Signs Of Hearing Loss In Adults

Hearing Aid


Hearing loss is the partial or total loss of the ability to perceive sounds. Hearing loss can affect one or both ears and can be temporary or permanent.

When sound waves in the environment enter the outer ear, they travel through the ear canal to the eardrum. As the sound wave approaches the eardrum, the eardrum begins to vibrate. This vibration is sent to the three tiny bones (malleus, incus, and stapes) in the middle ear.

When the vibration gets to these three tiny bones, the sound wave’s vibration is amplified then sent to the cochlea. The cochlea is a snail-shaped structure located in the inner ear. The cochlea sits on the basilar membrane in the inner ear, and it contains fluid.

As the vibration gets to the cochlea, the fluid in it begins to ripple. The rippling creates a wave on the hair cells on top of the basilar membrane and causes the hair cells to move up and down. As the hair cells move, they bump against the overlying structure and bend.

When the hair cells bend, the pores at the tip of the stereocilia (microscopic hair-like projections) open and cause chemicals to rush into the cells, where they create an electrical signal.

This electrical signal is transported to the brain through the auditory nerve. In the brain, the electrical signal is interpreted into recognizable and understandable sounds.

Any damage is done to the outer, middle, or inner ear can cause hearing loss. Hearing loss caused by damage to the outer and middle ear is known as conductive hearing loss.

While hearing loss caused by damage to the inner ear is known as sensorineural hearing loss.

A combination of both conductive and sensorineural hearing loss is called mixed hearing loss.

Causes of Hearing Loss in Adults

The causes of hearing loss can be congenital or acquired. Congenital causes of hearing loss are factors that cause hearing loss before birth, while acquired causes of hearing loss are factors that cause hearing loss later in life.

In this post, we will be focusing on the acquired causes of hearing loss because all cases of hearing loss in adults are acquired. Let's get started.

1. Ototoxic Medications

Ototoxic medications are drugs taken to treat certain health conditions that can affect your hearing. Many over-the-counter and prescription medications are ototoxic.

Ototoxic drugs damage the cochlea, and the hearing loss it causes develops quickly. Other symptoms like vertigo and tinnitus often accompany the hearing loss. Hearing often returns to normal if you stop taking the medication.

Common examples of ototoxic medications are; loop diuretics like furosemide or bumetanide used to treat heart failure and high blood pressure, large doses of aspirin, and anti-inflammatory drugs naproxen and ibuprofen.

Certain antibiotics like gentamicin, neomycin, and streptomycin and cancer medications like bleomycin, cyclophosphamide, and cisplatin can also cause hearing loss.

2. Exposure to Loud Noise

Sudden or constant exposure to loud noise can cause hearing loss. There is a normal noise level that your ears can tolerate. When sound exceeds that level, it can instantly damage your hearing.

Loud noise can cause your eardrum to rupture or damage the hair cells in your inner ear.

Hearing loss caused by eardrum rupture can be reversed if the tear in the eardrum heals. But hearing loss caused by damage to the hair cells in your inner ear due to exposure to loud noise is irreversible. This is because the hair cells cannot be repaired or replaced.

3. Aging

Lovely grandmother


Another cause of hearing loss in adults is aging. As you age, the organs in your body deteriorate. The hair cells in your inner ear also begin to deteriorate. When this happens, you will experience hearing loss.

Hearing loss caused by aging starts gradually and mildly. But with time, the hearing loss deteriorates until it becomes profound and permanent. Hearing loss caused by aging is not reversible. The only way you can hear is with the help of hearing aids.

4. Buildup of Earwax

Earwax is produced in the ear canal to protect the ear from particles, water, and bacteria that can cause infections. When the ear produces the normal quantity of earwax, the earwax flows out naturally and is washed away.

But in some cases, the ear can produce more earwax than is needed. Getting rid of the excess earwax becomes difficult; this results in the accumulation of the wax.

As the earwax accumulates, it solidifies and grows in size as more is added. With time the accumulated ear wax grows big and creates a blockage in the ear canal.

This blockage prevents sound coming from the outer ear from getting to the inner ear. When this happens, conductive hearing loss occurs. Hearing returns to normal when the excess wax is removed.

5. Ruptured Eardrum

The eardrum, which is also known as the tympanic membrane, is a thin membrane located between the outer and middle ear. It plays a vital role in the transmission of sound from the outer ear to the middle ear.

A tear or a hole in the eardrum is referred to as an eardrum rupture, and several factors can cause it.

Sudden exposure to loud noise can instantly rupture the eardrum. Also, sudden changes in pressure, direct impact on the ear, head injury or trauma, and poking the ear with objects can rupture the eardrum.

Ear infections that cause fluid to build up behind the ear can also cause the eardrum to rupture. As the fluid builds up behind the eardrum, it places pressure on the eardrum; this pressure can make it tear.

Ruptured eardrums usually get healed within a few weeks without any medical intervention. But in some cases, when the healing doesn't happen naturally, a surgical procedure may be required. Hearing returns to normal when the tear or hole in the eardrum is sealed up.

6. Ear Infections and Diseases

Ear infections like autoimmune inner ear diseases and middle ear infections can cause hearing loss.

Autoimmune inner ear diseases occur when the antibodies in the inner ear begin to fight against and destroy the hair cells in the inner ear. If the disease is not treated immediately, all the hair cells in the inner ear can be lost. This will result in permanent hearing loss.

Other infections like swimmer's ear, otitis externa, and otitis media with effusion can be caused by several factors and can cause hearing loss.

7. Other Factors

Several other factors can cause hearing loss in adults.

Examples of these causes of hearing loss in adults include; otosclerosis, eustachian tube dysfunction, Meniere's disease, head injuries, and tumors. Certain illnesses like meningitis and high fever can also cause hearing loss.

Signs of Hearing Loss in Adults

Hearing Aid


The symptoms of hearing loss in adults vary based on the cause and severity of the hearing loss, but the signs (warning signals) are the same in most cases.

In some cases, the signs experienced are dependent on the underlying cause of the hearing loss. For instance, the signs of hearing loss caused by the blockage of earwax will not be the same as the signs of hearing loss caused by autoimmune inner ear disease.

Asides from the fact that the root cause determines hearing loss in adults, it is also important to note that no two cases of hearing loss are the same.

This means that even if the hearing loss of two people has the same root cause, the signs of the hearing loss may vary because the degrees of the hearing loss vary.

Even if the degree of hearing loss in both people is the same, the effect of the hearing loss on their life will still be different.

This notwithstanding, there are general signs that often herald the presence of hearing loss. Before the symptoms kick in, you may notice some of these signs.

In this post, we will be examining the signs of hearing loss that is common to the different types of hearing loss. Every hearing loss patient experiences all or some of these signs.

Below are some of the common signs of hearing loss in adults:

1. Difficulty Communicating

Executives shaking hands during a business meeting


Most hearing loss patients do not realize they have a problem with their hearing until they begin to struggle to engage in everyday conversations.

Because this is one of the first signs of hearing loss most hearing loss patients have, they may not suspect hearing loss at the initial stage.

Some of the difficulties hearing loss patients encounter during conversations are:

  • Muffled hearing: the voices and sounds they hear sound low, indistinct, or muffled.
  • Difficulty identifying the source of a sound.
  • Constantly asking for repetition.
  • Asking others to speak louder or increasing the volume of the television or radio.
  • Difficulty having telephone conversations.
  • Asking others to speak slowly.
  • Inability to hear distant sounds.
  • Difficulty engaging in group conversations.

In most cases, it takes the people around the hearing loss patient to realize that they have problems with their hearing.

The hearing loss may make them misunderstand or not hear what is being said. If only one ear is affected, they may turn the "good" ear toward you to hear what is being said.

While communicating with hearing loss patients may be frustrating, the use of certain communication strategies can make it easier for you to communicate with them.

Here are certain communication tips to use when communicating with a hearing loss patient:

  • Face the hearing loss patient directly. Ensure that the face of the speaker is properly illuminated. Don't speak from another room or a distance.
  • Say the person's name before beginning the conversation. This will give the hearing loss patient time to pay attention to what you have to say.
  • Avoid using complex sentences.
  • Speak slowly, distinctly, and clearly. Avoid shouting. Shouting distorts the sound of speech.
  • Pause between sentences and phrases to ensure that the hearing loss patient understands what is being said.
  • Take turns speaking and avoid sudden changes in topics.

2. Difficulty Understanding Speech in Background Noise

Inability to hear well in background noise is another major sign of hearing loss. Background o ambient noise is any sound other than the primary sound being monitored.

Examples of background noise are noise from electrical devices like air conditioners, motors, refrigerators, noise from animals, traffic noise, water noise, and other types of environmental noises.

Adults with hearing loss can hear properly in quiet environments but struggle to hear when background noise is introduced. This difficulty to hear can be attributed to the fact that background noises can mask the fine sounds of speech like high-pitched consonants. These fine sounds make hearing easier, but when they are masked, hearing becomes difficult.

When these sounds are masked, the brain may not be able to fill up the blank spaces they leave because, at that point, the brain is also busy trying to separate speech from the background noise.

These blank spaces left by sounds that were masked make it difficult for the hearing loss patient to comprehend what is being said.

If the brain can fit in the missing sounds through the use of contextual clues, the hearing loss patient may experience fatigue because of the strenuous work the brain had to do during the conversation.

Also, the auditory systems in the inner ear of the hearing loss patients are different. The auditory system is responsible for filtering sounds into different channels that are tuned to different frequencies.

In people with normal hearing, the channels are sharp and focused, but they are broad and scattered in hearing loss patients.

When there is background noise, the neurons in the inner ear have to work harder because the channels are spread too thin.

This, coupled with the fact that the neurons are also distracted by background noise, makes the perceived sound to be fuzzy.

If hearing loss is caused by damage to the hair cells in the inner ear, you may also experience difficulty hearing in background noise.

This is because, aside from being responsible for how loud a particular sound needs to be for you to hear it, hair cells also help you understand speech in background noise. If they are damaged, the hearing may be difficult.

3. Difficulty Hearing Children Voices

Mother and children lying on a bed


Another common sign of hearing loss in adults is the inability to hear female and children's voices. If you can hear these voices, they may sound muffled or unclear.

This happens because female voices and children's voices are regarded as high-pitched sounds, and the first set of cells to fail when you have hearing loss are the cells responsible for detecting high-pitched sounds.

Asides from female and children voices, you may also find it difficult to hear sounds like: beeping of phones and appliances, birds and animal sounds, doorbells, and certain consonant sounds.

Examples of consonant sounds you may struggle to hear are "s,” "h," or "f.”

4. Listening Fatigue

This is an early sign of hearing loss in adults. Listening fatigue is the feeling of tiredness after listening to someone speak for a while.

People with normal hearing can experience listening fatigue, but it’s a bit different for those with hearing loss.

Listening fatigue sets in earlier for people with hearing loss. They also have frequent or increasing episodes of listening fatigue. It is caused by the extra work the brain has to do to interpret sounds due to hearing loss.

The hair cells in the inner ear are responsible for converting sound waves into electrical energy, which the brain interprets as sound.

When these hair cells are damaged, the ear can no longer convert sound waves into electrical signals.

The implication of this is that the brain will be getting the raw, unconverted soundwaves. This makes the brain do more work to make sense of the sound sent to it from the inner ear.

Also, each hair cell is responsible for translating a specific frequency; when the hair cells are damaged, the auditory system loses the ability to translate the missing frequency.

This means that your brain will constantly have to fill in blank sound spaces left by the lost frequencies when others are talking.

If more than one person is speaking at a time, your brain may have to do more work. This can make you very tired at the end of events.

Listening fatigue can make hearing loss patients withdraw from social activities and get depressed. This withdrawal is also due to the difficulty understanding conversations and the embarrassment associated with constantly asking for repetition.

5. Watching People's Lips When They Talk

Close up photo of woman's lips


One of the signs of hearing loss in adults is watching people's lips instead of making eye contact when they are talking. This is a subtle habit that most hearing loss patients develop unconsciously.

Watching the lips and trying to read what is being said is the brain's way of compensating for the malfunctioning of the auditory system.

Since the hearing sense is flawed, the brain tries to make up for it by relying on another sense (your eyesight) to understand what is being said.

By seeing the shape of the lips when the speaker is talking, the hearing loss patient may see the sounds they are making. This is, however, only effective when the words being spoken are words that the hearing loss patient is familiar with.


Considering the subtle nature of some of these signs, you may not quickly realize that you have hearing loss. In most cases, you only notice them when someone draws your attention to them.

It is important to seek medical attention immediately when you notice any of these signs. Prompt medical attention may help to prevent permanent damage from being done to your ear.

Do you have hearing loss? What were the first signs of hearing loss you experienced?
Share your experiences with us in the comment section.

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