The sounds of silence can be relaxing and peaceful – if it’s silence you’re looking for. But if the silence is due to hearing loss, those sounds of silence can be painfully isolating. People who lose their hearing may only hear a rumble of sound rather than individual conversations. Watching TV may involve putting up the volume so high, your partner objects, talking on the phone, too difficult. This reality affects more people than we may know, but not everyone realizes at first that they are losing their hearing. New research suggests that as many as a third of adults could have undiagnosed hearing loss as early as their mid-50s - and it affects more women than men.

The researchers, from the University of Manchester in the United Kingdom, weren’t sure why so many adults had undiagnosed hearing loss. One theory was that the U.K. doesn’t have a national screening program and those who are diagnosed, are usually diagnosed by their own doctor. But if the patient doesn’t bring the matter up, the doctor might not ask about it. “More research is needed to understand why so many people are undiagnosed, though we feel making hearing loss part of a routine primary care examination among older adults would be beneficial,” said one of the authors, Dialechti Tsimpida, MSc, in a press release. Mrs. Tsimpida is a PhD student at the university.

Hearing loss isn’t just about the ears. It can affect overall quality of life. Research published in The Lancet found that about a third of all dementia cases are caused by a combination of factors including hearing loss. The National Institute on Deafness and Other Communication Disorders found a strong connection between hearing loss and depression.

Despite how serious hearing loss is, and the other medical conditions it can cause, many people don’t notice at first. “ This lack of self-awareness of hearing loss is a problem for many people,” Mrs. Tsimpida said. Hearing loss is often degenerative over time, meaning that it gets worse slowly. At first, patients might ask people to repeat themselves and turn up the TV volume. These little signs can be that start of more serious hearing loss.

Losing your hearing can unavoidable as the insides of the ear get old just like the rest of the body. The loss can also be caused by repeated exposure to loud noises like guns going off, snowmobiles, lawn mowers, loud music through headphones, and woodworking tools. Proper ear protection can prevent noise induced hearing loss.

Hearing loss itself can be treatable. There are devices that can restore or amplify hearing, and strategies to help people with hearing loss continue to interact with the world around them and communicate. The first step, though, is diagnosing the problem.