Hearing loss is a condition that reduces or interferes with a person’s ability to perceive sounds. It can affect people of any age and may involve one or both ears. Common signs include difficulty following conversations (especially in noisy places), feeling as though others are speaking unclearly, trouble telling words apart, and needing to increase the volume on devices such as televisions. In children, hearing loss may show up as delays in speech or language, behavioral challenges, or problems at school.

Hearing loss is a common problem among children and adults in the United States. About one in 1,000 children is born with hearing impairment, and by age 18, nearly one in five children have experienced some degree of hearing loss. Most newborns are screened for hearing loss before leaving the hospital, which helps with early detection and intervention that can improve outcomes. Among adults, the likelihood of hearing loss increases with age. Nearly half of people in their 60s have hearing loss, and about two thirds of Americans aged 70 years or older are affected.

With appropriate management, many people with hearing loss can improve their ability to communicate and participate in daily life. Treatments such as hearing aids, cochlear implants, and assistive listening devices can make a significant difference.

Hearing loss occurs when the normal process of hearing is disrupted, making it harder to detect or understand sounds. In a healthy ear, sound waves travel through the outer ear, move down the ear canal, and cause the eardrum to vibrate. These vibrations are passed along by tiny bones in the middle ear to the inner ear, where specialized cells called hair cells convert the vibrations into electrical signals. These signals travel along the vestibulocochlear nerve (sometimes referred to as the “hearing nerve”) to the brain, which interprets them as sound. Damage or dysfunction at any point in this pathway can result in hearing loss.

There are three types of hearing loss, classified by the cause of the problem:

• Conductive hearing loss: This type is caused by issues in the outer or middle ear that prevent sound from reaching the inner ear. Examples include ear canal blockage, eardrum problems, or damage to the small bones in the middle ear.
• Sensorineural hearing loss: This type results from changes to the inner ear (cochlea) or the nerves that connect the inner ear to the brain. This may involve problems with the hair cells or nerves and can make sounds both quieter and less clear.
• Mixed hearing loss: This type involves both conductive and sensorineural components, meaning there are problems in both the outer/middle ear and the inner ear or vestibulocochlear nerve.

Hearing loss can range from mild to profound and may affect one or both ears. It can be present at birth (congenital), develop later in life (acquired), or progress over time. Hearing loss can impact communication, social interaction, learning, and overall well-being, especially if not identified and managed early.

Hearing loss can result from genetic factors, external factors, or a combination of both. In children, genetic causes account for about half of all cases and may be present at birth or develop later. Genetic changes can affect the structure or function of the ear or the way the brain processes sound. Some genetic forms of hearing loss are part of a syndrome (known as syndromic hearing loss), meaning other health conditions are present, while others affect only hearing (known as nonsyndromic hearing loss).

Nongenetic causes include exposure to loud noises, head injuries, and certain infections (especially recurrent middle ear infections, but also meningitis, measles, or mumps). Children who are not vaccinated against measles or mumps are more likely to experience hearing loss because of those infections. Some medications are ototoxic, which means they can damage hearing. These include aminoglycoside antibiotics, which are used to treat certain bacterial infections, and some chemotherapy agents.

Babies born prematurely are at higher risk for hearing loss. In adults, recognized risk factors include age-related changes in the ear, long-term noise exposure, chronic health conditions such as diabetes, and a history of smoking.

Sometimes, hearing loss is caused by a combination of genetic and external factors. For example, some medicines may only cause hearing loss in people who have specific gene changes. In other cases, the exact cause of hearing loss may remain unknown, even after thorough evaluation.

Risk factors for hearing loss include:

• Family history of hearing loss
• Genetic syndromes associated with hearing loss
• Premature birth
• Low birth weight
• Admission to neonatal intensive care unit
• Craniofacial abnormalities (abnormalities in the skull and face)
• Congenital infections (such as cytomegalovirus, rubella, syphilis)
• Complications during or right after birth, such as low Apgar score (the score that assesses a baby’s health one and five minutes after birth), jaundice (yellow discoloration of the skin or eyes due to high levels of bilirubin, a pigment in bile), or sepsis (a life-threatening response to infection)
• Exposure to ototoxic medications (such as aminoglycosides, cisplatin, loop diuretics)
• Head trauma
• Meningitis, measles, mumps, and other serious infections (especially if unvaccinated)
• Chronic ear infections
• Repeated exposure to loud noises
• Age (older adults)
• Smoking
• Diabetes
• Autoimmune disorders
• Structural abnormalities of the ear

Symptoms of hearing loss may include:

• Difficulty understanding speech, especially in noisy environments
• Speech sounds as if others are mumbling
• Trouble distinguishing between words and sounds
• Frequently turning up the volume on the television or other devices
• Withdrawal from social interactions or hobbies that involve communication or hearing
• Delayed speech or language development in children
• Behavioral problems or difficulties in school
• Problems with communication and learning
• Difficulty telling words apart
• Tinnitus (ringing in the ears)
• Aural fullness (a sensation of pressure or fullness in the ear)
• Vertigo (a spinning sensation, sometimes associated with certain types of hearing loss)
• Balance problems
• Depression or anxiety
  

To diagnose hearing loss, doctors typically review the patient’s medical history, conduct a physical exam, and order one or more diagnostic tests.

The doctor may ask about symptoms, when changes in hearing began, any family history of hearing loss, exposure to loud noises, use of certain medications, and other risk factors. In children, doctors may ask about speech and language development, behavioral issues, and school performance. During the physical exam, the doctor will look for signs such as ear canal blockage, infection, abnormalities of the ear, or other conditions that could affect hearing.

Hearing loss may also be diagnosed during routine newborn hearing screening. In the U.S., nearly all newborns are screened for hearing loss before leaving the hospital using otoacoustic emissions or auditory brainstem response tests. These tests check how the ears and brain respond to sound and do not require the child to be awake or respond.

Additional tests may be necessary to diagnose hearing loss, including:

• Audiometry: Measures hearing thresholds across different frequencies to determine the degree and type of hearing loss
• Weber and Rinne tests: Tuning fork tests used to help distinguish between conductive and sensorineural hearing loss
• Tympanometry: Assesses the movement of the eardrum and middle ear function
• Computed tomography (CT) scan: An imaging test used to visualize the structures of the ear and identify anatomical abnormalities
• Magnetic resonance imaging (MRI): Provides detailed images of the inner ear, auditory nerve, and brainstem to detect structural or nerve-related causes of hearing loss
• Electrocardiogram (ECG or EKG): Test that measures the heart’s electrical activity that is used in certain cases to screen for Jervell and Lange-Nielsen syndrome, which affects both hearing and heart function
• Genetic testing: May be recommended if a genetic cause is suspected, especially in children or those with a family history of hearing loss. This can help identify specific gene changes linked to hearing loss

These tests help doctors determine the type, severity, and possible cause of hearing loss, guiding further management and treatment.

There are no cures for most types of hearing loss, but many effective treatments are available to help people hear better and improve communication. Treatment depends on the type, cause, and severity of hearing loss, as well as individual needs and preferences.

Main treatments for hearing loss include:

• Hearing aids: These electronic devices amplify sound and help people with mild to moderate hearing loss hear more clearly. They come in various styles and are fitted to each ear.
• Cochlear implants: Cochlear implants bypass the inner ear and directly stimulate the vestibulocochlear nerve, allowing access to sounds and speech. A surgeon implants these devices into the ears of people with severe to profound sensorineural hearing loss who do not benefit from hearing aids.
• Bone-conduction hearing aids: Devices that transmit sound through the bones of the skull to the inner ear, bypassing the outer and middle ear. These are especially useful for people with conductive or mixed hearing loss, or those with ear canal or middle ear abnormalities.
• Assistive listening devices: Handheld or wearable devices, such as frequency modulating (FM) systems, can help people hear better in specific situations, such as classrooms or noisy environments.
• Removal of ear canal blockage: For hearing loss caused by wax buildup or foreign objects, removal can restore hearing.
• Medications or surgery: Some causes of conductive hearing loss—such as ear infections, fluid in the middle ear, or problems with the eardrum or middle ear bones—may be treated with medications or surgery. This may include a procedure to drain fluid from the middle ear or other procedures.
• Corticosteroids: These medications can reduce inflammation and improve hearing and are used to treat sudden sensorineural hearing loss. They are delivered either by mouth or by injection into the ear.
• Speech and language therapy: Especially important for children, this therapy helps support language development and communication skills.
• Aural rehabilitation: Learning techniques and strategies to help with communication such as speech reading (recognizing speech by observing the lips, facial expressions, gestures, and tone), managing the environment (such as the distance to the speaker and keeping background sounds low), asking the speaker to repeat themselves, and carrying a notebook so the speaker can write down significant words or phrases, among others.
• Sign language: Learning how to communicate using sign language can be helpful for people with profound hearing loss.

Treatment plans are tailored to each person’s needs, and early intervention promotes better outcomes. Regular follow-up and support from a team of specialists can help maximize hearing and communication abilities.

People with hearing loss may be at increased risk for certain complications, including:

• Speech and language delays in children, which can affect learning and social development
• Behavioral problems and difficulties in school, especially in children
• Social isolation and withdrawal from relationships and activities
• Depression and anxiety, due to challenges in communication and social interaction
• Problems with balance and vestibular function (the inner ear’s balance system), which can affect movement and coordination
• Reduced quality of life, including limitations in daily activities and participation
• Cognitive decline and increased risk of dementia, particularly in older adults
• Decreased educational and job opportunities, which may lead to lower income and employment rates
• Increased risk of falls and frailty in older adults
• Difficulties accessing health care, especially among older adults with untreated hearing loss, leading to higher rates of hospitalization and health care expenses
• Delayed diagnosis and treatment of medical conditions, which can worsen outcomes and limit rehabilitation success
  

The outlook for people with hearing loss depends on several factors, such as the type, cause, severity, age of onset, and how early the condition is identified and managed. If hearing loss is not treated in children, it may lead to challenges such as social isolation, difficulties in school, behavioral problems, depression, and reduced educational or job opportunities. Older adults may face increased risks for falls, frailty, and dementia.

For many children and adults with hearing loss, early diagnosis and intervention—such as hearing aids, cochlear implants, and speech or language therapy—can greatly improve communication, social interaction, and overall quality of life. Children who receive timely hearing rehabilitation often achieve better speech, language, and educational outcomes, while adults can maintain independence and engagement in daily activities.

With appropriate support and ongoing care, most people with hearing loss can participate fully in family, school, work, and community life.

“At Yale we understand that the treatment of hearing loss in children is best accomplished as a team,” says Yale Medicine pediatric ear, nose, and throat (ENT) specialist Michael Weinstock, MD. “Our Cochlear Implant Team brings together surgeons, audiologists, speech and language pathologists, and social workers to partner with families and patients to achieve the best outcomes in the most complex hearing loss patients. In addition, we include radiologists, geneticists, and other specialists when necessary. By working closely together we are able to support all children who have hearing loss regardless of the cause or severity.”