Age-Related Hearing Loss Guide: Signs, Tests, and Practical Next Steps

How Mohawk Valley adults and families can recognize gradual hearing changes, prepare for an exam, compare hearing devices, and communicate more clearly.

By Michelle LaGuerre

Age-related hearing loss guide steps begin with noticing what has changed. A person may hear a voice but miss the words, especially in a restaurant, meeting, or family gathering. The television slowly gets louder. Phone calls become tiring. Because these changes often happen over years, family members may notice before the person experiencing them does.

Age-related hearing loss is common and gradual

Age-related hearing loss is also called presbycusis. The National Institute on Deafness and Other Communication Disorders says about one in three people in the United States between ages 65 and 74 has hearing loss, and nearly half of people older than 75 have difficulty hearing.

The change often affects both ears. Aging of the inner ear and nerve pathways can contribute. Long-term noise exposure, certain medical conditions, some medicines, and genetic factors may also play a role. Hearing problems can make it harder to follow medical instructions, respond to alarms, use a phone, and stay connected with family and friends.

Hearing loss is not a measure of intelligence. Pretending to understand or withdrawing from conversation can hide the problem, but it can also create confusion and isolation.

Common signs to notice

Consider a hearing check if several of these situations sound familiar:

• Speech sounds muffled or unclear
• Conversations are difficult when more than one person speaks
• Restaurants and public meetings are exhausting
• You often ask people to repeat themselves
• You turn up the television higher than others prefer
• Phone calls are harder to follow
• You miss doorbells, timers, alarms, or turn signals
• You avoid gatherings because listening takes too much effort

A quick online quiz can raise awareness, but it cannot diagnose the cause or degree of hearing loss. A professional test measures hearing at different pitches and volumes and can help identify whether one ear differs from the other.

Know when to seek medical care first

Gradual, similar changes in both ears are common with aging. Other symptoms need professional evaluation before buying a device. The Food and Drug Administration’s OTC hearing-aid guidance advises seeing a doctor, preferably an ear, nose, and throat specialist, for warning signs such as:

• Blood, pus, or fluid from an ear
• Ear pain or discomfort
• A large amount of earwax or a possible object in the ear
• Severe dizziness or a spinning feeling
• A sudden hearing change
• Hearing that gets worse and then improves
• Much worse hearing in one ear
• Ringing or buzzing in only one ear

Sudden hearing loss can be time-sensitive. Do not wait for a routine retail appointment if hearing drops suddenly. Contact a medical professional promptly.

Step 1: Start with your primary care clinician

A primary care visit can identify earwax, infection, medication concerns, or a medical condition that may affect hearing. Bring a list of medicines and supplements. Do not stop a prescribed medicine without medical advice.

Describe the situations that cause difficulty. “I cannot hear” is less helpful than “I understand one person in a quiet room, but I miss speech when there is background noise.” Mention dizziness, ringing, pain, drainage, and whether one ear seems worse.

The clinician may refer you to an audiologist or an otolaryngologist, also called an ENT. An audiologist measures hearing and helps select and adjust hearing technology. An ENT is a physician who evaluates and treats ear, nose, and throat conditions.

Step 2: Prepare for the hearing test

Use this age-related hearing loss guide checklist before the appointment:

• Bring photo identification and insurance information
• Bring your medication list
• Write down when the problem began
• List the places where hearing is hardest
• Note ear pain, drainage, ringing, dizziness, or sudden changes
• Bring a family member if you want help remembering details
• Ask whether the visit includes testing, device sales, or both

A hearing test may include listening through headphones and responding to tones. Speech testing may check how well you understand words. The audiologist may also examine the ear canal and eardrum or perform other tests. Ask for a copy of the audiogram and a plain-language explanation.

Step 3: Check coverage before the visit

Insurance rules vary. Original Medicare generally does not cover hearing aids or routine exams for fitting them. Medicare may cover certain diagnostic hearing and balance exams when a provider orders them to determine whether medical treatment is needed. Review the current details on the official Medicare hearing-aid page and hearing and balance exam page.

Medicare Advantage plans may offer additional hearing benefits, but networks, allowances, copayments, and device rules differ. Call the number on the insurance card. Ask:

• Is a referral required?
• Which audiologists or ENTs are in network?
• Is diagnostic testing covered?
• Is there a hearing-aid allowance?
• Are specific suppliers or brands required?
• What costs count toward a deductible?

New York residents with Medicaid or employer, union, veteran, or retiree coverage should check those benefits directly. Get names, dates, and confirmation numbers for important calls.

Step 4: Understand OTC and prescription hearing aids

Adults age 18 or older who believe they have mild to moderate hearing loss can buy over-the-counter hearing aids without a medical exam, prescription, or audiologist fitting. The FDA created this category in 2022. OTC devices are not intended for children or for severe or profound hearing loss.

Prescription hearing aids are fitted through a licensed hearing professional and can address a wider range of hearing loss. Professional care may be especially useful when symptoms are complicated, one ear differs, hearing is severe, hand dexterity is limited, or an OTC device did not help.

Do not confuse hearing aids with personal sound amplification products. The FDA hearing-aid overview explains that hearing aids are medical devices for people with hearing loss. Personal amplifiers are intended to make sounds louder for people with normal hearing in certain situations, such as birdwatching.

Step 5: Compare devices by use, not advertising

A higher price does not automatically mean a better match. Begin with the listening situations you want to improve. One person may need clearer family conversation and television sound. Another may need help at church, public meetings, or a noisy workplace.

Before buying, ask:

• What degree of hearing loss is this device designed for?
• Can I adjust it without a smartphone?
• Does it use replaceable or rechargeable batteries?
• What is the return period?
• Which fees are nonrefundable?
• What warranty covers repairs or replacement?
• Who provides adjustments and support?
• Can I test it with my own phone?

The NIDCD hearing-aid guide recommends considering comfort, maintenance, warranty, repair service, and the user’s needs. Hearing aids do not restore normal hearing. They require practice and adjustment.

Step 6: Test a device in real life

Use any trial or return period actively. Try the device in a quiet room, during a phone call, while watching television, in a small group, and in a noisy public place. Keep a daily note of what improved and what remained difficult.

Learn how to insert, remove, charge, clean, and store the device. Ask how to manage feedback, background noise, and a voice that sounds unusually loud. If a device causes pain, skin injury, or a sudden worsening of hearing, stop using it and contact a hearing professional.

Check the written return policy before purchase. The FDA notes that OTC hearing-aid rules do not require manufacturers to offer a warranty. Understand the seller’s terms while you still have time to return the product.

Communication changes that help now

This age-related hearing loss guide also includes no-cost steps. Ask people to face you, get your attention before speaking, and use a clear voice without shouting. Turn down the television or move away from the kitchen in a restaurant. Good lighting makes facial expressions and lip movements easier to see.

At a medical appointment, tell staff that you have trouble hearing. Ask for written instructions and repeat important information back in your own words. Captioned phones, television captions, smartphone accessibility settings, and hearing-loop systems may also help.

Family members should avoid saying “never mind.” That phrase can leave someone out of decisions and conversation. Repeat or rephrase the message, then check that it was understood.

Protect the hearing you have

Age-related changes cannot always be prevented, but ears can still be protected from damaging noise. Reduce the volume of headphones, limit time near loud equipment, and use well-fitted earplugs or protective earmuffs around lawn equipment, power tools, firearms, fireworks, or loud music.

Do not push cotton swabs or other objects into the ear canal. Ask a clinician about safe earwax care, especially when using hearing aids.

Schedule the first hearing conversation

Choose one difficult listening situation and write it down today. Make a primary care or hearing-test appointment, check insurance coverage, and bring the checklist. If you shop for a device, compare return policies and support, not just price. An age-related hearing loss guide is most useful when it leads to a real evaluation and a solution that keeps people connected.

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