Hearing Loss Causes and Risk Factors

Some hearing loss can be prevented. This guide to the causes and risk factors of hearing loss will help you learn to identify potential issues so you can better protect your hearing.

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What Causes Hearing Loss

There are many potential causes of hearing loss, as well as risk factors that can increase your likelihood of developing it. While many people can expect some level of hearing loss as inevitable due to aging, there are other factors that are good to be aware of. Knowing what the most common risk factors are can help you avoid losing your hearing earlier or prevent greater severity of hearing loss. 

 

Some of the factors are internal or biological causes that are more difficult to avoid. However, some of them are more external or environmental causes over which you can have more control.

Risk Factors for Hearing Loss

First, we will address the most common risk factors you should know. These are elements that may exist in your life that are more likely to lead to hearing loss. They may not cause hearing loss right away, but they can all add up over time. As a result, you may lose your hearing earlier, or more severely, than you would otherwise. 

Genetics

For some people, hearing loss can happen due to your genetics. These are people who are more likely to be born with poor hearing, or who have hearing loss much earlier in their lives than most. 

 

Some people may be born with deformations of the ear itself, which can affect how well you hear.

 

If your family has a history of having earlier and more severe hearing loss than usual, you may have this same risk factor. We recommend that people with a common family history of early hearing loss get their hearing tested earlier and more regularly. 

Health Conditions

There are also health conditions that increase the risk of having hearing loss. Conditions like diabetes, some autoimmune disorders, cancer, and other diseases can cause nerve damage in your ears. If you are diagnosed with any disease or health condition that can affect your blood flow, nerves or brain, consult with your doctor. You can ask if your hearing may be affected by your condition. If your doctor says that a medication you take can cause hearing loss, we recommend having your hearing tested annually. This will help stop any hearing loss early and offer intervention options before it gets worse.

 

Another form of health condition that can cause hearing loss is due to side effects of some medications. Depending on what condition you have, some stronger medications and treatments may cause hearing loss. These can be temporary side effects that will go away once you stop taking the medication. Some, however, can cause permanent damage to your hearing.

Age

The older you get, the more likely you are to have gradual hearing loss. Here is some basic data on how many people have hearing loss by age brackets, according to the Canadian Health Measures Survey (CHMS):

 

  • Ages 20 to 39: 15%
  • Ages 40 to 59: 40%
  • Ages 60 to 79: 78%

 

You can see the percentage of population in each age group dramatically increases from early adulthood to senior status. This is due to a combination of things. First, you are more likely to slowly build small instances of damage to your hearing over your lifespan. Second, as you age the inner ear hair cells and nerves become less sensitive due to natural decay over time. 

 

When you are in your 20s, it is recommended that you get a hearing test every 10 years or so, unless you have reason to believe you have some hearing loss already. Once you reach your 50s, we recommend you get your hearing tested every two to three years. Once you have a diagnosed hearing loss, we recommend you get a full hearing test every year. 

Loud Noise

A common risk factor for hearing loss is exposure to loud noises. Loud noise can include things like machinery, very loud music, gun shots, and so on. The longer and more often you are exposed to loud noise, the more likely you are to have hearing loss.

 

That is why many occupations, such as machine workers, police officers, and more are all required to get their hearing screened regularly. It is also recommended that musicians, hunters, and anyone else exposed to loud noises wear proper hearing protection.

Sensorineural Hearing Loss

Sensorineural hearing loss is one of the two main types. It happens when your inner ear components that are necessary for hearing are damaged or deteriorate. Those components include the inner ear hair cells, nerve damage, and so on. You can read more in our full guide to the types of hearing loss.

 

There are several causes for sensorineural hearing loss, including the following:

Age-related Hearing Loss

The most common cause of hearing loss is presbycusis, or age-related hearing loss. This occurs when the inner ear hair cells deteriorate over time and become less sensitive. Age-related hearing loss most often occurs in both ears, but for some people the level of hearing loss can vary between both ears. 

 

It is a slow progression, and most people will not realize that they have any hearing loss right away. That is why we advise everyone over the age of 50 to get their hearing tested every two years. 

 

The initial sign of age-related hearing loss is losing the ability to hear sounds in higher pitches. This includes speech, where you have greater difficulty hearing someone who speaks in a higher pitched voice (e.g., women, children).

Long-term Exposure to Noise

The second most common cause of hearing loss is due to long-term exposure to loud noise, or sudden exposure to extremely loud noise.

 

For reference, here is a list of common types of noise and what their average decibel rating can be:

 

  • Whispering — 30 dB 
  • Normal conversation — 60 dB 
  • Vacuum cleaner — 70 dB
  • Dense vehicle traffic — 80 dB
  • Food blender — 91 dB
  • Indoor rock concerts — 115 dB
  • Jet engine — 140 dB

 

This is why many types of jobs have recommended or required hearing protection. People working around equipment that emits noise at 70 dB or more are also advised to get their hearing tested regularly.

Cardiovascular Disorders

Blood flow is necessary to maintain the health of your inner ear hair cells and nerve sensitivity. This is seen with a few different health conditions related to blood flow that are believed to have links to hearing loss.

 

One is cardiovascular disease (CDV). Although there has been no direct evidence to show that cardiovascular disease causes hearing loss, there are signs that there is a link. In a 2010 study performed by Hull, R. H., & Kerschen, S. R., it was shown that CVD may reduce blood flow to the ear. The lack of blood flow is what can cause deterioration and damage over time to parts of your auditory system in your inner ear.

 

Another big one is diabetes. A research survey conducted in the United States from 1999 to 2004 in more than 5,000 individuals demonstrated a link with hearing loss. 21% of persons with diabetes had a hearing loss, compared to only 9% of persons without diabetes. In fact, the prevalence of hearing impairment among people with diagnosed diabetes statistically exceeded it among those without diabetes in all age groups except those aged 60 to 69. 

Ear Infections

It is common for people who have an ear infection to deal with mild to medium hearing loss. Most of the time, this hearing loss is only temporary and will go away as your infection does. However, some severe infections may lead to permanent hearing loss. If your ear infection passes and you find that your hearing has not returned to normal, we recommend that you get a full hearing assessment.

Meniere's Disease

Meniere’s disease is an inner ear condition that is characterized by dizziness, vertigo, and hearing loss. It usually only affects one ear, and can happen to anyone of any age. It is a chronic condition that may come and go, but has treatments that can reduce the symptoms so it doesn’t affect you as much. The hearing loss will also come and go as the condition flares up and recedes.

Autoimmune Diseases

There are certain autoimmune disorders that can affect your ears and cause hearing loss. One is Autoimmune Inner Ear Disease (AIED), which happens when your immune system attacks and damages your inner ear. It leads to dizziness, tinnitus (ringing in your ears), and hearing loss. It is a very rare condition, however. There are other autoimmune diseases that can also lead to hearing loss as a symptom or indirect cause. 

Causes of Conductive Hearing Loss

Conductive hearing loss is the second of the two types of hearing loss. It occurs because something blocks sound from getting through your outer and middle ear and into your inner ear. The blockage can caused by a foreign objects or substances obstructing your ear canal. It can also be from an inflammation or abnormality of your ear structure.

 

There are several causes for conductive hearing loss, including the following.

Otitis Media or Middle Ear Infection

Otitis media refers to infections in the middle ear canal. These infections are caused when bacteria or a virus enters the middle ear. As a result, such an infection is very often caused by another illness. It is common for things like the common cold, seasonal flu, or even allergies to cause increased congestion and swelling in your sinuses. This can also lead to swelling in your middle ear, and lead to an infection.

Foreign Obstructions

It is not uncommon for a foreign object to enter your ear canal and cause a blockage that affects your hearing. It is more common in children, who can intentionally insert objects into their ear canals, where they could become stuck. Among adults, foreign obstructions can include cotton swabs breaking and getting stuck, or insects. Foreign objects stuck in the ear canal can lead to pain and infections, which can further affect your hearing. If you suspect you have a foreign object in your ear, please see your doctor.

Tympanosclerosis

Tympanosclerosis is the clinical term for scarring of the eardrum. It can happen after your eardrum is injured, after a surgery, or as a result of chronic inflammation. It can lead to conductive hearing loss, but it might not. Some adults will unknowingly have scarring and experience no noticeable issues. A surgical procedure can remove some of the scarring. If that fails or if the procedure is impossible, then your hearing loss may only be managed with hearing aids.

Microtia and Anotia

Microtia and Anotia are both rare types of birth defects where the external ear has not formed properly. With Anotia, the external part of the ear is completely missing. With Microtia, there is an external ear but it has not formed completely so it still affects the child’s hearing. How it affects the child’s hearing will vary depending on the severity of the condition. Surgery may be possible to reconstruct the external ear, but not until the child is older. 

Eardrum Rupture

A ruptured eardrum is a type of ear-related trauma that can cause infections and hearing loss. Here are the more common causes of an eardrum rupture: 

 

  • Head trauma
  • Sudden loud sounds/acoustic trauma
  • Imbalance of air pressure between your ear and external environment (e.g., air travel)

 

Typically, a ruptured eardrum can heal itself over a few weeks, which can also restore your hearing to its previous levels. More severe ruptures may require surgery to repair, and any hearing loss may be permanent. 

Eustachian Tube Dysfunction (ETD) 

Eustachian tubes run from your middle ears to your upper throat. They equalize the pressure in your ear, and drain fluid from your middle ear. These tubes are small, and as a result can be easily blocked. Blockages can lead to hearing loss, as well as pain or discomfort. When a blockage occurs, it is called eustachian tube dysfunction (ETD). The most common causes of ETD are blockages from sinus infections, allergies, common colds, and altitude changes. The blockages and hearing loss are most often temporary.

Otosclerosis

Otosclerosis refers to abnormal bone fusion inside your ear. It is most common among young adults. It occurs when three small bones within the middle ear fuse with the surrounding bone. These bones vibrate when sound waves enter the ear canal in order to transmit them to the inner ear. When they fuse with surrounding bones, sound waves are less efficiently transmitted to your inner ear. This results in mild to severe hearing loss. There is no clear cause of otosclerosis, but genetics are believed to play a role. There are two ways to treat this condition, depending on its specific nature and severity: surgery and hearing aids. 

Abnormal Growths & Tumors 

Other conditions that lead to abnormal growths protruding into your ears and ear canals can also lead to hearing loss. Tumors are the most common type of growth. These tumors are not necessarily cancerous, and can be benign. Acoustic neuroma is an example of such a tumor that specifically develops on your hearing nerves, which causes hearing loss. Medical management is the best treatment for this condition.

Ossicular Chain Discontinuity

Ossicular chain discontinuity is the clinical term where your middle ear bones become separated. Hearing loss and tinnitus are both common symptoms of this condition. It can be treated with surgery, and if some of the hearing loss is permanent you can explore using hearing aids.


There are many risk factors and causes for hearing loss. Some are minor and temporary, where treating the underlying cause can restore your hearing to its previous levels. Some are more serious, and can lead to permanent hearing loss. Some cannot be avoided, such as trauma from accidents or illnesses causing hearing loss, but some can be prevented with proper ear protection, healthy habits, and consulting with your doctor or a hearing care specialist.

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¹ Bainbridge KE, Hoffman HJ, Cowie CC. Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Ann Intern Med. 2008;149:1-10.

 

*National Health and Nutrition Examination Survey, 1999 to 2004. 5,140 (3,316 males; 2,624 females) noninstitionalzied adults age 20 to 69 years who had audiometric testing. Hearing impairment was assessed from the pre tone average of thresholds over low or mid-frequencies (500, 1000, and 2000 Hz) and high frequencies (3000, 4000, 6000, and 8000 Hz) and was defined as mild or greater severity (pure tone average >25 decibels hearing level [dB HL]) and moderate or greater severity (pure tone average >40 dB HL). Hearing impairment was more prevalent among adults with diabetes. Age-adjusted prevalence of low- or mid-frequency hearing impairment of mild or greater severity on the worse ear was 21.3% (95% CI, 15.0% to 27.5%) among 399 adults with diabetes compared with 9.4% (CI, 8.2% to 10.5%) among 4741 adults without diabetes. Similarly, age-adjusted prevalence of high-frequency hearing impairment of mild or greater severity in the worse ear was 54.1% (CI, 45.9% to 62.3%) among those with diabetes compared to 32.0% (CI, 30.5% to 33.5%) among those without diabetes. The association between diabetes and hearing impairment was independent of known risk factors for hearing impairment, such as noise exposure, ototoxic medication use, and smoking (adjusted odds ratios for low- or mid-frequency and high-frequency hearing impairment were 1.82 [CI, 1.27 to 2.60] and 2.16 [CI, 1.47 to 3.18], respectively). The diagnosis of diabetes was based on self-report. The investigators could not distinguish between type q and type 2 diabetes. Noise exposure was based on participant recall.¹