What is hearing?

Hearing refers to the awareness of the presence of sounds and placing meaning to that sound. It begins as vibrations that travel through your ear (outer ear, middle ear, and inner ear) through your nerves to your brain – where you hear.

What are the parts of our hearing system?

The hearing system (auditory system) consists of many different parts and sections. Successful hearing requires all of these parts and sections to function properly.

  • Outer ear: The pinna sits on the side of your ear and collects the sounds in the environment. The ear canal funnels the sounds to your eardrum.
  • Middle ear: The sound from the ear canal hits and vibrates the eardrum – a membrane that divides the outer ear from the middle ear. The eardrum is connected to a series of three tiny bones. You may know them as hammer, anvil and stirrup. As the eardrum moves, so do the tiny bones.
  • Inner ear: The third bone in the series of tiny bones in the middle ear is connected to another thin membrane that divides the middle ear from the inner ear. The inner ear consists of a spiral shaped structure known as the cochlea (means snail-shell). Within the cochlea sits the organ of hearing where we have thousands of tiny cells, known as hair cells. The hair cells are stimulated and send messages to the auditory nerve.
  • Auditory nervous system: The auditory nerve runs from the cochlea to a station in the brainstem (known as nucleus). From that station, neural impulses travel to the brain – specifically the temporal lobe where sound is attached meaning and we HEAR.

What conditions can impact our ability to hear?

Many conditions, illnesses and diseases can cause a problem with hearing. Most of these conditions can be treated or managed by healthcare providers. Here are a few examples of conditions that affect your hearing:

  • Aging: The longer we live the more we are exposed to sounds, to environmental toxins, and medicines, and experience greater health issues. All of these take their toll on our hearing. So hearing loss is common in the older population – not because we are old but because we have lived life for a lot of years.
  • Damage/trauma: Pushing cotton swabs or other objects into the ear can result in a punctured eardrum; a hard slap on the ear can cause trauma, and head trauma can cause fractures within the ear. These examples can result in hearing problems that can be temporary or permanent and may require medical intervention.
  • Disease: Cardiovascular diseases and diabetes can put you at greater risk for hearing issues by decreasing the blood supply to the ear and the auditory system.
  • Medication: Many drugs used to treat cancer, infections and heart disease can damage your hearing. If you take these drugs, your hearing should be monitored to detect changes. If possible, medications should be changed.
  • Sound exposure: Being exposed to sounds that are too loud for too long will damage the structures in the inner ear and cause hearing loss. The exposure can be long term (for example, working for many years in a factory), or it can happen with just one exposure (to things like firearms or firecrackers). The greater the exposure, the greater the hearing loss. Sound-induced hearing loss, however, is 100% preventable by using hearing protection devices like earplugs or earmuffs.
  • Ear wax: Ear wax in your ear canal is normal and healthy. Yet sometimes the wax can build up too much and block the sound from getting to your eardrum, causing hearing loss. Once the wax is removed by a healthcare professional, hearing should be restored.

When should I call a hearing care specialist?

Call or visit a healthcare provider for immediate medical treatment if you experience sudden hearing loss, even if it’s only in one ear. The treatment for your hearing loss may not be effective if you delay treatment.

Hearing care specialists are different from your primary care physician. They include:

  • Audiologist: Health professional trained to diagnose and treat non-medical hearing and balance problems.
  • Otolaryngologist: Physician who treats problems with the ear, nose and throat.
  • Otologist: Specialist whose practice is limited to the ear and the medical and surgical management of ear or hearing issues.

Schedule an appointment to see a hearing care specialist if you are noticing a change in your ability to hear or understand, or if it seems like everyone is mumbling. Hearing loss can occur very gradually so it is good practice to have your hearing tested to obtain a baseline and then on a regular basis. This is especially true if you have a family history of hearing loss.

How is my hearing tested?

To test your hearing, you’ll be given a test called an audiogram. During this test, your provider plays sounds through headphones. You’ll press a button when you hear a sound. The results measure your ability to hear. Tests take place in your provider’s or audiologist’s office in a soundproof booth.

How can I keep my hearing healthy?

To protect your hearing, you should:

  • Use hearing protection devices (earplugs or earmuffs) during louder activities, including concerts, riding motorcycles or snowmobiles, or working with loud machinery.
  • When listening to personal music players, keep the volume level low enough that you can hear people speaking around you. Another good rule is not to exceed 80% volume for more than 90 minutes a day.
  • Do not stick anything into your ear canal including cotton swabs. Anything in your ear canal can cause a ruptured eardrum or become lodged in the ear canal.
  • Avoid smoking, which can impair circulation and harm your hearing.
  • Get regular exercise to help prevent health issues like diabetes or high blood pressure that can cause hearing problems.
  • Manage any chronic illnesses to prevent further damage.

Last reviewed by a Cleveland Clinic medical professional on 01/16/2020.


  • AARP. AARP Hearing Center. (https://www.aarp.org/health/conditions-treatments/hearing-resource-center/) Accessed 1/29/2020.
  • Hearing Health Foundation. How Hearing Works. (https://hearinghealthfoundation.org/how-hearing-works) Accessed 1/29/2020.
  • National Institute on Deafness and Other Communication Disorders (NIDCD). How Do We Hear? (https://www.nidcd.nih.gov/health/how-do-we-hear) Accessed 1/29/2020.

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