6 lesser-known and better-known causes of hearing loss

About 48 million Americans, or approximately 20 percent of the population, have some degree of hearing loss. According to the Centers for Disease Control and Prevention, hearing loss is now the third-most common chronic health condition in the United States.

Many cases of hearing loss are preventable. And many more are treatable. We often have an easier time treating hearing loss if you have hearing exams on a regular basis. Talk to your doctor if you think you have hearing loss or if you’re at risk for it.

"Talk to your doctor if you think you have #hearingloss or if you’re at risk for it." via @MedStarWHC

Hearing loss can be a symptom of many other conditions. Some, like diabetes, we know a lot about. And some we’re just recently beginning to understand.

Lesser-known causes of hearing loss

Iron-deficiency anemia

Hearing loss has been in the news recently because of the results of a recent study linking it to iron-deficiency anemia. This study found that iron-deficiency anemia was associated with an 82 percent higher chance of sensorineural hearing loss. In cases of sensorineural hearing loss, there is damage to the inner ear or the nerves leading from the inner ear to the brain. The study didn’t determine that iron-deficiency anemia definitely causes hearing loss, but it suggested that the lack of iron may reduce blood flow to the inner ear.

Several groups of people are at particular risk for iron-deficiency anemia, including:

  • Babies and young children, especially premature babies or those with a low birth weight
  • People who get kidney dialysis treatment
  • People who have internal bleeding because of colorectal cancer, bleeding ulcers or other medical conditions
  • People whose diets don’t contain enough iron
  • Women of childbearing age who have regular menstrual cycles


Another cause of hearing loss that most people don’t know about is otosclerosis. Otosclerosis is a condition in which one of the ossicles, or the tiny bones in the middle ear, gets stuck and isn’t able to vibrate normally. This normally happens to the ossicle called the stapes. When these bones can’t vibrate, sound can’t travel through the ear to the auditory nerve, which carries signals to the brain that allow us to hear. This is a type of conductive hearing loss.

Otosclerosis tends to occur in people with a family history of the condition. Researchers think otosclerosis also could be associated with previous cases of measles, stress fractures to the bony area around the inner ear and immune disorders. Some researchers also believe a lack of fluoride in drinking water can contribute to the development of otosclerosis.

Better-known causes of hearing loss

Unfortunately, numerous factors can cause or contribute to hearing loss. Some of the better-known ones include:

  • Ototoxins
  • Ear infections and cholesteatomas
  • Microvascular disease
  • Age


One fairly common cause of hearing loss is exposure to chemicals or medications that can damage the ear. We call these ototoxic substances or ototoxins. Many medications and chemicals can cause either temporary or permanent ear damage, including:

  • Aspirin
  • Certain antibiotics, including gentamicin and vancomycin
  • Cisplatin and carboplatin, used in chemotherapy for cancer treatment
  • Loop diuretics, used to treat some kidney and heart conditions
  • Quinine, used to treat malaria

"One fairly common cause of hearing loss is exposure to chemicals or medications that can damage the ear." via @MedStarWHC

Ear infections and cholesteatomas

Untreated ear conditions like ear infections can also lead to hearing loss without proper treatment. Ear infections are a common childhood illness, but some adults continue to get them as they age. This can be linked to a condition called Eustachian tube dysfunction, which happens when the tube that links the nose to the middle ear doesn’t open or close properly. Adults with Eustachian tube dysfunction are at higher risk for ear infections.

Chronic ear infections can lead to the development of a cholesteatoma. A cholesteatoma is a cyst of skin in the middle ear space, or mastoid. Someone with a cholesteatoma might have painless ear drainage that they just might get used to over time. But without treatment, the cholesteatoma can break down the bones in the middle and inner ear. Not only can this cause hearing loss, but a cholesteatoma also can cause:

  • Brain infection, or encephalitis
  • Dizziness or a lack of balance
  • Facial paralysis, resembling Bell’s palsy
  • Meningitis

Diabetes, high blood pressure and high cholesterol

Hearing loss is linked to several fairly common conditions, including diabetes; high blood pressure, also known as hypertension; and high cholesterol, also known as hyperlipidemia. All of these conditions can cause microvascular disease, which is a problem with the tiny blood vessels that supply blood to the inner ear. Microvascular disease of the ear’s blood vessels can narrow these inner-ear blood vessels, which can either cause hearing loss or cause it to get worse.


Of course, perhaps the best-known cause of hearing loss has to do with the aging process. Our risk for hearing loss goes up as we get older. This is called age-related hearing loss, also known as presbycusis. Almost 25 percent of Americans between 65 and 74 have some degree of hearing loss. And nearly half of Americans 75 and older have hearing loss.

"Nearly half of Americans 75 and older have #hearingloss." via @MedStarWHC

Lower your risk of hearing loss

Of all the causes of hearing loss, exposure to loud noises is one of the most common. We can minimize this risk by protecting ourselves from loud noises when possible. Keep the volume down on your devices when listening to them with earbuds and headphones. And wear earplugs or other ear protection when you know you’ll be exposed to loud noises, like at a concert or while using noisy equipment.

Microvascular disease from diabetes, high blood pressure or high cholesterol also is something we can work to reduce or eliminate. Talk to your doctor about keeping your blood sugar, blood pressure and cholesterol under control through lifestyle changes, medications and other treatments to reduce your risk of microvascular disease.

Unfortunately, the most common cause of hearing loss is the aging process, and there isn’t much we can do to stop that. But we may be able to stop the aging process’s effects on hearing sometime in the future. During my PhD studies at the University of Minnesota, I created an antioxidant medication that was able to prevent the onset of age-related hearing loss and keep it from getting worse. The goal of my research is for people to one day have a supplement they can take to reduce their risk for age-related hearing loss.

Hearing loss can result from a number of factors. When we identify which of these factors apply to you, we’re one step closer to finding treatment options to either cure or manage your condition.

Listen up: Get your hearing tested!

According to data from the U.S. Department of Health and Human Services, nearly 25 percent of people between the ages of 65 and 74 have a hearing problem. And for people 75 and older, that number rises to nearly 50 percent.

People often think of hearing loss as a fact of life—something that comes along with getting older. But hearing loss can affect anyone. More than 10 percent of U.S. adults between 20 and 64 have hearing loss caused by exposure to loud noise. In total, about 48 million Americans, or 20 percent of the country, have some amount of hearing loss.

Unfortunately, most people don’t get their hearing checked until they notice hearing loss or people around them complain. And that’s a problem, because it can make hearing loss more difficult to treat in the long run. Every adult should have regular hearing tests to monitor for hearing loss.

Are you overdue for a hearing exam? Make an appointment today!

How often should you have a hearing test?

All adults should have their hearing tested at least once every five years, according to the Office of Disease Prevention and Health Promotion (ODPHP).

But 2012 ODPHP data show that only about 21 percent of adults between 20 and 69 had a hearing test in the previous five years. And just over 40 percent of adults 70 and older, who are much more likely to have a hearing problem, had a hearing test within the recommended time.

As part of its Healthy People 2020 initiative, the ODPHP hopes to improve these numbers by the year 2020. The goal is a 10 percent improvement for all adults. But even that increase would mean most adults still wouldn’t receive regular screening. We clearly have a lot of work to do to get the word out about the importance of regular hearing tests.

Why do you need regular hearing tests?

Just like we do for blood pressure, it’s helpful for your doctor to have a regular reading of your hearing function. Regular hearing tests help us establish your baseline, or normal, hearing level. That way, if you notice a change in your ability to hear, or if we start to see a change from one test to the next, we can identify how abnormal your hearing function is and when the change likely happened.

If you wait until there’s an issue to have a hearing test, it’s harder to determine the problem. The doctor will have just the current exam to work from. One test won’t help us determine just how much your hearing has changed and when. A problem you may think appeared out of nowhere might have been developing for many years before you noticed.

Different types of hearing loss have very different management and treatment strategies. In some cases, we can correct hearing problems with surgery. In others, we can’t correct the disorder itself, but we can improve hearing ability with the use of hearing aids. The more time we lose trying to find the cause of hearing loss, the more hearing you could lose.

Health effects of hearing loss

Hearing loss is a major problem that is related to multiple health and emotional disorders. As a 2011 study noted, older adults with hearing loss are more likely to have difficulty with the normal activities of daily life than older adults without hearing loss. Hearing loss is associated with several problems in adults of all ages, including:

  • Dementia
  • Depression
  • Emotional difficulties
  • Feeling isolated from friends and family members
  • Lower workforce participation

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In addition, many people are unaware of the link between hearing loss and diabetes. Over time, people with diabetes can develop a condition called diabetic neuropathy. This is a type of nerve damage that can cause pain, loss of function or other problems in different areas of the body.

In some cases, hearing loss can be an early warning of diabetic neuropathy. That can be a warning sign for people to get their blood sugars under control. Hearing loss might even be a sign to diagnose diabetes in patients if they’re not already being treated for the disease.

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Talk to your doctor about hearing tests

Most primary care doctors don’t regularly test their patients’ hearing. Your primary care provider can refer you to an audiologist—a doctor who evaluates patients’ hearing and treats hearing disorders.

Hearing tests are covered by most insurance plans with a doctor’s referral. The test takes about 30 minutes to an hour. Our Hearing and Speech team uses sounds with different tones, frequencies and intensities to measure your hearing threshold – the minimum level of sound a person can hear. During the test, the audiologist also will present a series of words to see what percentage you hear correctly and can repeat. The audiologist will plot your results on an audiogram, which is a visual readout of your hearing thresholds, and go over them with you after the test.

Hearing loss can sneak up on us if we’re not careful. But it doesn’t have to. Regular hearing tests can give your doctor a head start toward keeping your hearing strong and healthy as you age.

The dangers of loud–and dirty–earbuds and headphones

We live in a noisy world. The ear-splitting sounds of rush-hour traffic, the drone of a lawn mower, loud washing machines and vacuum cleaners, blaring TVs and computers—all of these loud noises and more can blast at us wherever we go. 

These everyday noises can do more than annoy us. They can put us in danger of hearing loss. Until recently, most researchers believed work-related exposure to loud noises was the greatest risk for noise-induced hearing loss, or hearing loss caused by loud noises. But as Centers for Disease Control and Prevention reported in February 2017, more than half of people who had noise-induced hearing loss reported no exposure to loud noises at work. Schedule regular hearing checkups to minimize your risk for hearing loss.

These findings mean hearing damage is coming from other environmental factors. And it’s not just unpleasant sounds that can damage our hearing. Standard headphones and earbuds at full volume are about as loud as a chainsaw. Just like other loud noises, we need to limit our exposure to loud sounds from earbuds and headphones to protect our hearing.

The science of sound

The subject of earbuds and headphones is controversial among hearing health specialists like me. Some people believe earbuds are more dangerous than headphones because earbuds rest inside the ear, while earphones rest over the ear.

It’s not an issue of the earbuds being more dangerous. What matters is the intensity of the sound the ear is exposed to. We measure the intensity of sound in decibels. Higher decibel levels mean sound is more intense. And more intense sounds are more dangerous to your ears.

Normal, comfortable sounds range from about 30 to 60 decibels. A 60-decibel sound is about the same as a normal conversation. Sounds at these levels don’t pose a threat to your hearing. But sounds that are higher than this on the decibel scale get much more intense very quickly—and much louder.

Each 10-level jump in decibels translates to sound intensity that’s 10 times as strong and about twice as loud. Music at 100 decibels is 10,000 times more intense and 16 times louder than a 60-decibel conversation

Regular exposure to sounds with a high decibel level can have a damaging effect to your hearing over time. Sounds at or above 85 decibels can cause hearing loss, particularly if you’re exposed to them for long periods.

Many commercially available earbuds and headphones, even those marketed for children, go above these levels. In fact, some are capable of producing sounds that are 100 decibels or higher. Sounds at 115 decibels can permanently damage hearing after just 15 minutes of exposure.

Turn the volume down when using earbuds or headphones

Keep your devices at 50 percent volume or less when using earbuds or headphones. That’s usually a safe area below the decibel level that can cause hearing loss. While listening to your earbuds or headphones, you should be able to hear and participate in a conversation. If you can’t hear the other person, your device probably is too loud.

Most sets of earbuds or headphones will list their maximum decibel level on the package or in the instruction manual. If you don’t have the packaging or instructions for your device anymore, search for your particular model online to find details about its maximum decibel level. However, keep in mind that these published or posted figures may not have the most accurate information. A December 2016 report in The New York Times noted that 30 sets of children’s headphones in a product analysis failed to restrict their volumes to the posted limits.

Be particularly mindful of children’s exposure to loud noises. As smartphones and other devices have become a part of everyday life, children are exposed to loud music and other sounds more often than we might realize. Make sure your children know to keep the volume down on their devices. One alternative for kids: Get them reading! Reading, of course, is perfectly safe for the ears—just watch the volume levels on audiobooks.

The dirty danger of earbuds and headphones

Perhaps just as important as the decibel levels of our devices is keeping our devices clean. Most people never think about cleaning their earbuds or headphones despite putting them in or on their ears several times a day.

Consider this: Your smartphone is likely one of the dirtiest things you own. You may carry it with you all the time, wherever you go, even in the bathroom. Then you plug the earbuds into the phone to listen to music, and put the earbuds in your ears. The bacteria from the phone now have a direct path into your ear canals.

Luckily, there’s an easy fix for this dirty dilemma. Clean your earbuds or headphones with alcohol at least once a day to reduce the risk of bacterial contamination. Make sure you don’t get the alcohol near the headphone jack or other sensitive electronic contact points. You also can use antibacterial wipes that are specially designed for electronic equipment to clean your phone, earbuds and headphones.

Headphones and earbuds are great tools while we’re hard at work, working out or just relaxing with our favorite tunes. But just like anything else, they’re best when used in moderation. Keeping the volume down now may mean you don’t have to turn it up so loud to hear later in life.

Safe Solution to Hearing Loss for People with Dementia

Improved Hearing May Decrease, Delay Dementia

Over the last few years, medical researchers made an interesting discovery: Severe hearing loss, in and of itself, contributes to and worsens cognitive decline and dementia among the elderly. While the chicken/egg relationship is not exactly clear—nor the mechanics of how or why—the effect is circular, with one condition feeding upon the other. Both lead to frustration, social withdrawal, depression and anxiety, causing many elderly patients to lose the ability to communicate with or understand the family, friends and others who love and care for them.

But a 2015 study in JAMA Otolaryngology-Head & Neck Surgery demonstrated marked improvements in thinking and memory skills after hearing- and cognitive-impaired patients received a sophisticated type of hearing device, a cochlear implant.

So why aren’t more patients with both dementia and profound hearing loss receiving the same treatment? The answer may lie in the procedure itself.  

“Typically, a patient undergoing a cochlear implant receives general anesthesia,” says Selena Heman-Ackah Briggs, MD, a head and neck surgeon specializing in hearing loss and ear disease at MedStar Washington Hospital Center. The Hospital Center was the first and, for many years, only site in the metropolitan area to offer cochlear implants for adults. “Yet anesthesia is a known risk factor for patients who are already experiencing cognitive decline, especially if they also have other problems like heart or lung disease.”  

To resolve the dilemma, Dr. Briggs began substituting local sedation for her elderly cochlear implant patients.

“The milder anesthetic lets patients rest comfortably and breathe on their own during the ‘twilight’ procedure, while reducing the risk of complications,” she says. “In-hospital recovery time is cut almost in half, with patients going home the same day.”  

Unlike traditional hearing aids which merely amplify sound, cochlear implants rely upon a sophisticated system of microphones, speech processors, transmitters and other complex parts to interpret and convey electrical impulses directly to the brain. As such, recipients must go through training sessions with audiologists to learn how to “hear” with their new device.

Despite their age, patient response has been remarkable, according to Dr. Briggs.

“Most of my elderly patients are just so excited about being able to hear again,” she says. “Through cochlear implant, we’re restoring their ability to communicate, to be active and functional, and stay in the game of life.”   

To listen to Dr. Briggs’s full podcast interview, click here.

Our specialists are experts in the diagnosis and treatment of hearing loss. Ready to schedule an appointment? Call us at



As heard on WTOP Radio:

Selena Heman-Ackah, MD

Selena Heman-Ackah Briggs, MD
MedStar Washington Hospital Center

For an appointment, call 202-877-3627.