Difficulty following conversations in noisy environments may be one of the earliest signs of hearing loss, often appearing alongside tinnitus—a persistent ringing, buzzing or hissing sound in the ears.
Experts say these symptoms typically develop when ageing or long-term exposure to loud noise damages delicate sensory hair cells in the inner ear. Beyond hearing difficulties, the condition can also affect sleep, concentration and mood and has been linked to a higher risk of falls and cognitive decline.
Hearing loss is often assumed to be a gradual and inevitable part of ageing, but specialists say early warning signs are frequently overlooked.
Tinnitus is the perception of sound without an external source and can vary from a faint background noise to a constant and intrusive ringing. Some people describe it as cicadas, static or distant machinery.
Susan Bianco, 87, from Lancaster, first noticed changes in her hearing when conversations became harder to follow, particularly in group settings.
“It’s very hard to hear in a crowd,” she said. “I can’t understand what one person is saying if other people are talking.” She later developed a buzzing sound in her ears, which became more noticeable when she was tired.
Her experience reflects broader trends. According to the US Centres for Disease Control and Prevention, around 13% of adults report hearing difficulties, rising to 27% among those aged 65 and older. Tinnitus affects roughly 10% of adults and is commonly associated with hearing loss.
Audiologist Dr Jackie Price said ageing and noise exposure are the two main risk factors, but prevention is possible.
“You can’t stop ageing, but you can take steps to conserve your hearing and reduce your risk of developing hearing loss and tinnitus,” she said.
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Tinnitus occurs when damage to the cochlea disrupts communication between the ear and brain. The cochlea’s hair cells normally convert sound vibrations into signals; when damaged, they can trigger phantom sounds.
Other related conditions include hyperacusis, where everyday sounds feel painfully loud, and misophonia, where certain sounds provoke strong emotional reactions.
Experts warn that hearing loss and tinnitus can have wide-ranging effects beyond hearing, including sleep disruption, reduced concentration, depression, strained relationships and increased risk of falls and cognitive decline.
Prevention focuses on limiting exposure to noise above 85 decibels, such as at concerts, sporting events or when using power tools. Experts also caution against listening to loud music through earbuds in already noisy environments.
Proper use of hearing protection is essential. Foam earplugs should be rolled tightly, inserted into the ear canal, and allowed to expand fully. Most are designed for single use.
While there is no cure for hearing loss or tinnitus, treatments can help manage symptoms. Hearing aids are commonly used, while tinnitus retraining therapy combines counselling and sound therapy to reduce the brain’s focus on internal noise.
Ms Bianco has recently begun such therapy alongside hearing aid use, with her device playing a soft background sound.
“It sounds like it’s raining, which I don’t mind too much,” she said.
Experts emphasise that hearing tests can reveal early damage even when symptoms are mild, helping people take steps to preserve hearing and maintain quality of life.
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