Good morning, and welcome back to The Exercise Doc!

Have you ever noticed that restaurants seem louder than they used to be? Or maybe your spouse has started mumbling more than they did 20 years ago?

Of course, there is another possibility.

Our hearing may be changing.

Hearing loss is incredibly common as we get older, but it often happens so gradually that we don't recognize it. We turn the television up a little louder. We ask people to repeat themselves. We have more trouble following conversations when there is background noise.

And eventually, we may start avoiding situations where hearing becomes difficult.

That is why today we're talking about hearing loss after 50—why it happens, the signs you shouldn't ignore, and what you can do about it.

Then we'll tackle something many people are reluctant to consider: hearing aids. Today's hearing aids are a long way from the bulky devices many of us remember. We'll talk about when you might need one, what your options are, and why improving your hearing may be about much more than simply hearing the television better.

My goal, as always, is not to tell you what you have to do. It is to give you good information so you can make better decisions about your health.

And if you know someone who might enjoy The Exercise Doc, would you do me a favor?

Invite them to join us.

Maybe it's your spouse, a brother or sister, a friend, or someone who keeps asking you to repeat yourself. (You might want to be diplomatic about that last one.)

You can send them here: https://px60r.mssg.me/

The more people we can help stay healthier, stronger, sharper, and independent as they age, the better.

Have a great Monday!

Dr. Mike
The Exercise Doc

Signs You Shouldn’t Ignore and What You Can Do About It

Maybe you have noticed it.

You are sitting in a restaurant with friends, and everyone seems to be talking at once. You can hear the voices, but you cannot quite make out the words.

Or maybe your spouse has started saying something you really do not want to hear:

“You need to get your hearing checked.”

Your response? “I hear just fine. You mumble.”

Sound familiar?

Hearing loss is incredibly common as we get older. But because it usually happens gradually, many people do not realize how much hearing they have lost.

And hearing loss is not simply an inconvenience. It can affect your relationships, your independence, your safety, and possibly even your brain health.

The good news is that we can do something about it.

Let’s talk about what happens to our hearing as we age, the warning signs you should watch for, and when it is time to have your hearing checked.

Inside your inner ear is a tiny structure called the cochlea. Think of it a little like a microphone.

Inside the cochlea are thousands of delicate sensory hair cells that help convert sound vibrations into electrical signals. Those signals travel along the auditory nerve to your brain, where they are interpreted as speech, music, a ringing telephone, or your grandchild asking you a question.

Unfortunately, those tiny hair cells can become damaged over time.

Aging itself plays a role, but so does a lifetime of exposure to loud noises. Power tools. Lawn mowers. Concerts. Firearms. Factory equipment. And, more recently, headphones and earbuds played too loudly.

Genetics can also affect your risk, and certain medications and medical conditions can contribute to hearing loss.

The result is often presbycusis, the medical term for age-related hearing loss.

It typically affects both ears and often makes higher-pitched sounds harder to hear first.

That creates an interesting problem. You may still hear someone’s voice—you just cannot understand everything they are saying.

This is one of the most common complaints I hear about hearing loss.

People assume that hearing loss means everything simply gets quieter. Not necessarily.

Imagine someone saying:

“Please pass the salt.”

You may hear the general sound of the sentence but miss some of the consonants that make the words understandable.

So instead you hear something that sounds like:

“Plea… pa… the… alt.”

Your brain tries to fill in the blanks. In a quiet room, it may do a pretty good job. Now walk into a crowded restaurant. Music is playing. Dishes are clattering. People at the next table are talking.

Suddenly your brain has to separate one voice from dozens of competing sounds.

That is why one of the earliest signs of hearing loss may be difficulty understanding conversations in noisy environments.

Hearing loss usually does not arrive one morning and announce itself.

It sneaks up on you.

You may notice that:

There is another sign that people sometimes overlook. You start avoiding situations where hearing is difficult.

Maybe you stop going to restaurants with friends. Maybe you participate less in family conversations. Maybe you sit quietly because you are afraid you will respond incorrectly to something you did not hear.

That is when hearing loss can become much more than an ear problem.

This is an area that has received a great deal of attention in recent years.

Research has found an association between untreated hearing loss and an increased risk of cognitive decline and dementia.

That does not mean hearing loss automatically causes dementia.

There are several possible explanations.

When hearing becomes difficult, your brain has to devote more energy to figuring out what people are saying. Hearing loss may also contribute to social isolation, and reduced social interaction itself has been associated with cognitive decline.

There may also be underlying health factors that contribute to both hearing and cognitive problems.

But we now have evidence suggesting that treating hearing loss may matter.

The ACHIEVE trial, a large randomized study of older adults, found that hearing intervention did not significantly slow cognitive decline across the entire study population. However, among participants who were at higher risk for cognitive decline, the hearing intervention was associated with substantially less cognitive decline over three years.

That is important.

We should not promise that hearing aids will prevent dementia.

But maintaining your ability to communicate and remain socially engaged is certainly an important part of healthy aging.

If you are noticing any of the symptoms above—or your family keeps telling you that you are—you should consider getting a hearing evaluation.

And yes, sometimes your spouse notices the problem before you do.

That is because your brain is remarkably good at adapting. You may unconsciously start reading lips, watching facial expressions, or avoiding situations where hearing is difficult.

A hearing evaluation is painless and can determine whether you have hearing loss, how severe it is, and which frequencies are affected.

It can also help determine whether something else is contributing to the problem.

Not every hearing problem is simply aging. Earwax buildup, infections, medication effects, and other medical conditions can sometimes affect hearing.

And sudden hearing loss, particularly in one ear, is different. Sudden sensorineural hearing loss can be a medical emergency and should be evaluated promptly.

Do not wait several weeks hoping it disappears.

This is where many people hesitate. For some reason, people will wear glasses without giving it a second thought but resist hearing aids for years.

Glasses help your eyes. Hearing aids help your ears. Neither one means you are old.

Modern hearing aids are also very different from the large devices many people remember from years ago. Some are remarkably small, rechargeable, and capable of connecting directly to smartphones and televisions.

There are also now over-the-counter hearing aids available for adults with perceived mild-to-moderate hearing loss.

But they are not appropriate for everyone.

If your hearing loss is significant, affects only one ear, has occurred suddenly, or is accompanied by symptoms such as dizziness, ear pain, drainage, or significant ringing in one ear, you should have a professional evaluation.

You cannot stop aging, but you can protect the hearing you still have.

The biggest step is simple: Protect your ears from excessive noise.

If you are using loud machinery, mowing the lawn, attending a loud concert, shooting firearms, or spending time around other intense noise, use appropriate hearing protection.

And be careful with headphones and earbuds.

If someone standing next to you can clearly hear what is coming through your headphones, they are probably too loud.

Also remember that hearing protection is not just for young people. At 60, 70, or 80, protecting your remaining hearing still matters.

If you are over 50, start paying attention to your hearing just as you pay attention to your vision, blood pressure, cholesterol, strength, and balance.

Ask yourself a few simple questions. Am I turning up the television? Am I asking people to repeat themselves? Do restaurants seem unusually difficult? Am I withdrawing from conversations because I cannot follow them?

And perhaps the most important question: Are the people who know me best telling me that I do not hear as well as I think I do?

If the answer is yes, get your hearing checked.

Do not think of hearing aids or other hearing treatments as signs of getting old. Think of them as tools that help you stay connected.

Because healthy aging is not simply about living longer. It is about continuing to participate in the world around you.

And sometimes that starts by making sure you can hear it.

What You Need to Know Before You Buy

I have always found something interesting about hearing aids. Tell someone they need glasses and they usually say, “Okay. Where do I get them?”

Tell someone they might need hearing aids and suddenly you get: “My hearing isn’t that bad.” “Everyone mumbles.” “The restaurant was just noisy.”

Or my favorite:

“I hear you just fine when you’re looking at me.”

There is still a stigma attached to hearing aids that simply doesn’t exist with eyeglasses. But if you are struggling to follow conversations, turning up the television, or constantly asking people to repeat themselves, hearing aids may make a tremendous difference in your daily life.

And hearing aids have changed.

They are smaller, smarter, and easier to use than the devices many of us remember our grandparents wearing. You can even buy certain hearing aids without a prescription.

But that creates another problem.

How do you know what to buy?

Let’s sort through it.

A hearing aid is basically a tiny computer that you wear in or around your ear.

A microphone picks up sound. A processor analyzes and adjusts that sound. A speaker delivers the amplified sound into your ear.

But modern hearing aids do much more than simply make everything louder.

That is important because age-related hearing loss is not usually a matter of turning up the volume on the world.

Certain frequencies are often affected more than others. Many people can hear someone talking but have difficulty understanding the words, particularly when there is background noise.

A properly fitted hearing aid can be programmed to emphasize the sounds you have difficulty hearing while doing less to sounds you already hear reasonably well.

Some hearing aids can also reduce background noise, use directional microphones to focus on the person in front of you, connect to your smartphone, and stream telephone calls or television audio directly into your ears.

We have come a long way from the hearing aids of 30 years ago.

Here’s a simple question. Is your hearing interfering with your life?

Maybe you have trouble understanding conversations in restaurants. Maybe your spouse complains about the television volume. Maybe you are constantly saying, “What?” Or maybe you have begun sitting quietly during group conversations because it is simply too exhausting trying to figure out what everyone is saying.

That last one concerns me.

When hearing becomes difficult, some people begin withdrawing socially without realizing it.

Instead of going to dinner, they stay home. Instead of participating in a conversation, they sit quietly. Instead of calling a friend, they avoid the telephone.

That is why hearing loss is not simply about your ears. It can affect your relationships and your quality of life.

Before spending hundreds or thousands of dollars on hearing aids, I generally recommend knowing what you are treating.

A hearing evaluation can tell you how much hearing you have lost and which frequencies are affected.

t can also identify situations where you may need medical evaluation rather than simply purchasing a hearing aid.

For example, hearing loss that is much worse in one ear deserves additional evaluation.

So does hearing loss associated with persistent one-sided ringing, dizziness, ear pain, drainage, or other unusual symptoms.

And if you suddenly lose hearing in one ear, don’t order a hearing aid online. Seek medical attention promptly.

Sudden sensorineural hearing loss can be a medical emergency, and treatment may be time-sensitive.

This is where hearing aids have changed considerably.

Adults can now purchase certain over-the-counter hearing aids without seeing a doctor or audiologist first.

These devices are intended for adults age 18 and older who perceive that they have mild-to-moderate hearing loss.

For the right person, this can be a reasonable option.

OTC hearing aids may cost considerably less than professionally fitted devices, and some allow you to adjust the settings yourself through a smartphone app.

But cheaper doesn’t automatically mean better—or worse. The important question is whether the device matches your hearing needs.

If your hearing loss is more severe, complicated, or difficult to manage, working with an audiologist may be worth the additional expense.

Think of it like buying reading glasses at the drugstore versus getting prescription glasses.

Drugstore readers work wonderfully for some people. Other people need something more customized.

This is an important distinction. You may see inexpensive devices advertised online that simply amplify sound. They are sometimes called personal sound amplification products, or PSAPs.

These are not the same thing as hearing aids.

A simple amplifier makes sounds louder. That may include the sound you want to hear along with the air conditioner, dishes clattering, the dog barking, and the person talking three tables away.

A hearing aid is specifically designed to compensate for hearing loss.

When shopping, make sure you know what you are buying.

A $49 device advertised as a “hearing solution” may not actually be a hearing aid.

Here is something people don’t always expect.

You put hearing aids in for the first time and suddenly everything sounds strange. Your own voice sounds different. Paper crinkling seems ridiculously loud. You hear footsteps. The refrigerator suddenly sounds like it has developed an engine.

And you think:

I don’t like these things.

That doesn’t necessarily mean the hearing aids aren’t working.

If you have gradually lost hearing over many years, your brain has become accustomed to a quieter world. Now you are giving it sounds it hasn’t processed normally for a long time.

There can be an adjustment period.

That is one reason professional fitting and follow-up can be valuable. The hearing aids may need to be adjusted, and you may need time to adapt to them.

Don’t necessarily give up after two days.

Hearing aids now come with an impressive—and sometimes overwhelming—list of features.

Bluetooth. Rechargeable batteries. Noise reduction. Directional microphones. Smartphone apps. Automatic environmental adjustments. Telecoil technology.

Some of these features can be extremely useful.

But don’t buy a hearing aid because it has the longest feature list.

Think about your life.

If you frequently eat in restaurants or attend meetings, performance in background noise may be particularly important.

If you use your smartphone constantly, Bluetooth connectivity might matter.

If changing tiny batteries would be difficult because of arthritis or vision problems, rechargeable hearing aids may make life much easier.

Buy for the life you actually live.

Not for the technology brochure.

You may have seen headlines suggesting that hearing aids can prevent dementia.

We need to be careful here.

Untreated hearing loss has been associated with cognitive decline and dementia, but an association does not necessarily prove that one causes the other.

A major randomized study called the ACHIEVE trial looked at whether treating hearing loss could slow cognitive decline.

Across the entire study population, hearing intervention did not significantly reduce cognitive decline over three years. However, among participants who were already at higher risk for cognitive decline, the hearing intervention appeared to provide a meaningful benefit.

So I would not tell you to buy hearing aids because they will prevent dementia.

We simply cannot make that promise.

But I would tell you to treat significant hearing loss because hearing better can help you communicate, remain socially connected, and participate more fully in life.

Those are pretty good reasons by themselves.

Whether you buy prescription or OTC hearing aids, pay attention to the practical details.

Understand the return policy. Ask how long you have to try the devices. Find out what the warranty covers. Determine whether adjustments and follow-up visits are included in the price. Consider whether you can comfortably insert, remove, clean, and charge the devices.

And don’t underestimate comfort. The most sophisticated hearing aid in the world won’t help you if it spends most of its life in your nightstand.

If you are struggling with your hearing, don’t ignore it for another five years because hearing aids make you feel old.

You know what can make you feel older?

Constantly saying: “What?”

Start with a hearing evaluation, particularly if you are uncertain how much hearing you have lost.

If you have uncomplicated mild-to-moderate hearing loss, an over-the-counter hearing aid may be worth considering.

If your hearing loss is more significant, complicated, or difficult to manage, I would strongly consider working with an audiologist.

Then give yourself time to adjust.

The goal isn’t perfect hearing. The goal is to hear your spouse across the dinner table. To follow the conversation when your family gets together. To hear your grandchildren tell you a story without pretending you understood every word. To remain involved.

Hearing aids aren’t about admitting you’re getting older.

They’re about making sure you don’t miss the good parts.

A few small things you can do this week that may make a surprisingly big difference.

👂 Give your ears a break.
If you use earbuds or headphones, you don't need the volume cranked up to enjoy them. If someone sitting next to you can hear what you're listening to, your ears probably can too—and they may not be happy about it.

🗣️ Stop blaming everyone else for mumbling.
If you're frequently asking people to repeat themselves, having trouble understanding conversations in restaurants, or turning the television louder than everyone else prefers, consider having your hearing checked. Hearing loss often sneaks up on us.

🚶 Take a 10-minute walk after dinner.
Not everything this week has to be about your ears. A short walk after a meal gets you moving, breaks up sitting time, and may help with blood sugar control. Ten minutes counts.

💪 Do five sit-to-stands.
Before you sit down for dinner tonight, stand up and sit down five times without using your hands if you can do so safely. That's strength training hiding in your everyday life.

📞 Call someone you haven't talked to recently.
Healthy aging isn't just about exercise and nutrition. Staying socially connected matters too. And while you're talking, notice how easily you can follow the conversation.

Here's your challenge for this week:

Pay attention to your hearing for seven days.

Don't change anything. Just notice.

Ask yourself:

Here's another simple experiment.

The next time you're watching television with someone else, let them set the volume.

Can you comfortably understand what is being said?

If you recognize several of these problems, don't simply write them off as "getting older."

Schedule a hearing evaluation.

You get your eyes checked. You check your blood pressure. You probably know your cholesterol.

Your hearing deserves some attention too.

Sometimes the first step toward fixing a problem is simply admitting that it's there.

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