As America’s Population Ages, Hearing Loss Is Soaring. Here’s What It Sounds Like

Delayed diagnoses in older adults

Like Rosch, many Americans who have a hearing problem wait years before seeking help. One study found that the average delay between a participant needing hearing aids and actually adopting them was nearly nine years.

The condition’s slow and incremental onset means patients often unknowingly adapt to hearing loss instead of seeking treatment, says Dr. Nicholas L. Deep, an otolaryngologist at Mayo Clinic Arizona. They don’t notice the television volume going up a few extra notches or that they’re lip-reading during conversations. Small daily adjustments, alongside heavier reliance on other senses — particularly vision and touch — help contribute to a false sense of normalcy.

Even Rosch, who understands sound better than most, didn’t notice the extent of the problem right away. “I was aware my hearing was starting to get dicey ... but I had not anticipated that loss in my lower registers,” he says. “Special little tricks” he adopted over the years, like a nighttime noise machine to drown out the ringing, or cupping his hands behind his ears while mixing records to accentuate midrange sounds, helped mask the mounting damage.

A widespread misunderstanding of what hearing loss actually is also delays diagnoses, says Dr. Maura Cosetti, director of New York’s Ear Institute at Mount Sinai. A common misconception is that hearing loss is the descent into silence; that it’s just a loss of volume. But “almost no one reports that they hear less,” Cosetti says of her patients with presbycusis. Instead, they report distorted or muffled sounds that are usually competing with persistent hissing or crackling noises. There’s “huge variability” in what hearing loss is to each person, given how highly complex our human senses are, she adds.

Older adults, therefore, need help in detecting hearing loss, but most aren’t getting it in routine medical checks, says Barbara Kelley, executive director of the Hearing Loss Association of America (HLAA). Eighty percent of Americans over 50 surveyed by the University of Michigan in 2020 said their primary care doctor hadn’t asked about their hearing in the past two years, and nearly as many — 77 percent — said they hadn’t had their hearing checked by a professional in that same time. “People listen to their family physicians,” Kelley says. “We need to get [them] more in tune with hearing health and asking more questions around it.”

Cascading consequences

Rosch’s untreated hearing loss wasn’t only impeding his ability to create and enjoy music. It also put him on the brink of social isolation. “I was right there,” he admits, “at the point where I thought, I’m not going to be able to hear this conversation, so I’m just going to eat my dinner in this noisy room and just smile.”

Those who don’t address hearing loss open themselves up to an array of increased risks, including falling, hospitalization and job loss. Social isolation, however, is often considered one of the biggest risks for patients due to the plethora of physical and mental problems it can then lead to, including heart disease, stroke, anxiety, depression and even premature death.

Social isolation is also at the core of a growing body of research linking hearing loss to dementia. While research doesn’t prove that hearing loss directly causes cognitive decline, multiple studies published over the past 15 years have drawn strong associations between the two. One of those studies was by Dr. Frank Lin, who tracked 639 adults for nearly 12 years and found that mild hearing loss doubled dementia risk, moderate loss tripled that risk, and severe loss increased it fivefold.

According to Lin, an otologic surgeon, epidemiologist and coauthor of AARP’s Hearing Loss for Dummies, there are three main theories, outlined in the video below, behind why hearing loss may cause dementia. 

Getting this research in front of older Americans could go a long way toward addressing the country’s hearing-loss crisis. More than 70 percent of adults age 40 and older surveyed by AARP in 2023 said knowing that hearing loss increased dementia risk would make them “extremely likely” or “very likely” to address hearing issues. Yet less than half of those surveyed were aware of the links.

Such intel “certainly” pushed Rosch down a path toward hearing aids, he says. “This evidence is coming out daily.... Pair that with a history of Alzheimer’s on my mother’s side, and I need all the help I can get.”

Rosch hosts friends at his home in Delaware. Noisy social settings are among the most challenging for him.

Ryan Collerd

New options, familiar obstacles

Rosch’s hearing-loss diagnosis came just before a historic moment in time for American hearing. In August 2022, the U.S. Food and Drug Administration finalized its rules permitting, for the first time, over-the-counter (OTC) sales of hearing aids for adults with mild to moderate hearing loss. Just a few months later, the brand-new products hit the shelves. 

The OTC policy, which AARP advocated for, aims to make hearing aids cheaper and more accessible by removing the need for a prescription or care from a licensed specialist to use the devices. Prescription hearing aids average $4,600 and are not covered by Medicare or most private insurance plans. Sometimes insurers cover hearing tests when referred by a doctor, but routine testing and fittings for aids often aren’t covered. 

Early evidence suggests that the OTC market is still finding its footing. While a 2024 Government Accountability Office report concluded that it was too soon to judge the policy’s performance, it did note that the new market is grappling with issues of affordability, product consistency and consumer mistrust. Advocates expect the services and technology to improve in the coming years, but today’s market requires purchasers to carefully evaluate their options. “You really have to be a vigilant consumer,” says the HLAA’s Kelley.  

Demand is expected to grow. By 2030, the U.S. OTC hearing-aid market is expected to reach $1.1 billion, according to industry trade publication The Hearing Review.

Rosch explored some OTC options shortly after their launch but felt the store he visited was more focused on profits than health care. He considered going to a Costco hearing center instead, where specialists test for, sell and fit OTC hearing aids, but the closest store was a roughly 90-minute drive away. “Difficult if I had any issues,” he says. 

Rosch ultimately chose not to go the OTC route and instead used the prescription from his hearing test to purchase a pair of Signia hearing aids for around $5,000 in August 2024. A licensed hearing instrument specialist at Delaware Otolaryngology Consultants recommended the model, then helped fit the hearing aids to Rosch’s ears for another $600. An extra $1,000 got Rosch an extended warranty that included unlimited adjustments for three years.

“They were expensive,” Rosch says, adding that he was “astounded” his Medicare didn’t cover any of the cost. (Medicare doesn't pay for most hearing, dental or vision benefits.) But he believes the investment was the right move for both his music and his mind. “Over whatever is left in my lifetime, that’s probably a small price to pay,” he says. “I can guarantee I’m not a rich person, but fortunately I can afford this.”

Rosch’s first order of business each day is to put in his hearing aids. He controls them using an app on his smartphone.

Ryan Collerd

‘Life changed’ with more hearing

Switching on his hearing aids for the first time was a dramatic moment for Rosch. “Life changed,” he says. “I had no idea how much I’d lost until I put these in.” As the weeks ticked by, though, he was glad to have a professional on board to help him through the transition. “These need some experimentation,” he says, “and some patience.”

Initially, itchy ears were the only issue Rosch noticed. But as he was exposed to noisy environments, he realized that the devices needed some human direction to capture relevant sounds and prevent unwanted feedback. His instrument specialist adjusted the physical fit of the hearing aids and tinkered with their technological settings across multiple follow-up visits over the past year. “She usually asks me, ‘Can you give me two weeks?’ She’ll make the adjustment, we’ll wait, then I’ll give her my impression of whether it’s better or worse,” Rosch explains.

While Rosch has enjoyed the experimental phase somewhat, for many, this process is unexpected, uncomfortable and ultimately unsuccessful. “Most people are so used to not hearing for such a long duration of time that when they finally can hear, it can be too overwhelming, too much sound,” says Dr. Janet Choi, an otolaryngologist and researcher at the University of Southern California who coauthored a study that found regular hearing-aid use among patients with hearing loss lowered their mortality risk by 24 percent. However, the study also found that the rate of regular use among those who would benefit from aids was stunningly low: around 12 percent.

Choi, a hearing-aid user herself, says it may take time — often months of regular use — before a patient’s brain adjusts to the new input and becomes comfortable with the devices. She also warns that becoming comfortable is distinct from a return to a familiar state of hearing. Users often expect a complete fix, similar to how glasses restore 20/20 vision. But “there are still a lot of technical limitations to hearing aids,” Choi says, noting that they don’t restore hearing but instead just amplify sound. “They are not perfect.”

Rosch recently faced that tough realization himself. Despite months of trying to master his hearing aids for live performances, he struggled to hear himself during his gigs and rehearsals over the summer. Meanwhile, his band members reported that Rosch was really all they could hear. “My monitor and guitar are dominating, causing everyone to have to make their own adjustments,” he says. Even with the aids in live-music mode, they aren’t properly capturing the complex soundscapes of the stage.

Rosch, a guitarist and singer, rehearses with his band Funktown ahead of a summer gig.

Ryan Collerd

Unable to find a fix, Rosch has decided his days in a live band are done. He resigned from one band in August and committed to the other through June “to allow me, perhaps, my last theater concert,” he says. Still, he’s hopeful that he may find a way to continue to perform. “Perhaps some solo or duo shows with less instruments to compete with,” he says — like John Lennon did, post-Beatles. And he’s hopeful that hearing-aid technology will continue to progress. 

In the meantime, he remains grateful for what the devices can do. He is hearing his wife more clearly, isn’t putting off social outings anymore and has peace of mind knowing that if a fire alarm ever goes off, he’ll be able to hear it. “As far as everyday life goes, they’re making it better,” he says. “There’s some compromise, but I’m OK with that.”