Read my lips: 36 million Americans have some degree of hearing loss -- and many are in denial about it. Only a fifth of those who would benefit from help for hearing trouble get it, according to the American-Speech-Language-Hearing Association.
"Hearing loss is an occupational hazard of getting older," says Richard M. Rosenfeld, chief of otolaryngology at SUNY Downstate Medical Center in New York City. By "older" he means, well, any of us. Sound exposure -- to rock concerts, loud workplaces, power tools, iPods -- adds up over time, so it's possible to begin losing some hearing in early adulthood. Smoking and chronic diseases (including circulatory ailments like diabetes, heart disease, and hypertension) can change blood supply to the ear, causing damage. Certain "ototoxic" medications, from aspirin and some antibiotics to quinine and chemotherapy drugs, can worsen hearing, too.
Damage tends to be so gradual that you might not notice. By ages 45 to 65, about a fifth of adults have some hearing loss, as do almost half of all 75-year-olds, says the National Institute on Deafness and Other Communication Disorders.
Here are six early warning signs of hearing loss:
Warning sign: Irritation that women and kids don't "speak up" enough
Higher-pitched sounds are among the first to go unheard, Rosenfeld says. That's because they're picked up by the most external part of the cochlea, the cavity of the inner ear where little hair cells pick up sound vibrations and convert them to nerve impulses that the brain recognizes as sounds. This external cochlea happens to be the most vulnerable to damage by chronic noise or health problems.
Women and children can be harder for someone with hearing problems to understand because they tend to have higher-pitched voices than men. "Many people brush off this change for a long time before realizing it's a hearing problem," Rosenfeld says. "It doesn't suddenly jump out and bite you."
Related sign: Trouble hearing other high-pitched sounds. These can include the cymbals or flute in music, babies crying, squeaks, and birdsong.
Warning sign: Not being sure where a sound is coming from
When someone starts talking, people with perfect hearing have an almost intuitive sense of where the speaker is in the room. Out in nature, a sharp-eared listener can easily tell where a bird or other noise is located. But for those with hearing loss, this ability to localize sounds is impaired. The person spends time looking around for visual cues to get a sense of where the sound or voice is coming from.
Related sign: Craning your neck to see where a speaker or sound is located. Interestingly, hearing loss can affect one ear more than another -- so you get a different signal from each side of your head. This makes localizing sounds more challenging, depending on where you and the sound are positioned.
Warning sign: Being asked to turn down the TV
Do you tend to set the TV louder than other people want it? Is controlling the volume a contact sport in your house? Amping it up is one of the most common warning signs of hearing loss, says audiology director Stephanie Lockhart of the University of Cincinnati Medical Center.
When we set the volume control to where it's comfortable for us, we have little idea how that sounds relative to others' ears. But if one viewer has good hearing and the other doesn't, the contrast is readily apparent to the person who hears fine.
Related sign: Playing your MP3 player so loudly that others say they can hear it through your headphones. "If a person a few feet away from you can hear your music, you're either a person who really enjoys music or one who is having trouble hearing." Rosenfeld says. (And those in the former group are destined for the latter anyway, Rosenfeld adds: "MP3 devices are the most effective way to induce hearing loss that you could devise.")
Warning sign: Complaints from relatives about having to repeat themselves to you
One of the earliest signs of ear trouble comes from your mouth. Someone with difficulty hearing often begs for repetition or clarifications: "What did you say?" "Huh?" "What??" And if you don't notice this trait, the relatives and good friends you see every day do.
Your companions, in turn, may say things to you like, "I'm tired of repeating myself to you." "You don't seem to know what's going on the way you used to." "Why don't you pay attention?" Or they may just come out and say it: "You're going deaf!" "You can't hear!"
Spouses of those with hearing loss often become "human hearing aids," having to interpret and repeat everything that goes on. As you can imagine, they grow frustrated over time. A 2004 study at the University of California, San Francisco, School of Nursing found that spousal hearing loss increased the likelihood of poorer physical, psychological, and social well-being in partners. Wives of men with hearing loss bore the biggest burden.
Related sign: Mishearing what was said and saying the wrong thing in response -- which can make you look loopy or inattentive and further frustrate your companions or embarrass you.
Warning sign: Leaning in closer to hear your companion in a restaurant or at a party
Say you're at a lovely table, looking forward to nice evening with a friend, but then you can't hear your tablemate over the clinking of glasses and silverware, the piped-in music, and the murmurs of other diners. It's frustrating "“ and, often, the problem isn't the environment. It may be you.
Background noise makes it more difficult to separate the signal you want to hear from the distractions. If your hearing isn't 100 percent, Rosenfeld says, "You begin to appreciate a quiet room, or an amplifier like a microphone."
Related sign: Needing to pay attention more closely than before in a conversation with two or more other people. Having even more voices to attend to adds to the challenge. You may find yourself looking more intently at each speaker, trying to read lips or interpret body language. In general, it takes more energy to consciously focus than to be the passive, less attentive listener you once were.
Warning sign: Avoiding favorite activities or places
People who have trouble hearing often find their world grows smaller as they grow more sensitive to the frustration or embarrassment of not being able to follow conversations and enjoy themselves. Without necessarily identifying hearing problems as the cause, they simply withdraw. Self-esteem can wilt.
"Avoiding certain environments because you can't hear well is a common warning sign of hearing loss," Lockhart says.
Related sign: Depression. There's a growing link between hearing loss and depression, a condition that shares the warning sign of increased social withdrawal. As many as 60 percent of those with hearing loss also have symptoms of depression, according to a 2008 report by Australia Hearing. "Hearing loss can lead to isolation and other emotional conditions that can affect both qualify of life and mental health," says Sergei Kochkin, executive director of the Better Hearing Institute.
"People who can't see are usually quick to go to an eye doctor and get glasses, but for some reason we accept hearing loss and have a stigma about saying, 'I need help,'" Rosenfeld says. Yet hearing aids have evolved "incredibly" in the past 10 to 15 years, he says. "They're basically programmed exactly to your pattern of hearing, and they're inconspicuous and lightweight." An exam by a primary physician can rule out other causes for hearing loss, such as ear infection, the jaw disorder TMJ (temporomandibular joint disorder), or a foreign object lodged in the ear.