Approximately 20 percent of Americans know they have hearing loss. Unfortunately, many people with hearing loss are not diagnosed, which means the actual number of people who can't hear like they used to is much higher. In most cases, hearing loss is subtle and gradual, making it difficult for people to recognize it. Your first warning signs may be those around you. If someone tells you that you talk too loud or that the TV is too loud, you may have hearing loss. But what causes it? Following are the top four causes of hearing loss. 

Age

When most people think of hearing loss, they think of the elderly, and for good reason. Hearing loss becomes more prevalent with age. Before the age of 54, only about 2 percent of the population has disabling hearing loss. And only about 25 percent of people aged 65 to 74 have hearing loss. However, that number jumps to 50 percent when you're talking about people over the age of 75. Age-related hearing loss is thought to be caused by damage to the structures of the ear that occurs over time. 

Noise

Loud and/or continuous noise can cause you to lose your hearing over time. If you work in a profession where you're continuously exposed to noise, such as bartending and construction, you may experience hearing loss. The best way to prevent loss is to protect your ears by wearing ear plugs. 

Medication

Certain medications can cause hearing loss. Drugs that list hearing loss as a side effect include some antibiotics and pain relievers as well as some chemotherapy treatments and drugs used to treat erectile dysfunction. If you're taking any of these medications, your doctor should monitor your hearing. 

Trauma

Damage to the ear drum or other structures of the ear can result in sudden and devastating hearing loss. A car accident, fall or any other traumatic incident may be to blame. However, you can also cause trauma to your ear yourself by cleaning it with a sharp or hard object. 

In addition to the above, some people experience sudden and unexplained hearing loss, usually in one ear. If you think you're losing your hearing, it's vital that you speak to your doctor or an audiologist right away. While you may not be able to restore your hearing, you may be able to slow or stop the loss of hearing as well as treat the problem so you can hear better.