What is age-related hearing loss and how common is it?

Age-related hearing loss, known clinically as presbycusis, is the gradual loss of hearing that occurs as part of the normal ageing process. It is the most common cause of hearing loss in adults and one of the most prevalent conditions in older Australians. Approximately one in six Australians has some degree of hearing loss, and the prevalence rises steeply with age: around one in three people over 65 and more than half of people over 75 have significant hearing loss. Presbycusis affects both ears in a roughly symmetrical pattern and typically involves loss of high-frequency sounds first, which is why speech clarity (distinguishing consonants such as s, f, th, p) is often the first thing affected. The loss is permanent and does not reverse, but it can be managed effectively with the right intervention.

What are the first signs of age-related hearing loss?

The early signs of age-related hearing loss are often subtle and develop gradually, which means many people do not notice them for years. Common early signs include: asking people to repeat themselves frequently; difficulty following conversations in noisy environments (restaurants, gatherings) even when one-to-one conversation is manageable; finding it easier to hear men's voices than women's or children's voices (because high-frequency hearing is lost first); turning the television or radio volume up higher than others in the room find comfortable; missing the doorbell or phone ringing; difficulty hearing clearly on the telephone; and fatigue from the concentration required to listen in difficult environments (called listening fatigue). A common pattern is the person themselves not noticing, but family members raising concerns. Both the person's self-report and family observation should be taken seriously.

How is age-related hearing loss assessed and diagnosed?

Hearing loss is assessed by an audiologist through a comprehensive audiological assessment. This includes a pure tone audiogram, which measures the softest sounds the person can hear at a range of frequencies, producing a chart that maps the degree and pattern of hearing loss. The audiologist also conducts speech discrimination testing (how well the person can understand speech, not just detect sounds) and middle ear assessment (tympanometry). The assessment identifies the type of hearing loss (sensorineural, conductive, or mixed), the degree (mild, moderate, severe, or profound), and which frequencies are most affected. A GP referral is not required to see a private audiologist; however, a referral is needed to access Medicare rebates for audiology services and for the government-subsidised hearing program.

What is the Australian Government Hearing Services Program?

The Australian Government Hearing Services Program (HSP) provides subsidised hearing services and devices to eligible Australians. Eligibility includes: people who hold a Pensioner Concession Card, a Veterans' Affairs Gold or White Card, or certain other concession cards; children and young people under 26; and Aboriginal and Torres Strait Islander people. Eligible clients receive a full audiological assessment, hearing aid fitting, and ongoing support at little or no out-of-pocket cost through the HSP. The program is delivered through an approved network of providers including both private audiology practices and not-for-profit providers such as Australian Hearing (now part of Hearing Australia). People who do not meet HSP eligibility can access private audiology services and hearing aids at full cost, or through NDIS if they meet access criteria.

Does age-related hearing loss qualify for NDIS?

NDIS eligibility for hearing loss depends on age and the degree of functional impairment. For people under 65, significant permanent hearing loss that substantially affects daily functioning can qualify for NDIS. For people 65 and over, the primary pathway is not NDIS but the Australian Government Hearing Services Program (which is specifically designed for older Australians) and the My Aged Care Support at Home program for associated daily living support. People who were already NDIS participants before turning 65 may remain on the scheme. NDIS can fund hearing aids, cochlear implants, and related services for eligible participants under 65. A referral from an audiologist or ENT specialist with supporting documentation of functional impairment is needed for the NDIS access request.

What types of hearing aids are available and how do I choose?

Hearing aids come in several styles and with varying technology levels. Styles include: behind-the-ear (BTE), which sits behind the ear with a tube connecting to an earmould or dome; receiver-in-canal (RIC or RITE), similar to BTE but with the receiver in the ear canal; in-the-ear (ITE), custom-made to fit in the outer ear; and in-the-canal (ITC) and completely-in-canal (CIC), smaller custom devices that fit further into the canal. Technology levels range from basic (sufficient for mild to moderate loss in quiet environments) to premium (multiple microphones, directional processing, background noise reduction, Bluetooth streaming from phones and televisions, app control). The right choice depends on the degree and pattern of hearing loss, dexterity (smaller devices require finer motor skills to handle), lifestyle, and budget. An audiologist prescribes and fits hearing aids based on the audiogram and the person's individual needs.

When is a cochlear implant considered for age-related hearing loss?

Cochlear implants are considered for people with severe to profound sensorineural hearing loss who receive inadequate benefit from hearing aids. Unlike hearing aids, which amplify sound, a cochlear implant bypasses the damaged hair cells in the cochlea and directly stimulates the auditory nerve. The assessment process for cochlear implant candidacy involves audiological testing, an ENT surgeon assessment, imaging, and a trial of hearing aids to confirm that aids are not providing sufficient benefit. Surgery is performed by an ENT surgeon and is followed by programming (mapping) of the implant by an audiologist and hearing rehabilitation. Cochlear implants are highly effective for appropriate candidates, including older adults. In Australia, cochlear implants are funded through Medicare (for appropriate candidates), NDIS (for eligible participants under 65), and the government hearing program in some circumstances.

What communication strategies help with age-related hearing loss in daily life?

Communication strategies reduce the impact of hearing loss on daily interactions while hearing aids and other technology are in use. Strategies for the person with hearing loss include: positioning to see the speaker's face (lip reading supports comprehension even with partial hearing); requesting that people speak clearly and at a moderate pace rather than shouting (shouting distorts speech); reducing background noise where possible (turning off the television during conversations); using captioning on television; and using assistive listening devices in specific situations. Strategies for communication partners include: getting the person's attention before speaking; facing them directly; speaking clearly without exaggerating lip movements; not shouting; rephrasing rather than repeating if not understood; and being patient. An audiologist or hearing rehabilitation specialist provides communication strategy training as part of hearing rehabilitation.

Age-Related Hearing Loss: From First Signs to Hearing Support Provider Selection

Key Points

Age-related hearing loss (presbycusis) affects around one in three Australians over 65 and more than half of those over 75; it is permanent but highly manageable with timely intervention
Early signs include difficulty following conversations in noise, asking for repetition, and turning television volume up; family observation is often the first alert
The Australian Government Hearing Services Program provides subsidised hearing aids and audiology for eligible Australians (pensioners, veterans, under 26s, Aboriginal and Torres Strait Islander people) at low or no cost
For people under 65, significant hearing loss may qualify for NDIS; for 65 and over, the primary pathways are the Hearing Services Program and My Aged Care
Cochlear implants are an option for severe to profound loss where hearing aids provide insufficient benefit; they are funded through Medicare for eligible candidates
Communication strategy training by an audiologist or hearing rehabilitation specialist helps both the person with hearing loss and their family and support workers

Age-related hearing loss is the gradual reduction in hearing that comes with ageing. Known clinically as presbycusis, it is the most prevalent sensory impairment in older adults and one of the most common conditions overall in Australia. Despite its prevalence, it is chronically under-recognised and under-treated: the average person waits seven to ten years between noticing hearing difficulties and seeking an assessment.

This delay has real consequences. Untreated hearing loss is associated with social withdrawal, depression, reduced quality of life, increased risk of falls (because hearing contributes to spatial awareness), and, in growing evidence, increased risk of cognitive decline. Earlier identification and intervention reduce these downstream effects.

This guide covers the early signs of age-related hearing loss, how assessment works, the funding pathways available in Australia, hearing aid and cochlear implant options, and how to choose the right provider.

Early Signs: What to Look For

Age-related hearing loss develops gradually over years, which is why it so often goes unnoticed until it is already moderate in degree. Understanding the early signs helps families and individuals act sooner.

Signs the Person Themselves May Notice

Difficulty in noise: Struggling to follow conversations at family gatherings, in restaurants, or at social events even when one-to-one conversations at home feel manageable. This is one of the most consistent early signs: high-frequency hearing loss reduces the ability to separate speech from background noise.

Asking for repetition: Regularly asking people to repeat what they said, particularly on the phone or when someone is not facing them directly.

Mishearing words: Hearing the sound of speech but not understanding the words clearly; words sound muffled or unclear rather than absent entirely.

Volume: Needing the television or radio louder than others in the household find comfortable.

Fatigue from listening: Finding conversations, particularly in noisy environments, exhausting because of the concentration required to follow speech. This listening fatigue is a recognised and underappreciated consequence of hearing loss.

Telephone difficulty: Finding the telephone harder to follow than face-to-face conversations (because lip reading cues are absent on the phone).

Signs Family Members May Notice

Family members often notice hearing loss before the person themselves does. Common patterns:

The person does not respond when called from another room
Conversation feels one-sided because the person is not picking up all of what is said
The person misinterprets things said in passing
Social events become less enjoyable or the person withdraws from them
The person frequently responds to a different version of what was said

Both the person’s experience and family observation should be taken seriously. If any of these signs are present, an audiological assessment is the appropriate first step.

How Hearing Loss Is Assessed

The Audiological Assessment

An audiologist conducts a comprehensive hearing assessment, typically taking 60 to 90 minutes:

Pure tone audiogram: The person wears headphones and responds to tones at different frequencies and volume levels. The results are plotted on an audiogram, showing the softest sound the person can detect at each frequency. The audiogram reveals the degree and pattern of loss.

Speech discrimination testing: Beyond detecting sounds, the audiologist tests how well the person understands speech at comfortable volumes. Speech discrimination score is clinically important: two people with the same audiogram may have very different speech clarity, which affects hearing aid expectations and candidacy for cochlear implants.

Middle ear assessment (tympanometry): Tests the function of the eardrum and middle ear, distinguishing sensorineural loss (inner ear, as in presbycusis) from conductive loss (outer or middle ear, which may be reversible).

Otoscopy: Visual examination of the ear canal and eardrum; checks for wax build-up, infection, or structural issues.

The Degree of Hearing Loss

The audiogram result classifies hearing loss by degree:

Degree	Threshold	Typical Impact
Mild	26-40 dB	Difficulty in noise, quiet speech; manages in quiet
Moderate	41-55 dB	Difficulty with normal speech; conversation requires effort
Moderately severe	56-70 dB	Difficulty with loud speech; hearing aid strongly recommended
Severe	71-90 dB	Cannot understand speech without hearing aids or cochlear implant
Profound	91+ dB	Cochlear implant candidacy assessment appropriate

Accessing Assessment

An audiological assessment can be accessed:

Through the Australian Government Hearing Services Program (eligible clients at low or no cost)
Through a private audiology practice (Medicare rebate with GP referral via a Chronic Disease Management plan; otherwise full fee)
Through a hospital ENT department (public wait times; typically for complex cases)

The Australian Government Hearing Services Program

The Hearing Services Program (HSP) is the primary government-funded pathway for hearing assessment and hearing aids in Australia.

Who Is Eligible

Holders of a Pensioner Concession Card
Holders of a Veterans’ Affairs Gold Card or White Card (for a condition that includes hearing loss)
People under 26 years of age
Aboriginal and Torres Strait Islander people aged 50 and over (reduced age threshold)
People who receive a Disability Support Pension

What the Program Covers

Comprehensive audiological assessment
Hearing aid fitting and prescription
Ongoing follow-up appointments and device maintenance
Replacement hearing aids when clinically required

How to Access

Contact an HSP-approved provider (found via the Services Australia hearing services online portal). Hearing Australia (formerly Australian Hearing) is the largest provider under the HSP and has branches in most metropolitan areas and some regional centres.

Hearing Aids

For the majority of people with age-related hearing loss, hearing aids are the primary intervention. Modern hearing aids are significantly more capable than devices of even ten years ago.

How Hearing Aids Work

Hearing aids amplify sound, but modern devices do far more than simply make everything louder. Digital processing separates speech from background noise, adjusts amplification dynamically based on the listening environment, and delivers personalised amplification matched precisely to the individual’s audiogram pattern.

Styles

Behind-the-ear (BTE): The electronics sit behind the ear; a tube connects to an earmould or open dome in the ear canal. Suitable for all degrees of loss; easy to handle; battery compartment is accessible.

Receiver-in-canal (RIC): Similar to BTE but the receiver (speaker) sits in the ear canal; smaller and more discreet; suitable for mild to moderately severe loss. The most commonly prescribed style for age-related hearing loss.

In-the-ear (ITE): Custom-fitted to the outer ear; all electronics in the ear; larger and easier to handle than smaller custom styles. Suitable for mild to severe loss.

In-the-canal / completely-in-canal (ITC/CIC): Smaller custom devices; less visible; require good dexterity to handle. Less suitable for people with significant dexterity impairment.

Technology Features

Modern hearing aids include:

Directional microphones: Focus on speech in front while reducing noise from sides and behind
Bluetooth connectivity: Stream audio directly from smartphones, televisions, and other devices into the hearing aids
App control: Adjust volume and settings via a smartphone app
Rechargeable batteries: Avoid the need to change small batteries
Remote microphones: A small microphone worn by a communication partner streams their voice directly to the hearing aids; very useful in noisy environments and for family members

Adjusting to Hearing Aids

Hearing aids require an adjustment period. The brain needs time to relearn how to process amplified sound, particularly after years of untreated hearing loss. The audiologist programmes the device and adjusts the fitting over multiple appointments. Consistent wear, starting in easier listening environments and progressing to more challenging ones, accelerates adjustment.

Cochlear Implants for Severe to Profound Loss

When hearing aids do not provide sufficient speech clarity despite appropriate fitting and an adequate trial period, cochlear implant candidacy should be assessed.

How Cochlear Implants Work

A cochlear implant consists of an internal component (surgically implanted by an ENT surgeon) and an external processor (worn behind the ear). The implant bypasses the damaged hair cells of the cochlea and directly stimulates the auditory nerve with electrical signals. This restores access to sound even when the cochlea has lost the hair cells that would normally transduce sound.

The Assessment Process

Cochlear implant candidacy involves:

Audiology testing confirming severe to profound loss and poor speech discrimination with hearing aids
ENT surgeon assessment and discussion of surgical risk
CT or MRI imaging of the cochlea and auditory nerve
Trial of optimal hearing aids to confirm insufficient benefit
Multidisciplinary team review

After Surgery

Post-implant rehabilitation involves:

Programming (mapping) sessions with an audiologist to optimise the implant’s settings
Hearing rehabilitation to help the brain adapt to the new auditory signal
Regular follow-up for ongoing optimisation

Cochlear implants are highly effective for appropriate candidates, including people in their 70s, 80s, and beyond. Benefits include improved speech understanding, telephone use, and quality of life.

Funding

Medicare: Cochlear implants are MBS-funded for eligible candidates (both ears in people under 26; one ear for adults)
Private health insurance: Many policies cover implant surgery with appropriate hospital cover
NDIS: For eligible participants under 65

Assistive Listening Technology

Beyond hearing aids, a range of assistive listening devices supports independence in daily life.

Television streaming devices: Stream television audio directly to hearing aids via Bluetooth or a neck loop; eliminates the need to increase TV volume.

Telephone captioning: Apps and telephone services that display real-time captions of the conversation.

Alerting systems: Visual or vibrating alerts for the doorbell, telephone ring, smoke alarm, and alarm clock; important for safety when hearing aids are not worn (overnight).

Loop systems (telecoils): Many public buildings, including theatres, churches, banks, and community centres, have hearing loop (audio induction loop) systems. Hearing aids with a telecoil (T-coil) pick up the loop signal directly, significantly improving hearing in these environments.

Personal communication devices: Pocket-sized amplifiers or microphone systems for one-to-one conversations in noisy environments.

Provider Team for Hearing Loss

Provider	Role	Funding
Audiologist	Assessment, hearing aid prescription, fitting, ongoing management	HSP, Medicare (with GP referral), private
Hearing Australia	HSP-registered assessment and device fitting	Hearing Services Program
ENT surgeon	Medical ear assessment, cochlear implant surgery	Medicare
Cochlear implant audiologist	Implant mapping and programming	Medicare, NDIS
Hearing rehabilitation specialist	Communication strategy training	NDIS Capacity Building, private
Support worker	Daily living assistance	NDIS Core, My Aged Care

Choosing a Hearing Provider

When selecting an audiologist or hearing provider:

Check credentials: Audiologists in Australia must be members of Audiology Australia and hold the Certificate of Clinical Practice (CCP). Check registration on the Audiology Australia website.

Ask about independence: Some audiology practices are aligned with or owned by specific hearing aid manufacturers; an independent audiologist can prescribe across all brands. This is not always a problem, but knowing whether the practice is independent helps you evaluate the advice you receive.

Understand the follow-up commitment: Hearing aids require ongoing adjustments and servicing. Ask what follow-up appointments are included in the fitting fee, what ongoing costs look like, and whether telehealth follow-up is available.

Ask about trial periods: Most audiologists offer a trial period for hearing aids (typically 30 to 60 days). If the aids are not working well, adjustments or a different device should be offered within the trial period.

Consider location and access: For older Australians with limited transport, a provider who offers home visits or telehealth follow-up is important.

Key Resources

Hearing Australia - the largest Australian Government Hearing Services Program provider; branches in most states
Audiology Australia - Find an Audiologist directory and information for consumers
Cochlear Ltd - information on cochlear implants and the candidacy process
Deafness Forum of Australia - national voice for people with hearing loss, tinnitus, and deafness
My Aged Care - home support funding for people 65 and over (1800 200 422)
NDIS - disability support funding for eligible Australians under 65 with significant hearing loss

Connecting with Hearing Support Providers

Carevo connects people with age-related hearing loss to audiologists, cochlear implant specialists, hearing rehabilitation providers, and daily support services across Australia.

Find a hearing support provider through Carevo

Age-Related Hearing Loss: From First Signs to Hearing Support Provider Selection

Key Points