Clinical Research
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December 2025
About Hearing Loss
The science behind the small signs you need a hearing test
Product
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June 2026
Reviewed by Dr. Bess Nagler, AuD
There's a particular kind of frustration that builds quietly over years. People seem to have gotten harder to understand. Restaurants feel louder than they used to. You keep the TV one or two notches higher than anyone else in the room seems to need it. You're exhausted after dinner parties in a way that doesn't quite track with how much you drank or how late you stayed.
Often, the first signs of hearing loss feel like minor inconveniences that are easy to dismiss or rationalize. But addressing hearing loss early makes a meaningful difference for your brain, your relationships, and your quality of life.
At Fortell, our audiologists hear it all, and the patterns between patients are remarkably consistent. What patients often label as a social problem is often a hearing one.
"Everyone mumbles now”
This is usually the first complaint. It feels like a social critique (“why can’t people just enunciate!?”) rather than a medical symptom, which is exactly why so many people carry it for years without connecting it to their hearing health.
Here's what's actually happening: the cochlea—the spiral-shaped structure deep in your inner ear—is lined with thousands of microscopic hair cells. These cells are organized like a piano keyboard: the ones near the base of the cochlea respond to high-pitched sounds while the ones at the apex respond to low-pitched sounds. The outer hair cells at the base of the cochlea are the most vulnerable to the outside environment, and are often the first to experience damage¹.
This means that high-frequency sounds are often the first to go for those with hearing loss. These are where consonants like “s” “f” “th” “sh” and “z” live. Meanwhile, vowels produce the lower pitched sounds. Hearing vowels clearly gives you the sensation of hearing speech; however, without the ability to distinguish consonants, words start to sound mumbly.
The high frequency sounds carry a disproportionate amount of information in English. The difference between “f” “s” and “z” or the two “th” sounds differentiate hundreds of word pairs². For example “fan” from “van” or “sip” from “zip” or “thigh” from “thy.” Without high-frequency sounds in tact, the person you’re listening to might sound careless, but in reality your ears and brain are filling in less of the picture.
Understanding speech in background noise is more difficult
A cocktail party, a restaurant on a busy Friday evening, or a conference room with twelve people talking over each other… These environments have shifted from merely loud to completely disorienting. Where once you could easily pick out a person’s voice over the noise to have a conversation, you now find yourself unable to hear their words above the din of the room.
This challenge is what researchers call “The Cocktail Party Problem” which describes the brain’s remarkable ability to separate a target signal (the person you’re talking to) from competing signals (everyone else). That separation relies on the health of the ear-brain connection. With sensorineural hearing loss, the hair cells in the inner ear degrade over time, and the brain receives fewer and weaker signals.
You're tired after conversations
When the ear-brain connection is compromised, the brain tries to compensate by filling in gaps. This constant guesswork increases listening effort, which can quickly lead to mental exhaustion during conversations. In clinical literature, this is called “auditory fatigue,” and it’s a measurable phenomenon³.
As a consequence of hearing loss, all listening becomes effortful and cognitive load is constantly high. Your brain compensates by redirecting processing power from memory and focus to decipher words, creating constant mental strain. The result is a kind of exhaustion that doesn’t seem to match the activity. You sat through a two-hour lunch with friends, but you feel like you ran a 10k. In a very real sense, your brain was sprinting the entire time.
You feel more isolated
It starts with small decisions that seem completely reasonable at the time. You skip the birthday dinner because the restaurant is always so loud or you leave the party earlier than you used to because you get tired quicker. You may chalk it up to “getting older” but what looks like a quieter season of life is sometimes the nervous system protecting its resources.
Several studies reflect the connection between isolation and hearing loss. In one study of nearly 6,000 adults⁴, those with severe to complete hearing loss had nearly four times the odds of experiencing loneliness, and those with mild to severe hearing loss had meaningfully higher odds of significant depressive symptoms compared to those with normal hearing. The connection isn't surprising when you consider what's actually happening: the more effortful conversation becomes, the less of it you seek out and the less of it you seek out, the more isolated you become.
This isn't a sign of depression appearing out of nowhere, it's a downstream effect of something treatable and the first, simple step is getting a hearing test.
You watch people's faces when they speak and can’t follow conversations with multiple talkers
You might not have named it yet, but you've noticed that phone calls are harder than in-person conversations or that you struggle more when someone is speaking from another room. You’ve found that the best listening conditions are when you can clearly see the person’s face.
This is lip-reading (or what researchers call “visual speech reading”) is often done without any conscious decision to start. The brain, hungry for more information, reaches for visual cues to supplement what the peripheral auditory system is unable to gather⁵. It’s a clear sign that you’re adapting and that your hearing loss has progressed far enough that the ears alone are no longer sufficient.
When multiple people are speaking at once, lip reading becomes impossible. Your eyes can’t take in two sets of mouths simultaneously, and you’re often left asking people to speak one at a time so you can hear them.
You often miss important, everyday sounds
Someone answers the door before you even hear a knock. The microwave has been beeping for a while, apparently. Your phone rang and you only found out when you saw the missed call.
These aren't moments of distraction. They're the same high-frequency loss described earlier, showing up outside of conversation. As noted earlier, age-related hearing loss most often affects the ability to hear high-pitched sounds first (a phone ringing, a microwave beeping) while the ability to hear lower-pitched sounds is often preserved.
The dissonance is confusing. You can hear other sounds or register that someone next to you is talking, but you can't hear that a timer went off. It may make you feel uneasy or on the edge of anticipation that you’re going to miss something important.
Your family or friends have told you that you need a hearing test
Age-related hearing loss arrives slowly and progressively. There’s no sudden moment or dramatic event, just a gradual narrowing of the range of sounds you can access. Your brain adjusts in real time and masks the loss until it’s so acute that you can’t avoid it. This is why most people wait an average of nine years⁶ before seeking a hearing test or hearing aids.
The signs are there long before that and the people around you likely notice them before you do. A hearing evaluation takes about half an hour and it is by most measures, the lowest-friction health screen available for adults. If your family and friends are commenting that it might be time to get tested, it’s probably worth checking out.
If any of this feels familiar, the first step is to get a hearing evaluation. Get started by booking an appointment with a Fortell audiologist here.
² ScienceInsights. (2026, March 8). What is a fricative? Definition and speech sounds.
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