One of the first signs of noise- or trauma-induced hearing loss is an inability to hear high-pitched sounds and an inability to discern someone’s voice in the presence of background noise. It starts with a difficulty hearing higher tones and pitches, like birds or similar sounds at higher frequencies. Consonants may be hard to hear, and voices may start to sound muffled. As hearing loss continues, low-pitched sounds will be harder to hear. Radios and televisions must be turned louder to be heard.