Hearing loss is invisible and almost always painless. There are no physical warning signs, except for the occasional cases of tinnitus or ringing in the ear. Most hearing losses develop over a period of 25 to 30 years and often get gradually worse with age. Typically between the ages 45 to 60, there can be enough deterioration to interfere with communication.

Hearing researchers believe that hearing loss in older adults is the accumulation of two or more causes, such as exposure to loud noise, family history or simply the natural aging process. In most cases, there is damage to the microscopic hair cells in the inner ear causing irreversible hearing loss. For the vast majority of individuals with nerve damage or sensorineural hearing loss, the damaged hair cells will function again if vigorously stimulated with amplification.

Other causes of hearing loss include ototoxic drugs, viral and toxic illness, disturbance of fluid to the inner ear and excessive temporal bone growth in the inner ear. Only about five percent of all hearing losses are the result of structural damage to the ear. This type of loss is called a conductive hearing loss. Common causes are impacted wax, perforated eardrum, middle ear effusion, otosclerosis, cholesteatoma and congenital anomalies.