This new coinage may help convince more of us to take care of our hearing, for life.
By Daniel Fink, M.D.
Do you suffer from “otoaging”? If you are among the estimated 50 million Americans who have hearing loss, or the 20 million who have tinnitus, you probably do. The number of Americans who have difficulty following one conversation among many in a noisy restaurant isn’t clear, but pretty much anyone over 50 has this problem, too. I have all three auditory conditions.
Otoaging is a new word I coined to describe both the premature aging of cochlear hair cells and synapses caused by noise, and the end result, hearing loss in old age. I was inspired by the term photoaging, used by dermatologists to describe the premature aging of the skin by sun or ultraviolet light exposure, and the end result: deeply wrinkled and pigmented skin.
Decades ago dermatologists recognized that photoaging started in childhood. Their concern wasn’t just about preventing wrinkled skin in children when they got old. Cumulative sun exposure can lead to skin cancers, with five or more sunburns between the ages of 15 to 20 associated with an 80 percent increased risk for melanoma. This led to current recommendations to protect children and teens from sun exposure.
I want otolaryngologists, audiologists, and primary care practitioners to use the same approach for noise, recommending reduced noise exposure starting in childhood to prevent hearing loss in old age.
Shakespeare wrote, “A rose by any other name would smell as sweet.” Why does terminology matter? Because words influence how we think. The current terminology, “age-related hearing loss” (presbycusis), implies that hearing loss in old age is a part of life. If hearing loss in old age is due to typical physiological aging, like thinning, graying hair, nothing can be done to prevent it.
From left: Quiet Communities scientific adviser Kathleen Romito, M.D., founder Jamie Banks, Ph.D., and Quiet Coalition chair Daniel Fink, M.D., each presented their research at the International Commission on Biological Effects of Noise’s 15th Congress in Copenhagen in June 2026. Every three years the ICBEN brings together hundreds of researchers, public health experts, acousticians, and policymakers from around the world.
But if age-related hearing loss is really otoaging—the cumulative effect of a lifetime of excessive noise exposure on delicate structures in the inner ear—then reducing noise exposure beginning early in life should preserve typical hearing into old age.
The most common treatment for noise-induced hearing loss is hearing aids, with cochlear implants reserved for the profoundly hearing impaired. Both are costly, and neither fully restores typical hearing. Unlike eyeglasses or contact lenses, which provide a visual correction, hearing aids merely deliver an amplified sound wave to dead or dying cochlear hair cells, and this does not provide an auditory correction.
In the past few decades, many conditions or diseases once thought to be inevitable parts of aging have been shown to be largely preventable by changes in diet, exercise, or reducing exposures to sun or cigarette smoke. Among these are obesity, muscle weakness, type 2 diabetes, hypertension, heart disease, dementia, and skin and lung cancers.
Otoaging should be added to this list. Without anthropogenic noise, nature is quiet, but life in industrialized societies is not. One might consider otoaging to be a disease of civilization, caused by the changes in our world due to modern life.
The World Health Organization appears to understand that noise exposure is the major cause of hearing loss, estimating that 1.1 billion young people are at risk of hearing loss from using personal listening devices or attending dance clubs or rock concerts. When these young people reach old age, they will almost assuredly have largely preventable noise-induced hearing loss due to a lifetime of excessive noise exposure.
If I’m wrong about what causes hearing loss with old age—if there is any published research showing that significant hearing loss (meeting the World Health Organization’s 25-decibel threshold) is indeed caused by typical physiological processes, or by nutritional, vascular, or genetic factors, or the use of ototoxic medications, I ask that someone show me those articles. I haven’t been able to find them.
Yes, just about everything gets worse with age, some things a little and some a lot. But not being able to hear shouldn’t be one of them. Preventing noise-induced hearing loss is simple and inexpensive.
If something sounds loud, it is too loud, and our auditory health is at risk. By auditory health, I mean not only protecting hearing but also avoiding tinnitus (ringing in the ears) and hyperacusis (noise-induced pain).
Reducing noise exposure will probably also prevent speech-in-noise difficulty. There are no published studies of the noise dose required to develop tinnitus, hyperacusis, or speech-in-noise difficulty, but reducing noise exposure to prevent noise-induced hearing loss will probably reduce the likelihood of developing these other auditory conditions.
If we turn down the volume, leave the noisy environment, and/or use hearing protection, our ears should last a lifetime.
Frequent contributor Daniel Fink, M.D., is the program chair of The Quiet Coalition, a program of Quiet Communities Inc., a longtime partner of Hearing Health Foundation. For references, see hhf.org/references.
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Otoaging is a new word I coined to describe both the premature aging of cochlear hair cells and synapses caused by noise, and the end result, hearing loss in old age. I was inspired by the term photoaging, used by dermatologists to describe the premature aging of the skin by sun.