Have you ever caught yourself impatiently asking your spouse to repeat what they said? It may not be that they need to improve their enunciation; rather, you may suffer from any variety of hearing loss. Let’s look at some common signs of auditory damage and how you can guard yourself against it.

Editor’s note: this article was updated on March 23, 2021 to address reader questions, and to include a contents menu.

Signs of hearing loss

A picture of a man wearing the Fiio FH5 in-ears

Sensitive hairs called stereocilia must be in-tact for optimal hearing ability.

Before we jump into the three broad types of hearing loss, let’s cover the warning signs and symptoms as detailed by the CDC.

  1. Sounds, speech in particular, appear muffled. This can happen when your eustachian tubes are blocked from an ear infection or common cold. Although perceiving speech as muffled is a common sign, it isn’t something to immediately worry about.
  2. Difficulty registering high-frequency sounds like doorbells, telephone rings, and alarms.
  3. Difficulty understanding conversations when in a loud environment. This sign relates back to the first one: as speech can be difficult to distinguish from background noise.
  4. Difficulty understanding speech over the phone.
  5. Difficulty distinguishing consonants. Many consonants can sound confusing, hence why we use the NATO phonetic alphabet when spelling things over the phone. Discerning speech over the phone is difficult enough without hearing loss issues, but those who struggle to discern consonants may find themselves particularly frustrated when speaking on the phone.
  6. Asking others to speak slowly and clearly.
  7. Asking others to repeat what was said or say something louder. As you can see, our ability to recognize and register speech is a strong indicator of auditory health. If you frequently find yourself iterating, “What?” you may not just be a selective listener. It could be that you’re suffering from noise-induced hearing loss or the like.
  8. Increasing the volume during media playback (e.g. on the TV or through your headphones).
  9. Ringing in the ears. Concert-goers are likely familiar with this sensation: when loud noises cause an internal hiss or ring in one’s ears. It typically subsides, but if it occurs without warning, it’s a potential sign of hearing loss.
  10. Hypersensitivity to specific sounds, particularly to loud noises. Noises that may seem loud but not uncomfortable to most people could cause others to wince in pain. If that’s the case, it can be an indication of hearing damage.

Who’s at risk for hearing damage?

Stock image from Pexels of a baby's ear.

Age is only part of the picture when discussing damage to one’s auditory system.

There are a few factors that come into play when addressing who’s more or less at risk for hearing loss. Unfortunately, sometimes it’s just a roll of the dice: genetics can affect one’s predisposition for auditory damage. Alternatively, damage may occur from physical injuries to the ear.

Chronic conditions like high blood pressure and diabetes can also be cause for concern. A study published in the Indian Journal of Otolaryngology and Head and Neck Surgery posits there exists a significant association between hypertension and hearing loss. The cardiac disease can catalyze the degeneration of hearing mechanisms typically associated with aging.

Hypertension and exposure to ototoxic chemicals are just a couple of risk factors to remain aware of.

Another major risk factor can be exposure to certain chemicals and medicine. The American Speech-Language-Hearing Association (ASHA) states that ototoxic chemicals may harm hearing and balance. One dangerous chemical many of us know to avoid is Arsenic. It’s largely known to cause poisoning but is also associated with hearing loss; the same can be said from carbon monoxide and toluene, which is often found in paint thinners. Workers who encounter dangerous chemicals should always use proper protection like a ventilation hood, mask, or gloves (when appropriate).

Three major types of hearing loss

Sensorineural Hearing Loss (SNHL)

This is the most pervasive form of hearing loss, and it’s a result of damage to the stereocilia, or hair follicles, on the inner ear and nerve pathways. According to the ASHA, this results in an inability or difficulty to perceive soft, high-frequency sounds and can even extend to loud sounds, which may be unclear. Typically sensorineural hearing loss can’t be remedied with surgery or medicine, but can be mitigated with the use of hearing aids. ASHA audiologist Paul Farrell shed light on noise-induced hearing loss.

According to the National Institute for Occupational Safety and Health (NIOSH), there are a variety of factors that can affect risk of noise-induced hearing loss. They include the noise conditions in which a person is exposed, how long you are exposed, biological factors, like gender, age, race/ethnicity, genetics and general health issues that can influence susceptibility to the effects of noise. When sounds are both loud and last a long time, these sound can damage sensitive structures in the inner ear and cause noise-induced hearing loss (NIHL). NIHL can be caused by one time exposure to an intense sound, or exposure to loud sounds over a period of time.

—Paul Farrell, ASHA

Anyone can develop SNHL naturally as a result of aging, from noise-induced hearing loss, viral infections like meningitis, cranial trauma, tumors (e.g. acoustic neuroma), and ototoxic chemicals or medications.

Conductive Hearing Loss

A man using a smartphone to make a phone call using his voice.

It’s difficult for those with hearing loss to understand speech.

Conductive hearing loss can be either temporary or permanent and is caused by issues pertaining to the outer or middle ear. Regardless of the anatomical location, conductive hearing loss prevents sound from reaching the inner ear, meaning its unable to be sent to and processed by the brain. The condition manifests as a difficulty in discerning voices and general speech. Fortunately for those who suffer from conductive hearing loss, there are medical solutions including surgery in extreme cases.

Related: Bone conduction headphones, gimmick or godsend?

An array of seemingly innocuous issues can cause this hearing condition: ear infections, fluid in the middle ear, eardrum perforation, excess earwax (note: do not clean your ears with Q-tips), tumors, and otosclerosis.

Mixed Hearing Loss

Conductive and sensorineural hearing damage may occur simultaneously; when this happens it’s classified as mixed hearing loss, resulting in damage in the outer or middle ear and inner ear or nerve pathway to the brain.

If you suffer from chronic hearing issues, a visit to the audiologist is worthwhile.

This type of damage may be caused by anything that causes SNHL or conductive hearing loss. An example given by the ASHA is of those who work near loud noises and also happen to have fluid in their middle ears. One can exacerbate the problems of the other.

How to prevent hearing loss

The Puro Labs PuroCalm headphones prevent hearing loss

The PuroClam headphones do a great job at attenuating external noise, and serves as an excellent choice for children.

We aren’t here to scare you into walking around with hearing protection at all times, but there are prophylactic measures you can take to minimize risk for SNHL. One of the easiest preventative measures we can take is turning down the volume dial, be it on our home theater system or favorite pair of headphones. If you’re not in charge of the music, it may just be easier to step away from the source. For those at festivals or concerts, take a break every now and then from the hullabaloo, or carry around a pair of earplugs just in case. It’s important for you to limit exposure to loud noises as prolonged listening can expedite the degradation process.

Related: Why we should actively prevent hearing loss

As far as the SoundGuys community is concerned, we’re best off refraining from those tempting volume increases as a means of shutting the world out. Those of us who often crank the volume may want to consider noise cancelling headphones. Yes, good ones are expensive, but if you’re financially able to swing it, the cost is worth safeguarding your health.

If you think you’re affected by hearing loss

The Sennheiser earplugs on a table.

Earplugs are an effective form of hearing loss prevention and a must-have for concert-goers.

If you’ve read this article and believe you suffer from any of the symptoms above, there are a number of things you can do. For starters, make sure you’re properly hydrated, not suffering from a cold or flu, and aren’t currently suffering from another condition that could impact your hearing. If you’ve ruled all that out: talk to your healthcare professional. They will know better than anyone online how to proceed with your individual needs based on your risk factors and personal history. It might be legit hearing loss, or maybe there’s a blockage. Your doctors will know how to test for these possibilities far better than we will.

Do not be afraid to talk to your doctors, because the situation is often not as dire as you may think. Impairment can be temporary if it’s the result of an illness or blockage, but the only way to know is to go get it checked out.

If the worst happens and you have a case of hearing impairment that’s permanent, there are plenty of options on the market now that will be able to help in ways never made available to your parents—and they’re getting better all the time. With the announcement of Bluetooth LE Audio and the LC3 codec, those suffering from SNHL will experience increased functionality from compatible hearing aids, making life with hearing impairment less difficult.

Next: Best bone conduction headphones

Frequently Asked Questions

Are noise cancelling earbuds or headphones better for preventing hearing loss?

Generally speaking, over-ear headphones are the most conservative choice because you don't directly insert them into your ears as you do with earbuds. Earbuds may have more effectively passive isolation properties because of the more acute occlusion, but there's a chance that they can push earwax farther into your ear canals. This isn't too likely, but if you want to err on the side of caution, over-ear or on-ear noise cancelling headphones are your best bet. Whether you go with earbuds or headphones, we recommend that you clean them regularly.

I am 80% deaf in one ear. The sounds that I do hear are very tin can like noise. When my eustachian tubes are clear I can hear myself breathing perfectly from the interior. Any suggestions?

We asked Paul Farrell of the American Speech-Language Hearing Association (ASHA) for an answer to this one: "It’s best to seek professional help to more accurately evaluate your individual case. If you have not scheduled an appointment with an audiologist and an otolaryngologist (ENT), I would recommend that you take that step first. There are many reasons that may result in the symptoms that you describe. Here is a resource that can help prepare you for your visit with an audiologist"

I have musical ear syndrome....what can I do

We asked Paul Farrell of the American Speech-Language Hearing Association (ASHA) for an answer to this one: "Musical Ear Syndrome (MES) is a rare condition that causes patients with hearing loss to have non-psychiatric auditory hallucinations. The hallucinations are usually musical in nature and can range from popular music, orchestral symphonies, or radio tunes. Musical hallucinations can disappear without intervention. When hallucinations are bearable, some patients can be reassured without any other treatment. However, in other cases patients musical hallucinations are so disturbing that treatment is indicated. I would recommend that you seek consultation with a physician, preferably a neurologist or otologist to discuss your case and if any treatment options available." Maybe not the answer you wanted to hear, but we agree with his assessment—try to find a specialist. I'm sorry that you're suffering from this, it doesn't sound fun. Best wishes

I have hearing loss difficult to hear TV dialogue please suggest the remedy

We asked Paul Farrell of the American Speech-Language Hearing Association (ASHA) for an answer to this one: "Listening to television programming can be a challenge for everyone and especially people with hearing loss. Sound quality and the type of the programming can also make a difference (e.g. news vs. a documentary). Make sure that you turn on the closed captioning option. I would also suggest that you take a look at this hearing self-test https://www.asha.org/public/hearing/Self-Test-for-Hearing-Loss/ If you answer yes to two or more of the questions, you should see an audiologist." You may also want to see if your TV has advanced sound settings, and to see if there's a setting called "Downmixing mode" and set that to "Stereo." It's entirely possible that your TV is struggling with the audio because it doesn't have the best sound system. If that's the case, then you might benefit from a soundbar that is designed to downmix many channels at once, or a 5.1 system that you can turn up the center channel on. I personally like the 5.1 system because it also allows me to turn off voices in surround sound broadcasts, so I can watch football without hearing the announcers.