Hearing Aids Work. So Why Don’t More People Wear Them?

Stigma. Discomfort. High pitched feedback. These are some reasons that people opt out of wearing hearing aids. Yet, hearing loss has been linked to dementia and social isolation, and one-third of Americans aged 70 and older suffer from the condition. Even young people are not immune: 20% of Gen Z suffers from noise-induced hearing problems. We talk about innovations in treating hearing loss. Have you resisted wearing a hearing aid?

This partial transcript was computer-generated. While our team has reviewed it, there may be errors.

Grace Won: Welcome to Forum. I’m Grace Won, in for Alexis Madrigal.

We live in a noisy world. We jam headphones on our ears to rock out to our favorite songs. We go to concerts, movies, and sporting events where the sound is so loud we feel it not only in our ears, but in our bodies. And our hearing is paying the price.

By the age of 70, two-thirds of Americans will suffer from some form of hearing loss, and the condition is on the rise among people ages 18 to 34. In fact, hearing loss is the third most common chronic health condition in the United States.

Cutting-edge research is focused on arresting hearing loss. In the meantime, we have hearing aids—which people often choose not to wear because of stigma, cost, or discomfort. Hearing aids can cost as little as $89 and as much as $6,000.

To tell us more about hearing loss and hearing aids, we’re joined by an all-star panel. Nicholas S. Reed is an adjunct professor at both the Johns Hopkins Bloomberg School of Public Health and NYU Medical School. He’s an audiologist and epidemiologist. Welcome to Forum, Nick.

Nicholas S. Reed: Thanks for having me.

Grace Won: We also have Dr. Konstantina Stankovic. She’s an ear and skull base surgeon at Stanford and chair of the Department of Otolaryngology–Head and Neck Surgery. She’s also an auditory neuroscientist. Welcome to the show, Dr. Stankovic.

Dr. Konstantina Stankovic: Thank you for having me.

Grace Won: Nick, I want to start with the different types of hearing loss. There are lots of kinds, but what happens when we lose hearing as we age?

Nicholas S. Reed: There are different kinds of hearing loss. You can have things that block sound from getting into the ear. But what we’re talking about with age-related hearing loss is really the accumulation of life-course exposures. All the meals that contributed to higher blood pressure, the noise exposures you mentioned—concerts, behaviors over time—all of that affects the ear.

The ear isn’t something that lasts forever. Over time, there’s cellular degradation, and we lose hearing from high frequencies to low frequencies. It’s really about how sound is encoded in the ear. This isn’t about wax or blocked sound—it’s the ear naturally breaking down. And the speed at which that happens is very much affected by lifestyle and environmental factors.

Grace Won: You’ve compared hearing loss to losing piano keys. Can you talk about that?

Nicholas S. Reed: When most people think about hearing loss, they simulate it by putting their fingers in their ears. That’s a volume issue—everything just gets quieter. But hearing loss is different.

Your ear is organized like a piano, from high frequencies to low frequencies. With hearing loss, you’re slowly and insidiously removing keys, starting at the high-frequency end. Imagine translating that to vision. We don’t just see “less”—we lose parts of the spectrum. Maybe red is gone, orange is mostly gone, blue is partially gone.

That’s what happens with hearing. It’s not just volume; it’s clarity. That’s why people with hearing loss say everyone is mumbling. The word “sat” becomes “at.” Those soft, high-frequency sounds disappear, and the brain has to work much harder to fill in the gaps.

Grace Won: Dr. Stankovic, what’s happening in our ears when we lose hearing as we age?

Dr. Konstantina Stankovic: Broadly speaking, there are two categories of hearing loss: conductive and sensorineural.

To understand these, it helps to review how we hear. Sound travels down the ear canal, where earwax is made. At the end of that canal is the eardrum. When the eardrum vibrates, it sets in motion the tiniest bones in the human body. Those bones then move fluid in the inner ear.

The inner ear is an incredibly delicate organ. The human organ of hearing, called the cochlea, is about the size of Lincoln’s head on a penny. It contains the most sensitive sensory cells in the body, and the total fluid volume inside it is less than a raindrop.

Grace Won: Wow.

Dr. Konstantina Stankovic: Conductive hearing loss means there’s a problem conducting sound to the inner ear—maybe a hole in the eardrum, fluid behind it, bones that aren’t moving properly, or earwax. These problems are often solvable and sometimes curable, with treatments ranging from simple office procedures to surgery.

The real challenge is sensorineural hearing loss, which originates in the inner ear. There are more than 30 different cell types there, and damage to any one of them can cause hearing loss. The most well-known are hair cells and the neurons that connect to them—but there are many other essential cells involved.

What’s frustrating is that today, we can’t tell exactly which cell type is affected in a given person’s inner ear.

Grace Won: That may be the best explanation of hearing loss I’ve ever heard. Can a single event—like a loud concert or explosion—cause hearing loss, or does it usually happen over time?

Dr. Konstantina Stankovic: It can be both. Like many things in biology, it’s a combination of genetics and environment.

Some people have a genetic predisposition to hearing loss. They may be born with it, or it may progress over time. Noise exposure or toxic medications can worsen it. That’s the genetic component.

The environmental component often involves acoustic trauma. Some people have what we call “tender ears,” where a single loud exposure can cause permanent hearing loss. Others have “tough ears” and may tolerate the same exposure without issue.

There are also other causes: certain antibiotics and chemotherapy drugs, viral and bacterial infections, chronic diseases like diabetes or high blood pressure, autoimmune conditions, tumors such as acoustic neuromas, and physical trauma like head injuries. There are many pathways to hearing loss.

Grace Won: Nick, hearing loss can be hard to recognize, especially when it comes on gradually. What’s the moment when people usually realize they should get their hearing checked?

Nicholas S. Reed: Sudden hearing loss does happen, but it’s relatively rare. Most hearing loss is slow and gradual. Because it happens so slowly, people don’t realize what they’re missing.

We can’t see sound, so there’s nothing obvious to point to. People often start blaming others—saying everyone is mumbling. The turning point is usually personal: family or friends start pointing it out, or communication breaks down.

Higher-pitched voices—often women’s and children’s voices—are usually the first to become hard to hear. Eventually, people realize it’s not everyone else. It’s them.

Grace Won: So if you find yourself saying “What?” all the time, that might be a sign?

Nicholas S. Reed: Exactly. When you’re blaming the whole world for mumbling, that’s the moment to ask whether it might be your hearing.

Grace Won: We’re talking about hearing loss, something nearly all of us will experience as we age, and about the evolving technology and research addressing it.

We’re joined by Dr. Konstantina Stankovic, ear and skull base surgeon and auditory neuroscientist at Stanford University, and Nicholas S. Reed, adjunct professor at NYU Medical School and the Johns Hopkins Bloomberg School of Public Health.

We want to hear from you. Are you experiencing hearing loss but reluctant to use hearing aids? Why or why not? Has new technology changed your experience?

I’m Grace Won, in for Alexis Madrigal. More Forum after the break.