Your hearing could be declining for a number of reasons, from something as simple as earwax buildup to age-related changes in the inner ear or damage from years of noise exposure. Over 1.5 billion people worldwide, nearly 20% of the global population, live with some degree of hearing loss. If you’ve noticed that conversations sound muffled, you’re turning up the TV louder than you used to, or you’re struggling to follow speech in noisy rooms, something specific is driving that change.
The Two Main Types of Hearing Loss
Hearing loss falls into two broad categories, and knowing which one applies to you points toward very different causes and solutions.
Conductive hearing loss happens when sound waves can’t travel properly through the outer or middle ear to reach the inner ear. Think of it as a physical blockage or mechanical problem. Earwax, fluid from an infection, a foreign object in the ear canal, a bone abnormality in the middle ear, or an injured eardrum can all cause this type. Conductive hearing loss is often treatable or even fully reversible.
Sensorineural hearing loss occurs when the inner ear or the hearing nerve itself is damaged, typically because the tiny hair cells inside the cochlea have been destroyed. These hair cells convert sound vibrations into electrical signals your brain can interpret, and once they’re gone, they don’t grow back. This is the most common type of hearing loss and is usually permanent. Aging, loud noise, certain medications, injuries, and inherited conditions can all cause it.
Age Is the Most Common Cause
Age-related hearing loss, known clinically as presbycusis, is far and away the leading reason people notice their hearing getting worse. About 30% of people over 60 have measurable hearing loss. It happens because the hair cells at the base of the cochlea, which are responsible for detecting high-pitched sounds, deteriorate over time. The blood supply to the inner ear also weakens, and the nerve pathways that carry sound signals to the brain gradually lose function.
This is why high-frequency sounds disappear first. You might struggle to hear consonants like “s,” “f,” “p,” “k,” and “ch” while vowels still come through clearly. The result is that people seem to be talking, but their words sound muddy or unclear. You hear volume but lose clarity. As the condition progresses, lower-frequency sounds become harder to detect too, but the early stages are almost always about losing the upper range.
Noise Damage Adds Up Over Time
Noise-induced hearing loss is the second major driver, and it can happen alongside age-related changes or entirely on its own. Sounds at or below 70 decibels, roughly the level of a washing machine or normal conversation, won’t damage your hearing even with prolonged exposure. But repeated or sustained exposure to sounds at or above 85 decibels, the level of heavy city traffic or a loud restaurant, can cause permanent damage.
The louder the sound, the less time it takes to do harm. A rock concert at 110 decibels can cause damage in minutes. A single explosive sound, like a gunshot or fireworks (which can reach 140 to 160 decibels), can rupture the eardrum or damage the bones of the middle ear instantly. Years of using earbuds at high volume, working in loud environments without ear protection, or attending concerts without earplugs all contribute to cumulative, irreversible hair cell destruction in the cochlea.
Earwax Buildup Is an Overlooked Culprit
If your hearing loss came on gradually and feels like sounds are muffled rather than distorted, earwax impaction is worth considering. When wax builds up enough to block the ear canal or press against the eardrum, it causes a noticeable drop in hearing along with a sensation of fullness, itching, or mild pain. This is entirely reversible once the wax is removed.
Over-the-counter ear drops containing carbamide peroxide or other softening agents can help. You typically apply five to ten drops twice daily for up to four days, which softens the wax enough for it to work its way out naturally. Oil-based drops using olive or almond oil also work. If drops don’t resolve it, a clinician can flush the ear with warm water or remove the wax manually. Don’t try to dig it out with cotton swabs, which tend to push wax deeper and can injure the eardrum.
Medications That Harm Your Hearing
Certain medications are toxic to the inner ear and can cause or worsen hearing loss. The most commonly implicated drug classes include loop diuretics (often prescribed for heart failure or high blood pressure), NSAIDs like ibuprofen and aspirin, certain antibiotics, chemotherapy agents, quinine, and even acetaminophen. Research in the Journals of Gerontology identified NSAIDs and loop diuretics as potentially modifiable contributors to age-related hearing loss, meaning that adjusting these medications could slow the decline.
If you take any of these regularly and have noticed your hearing worsening, it’s worth discussing alternatives with your prescriber. In some cases the hearing effects are reversible once the medication is stopped; in others, the damage is permanent.
Health Conditions That Affect Your Ears
Your ears depend on healthy blood flow and intact nerves to function properly, which means conditions affecting your circulatory or nervous system can quietly erode your hearing. Diabetes is a well-documented example. High blood sugar damages the small blood vessels and nerves in the inner ear over time, while episodes of low blood sugar can disrupt the nerve signals traveling from the ear to the brain. Both pathways lead to hearing loss.
Cardiovascular disease operates through a similar mechanism. The cochlea is supplied by tiny blood vessels that are vulnerable to the same plaque buildup and stiffening that affects blood vessels elsewhere in the body. When blood flow to the inner ear is reduced, the hair cells don’t get the oxygen and nutrients they need to survive.
Ringing in Your Ears Is a Related Warning Sign
If you’re also experiencing ringing, buzzing, or hissing in your ears, that’s not a separate problem. Tinnitus and hearing loss are deeply connected. When the cochlea is damaged and sends less input to the brain, the brain’s auditory centers attempt to compensate by increasing their own activity. This ramped-up neural firing, essentially the brain trying to fill in the gaps left by missing sound, is what you perceive as ringing.
The great majority of people with chronic tinnitus have some measurable degree of hearing loss. The phantom sound tends to match the frequency range where hearing has dropped off. This is why many people with age-related hearing loss experience high-pitched ringing, corresponding to the high-frequency sounds their cochlea can no longer detect. Tinnitus doesn’t always show up on a standard hearing test, though. Cochlear damage can exist at a level too subtle for an audiogram to catch while still being enough to trigger the brain changes that produce ringing.
What a Hearing Test Actually Measures
A professional hearing evaluation involves more than just detecting beeps through headphones. The core test is an audiogram, which maps the quietest sounds you can hear across a range of frequencies. But audiologists also measure your ability to understand speech, not just detect it. In a speech recognition test, you’re asked to repeat single-syllable words played at a comfortable volume. A normal score is 80% or higher. Scoring below that suggests sensorineural damage and helps pinpoint whether the problem lies in the cochlea or further along the nerve pathway to the brain.
This distinction matters because two people with the same audiogram can have very different real-world experiences. One might understand conversation reasonably well with a hearing aid boosting volume, while the other might find that amplification alone doesn’t help because their ability to discriminate between similar-sounding words has been compromised.
Sudden Hearing Loss Is a Medical Emergency
If your hearing dropped sharply in one ear over a period of hours or days, that’s a different situation entirely from the gradual decline most people experience. Sudden sensorineural hearing loss is an unexplained, rapid loss that requires urgent treatment. Steroid therapy is most effective when started as soon as possible, and treatment delayed beyond two to four weeks is significantly less likely to reverse the damage. Many people dismiss sudden hearing loss as a plugged ear or allergies and wait too long. If one ear goes noticeably quieter over a short timeframe, get it evaluated immediately rather than waiting to see if it resolves on its own.