Incidence and Prevalence of Hearing Loss and Hearing Aid Use
in the United States - 2008 Edition
Communication skills are central to a successful life for all
individuals. Such skills affect education, employment, and
general well-being. However, each day is a challenge for those
individuals who have a communication disability.
- The pertinent literature presents different statistics
concerning the overall incidence and prevalence of individuals
with hearing loss. Readers should keep in mind that data are
often collected via voluntary surveying of the
non-institutionalized population (i.e., with participants who
admit to having some degree of hearing loss), as well as other
survey methods (1-6). Clinical data to determine if hearing
impairment rates are changing are not available since there are
no ongoing, clinical, annual studies of hearing impairment in
the United States (6).
- An independent researcher estimates that 31.5 million
Americans had hearing loss in 2004, with continued major
increases in the baby boomer and elderly 75+ age brackets (5).
This figure is similar to the figure gleaned from the National
Health Interview Survey in 2005 (3).
Incidence/Prevalence of Selected Causes of Auditory
An acoustic neuroma is a tumor arising in or just outside the
internal auditory canal, from the nerve sheath of the inferior
branch of the vestibular nerve.
- According to several studies, acoustic neuromas may affect
one in 80,000 to 100,000 individuals (7, 8).
- Acoustic neuromas are thought to account for the majority
of intracranial nerve sheath growths (8).
Ototoxicity is drug-induced damage affecting the auditory
- Ototoxicity has been recognized since the 1800s. Among the
drugs on the list as ototoxic substances: aminoglycoside
antibiotics, loop diuretics or antineoplastic drugs,
salicylates, and antimalarial drugs (9-11).
- The number of therapeutic substances and industrial
chemicals available that can cause a greater or lesser degree
of ototoxicity is very large (12). Over 130 drugs and chemicals
are reported to be potentially ototoxic (10, 13).
- The most common symptoms of drug-induced ototoxicity are
tinnitus, sensorineural hearing loss, and vestibular
- Ototoxicity-induced hearing loss tends to first manifest in
the high frequencies and in the basal portion of the cochlea
- Individual susceptibility seems highly variable, but some
predisposing factors are renal failure; age; combination of
ototoxic drugs; familial sensitivity to ototoxic effects, or
previous neurosensorial deficit (13).
Meniere's disease affects the membranous inner ear and may
be characterized by episodes of deafness, vertigo, and
- Meniere's disease affects 615,000 individuals in the
United States (15).
- Meniere's Disease is more common in adults, with an
average age of onset in the fourth decade, the symptoms
beginning usually between ages 20 and 60 years (16).
Otosclerosis is an abnormal growth of bone that affects the
function of the ossicles and can invade the inner ear.
- Otoslcerosis is an uncommon disease, typically presenting
in young patients, with a 2:1 female:male ratio. It is
bilateral in up to 85% of patients, but is often asymmetric
- Otosclerosis occurs most frequently between 30 years and 50
years of age and is known to worsen during pregnancy. The
etiology remains unknown, although an inflammatory response may
be responsible. The condition may also be inherited (17).
- Otosclerosis occurring with other pathologies has received
little attention in the literature, although these concomitant
occurrences can be clinically relevant. One study found
clinical pathologic relationships between oto- and vestibular
symptoms and otitis media (18).
Presbycusis is the loss of auditory sensitivity as a result of
- Hearing loss is the third most prevalent chronic condition
in older Americans, and it is the number one communicative
disorder of the aged; between 25% and 40% of the population
aged 65 years or older is hearing impaired (19, 20).
- The prevalence of presbycusis rises with age, ranging from
40% to 66% in patients older than 75 years, and more than 80%
in patients older than 85 years (19).
Tinnitus is often described as "head noises" or
"ear noises," with ringing, roaring, or hissing in the
ears as common characteristics.
- One-third of all adults report experiencing tinnitus at
some time in their lives. Ten percent to 15% of adults have
prolonged tinnitus requiring medical evaluation (21).
- Up to 18% of the general population of industrialized
countries is mildly affected by chronic tinnitus, and 0.5%
report tinnitus having a severe effect on the ability to lead a
normal life (22, 23).
- Prevalence estimates of individuals with tinnitus vary; an
overview of several studies indicate a 10%-15% rate in adults
- While the exact cause of tinnitus is unknown, it may be a
symptom of other problems such as hearing loss, exposure to
loud noise, exposure to ototoxic medicine, or allergies (25,
Incidence and Prevalence by Type of Hearing Loss
Central Auditory Processing Disorder (CAPD)
Central auditory processing disorder refers to limitations in
the ongoing transmission, analysis, organization, transformation,
elaboration, storage, retrieval, and use of information contained
in audible signals (27).
- The body of literature on CAPD indicates that the disorder
is not uncommon. Several groups of patients have been
identified with CAPD such as children with language-learning
problems, people with known lesions of the central auditory
system, people complaining about an apparent inability to hear
well in difficult listening situations, and people with
age-related changes in the central rather than the peripheral
auditory system (28).
- Prevalence data for CAPD are lacking. Although reports have
appeared consistently in the literature describing auditory
perceptual and auditory processing deficits associated with a
variety of conditions, no authoritative estimates of the
prevalence of CAPD are available (29).
- Age-related CAPD abnormality has been described in many
studies with widely varying prevalence reported. To date, there
has been only one population study to report prevalence of this
age-related condition, and these rates were significantly lower
than in reports from clinical studies (30).
Conductive Hearing Loss
- According to one study within a population of individuals
with Rett Syndrome, the prevalence of hearing loss was
increased in older participants and in those with seizures
requiring the use of anticonvulsants (31).
- Hearing loss, both sensorineural and conductive, has been
reported in patients with rheumatoid arthritis (RA).
Sensorineural hearing loss of the cochlear variety is a common
finding in patients with RA, whereas conductive loss, although
seen, is much less common. Increased laxity of the middle ear
transducer mechanism is the likely cause of the conductive
Hyperacusis may be defined as an unusual intolerance of
ordinary environmental sounds presented at normal levels.
- Little research has been done on hyperacusis. One study
suggests that the prevalence of hyperacusis in the general
population is probably underreported when it occurs with
medically recognized symptoms such as tinnitus, headache, or
- Hyperacusis is mainly a consequence of the noise level in
the 21st century, owing to dramatic changes in people's
lifestyles. Of every 100 people affected with otological
complaints (e.g., tinnitus and hyperacusis), 20 are affected by
hyperacusis. Because of its high incidence, this symptom has
long been the subject of investigation (34).
- Hyperacusis is associated with concentration difficulties,
use of ear protection, avoidance, tension, and sensitivity to
light/colors. According to one study, hyperacusis is a common
Mixed Hearing Loss
Authoritative data concerning the general incidence and
prevalence of mixed hearing loss are unavailable in the allied
health or medical literature.
Sensorineural Hearing Loss
Sensorineural hearing loss (SNHL) describes abnormalities of
the inner ear and/or nerve pathways beyond the inner ear to the
- Sudden hearing loss is infrequent, with an estimated 5-20
cases yearly per 10,000 individuals (35).
- Sudden sensorineural hearing loss (SSHL) is a symptom of
cochlear injury resulting from idiopathic causes. It is defined
as a sensorineural hearing loss of 30dB or more over at least
three contiguous audiometric frequencies that develops over a
period of a few hours to three days (36, 37).
- In SSHL, many hypotheses have been proposed to explain the
etiology: viral inflammation, vascular occlusive disease,
allergic reactions, rupture of intralabyrinthine membranes,
local histamine production, and autoimmune disease (36, 38,
Hearing Aid Use and Cochlear Implants
- According to a study conducted 2004, there were 24.1
million individuals with a hearing loss who do not own a
hearing aid device. This is in contrast to 12.5 million
individuals who own hearing instruments, and 11.1 million
individuals who use their instruments (5).
- About 6 out of 10 hearing instrument owners and non-owners
are male (5).
- The overall prevalence of device nonuse, according to one
study, was noted to increase slowly with time. The role of
psychological factors in contributing to the decision of an
individual to elect to opt out of device use remains unproven
- Both hearing loss and the use of hearing aids are widely
reported as unacceptably different from normal, or
stigmatizing. Perceptions of stigmatization often result in
denial of hearing problems and lack of adherence to
professional recommendations to use hearing aids (41, 44).
- Barriers to hearing aid use are complex and multifactorial
involving, among other things, a lack of system commitment to
utilization of hearing aids and hearing aid design, fit issues,
and price of aid (42, 44).
- Overall customer satisfaction with new hearing instruments
is 77%, placing this product in the top-third of products and
services in the United States (5).
- Cochlear implants are electronic devices that contain a
current source and an electrode array that is implanted into
the cochlea; electrical current is then used to stimulate the
surviving auditory nerve fibers (43). Worldwide, about 60,000
cochlear implants have been placed during the past 20 years,
approximately one half of them in adults and one half in
- Data vary as to how many individuals in the U.S. are
potential candidates for receiving cochlear implants. These
figures range from 250,000 (46) to 1 million people (45).
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More about cochlear implantsâ€¦
(NIH Pub. No. 03-5360A). Bethesda, MD: Author.
Compiled by Andrea Castrogiovanni * American
Speech-Language-Hearing Association * 2200 Research Boulevard,
Rockville, MD 20850*