Susan Bianco, 87, of Lancaster, first realized her hearing was changing when conversations became more difficult.

She often found herself asking her husband to repeat what he said. Phone calls became challenging, and noisy social settings were especially frustrating.

"It's very hard to hear in a crowd," she said. "I can't understand what one person is saying if other people are talking."

Later, she began noticing another symptom. A buzzing noise in her ears would appear and become more noticeable whenever she felt tired.

Bianco's experience is common. According to the Centers for Disease Control and Prevention, about 13% of U.S. adults have hearing difficulties. Among adults age 65 and older, that number rises to 27%. Around 10% of adults also experience tinnitus, a condition commonly associated with hearing loss that causes sounds such as ringing or buzzing in the ears.

The likelihood of developing hearing loss or tinnitus increases with age and exposure to loud noise.

"You can't stop aging, but you can take steps to conserve your hearing and reduce your risk of developing hearing loss and tinnitus," said Dr. Jackie Price, an audiologist at Penn State Health Otolaryngology -- Head and Neck Surgery.

October is National Protect Your Hearing Month. Price explains what causes tinnitus, how hearing can be protected, and when it may be time to seek help.

What Is Tinnitus?

Tinnitus is the perception of sound when no external sound source is present. People often describe it as ringing, buzzing, hissing, or whooshing in one or both ears.

Some individuals compare the noise to cicadas or even a passing freight train, Price said.

"For some people, the noise is constant and bothersome, interfering with their productivity and quality of life," Price said.

The sounds are not coming from the environment around you. Instead, they result from a communication problem between the ears and the brain.

Other sound-related conditions can occur as well. Hyperacusis causes everyday noises to seem unusually loud or overwhelming. Misophonia triggers strong emotional reactions to certain sounds.

How Hearing Loss and Tinnitus Develop

According to Price, tinnitus and similar sound disorders are frequently among the earliest signs of hearing loss.

The process often begins inside the cochlea, a spiral-shaped structure in the inner ear. Tiny sensory hair cells located there convert sound vibrations into signals that travel to the brain.

When those delicate cells become damaged, they can no longer transmit information properly. As hearing ability declines, communication between the ears and brain may also become distorted, contributing to the phantom sounds associated with tinnitus.

The effects can extend far beyond hearing itself.

Hearing loss and tinnitus have been linked to problems with sleep, concentration, and personal relationships. Research also shows they may contribute to faster cognitive decline, a higher risk of depression, and an increased likelihood of falls.

How To Protect Your Hearing

One of the most effective ways to reduce the risk of hearing damage is to limit exposure to loud noise.

Price recommends using hearing protection whenever sound levels exceed 85 decibels. Situations such as concerts, sporting events, fireworks displays, and power tool use can all expose people to potentially harmful noise levels.

"I counsel people to wear hearing protection when they're mowing grass instead of listening to music through earbuds," Price said. "It's like a double whammy because people have the noise from the mower, and then they crank up the music so they can hear it, and then they listen to excess noise for 45 minutes or more, sometimes twice a week."

Choosing effective hearing protection is also important. Earplugs and earmuffs should have a Noise Reduction Rating of at least 22 decibels. This rating, displayed on product packaging, indicates how much noise the product can reduce.

Proper insertion matters as well.

"Take a foam earplug between your two fingers and smoosh it down and roll it," Price explained. "Then, when you go to put it in your ear, pull on your ear lobe with the opposite hand to open up the ear canal, insert the earplug and let it fully expand."

Most foam earplugs are designed for one-time use to ensure they maintain a tight seal against noise.

Treatment Options for Hearing Loss and Tinnitus

Although there is currently no cure for hearing loss or tinnitus, available treatments can help improve daily functioning and quality of life.

For hearing loss, treatment depends on the cause and severity. Hearing aids and other assistive technologies are often recommended to improve communication.

For tinnitus, one option is Tinnitus Retraining Therapy. This approach combines counseling and sound therapy to help people reduce the impact of the condition.

Counseling helps patients better understand and cope with tinnitus. Sound therapy uses gentle background noise to draw attention away from the ringing or buzzing sensation.

Bianco recently began Tinnitus Retraining Therapy and now wears hearing aids.

As part of her treatment, Price programmed a soft, continuous sound into Bianco's hearing aid. The goal is to make the tinnitus less distracting.

"It sounds like it's raining, which is a sound I don't mind too much," Bianco said.

When To Get a Hearing Test

Anyone experiencing ringing or other unusual sounds in their ears should consider a hearing evaluation, Price said.

"Sometimes people think they hear fine, but there are signs of change inside the ear, such as hair cell damage or hearing loss at the highest frequencies," Price said. "Testing can help you become better educated about what's going on so you can manage those changes."

Even when hearing problems are not obvious, testing can reveal early signs of damage and provide an opportunity to take steps that may help preserve hearing and improve long-term quality of life.