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“Huh? Could you repeat that?”

“Can you turn up the volume? I can’t hear it.”

If you’re frequently saying things like this, you might suffer from a hearing loss or impairment. According to the Centers for Disease Control and Prevention and Heal 2016, 5.2 million teenagers show signs of hearing loss. Unfortunately, many teens don’t realize they are losing their hearing until it’s too late to correct.

How You Hear

Your ear has three parts: the outer ear, the middle ear, and the inner ear. When sound waves travel down your outer ear, the curve of your ear canal funnels the sound waves into the middle ear. The waves make the eardrum, a thin layer of tissue, vibrate. The three tiniest bones in the body–the malleus, incus, and stapes–work together with the vibrations of the eardrum to amplify the waves and carry them to the inner ear. The inner ear has a snail-shaped chamber called the cochlea that is filled with fluid and lined with thousands of tiny hair cells. These cells convert the vibrations into electrical impulses. The impulses go to the auditory nerve and then to the brain, where the brain translates them into sounds.

Kinds of Hearing Impairment

Hearing impairment occurs when there is damage to one or more parts of the ear.

Conductive bearing loss is caused by a problem in the outer car or the middle ear. This kind of loss cast result from an infection of the middle ear, abnormalities, or damage to parts of the ear. Ear damage may come from rupturing the eardrum by sticking an object such as a cotton swab too far into the ear. Impacted wax can also prevent sound waves from reaching the eardrum. Medical treatment can often correct the condition. People with permanent conductive hearing loss can use a hearing aid successfully.

Sensorineural hearing loss occurs when the sensory hair cells of the inner ear are damaged. This kind of loss may result from a genetic condition, injuries to the ear or head, illnesses such as meningitis, very powerful antibiotics, and loud noises. Sensorineural loss can’t be corrected with medical treatment (medications or surgery), but people can benefit from hearing aids.

Mixed hearing loss is a combination of both conductive and sensorineural damage.

Teens at Risk

One of the biggest causes of hearing impairment in teens is noise-induced hearing loss (NIHL). Even a one-time exposure to a very loud sound can have this effect. Loud noise can even cause permanent hearing loss. One frightening part of NIHL is that it often happens gradually–you may not realize that you’re losing the ability to hear. Exposure to loud sounds higher than 80 decibels over time (see “How Loud Is It?” above) can cause hearing loss. The intensity of loud sounds eventually breaks the delicate hair cells in the inner ear and prevents them from carrying the impulses to the brain. Damaged hair cells do not repair themselves. This hearing loss lasts a lifetime.

You’re bombarded with noise every day–Walkmans, MP3 players, cars, buses, airplanes, snowmobiles, lawnmowers, hairdryers, TVs, rock music, and sound systems in cars.

Teens should be especially careful about using portable radios or CD players with earphones. The problem with using earphones is that the sound goes straight into your ears. When you play a CD or a radio at home, the sound is partially absorbed by the walls, rugs, and furniture. A good rule when using headphones is that if someone else can hear your music, it’s too loud for you.

Rock concerts, which expose you to loud noise over several hours, can cause hearing loss. The next time you go to a concert, take a pair of good earplugs. You can find these at hardware and sporting goods stores. Don’t try to save money by making your own earplugs from tissues, napkins, or cotton balls; sound goes right through these materials. You don’t need to feel like a nerd. Many rock band members–such as three members of Metallica, the Dave Matthews Band, Everclear, and many more–lower the loud music levels by wearing ear monitors during their concerts (look at MTV and notice the ears of the musicians). Pete Townshend of The Who now has severe hearing loss because he didn’t protect his ears from constant loud music.

If you do noisy jobs, mowing or leaf blowing, or if you participate in activities such as snowmobiling or woodworking, get a pair of good “earmuffs” designed to protect you from the excessive noise.

A 1998 study by the Worker’s Compensation Board in British Columbia found that 30 percent of the young adults entering the workplace already have a hearing loss due to overexposure to noise. Use a few precautions–and earplugs–so you don’t become part of that statistic!