In a national survey of adults in the United States, 21.0% said they had difficulty following a conversation when there was background noise (Zelaya et al., 2015). That is about 1 in 5 adults.
Struggling in noise is often one of the first things people notice. It is easy to blame the restaurant, the music or people who mumble. Hearing loss usually starts slowly, so the early signs can blend into everyday life.
This article explains the early signs of hearing loss and why they are easy to miss. By the end, you will know the signs that mean it is time for a hearing test, and why waiting tends to make things harder.
What are the early signs of hearing loss?
The early signs of hearing loss are usually small changes in how well you follow speech, especially in noise. Many people notice them in conversation before they notice them anywhere else.
The national survey asked about difficulty following conversation in background noise. The researchers describe this as a symptom of high-frequency hearing loss (Zelaya et al., 2015). High-frequency sounds include “s”, “f” and “th”. When they fade, words can sound unclear even when they are loud enough.
The same survey found that adults aged 70 and older were more than three times as likely to have trouble following conversation in noise (Zelaya et al., 2015).
Here are early signs to look out for:
| Sign | What it can feel like day to day |
|---|---|
| Trouble in noisy places | Restaurants, braais and family gatherings feel tiring |
| Asking people to repeat themselves | “Sorry, what was that?” becomes a habit |
| People seem to mumble | Speech sounds unclear rather than too soft |
| Turning up the TV or radio | Others in the room say it is too loud |
| Trouble on the phone | Calls are harder than face-to-face chats |
| Missing quiet sounds | The kettle, doorbell or birds go unnoticed |
| Feeling tired after social events | Listening takes more effort than it used to |
| Ringing or buzzing in the ears | A sound no one else can hear |
You may only notice one or two of these. That is common in the early stages.
Why do early signs of hearing loss often go unnoticed?
Early signs often go unnoticed because hearing loss usually develops slowly and people adjust without realising. You may lean in, watch lips or avoid noisy places long before you think of your hearing.
People are not always accurate judges of their own hearing:
- In a Brazilian study of 188 adults, the question “Do you feel you have a hearing loss?” picked up about 8 in 10 people whose hearing test showed a loss (Ferrite et al., 2011). About 2 in 10 were missed.
- A study of 857 adults found that people waited 8.9 years, on average, between needing hearing aids and getting them (Simpson et al., 2019).
- Among Americans aged 50 and older with hearing loss, only 14.2% wore hearing aids (Chien and Lin, 2012).
Family members often notice first. They may comment on the TV volume or on missed parts of conversations. Their comments are worth taking seriously, even if your hearing feels fine to you.
Can ringing in the ears be an early sign of hearing loss?
Ringing in the ears can be a sign that something has changed in your hearing, so it is a good reason to have a hearing test. Ringing, buzzing or hissing that no one else can hear is called tinnitus.
Tinnitus is common, and it becomes more common with age. A large review found these rates in adults (Jarach et al., 2022):
- 9.7% of adults aged 18 to 44
- 13.7% of adults aged 45 to 64
- 23.6% of adults aged 65 and older
The national survey in the United States found that 11.2% of adults had ringing in the ears (Zelaya et al., 2015).
Tinnitus does not always mean you have hearing loss. A hearing test is the way to find out. If the ringing beats in time with your pulse, comes on suddenly, or affects only one ear, see a doctor soon.
Who is more likely to develop hearing loss?
Hearing loss becomes more likely as you get older, and noise exposure adds to the risk. It can still happen at any age.
- A South African study screened 1,236 people at two primary health care clinics. It found hearing loss in 17.5% of them (Louw et al., 2018).
- In that study, people aged 40 and older had a much higher risk of hearing loss (Louw et al., 2018).
- The Beaver Dam Offspring Study found that hearing difficulties were linked to loud hobbies and to firearm use (Tremblay et al., 2015).
You may be at higher risk if you:
- Are aged 40 or older
- Work in a noisy place, such as a factory, mine or building site
- Shoot, ride motorbikes or play loud music
- Have family members who lost their hearing early
- Have had many ear infections or ear surgery
If any of these apply to you, a baseline hearing test gives you a record to compare against in future.
What if your hearing test is normal but you still struggle to hear?
If your hearing test is normal but you still struggle, your difficulty is real and worth discussing with an audiologist. A standard beep test does not capture every kind of listening problem.
In the Beaver Dam Offspring Study, 12.0% of adults with normal hearing test results still reported hearing difficulties (Tremblay et al., 2015). People in this group were also more likely to report symptoms of depression and problems with their vision (Tremblay et al., 2015).
This is why a full hearing test includes speech testing and a detailed conversation about your daily listening. Sometimes the cause is simple. A study of 14,230 people found blocked ear wax in 18.6% of people aged 12 and older (Tolan et al., 2024). Wax that fully blocks the ear canal was linked to slightly worse hearing (Tolan et al., 2024).
When should you book a hearing test?
You should book a hearing test when you notice early signs such as trouble following conversation in noise, turning up the TV, or ringing in your ears. That is the payoff: the early signs are everyday moments, not dramatic changes, and acting on them early means less time spent struggling.
The main points to remember:
- Trouble hearing in background noise is a common early sign.
- Hearing loss usually develops slowly, so it is easy to miss.
- Family members often notice before you do.
- Ringing in the ears is a reason for a hearing test.
- Age and noise exposure raise the risk.
- A normal beep test does not rule out every listening problem.
If you recognise some of these signs, a hearing test can show what is going on. Strauss Audiology is happy to answer your questions about what the test involves. You can call 021 492 3230, send a WhatsApp to +27 78 052 9362 or email admin@strausshearing.co.za.
This article is for informational purposes only and does not constitute medical advice. Please speak to a qualified healthcare professional about your own health.
References
- Zelaya CE, Lucas JW, Hoffman HJ. QuickStats: Percentage of adults with selected hearing problems, by type of problem and age group. National Health Interview Survey, United States, 2014. Morbidity and Mortality Weekly Report. 2015;64(37):1058. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6437a8.htm
- Ferrite S, Santana VS, Marshall SW. Validity of self-reported hearing loss in adults: performance of three single questions. Revista de Saude Publica. 2011;45(5):824-830. https://doi.org/10.1590/S0034-89102011005000050
- Simpson AN, Matthews LJ, Cassarly C, Dubno JR. Time from hearing aid candidacy to hearing aid adoption: a longitudinal cohort study. Ear and Hearing. 2019;40(3):468-476. https://doi.org/10.1097/AUD.0000000000000641
- Chien W, Lin FR. Prevalence of hearing aid use among older adults in the United States. Archives of Internal Medicine. 2012;172(3):292-293. https://doi.org/10.1001/archinternmed.2011.1408
- Jarach CM, Lugo A, Scala M, et al. Global prevalence and incidence of tinnitus: a systematic review and meta-analysis. JAMA Neurology. 2022;79(9):888-900. https://doi.org/10.1001/jamaneurol.2022.2189
- Louw C, Swanepoel W, Eikelboom RH, Hugo J. Prevalence of hearing loss at primary health care clinics in South Africa. African Health Sciences. 2018;18(2):313-320. https://doi.org/10.4314/ahs.v18i2.16
- Tremblay KL, Pinto A, Fischer ME, et al. Self-reported hearing difficulties among adults with normal audiograms: the Beaver Dam Offspring Study. Ear and Hearing. 2015;36(6):e290-e299. https://doi.org/10.1097/AUD.0000000000000195
- Tolan MM, Choi JS, Tibesar MT, Adams ME. Cerumen impaction: prevalence and associated factors in the United States population. Laryngoscope Investigative Otolaryngology. 2024;9(2):e1228. https://doi.org/10.1002/lio2.1228
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