Susan Bianco noticed something was off during a conversation with her husband. He had to repeat himself constantly. Phone calls became a struggle. Crowded rooms turned into a frustrating blur of overlapping voices she couldn't untangle.
Then came the buzzing. A persistent sound in her ears that nobody else could hear, especially when fatigue set in. The 87-year-old from Lancaster had stumbled onto one of hearing loss's most overlooked early warnings: tinnitus, the phantom ringing or buzzing that arrives before the hearing itself noticeably fades.
Tinnitus affects roughly 10% of American adults, according to the Centers for Disease Control and Prevention. But it rarely travels alone. About 13% of all U.S. adults report hearing difficulties, a number that nearly doubles to 27% among people 65 and older. These conditions cluster together, often with tinnitus appearing first.
"Tinnitus and similar sound disorders are frequently among the earliest signs of hearing loss," explained Dr. Jackie Price, an audiologist at Penn State Health Otolaryngology. "You can't stop aging, but you can take steps to conserve your hearing and reduce your risk of developing both."
Where the phantom sounds come from
The sounds aren't real, but the problem is. Inside the cochlea, a spiral-shaped chamber deep in the inner ear, sits a delicate army of sensory hair cells. Their job is converting vibrations into electrical signals the brain understands as sound.
When those cells sustain damage, they stop transmitting information properly. As hearing declines, communication between ear and brain frays. The result: phantom sounds the brain generates to fill the gap. Patients describe these as ringing, buzzing, hissing, whooshing, or even the roar of a passing freight train.
For some, the noise is occasional background static. For others, it becomes relentless and intrusive, tangling with sleep, concentration, and mood. Research links untreated hearing loss and tinnitus to faster cognitive decline, depression, and increased fall risk.
But the damage doesn't have to happen. Loud noise is the primary culprit, and it's largely preventable.
Price recommends hearing protection whenever sound levels exceed 85 decibels. That threshold covers concerts, sporting events, fireworks, and lawn mowing. Many people skip protection during these activities, compounding the risk. "I counsel people to wear hearing protection when they're mowing grass," Price said. "If they're also listening to music through earbuds, that's a double whammy of excess noise for 45 minutes or more, sometimes twice a week."
Effective earplugs and earmuffs should carry a Noise Reduction Rating of at least 22 decibels. But insertion matters enormously. Foam earplugs need to be compressed, rolled, and inserted correctly with the ear canal gently opened. Improper placement leaves dangerous gaps.
Once damage occurs, reversal isn't possible. Hearing loss and tinnitus have no cure. But treatment exists.
For hearing loss, aids and assistive devices restore communication ability. For tinnitus, Tinnitus Retraining Therapy combines counseling and sound therapy. The approach teaches patients to cope with the condition while masking it with gentle background noise. Bianco's hearing aid was programmed with a soft, continuous sound resembling rainfall. "It's a sound I don't mind too much," she said.
Early detection changes outcomes. Many people think their hearing is fine until testing reveals hair cell damage or high-frequency loss hiding beneath normal conversation. A hearing evaluation can catch these silent shifts before they compound into noticeable difficulty.
Anyone experiencing ringing or unusual ear sounds should schedule an evaluation. The test serves as both a baseline and an opportunity to begin protective measures before further loss occurs.
Author Jessica Williams: "Tinnitus gets dismissed as an annoyance when it's actually your ears' distress signal, and most people wait years before getting tested. The time to act is the moment you hear the ringing."
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