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Signs You Need a Hearing Test — and What to Do Next

About 15% of American adults — roughly 37.5 million people — report some trouble hearing, and hearing loss is often gradual enough that many adapt to it for years before seeking help. Regularly asking people to repeat themselves, turning up the TV, or struggling in noisy places are reliable signs a hearing evaluation is worthwhile. Sudden hearing loss in one or both ears is a medical urgency needing evaluation within 24–48 hours.

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What are the common signs that hearing may have changed?

The clearest signs include:

  • Frequently asking people to repeat themselves
  • Turning up the TV or radio louder than others prefer
  • Difficulty following conversations in a group or noisy setting (a restaurant, a party)
  • Mishearing words — especially consonants — so speech sounds muffled or unclear
  • Difficulty hearing on the phone
  • Trouble understanding speech when you cannot see the speaker's face
  • Missing sounds you used to hear easily — a doorbell, birds, a ringing phone in another room

Tinnitus — a ringing, buzzing, or hissing sound in one or both ears — can accompany hearing loss, though it can also occur independently 2.

How common is hearing loss, and who is most at risk?

Approximately 15% of American adults (37.5 million people) ages 18 and over report some trouble hearing. Age is the strongest predictor: about one in three people between ages 65 and 74 has hearing loss, and nearly half of those over 75 have difficulty hearing 1.

Beyond age, several factors raise risk:

  • Noise exposure: As many as 24% of U.S. adults ages 20–69 show hearing-test features suggesting noise damage — from jobs in construction, manufacturing, or the military, or from recreational use of firearms, power tools, or high-volume earphones 2.
  • Diabetes and cardiovascular disease: Both can affect blood flow to the inner ear and are associated with higher rates of hearing loss 1.
  • Ototoxic medications: Certain chemotherapy drugs and some antibiotics can damage cochlear hair cells. A prescribing clinician can tell you whether your medications carry this risk 1.
  • Family history: Genetic predisposition contributes to age-related hearing loss.

Which hearing changes need prompt evaluation?

Sudden hearing loss in one or both ears is a medical urgency — it should be evaluated within 24–48 hours, as some causes respond well to early treatment 3. Other symptoms that warrant relatively prompt evaluation include:

  • Hearing loss accompanied by dizziness, vertigo, or balance problems
  • Hearing loss with ear pain, drainage, or a feeling of fullness in the ear
  • Hearing that fluctuates significantly from day to day

For everyday gradual hearing changes without these features, scheduling a routine audiology appointment is appropriate — but do not delay indefinitely.

Who should consider a baseline hearing test even without obvious symptoms?

NIDCD's age-related hearing loss guidance suggests self-assessment if you are over 50, particularly over 60 or 65. A brief validated questionnaire — answering 'yes' to two or more questions, or 'sometimes' to three or more — is an indication to have your hearing checked 1.

Others who should not wait for noticeable symptoms include:

  • Anyone with significant occupational or recreational noise exposure 2
  • People with diabetes or cardiovascular disease 1
  • Those taking medications known to affect hearing

What does a hearing evaluation involve?

An audiologist performs a standard hearing test (audiogram) in a soundproof booth, playing tones at different pitches and volumes to map exactly where your hearing sits. The test is painless and usually takes 30–60 minutes. Some primary care offices offer basic screening tests. An ENT physician (otolaryngologist) evaluates the medical causes of hearing loss — examining the ear canal and eardrum, and ordering imaging or additional testing when needed.

Hearing aids are now available over the counter for mild-to-moderate hearing loss (FDA-approved since 2022), which has lowered barriers to accessing amplification without a prescription 1. A licensed audiologist can still provide fitting and follow-up for the best outcome.

Gale does not offer audiology services. Your next step is scheduling with an audiologist, an ENT, or your primary care clinician.

Why does it matter to act on hearing loss?

Untreated hearing loss has been associated with social withdrawal, increased communication effort and fatigue, and — in research on older adults — with cognitive decline and increased risk of dementia 4. Hearing aids and other assistive technologies have improved substantially, and many people find them genuinely helpful once fitted. The earlier hearing loss is identified, the more options are available.

Common questions

Is ringing in the ears (tinnitus) a sign I need a hearing test?

Tinnitus can accompany hearing loss and is a reasonable reason to get a hearing evaluation. That said, tinnitus can also occur with normal hearing. An audiologist or ENT can assess both at the same visit.

Can hearing loss be reversed?

It depends on the cause. Conductive hearing loss from earwax buildup, fluid in the middle ear, or certain infections can often be treated and reversed. Age-related or noise-induced sensorineural hearing loss is typically permanent, though hearing aids can significantly improve function.

What is the difference between an audiologist and an ENT for hearing problems?

An audiologist specializes in measuring and managing hearing function — they perform the audiogram and fit hearing aids. An ENT (otolaryngologist) is a physician who diagnoses and treats the medical and surgical causes of hearing loss. They often work together, and your primary care clinician can refer you to either.

When should I take my child in for a hearing test?

Hearing is tested at birth and periodically through childhood in the US. If a child has speech delays, seems inattentive at school, or frequently asks for things to be repeated, mention it to the pediatrician — they screen for hearing problems at routine visits.

Are over-the-counter hearing aids a good option?

Since the FDA authorized OTC hearing aids for adults with mild-to-moderate hearing loss in 2022, they have become a more accessible and lower-cost option. They work best when paired with a hearing test to confirm the degree of loss. For severe loss or complex cases, a licensed audiologist remains the right path.

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Hearing symptoms that need urgent evaluation

  • —Sudden hearing loss in one or both ears with no obvious cause — needs evaluation within 24–48 hours, call an audiologist or ENT today
  • —Hearing loss with one-sided facial weakness, numbness, or drooping — go to an emergency department
  • —Hearing loss with severe vertigo, loss of balance, or inability to walk steadily — seek urgent evaluation
  • —Blood or fluid draining from the ear — see a clinician promptly

Sudden hearing loss is a medical urgency. Call your doctor or an ENT's office today for same-day or next-day evaluation. If you develop facial weakness or severe balance loss alongside hearing loss, go to an emergency department.

This article is general health information and does not constitute a diagnosis or medical advice. Gale does not provide audiology or ENT services. Please consult a licensed audiologist, ENT physician, or your primary care clinician for a personalized evaluation.

References

  1. 1.National Institute on Deafness and Other Communication Disorders (NIDCD) (2023). Age-Related Hearing Loss (Presbycusis). NIDCD Health Topics. link ✓Prevalence of hearing loss by age (1 in 3 adults 65–74; nearly half over 75), risk factors including diabetes and cardiovascular disease, and FDA OTC hearing aid approval
  2. 2.National Institute on Deafness and Other Communication Disorders (NIDCD) (2023). Noise-Induced Hearing Loss (NIHL). NIDCD Health Topics. link ✓Up to 24% of adults ages 20–69 show hearing-test features suggesting noise damage; occupational and recreational noise sources; noise-induced hearing loss is preventable
  3. 3.National Institute on Deafness and Other Communication Disorders (NIDCD) (2023). Quick Statistics About Hearing, Balance, and Dizziness. NIDCD Health Statistics. link ✓Overall prevalence statistics: ~15% of adults (37.5 million) report trouble hearing; 28.8 million could benefit from hearing aids; age and gender distribution
  4. 4.Hearing Loss & Tinnitus — Reducing the Risk of Cognitive Decline (PMC) (2025). Hearing Loss and Tinnitus — Reducing the Risk of Cognitive Decline. PMC / National Institutes of Health. link ✓Untreated hearing loss and tinnitus are potentially modifiable risk factors for cognitive decline and dementia; hearing aid treatment associated with improvements in memory and executive function

4 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.