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Hearing loss typically doesn’t happen overnight. Its earliest signs—an extra “What did you say?” here, a missed word there—are so subtle they may be easy to dismiss until everyday conversations feel much harder.

Although these signs may be minor at first, ignoring them can lead to longer-lasting impacts on health. “Research clearly shows that untreated hearing loss can accelerate cognitive decline,” says William H. Shapiro, AuD, director of audiology and co-director of the Cochlear Implant Center at ����TV Langone Health. “It can impact your social relationships and quality of life.”

As part of National Audiology Awareness Month, Dr. Shapiro shares five early signs of hearing loss you shouldn’t ignore—and why you should include regular hearing tests as part of a preventive healthcare plan.

Sign No. 1: It’s Harder to Hear in Restaurants

As hearing declines, noisy settings such as restaurants, group gatherings, or even family celebrations present extra challenges to hearing. Background noise common in group gatherings or busy public spaces competes with speech, making it hard to follow conversations clearly.

“It’s difficult for our auditory system to separate speech from noise,” Dr. Shapiro explains. “So when speech and background noise happen at once, even mild hearing loss becomes much more noticeable.”

Modern hearing aids are designed with this in mind, Dr. Shapiro adds. Sophisticated directional microphones and noise-reduction technology help people focus on speech while minimizing background distractions. For those with milder hearing loss, even over-the-counter hearing aids can be helpful.

Sign No. 2: You Have Trouble Understanding Higher-Pitched Voices

Women’s and children’s voices often fall into higher frequencies, which are typically the first to present challenges with age-related or noise-induced hearing loss. Consonants like b, c, and d also fall into the high-frequency category—so “car” and “carve,” for example, may sound alike to those with high-frequency hearing loss.

“Someone may say that their wife or daughter constantly mumbles when in fact they are losing their ability to hear those higher frequency sounds,” notes Dr. Shapiro.

Sign No. 3: You Have Ringing or Buzzing in Your Ears

Tinnitus—which refers to any unwanted sound, including a ringing, buzzing, or humming in the ears—often accompanies hearing loss, especially in quiet settings. For many, it’s one of the first symptoms that brings them to an audiologist.

“Tinnitus can be especially disruptive at night, when it’s quiet,” explains Dr. Shapiro. “Many patients find relief when they’re fit with hearing aids, because the devices amplify environmental sounds and make the tinnitus less noticeable.”

Sign No. 4: You Have Unexplained Dizziness or Balance Problems

Hearing and balance are closely connected. Both rely on the inner ear and share the same cranial nerve. That means some people with hearing loss also experience dizziness or instability.

“Audiologists can do vestibular testing to help determine if balance problems are related to inner ear changes,” says Dr. Shapiro. "At ����TV Langone, vestibular rehabilitation is an important part of care for older adults with these combined issues.”

Sign No. 5: Family and Friends Are Speaking Up

Many people with hearing loss don’t realize how often they say, “What?” or “Can you say that again?”—but their family members do. A spouse may speak louder or repeat things constantly, while a friend may comment on the TV being too loud.

“If there’s a vision problem, it’s between you and the page. But with hearing, it’s a communication problem between two people,” Dr. Shapiro explains. “Often, the person with hearing loss says, ‘I don’t have a problem,’ but their partner is already acting as their hearing aid. That’s a big sign to pursue an evaluation.”

Even more reason: When conversation grows exhausting, people may begin to avoid social settings completely—a pattern linked to isolation, depression, and cognitive decline.

Getting Help for Suspected Hearing Loss

Even if signs of hearing loss seem minor, it’s important to get a professional hearing evaluation. Dr. Shapiro recommends that everyone over the age of 60 get a routine hearing check—even if they aren’t noticing symptoms—since hearing loss impacts other aspects of health.

“Seeing an audiologist doesn’t automatically mean you’ll walk out with a hearing aid,” Dr. Shapiro emphasizes. “It means you’ll get answers—and if you do need help, today’s technology is better than ever at improving quality of life.”

For some with medical problems such as fluid in the ear, medication may be indicated. For others with age- or noise-related hearing loss, hearing aids tailored to the patient’s lifestyle can provide immediate relief. Modern devices are small, discreet, and highly programmable. Often, they’re able to connect directly to smartphones or other devices. Some models can even switch modes for different environments, from quiet conversations to noisy restaurants or concerts.

At ����TV Langone, the process usually begins with a referral from a primary care physician or ear, nose, and throat specialist. From there, a comprehensive hearing test with an audiologist helps determine whether hearing loss is present and what interventions might help. To make an appointment with one of our audiologists, visit ����TV Langone Audiology Associates.