For many people, one of the more difficult-to-accept consequences of aging is the steady loss of hearing. It can be so gradual that you might not even notice it happening (although others may suspect there’s a problem).

But ignoring or denying it doesn’t make it any less real. According to the Hearing Loss Association of America, by age 65, one in three Americans will experience some degree of hearing loss. After arthritis and heart disease, hearing loss is the third most common physical condition caused by aging.

Causes & Types of Hearing Damage
Other reasons for diminished hearing include exposure to loud noise, head trauma, viruses or disease, tumors, hearing loss that runs in the family and malformations of the inner ear. Hearing loss can also occur due to earwax buildup, a ruptured eardrum or an object getting jammed into the ear.

When hearing loss is related to aging, it’s due to changes occurring in the inner ear over time. This type of hearing loss, which is called presbycusis, is often slow but steady and may be mild or severe, but is always permanent.

Other types of hearing loss include conductive hearing loss, which happens when there are problems in the ear canal, eardrum or middle ear and its bones, or sensorineural hearing loss, which occurs due to problems with the inner ear, also known as nerve-related hearing loss. Presbycusis belongs in this second category. Some people experience a mix of both conductive and sensorineural hearing loss.

Many people experience impairment from exposure to loud noises, either suddenly or over a prolonged period of time. For example, people who work in very noisy environments or listen to extremely loud music for long periods of time can experience this type of loss.

Some people who experience hearing loss also hear a ringing in their ears, known as tinnitus. This can be extremely debilitating and distracting.

Using a Hearing Aid
While presbycusis — the most common type of hearing loss — may be permanent, that doesn’t mean there’s nothing you can do about it. For most people, it can be managed with a hearing aid. These are small, electronic devices worn in or behind the ear. They work by magnifying sound vibrations entering the ear. The National Institute on Deafness and Other Communication Disorders (NIDCD), a division of the National Institutes of Health (NIH), estimates that only one in five people who could benefit from the use of a hearing aid actually uses one.

Medicare does not cover all types of hearing aids, although it will cover a hearing evaluation if ordered by your healthcare provider. Bone-anchored hearing aids (BAHA), which attach to the bone behind the ear, have been classified as prosthetic devices and may be covered by Medicare if other policy requirements are met. These aids are surgically implanted devices that transmit sound vibrations to the inner ear through the skull, bypassing the middle ear.

Cochlear Implants
When hearing aids aren’t sufficient, hearing loss may be surgically treated with cochlear implants, which are medical devices that bypass the damaged part of the ear and stimulate the auditory nerve. Cochlear implants, which are also surgically implanted, produce a range of sound but do not replace normal hearing. They are used in cases of severe hearing loss and are not recommended for people who can manage their loss with hearing aids alone.

According to the NIH, more than 188,000 people worldwide use cochlear implants, including more than 41,000 American adults and 26,000 American children. In the United States, these implants are usually covered by insurance, including Medicare.