Dear Doctors: My wife’s insurance company is suggesting she get a hearing test. She is only 51, and her hearing is fine. Does she really need this screening? 

Answer: Hearing loss can begin at any age. In some cases, it begins as early as the 30s and 40s, and it increases over time. 

It can occur in the outer, middle or inner ear and have various causes.

With what’s called conductive hearing loss, sound can’t move from the outer or middle ear into the inner ear. This often can be repaired medically.

Sensorineural hearing loss refers to damage to nerves involved in hearing. This hearing loss is irreversible.

Some people have a combination of the two, known as mixed hearing loss.

Age-related hearing loss is associated with physical changes to the hearing apparatus that occur as we grow older. 

Other causes of hearing loss can include injury, high fever, diabetes, viral infections such as measles or mumps, stroke, certain medications, repeated exposure to loud noise and heredity. An obstruction, such as a buildup of wax in the outer ear or fluid in the middle ear, also can diminish hearing.

It’s recommended that adults have a hearing test when they reach their mid-20s. The results provide a baseline against which future tests can be measured.

Once people reach their 50s, it’s a good idea for an annual hearing test. You can arrange this via your health care provider or an audiologist. 

The most common hearing test, known as a sound test, checks ’s response to a range of sounds, tones, pitches, volumes and spoken words.

Another type, a tympanometry test, evaluates movement of the eardrum to check for infection, buildup of wax or fluid and damage to the eardrum, such as a hole or tear.

Age-related hearing loss affects about one-third of older adults.

The initial indications of this can be subtle. Speech becomes a bit difficult to understand, particularly amid background noise. This leads to the need for repetition. Softer and higher voices become harder difficult to hear. Words that include high-pitched “s” and “th” sounds seem muffled. Some people begin to develop the ringing sound of tinnitus.

If you find yourself consistently turning up the volume, it can be an indicator something is amiss.

Even if your wife’s hearing is fine, it’s a good idea to have a hearing test to set a baseline for the future.

Dr. Eve Glazier and Dr. Elizabeth Ko are UCLA Health internists.