Richard Einhorn first noticed that he was losing his hearing in a way that many others do—through a missed connection, when he couldn’t make out what a colleague was saying on a phone call. He was 38, which might seem early in life to need a hearing aid but in fact is common enough. His next step was common too. “I ignored it,” Einhorn, now 72, told me. “Hearing loss is something you associate with geezers. Of course I hid it.” He didn’t seek treatment for seven years.
About 15 percent of Americans, or nearly 53 million people, have difficulty hearing, according to the CDC. Yet an AARP survey found that Americans older than 40 are more likely to get colonoscopies than hearing tests. Even though hearing starts to deteriorate in our 20s, many people think of hearing damage as a sign of old age, and the fear of being seen as old leads people to delay treatment. According to the Hearing Loss Association of America, people with hearing loss wait, on average, seven years to seek help, just as Einhorn did.
When people ignore their hearing loss, they put themselves at a higher risk for social isolation, loneliness, and even dementia. One of the best things you can do to feel less old is, ironically, get a hearing aid. And in the past two years, these devices have become cheaper, more accessible, and arguably cooler than they’ve ever been, even before the FDA approved Apple’s bid last week to turn AirPods into starter hearing aids. This new technology is more of a first step than a complete solution—think of it as analogous to drugstore reading glasses rather than prescription lenses. That, more than anything about AirPods themselves, may be the key to softening the stigma around hearing aids. Creating an easier and earlier entry point into hearing assistance could help Americans absorb the idea that hearing loss is a spectrum, and that treatment need not be a rite of passage associated with old age.
As it stands, one demographic that could especially benefit from destigmatized hearing aids is older men. “Men are at a greater risk for hearing loss early on because they have typically had more noise exposure than women,” says Steven Rauch, who specializes in hearing and balance disorders at Harvard Medical School. But men are also less likely to go to the doctor. (Several men I interviewed spoke about being prodded by their wives to go to an audiologist.) Instead, many hide their hearing loss by nodding along in conversation, by hanging back at social gatherings, by staying home.
Faking it makes the situation worse. Without treatment, hearing can decline, and people become socially isolated. “When you’re sitting in a room and people are talking and you can’t participate, you feel stupid,” says Toni Iacolucci, a communication-access advocate who waited a dozen years before she got a hearing aid. “The amount of energy you put into the facade that you can hear is just exhausting.”
Compensating for untreated hearing loss is so taxing, in fact, that it can have a meaningful impact on the brain. “Hearing loss is arguably the single largest risk factor for cognitive decline and dementia,” says Frank Lin, the director of the Cochlear Center for Hearing and Public Health at Johns Hopkins University. Lin and his colleagues have found that mild hearing loss doubles the risk of dementia, and moderate loss triples it. In this context, a hearing aid can look almost like a miracle device for slowing aging: In that same study, Lin also found that among older adults at increased risk for cognitive decline, participants who wore a hearing aid for three years experienced about 50 percent less cognitive loss than the control group.
Lin hypothesizes that the difference is because of cognitive load. “Anybody’s brain can buffer against the pathology of dementia,” he told me. “But if you have hearing loss, too, a lot of that buffer is having to be used up to deal with hearing loss.”
In many cases, the gap between onset and treatment means years of missed conversations and declining social connection; hearing loss is associated with both loneliness and isolation. For Einhorn, who worked as a composer and a classical-record producer, his declining hearing meant maintaining a constant effort to keep up appearances. He remembers going to restaurants and tilting his head entirely to the left to favor his better ear while denying to his friends that he had any issue with his hearing; he started to avoid going to parties and to the movies. “Phone calls became hellish,” he told me. He eventually had surgery on one ear and finally started wearing hearing aids in 2010, when he suddenly lost all of his hearing on one side. “When I lost my good ear, I fell into an abyss of silence and isolation,” he says. “It was an existential crisis: Either I figure out how to deal with this, or, given the isolation I was already experiencing, it was going to become really serious.” Only then did he realize that the devices were less visible than he’d imagined and that the integration into his world was worth the ding to his vanity. Like many who use the devices, he still struggles to hear at restaurants and parties (carpets and rooms without music help), but the hearing aids have made an enormous difference in his quality of life. He still regrets the years he spent posturing instead of listening. “When you get to 72, you realize you’ve done a lot of dumb things, and not getting treatment was probably the dumbest thing I’ve ever done in my life,” he said.
That anyone is straining this much when a fix exists is a testament to how powerful ageism and the pressure to project youth can be. As long as people see the choice as one between hearing well and looking young, many will opt for faking their ability to hear. Overcoming that association with age may be the last challenge of persuading people to try hearing aids out.
Some of the barriers were, until recently, more basic. Hearing aids were available only with a prescription, which usually requires visits to an audiologist who calibrates the device. Prescription hearing aids also cost thousands of dollars and aren’t always covered by insurance. Pete Couste, for instance, did go to the doctor a couple of years after first noticing he was off pitch when playing in his band, but he decided not to get hearing aids because of the cost. Instead, he dropped out of the band and his church choir.
But these barriers are getting lower. In 2022, the FDA approved the sale of hearing aids to adults without a prescription, opening the technology up to industry for the first time. Over-the-counter options have now hit the market, including from brands such as Sony and JLab. Apple’s hearing-aid feature, compatible with some AirPod Pros, is the first FDA-approved over-the-counter hearing-aid software device and will be available later this fall via a software update. EssilorLuxottica plans to release the first-ever hearing-aid eyeglasses later this year. Hearing about the over-the-counter options triggered Couste to address his hearing loss, and he ended up with prescription aids that have made a “tremendous difference” in his confidence, he told me. This year, he went to four weddings and a concert at Red Rocks; he’s even started to play saxophone again and plans to get back onstage within a year.
None of that undoes hearing aids’ association with aging though. A selling point of the new AirPod technology is simply that “everybody wears AirPods,” Katherine Bouton, a hearing-loss advocate and the author of the memoir Shouting Won’t Help, told me. “The more you see people wearing something, the more normal it becomes.” At the same time, AirPods are typically a signal that someone’s listening to music or a podcast rather than engaging with the world around them: The AirPods might improve someone’s hearing, but they won’t necessarily make hearing loss less lonely. Even if Iacolucci’s hearing loss could be treated with AirPods, she doesn’t think they would fully address the loss’s impact: “I still have to deal with the internal stigma, which is a thousand times worse,” she told me.
The real power of the Apple technology, then, might be that it’s targeted to users with mild to moderate hearing loss. Changing the stigma around hearing loss will take far more than gadgets: It’ll require a shift in our understanding of how hearing works. “Hearing loss implies that it’s binary, which couldn’t be further from the truth,” Lin said. Most people don’t lose their hearing overnight; instead, it starts to deteriorate (along with the rest of our body) almost as soon as we reach adulthood. Over time, we permanently damage our hearing through attending loud concerts, watching fireworks, and mowing the lawn, and the world is only getting louder. By 2060, the number of Americans ages 20 years and older with hearing loss is expected to increase by 67 percent, which means that nearly 30 million more people will need treatment. If devices we already use can help people transition more easily and at a younger age to using hearing assistance, that could make the shift in identity less stark, easing the way to normalizing hearing aids and changing the idea that they’re for geezers only.
