Hearing loss

Age-related hearing loss, called presbycusis, comes on so slowly that many people do not notice it until a spouse complains about the television volume. It usually affects both ears, hits high-pitched sounds first (which is why consonants and children's voices go fuzzy before vowels do), and stems from wear on the tiny hair cells of the inner ear. It cannot be reversed, but it can almost always be helped.

The numbers make clear how ordinary this is. About 1 in 3 people in the United States between 65 and 74 has hearing loss, and nearly half of those older than 75 have trouble hearing ¹⁸. Yet most people who could benefit from hearing aids do not use them, often waiting years after they first notice a problem.

Two things have changed the picture recently. Since 2022, hearing aids for mild to moderate loss can be bought over the counter without a prescription, which has lowered prices. And research has sharpened the link between untreated hearing loss and problems with thinking, mood, and social life. Neither development makes hearing loss an emergency, but both are reasons not to just live with it.

How common age-related hearing loss is#

Hearing loss rises steeply with age. "Disabling" hearing loss, meaning loss severe enough to interfere with everyday communication, is the measure public health agencies track.

Those figures come from the National Institute on Deafness and Other Communication Disorders, which also reports that about 1 in 3 people aged 65-74 has some degree of hearing loss ¹⁸. Even the milder loss that falls short of "disabling" can make group conversation and phone calls tiring. Roughly 28.8 million US adults could benefit from hearing aids, but among those 70 and older who could benefit, fewer than 1 in 3 has ever used them ¹.

Sources for this section: [1] [8]

Signs people miss#

Because the change is gradual, the person losing hearing is often the last to notice. Common signs include asking others to repeat themselves, thinking people mumble, turning up the television louder than others prefer, struggling to follow conversation in a noisy restaurant, having trouble on the phone, and missing the doorbell or a beeping appliance. Withdrawing from gatherings that have become hard to follow is a quieter sign, and it shades into the social effects covered in staying socially connected.

Not all hearing loss is age-related. Earwax buildup, some medications, or a single-sided loss all deserve a medical look, because some causes are treatable. Hearing that drops suddenly is a specific emergency. Sudden sensorineural hearing loss, an unexplained drop that comes on all at once or over a few days and usually affects one ear, calls for a doctor right away. Corticosteroids are the usual treatment and work best when started early, so a delay past two to four weeks makes them much less likely to help. About half of people recover some or all of their hearing on their own, usually within one to two weeks ¹⁰.

Sources for this section: [10]

The link to thinking and mood#

Untreated hearing loss is associated with faster cognitive decline, higher rates of depression, and social isolation. The 2024 Lancet Commission on dementia estimated that hearing loss accounts for about 7 percent of dementia cases worldwide, one of the largest shares among the risk factors it identified ². The likely reasons include the mental effort of straining to hear, reduced stimulation to the brain, and withdrawal from social life.

Whether treating hearing loss protects thinking is a fair question, and the best trial gives a careful answer. The ACHIEVE study, published in 2023, followed nearly 1,000 older adults for three years. In the overall group of generally healthy volunteers, hearing aids did not significantly slow cognitive decline. But in a pre-specified subgroup at higher risk (older participants with more risk factors and faster decline), hearing intervention slowed cognitive decline by about 48 percent ³. The honest reading is that hearing aids are not proven to prevent dementia in everyone, but they may help protect thinking in people already at higher risk, on top of the clear day-to-day benefit of hearing better. The connection to brain health is discussed further in dementia and Alzheimer's disease, and the parallel case for vision is in vision and eye health.

The consequences reach beyond thinking and mood. Untreated hearing loss also tracks with a higher risk of falls. In a national study of adults ages 40 to 69, going from normal hearing to a mild (25 decibel) loss was associated with nearly three times the odds of having fallen in the past year, and the odds climbed with greater loss even after accounting for age, balance function, and heart-disease risk factors ¹¹. Other ways to lower fall risk are covered in fall prevention.

Sources for this section: [2] [3] [11]

Getting your hearing tested#

A hearing evaluation is painless and takes under an hour. An audiologist (a licensed hearing specialist) tests the quietest sounds you can hear across pitches and how well you understand speech, and plots the results on a chart called an audiogram. That chart guides whether hearing aids would help and how they should be set. An ear, nose, and throat physician can look for medical causes such as wax, infection, or, rarely, a tumor.

You do not need a doctor's referral to see an audiologist for a gradual hearing problem. If cost is a barrier, some audiology schools and community health centers offer lower-cost testing.

Hearing aids: over-the-counter versus prescription#

In October 2022, the FDA created a category of over-the-counter (OTC) hearing aids for adults with perceived mild to moderate hearing loss, sold in stores and online without a prescription or a professional fitting ⁴. For people with more than mild to moderate loss, or who want professional tuning and follow-up, prescription hearing aids fitted by an audiologist remain the route.

Prices vary widely, and the ranges above reflect the 2025-2026 market ⁵. OTC aids suit many people with early loss and cost far less, but they put the fitting and troubleshooting on you. Prescription aids cost more partly because the price bundles the audiologist's testing, fitting, and follow-up. A middle path is buying an OTC device but paying an audiologist separately for a fitting. Hearing aids take weeks of consistent wear for the brain to adjust, so patience during the break-in period matters. Managing the apps and Bluetooth features connects to technology for seniors.

Caution: Over-the-counter hearing aids are not the same as personal sound amplification products, sometimes sold as sound amplifiers. Those are regulated as ordinary consumer electronics rather than medical devices, and they are meant for people with normal hearing who want to boost sound during activities like birdwatching, not to treat hearing loss ¹².

In September 2024, the FDA authorized the first over-the-counter hearing aid software, which lets compatible Apple AirPods Pro 2 earbuds work as a hearing aid for adults 18 and older with perceived mild to moderate loss ⁹. It sets itself up through a self-fitting process instead of a professional fitting, and in the FDA's 118-person review the self-fitting approach produced perceived benefit similar to a professional fitting ⁹. It covers the same mild to moderate range as other OTC aids, so it is not a substitute for evaluating loss that is more than moderate.

Sources for this section: [4] [5] [9] [12]

Why Medicare does not cover hearing aids#

Original Medicare does not pay for hearing aids or for exams to fit them. The reason is old: when Medicare was written into law in 1965, the statute specifically excluded hearing aids as routine items, alongside eyeglasses and dental care, and changing that requires an act of Congress ⁶. What Medicare Part B does cover is a diagnostic hearing and balance exam when a doctor orders it to evaluate a medical problem, with the usual 20 percent coinsurance after the deductible ⁶.

Several routes help with the cost of aids. Many Medicare Advantage plans include a hearing benefit, though the payment is often capped well below the full price. Some Medicaid programs cover aids for those who qualify, the Department of Veterans Affairs provides them to eligible veterans, and OTC aids have lowered the entry price. The broader gaps in Medicare are covered in dental, vision, and hearing coverage.

Sources for this section: [6]

Cochlear implants for severe loss#

When hearing aids no longer help because too many inner-ear hair cells are gone, a cochlear implant may. It is a surgically placed device that bypasses the damaged parts of the ear and stimulates the hearing nerve directly. Unlike hearing aids, cochlear implants are covered by Medicare because they are classified as prosthetic devices. In 2022, Medicare widened eligibility to include people who score 60 percent or less on a sentence-recognition test with their best hearing aids, up from the older 40 percent threshold, which brought coverage in line with common practice ⁷. Adjusting to an implant takes months of rehabilitation, and results vary, but for people with severe loss it can restore useful hearing that aids cannot.

Sources for this section: [7]

Tinnitus#

Tinnitus is the perception of ringing, buzzing, or hissing with no external source, and it often accompanies hearing loss. About 10 percent of US adults, roughly 25 million people, have experienced tinnitus lasting at least five minutes in the past year ¹. For most, there is no cure, but it can be managed. Treating any underlying hearing loss often helps, because hearing aids bring back background sound that masks the ringing. Sound therapy, cognitive behavioral therapy for the distress it causes, and avoiding total silence all reduce how intrusive it feels. New tinnitus in one ear, or tinnitus with sudden hearing loss or dizziness, should be checked promptly.

Sources for this section: [1]

Communicating with someone who has hearing loss#

Families can make a large difference without any special equipment. Face the person and let them see your lips, since most people read lips more than they realize. Get their attention before speaking. Speak clearly at a normal pace rather than shouting, which distorts sound. Reduce background noise by turning off the television or choosing quieter tables in restaurants. Rephrase rather than simply repeating a missed sentence, because different words may carry the sounds a person can hear. Patience on both sides prevents the frustration that leads people to stop trying, which also protects against the isolation and low mood covered in mental health in older adults.

RetiredWiki. (2026, July 18). Hearing loss. https://retiredwiki.com/article/hearing-loss