with the steps in our guide to fall prevention for older adults.

Can you protect your hearing as you age?

You cannot stop the aging process in your ears, but you can prevent noise damage that adds to it. NIDCD notes scientists do not yet know how to prevent age-related hearing loss, while noise-induced hearing loss is preventable.

The CDC's National Institute for Occupational Safety and Health (NIOSH) recommends limiting exposure to 85 decibels (dBA) averaged over an eight-hour day. For every 3 dBA above that, safe exposure time is cut in half. Lawn mowers, vacuums and power tools are around 85 to 90 dBA. Chain saws, sirens, nightclubs and large sporting events can reach 95 dBA or more.

Follow these steps to protect your hearing:

1. Wear earplugs or earmuffs when using power tools, mowers or leaf blowers, and at concerts or games.
2. Keep headphone and phone volume low, and listen in quiet places so you do not need to turn it up.
3. Notice warning signs: ringing ears or dull, flat sound after leaving a loud area means it was too loud.
4. Manage blood pressure and blood sugar, since NIDCD links both high blood pressure and diabetes with hearing loss.
5. Never put cotton swabs in your ear canal. NIA warns they can damage the eardrum.
6. Get a baseline hearing test and repeat it if you notice changes.

These habits fit with the wider routines in our guide on how to age well after 50.

When to see a doctor

See a doctor right away if you lose hearing suddenly. NIA says sudden hearing loss, an unexplained rapid loss that can happen at once or over a few days, should be treated as a medical emergency. Early treatment gives the best chance of recovery.

The FDA advises seeing a doctor, preferably an ENT, rather than buying OTC hearing aids if you have:

• A sudden change in hearing in the past 6 months, or hearing that comes and goes
• Hearing that is worse in one ear, or ringing or buzzing in only one ear
• Blood, pus or fluid draining from the ear in the past 6 months
• Ear pain or discomfort
• Severe dizziness or vertigo (a spinning feeling)
• Heavy earwax or a suspected object in the ear
• An ear injury, birth defect or unusual ear shape

If sudden hearing loss comes with face drooping, arm weakness, slurred speech or sudden loss of balance, call emergency services. Learn the full list in our article on stroke warning signs and what to do.

Common mistakes with age-related hearing loss

• Waiting years to get tested. Slow change is easy to ignore, but earlier treatment helps you adapt and stay social.
• Assuming it is "just age." Earwax, infection or a medicine side effect can cause or worsen hearing loss and may be treatable.
• Buying OTC aids for severe loss. OTC devices are only for perceived mild to moderate loss.
• Waiting out sudden hearing loss. It needs prompt medical care, not a wait-and-see approach.

FAQ

Can age-related hearing loss be reversed?

No. Damage to the inner ear's hair cells and hearing nerve is usually permanent. Hearing aids, cochlear implants and assistive devices can greatly improve how well you hear and understand speech.

Do I need a hearing test before buying OTC hearing aids?

No. The FDA lets adults 18 and older with perceived mild to moderate loss buy them without an exam. A hearing test is still useful to confirm the level of loss and rule out fixable causes like earwax.

At what age does presbycusis usually start?

It often becomes noticeable after 60, and NIDCD reports that about one in three people aged 65 to 74 has hearing loss. Noise exposure and health conditions can make it start earlier.

Will hearing aids prevent dementia?

Not proven. The ACHIEVE trial found no overall difference in cognitive decline, but hearing aids slowed decline by nearly 50% in a higher-risk group.

What to do next

If you recognize any of the early signs, book a hearing check with your doctor or an audiologist. If your loss is mild to moderate, OTC hearing aids may be a reasonable first step, but see a professional if they do not help. Protect your ears from loud noise from now on, and treat any sudden change in hearing as urgent. Our guide on why older adults struggle with sleep is a useful next read.

Sources

• NIDCD: Age-Related Hearing Loss (Presbycusis)
• National Institute on Aging: Hearing Loss, A Common Problem for Older Adults
• FDA: OTC Hearing Aids, What You Should Know
• NIH Research Matters: Hearing Aids Slow Cognitive Decline in People at High Risk
• Mayo Clinic: Hearing Loss, Diagnosis and Treatment
• CDC NIOSH: Noise-Induced Hearing Loss

Last reviewed: November 2026.