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An interactive map has revealed the US counties where hearing loss is more common for the first time, producing surprising results.
Contrary to popular belief, it shows that people living in rural areas are up to twice as likely to be suffering from hearing loss as their fellow Americans who live in urban areas.
The study estimated that in swathes of rural New Mexico, Texas and Oregon up to one in three people aged five years and over were suffering from the condition — which is diagnosed when someone is struggling to hear lower sounds such as rustling leaves and buzzing mosquitoes.
The University of Chicago researchers believe rural Americans are more likely to be exposed to loud noises from farming equipment and guns, which could damage their hearing.
It comes despite previous research indicating that up to nine in ten city dwellers are at risk of hearing loss due to the high volume of traffic, bars and nightclubs.
The above map shows the proportion of people estimated to have hearing loss by county
They warned that, overall, their study — based on data from 2015 to 2018 — showed that hearing loss is a widespread problem across the US, with older men most likely to suffer from the condition.
Studies suggest people with the condition are more likely to be depressed and suffer from falls and cognitive decline — which is linked to their inability to hear others and small sounds clearly.
The study used a mathematical model that was based on data on hearing loss from the CDC's annual survey carried out from 2015 to 2018. It was compared to population estimates from 2019.
The National Health and Nutrition Examination Survey (NHANES) interviews a nationally-representative sample of 7,000 people every year on their health — including whether they are suffering from hearing loss.
Dr David Rein, a public health expert who led the study, and others wrote in the paper: 'Our model results suggest that those living in rural areas experience higher rates of hearing loss.
'[This is] perhaps due to potential noise exposure from outdoor work and recreation such as forestry, all-terrain vehicles, and recreational firearms.'
Hearing loss is defined as not being able to hear as well as someone with normal hearing — or sounds up to a threshold of 20 decibels or more in both ears.
Sounds at 20 decibels include hearing rustling leaves or the buzzing of a mosquito.
The condition is diagnosed via a test where sounds and words are directed through headphones to each ear, with the patient then told to say what they heard.
Hearing loss can be treated through the use of hearing aids although these are often expensive — at up to $3,500 per ear out-of-pocket — leading many patients to leave the condition untreated.
Across all 3,143 counties that make up the US, the model suggested that Mora County in New Mexico had the worst hearing loss in the nation — at 31.3 percent of adults having trouble with their hearing.
Sumter County in Florida, a rural area outside Orlando, also came top with 31.3 percent of adults having suffered from hearing loss.
Only about 4,100 people live in Mora County, whose biggest town — Wagon Mound — is populated by just 265 people. The area is largely made up of farms.
The above image is from outside the largest settlement in Mora County, New Mexico, An estimated one in three adults is suffering from hearing loss in this area
Sumter County, on the other hand, has a population of 135,000 people — largely linked to the new urbanization areas being built in the north of the county.
Most of the area is, however, also made up of farms and agricultural land.
Broken down by state, West Virginia had the highest levels of hearing loss in the country — with 18.2 percent of residents estimated to have the issue.
Maine had the second highest levels, at 16.2 percent according to estimates, and Montana had the third highest, at 15.4 percent.
Revealing the data, Dr Rein added to Axios: 'Hearing loss is a problem everywhere.
'Even if you look at places like Washington DC, where the prevalence is the lowest of any metro area in the county, you're still talking about almost 400,000 people with hearing loss.
'It's something that affects all groups and affects all of us as we age.'