What is Age-related Hearing Loss?

Age-related hearing loss (also referred to as presbycusis) is a kind of hearing disorder that slowly impacts people they grow older. It is one of the most prevalent conditions afflicting aging/elderly adults.

Nearly one in three people in the United States between the ages of 65 and 74 suffer from hearing loss, and nearly half of all adults over the age of 75 have trouble hearing. If you have trouble hearing, and it can be challenging to comprehend your doctor’s directions and follow their advice, respond to warnings, and hear phones, doorbells, and smoke alarms. Therefore safety considerations should be taken. Hearing loss can also cause stress and complicate conversations, making enjoyment difficult with family and friends, causing feelings of isolation.

Age-related hearing loss most commonly happens in both ears, affecting them evenly. Since the damage is progressive, if you have age-related hearing loss, you may not recognize that you’ve lost some of your capability to hear.

There are various causes of age-related hearing loss. Ordinarily, it arises from advances in the inner ear as we grow older, but it can also occur from changes in your middle ear or complex developments along the nerve pathways from the ear to the brain. Certain pathological conditions and medications may also play a role.

How do we hear?
Sound waves penetrate the outer ear and progress through a narrow passageway referred to as the ear canal, leading to the eardrum.
The eardrum then reverberates from the entering sound waves and transmits these vibrations to three miniature bones in the middle ear, the malleus, incus, and stapes.
These bones combine the sound vibrations from the air to oscillations in the cochlea of the inner ear, shaped like a snail and is filled with fluid. An elastic partition moves from the opening to the end of the cochlea, dividing it into an upper and lower portion. This partition is known as the basilar membrane and serves as the foundation on which fundamental hearing structures are created.
Once the vibrations trigger the fluid inside the cochlea to ripple, a moving wave develops along the basilar membrane. Hair sensory cells are positioned on top of the basilar membrane-ride the flowing wave.
As the hair cells move up and down, microscopic hair-like projections (known as stereocilia) that perch on top of the hair cells bounce against an overlying structure and bend. This bending produces pore-like channels, which are at the tips of the stereocilia, to open up. When that occurs, chemicals race into the cells, generating an electrical signal.
The auditory nerve transmits this electrical signal to the brain, which converts it into a sound that we recognize and comprehend.

Why do we start losing our hearing as we age?

Several components can contribute to hearing loss as you grow older. It can be challenging to differentiate age-related hearing loss from other types of hearing loss that can happen for other reasons, such as extensive exposure to noise.

Noise-induced hearing loss is accelerated by long-term exposure to sounds that either last too long and/or are too loud. This kind of noise exposure can damage and impair the sensory hair cells in your ear that enable you to hear. Once these hair cells are degraded, they cannot grow back, and your ability to hear is reduced.

Conditions that are more prevalent in older individuals, such as high blood pressure or diabetes, can present hearing loss. Some medications can also damage the ear’s sensory cells (such as chemotherapy medications) and lead to hearing loss.

In very rare cases would the age-related hearing loss be due to abnormalities within the outer ear or middle ear. Such abnormalities may include the decreased function of the tympanic membrane (the eardrum) or diminished function of the three small bones within the middle ear that transfer sound waves from the tympanic membrane to the inner ear.

Most older individuals who experience hearing loss have multiple factors, including age-related hearing loss and noise-induced hearing loss.

How can I prevent age-related hearing loss?
Today researchers still do not know how to prevent age-related hearing loss. Nevertheless, you can guard yourself against noise-induced hearing loss by protecting your ears from the noise that is either too loud and lasts too long. It’s essential to be conscious of potential sources of damaging noises, such as motorcycles, snowmobiles, loud music, loud concerts, firearms, snowmobiles, lawnmowers, and leaf blowers. Shunning loud noises, lessening the amount of time you’re exposed to loud noise, and shielding your ears with earplugs or earmuffs are simple ways you protect your hearing and restrict the level of hearing you might lose as you get older.

How can I know if I have a hearing problem?
Ask yourself the following questions. If the answer is “yes” to three or more of the questions below, you could have a hearing impairment and may require a medical evaluation.

  • Do you occasionally feel uncomfortable when you meet new people, and you struggle to hear or understand what they are saying?
  • Do you feel irritated and flustered when talking to members of your family as you have difficulty listening to what they are saying?
  • Do you have trouble hearing or understanding co-workers, clients, or customers?
  • Do you feel limited or restrained by a hearing problem?
  • Do you have trouble hearing when visiting friends, relatives, or neighbors?
  • Do you struggle to hear in the cinema or the theater?
  • Does a hearing strain cause you to argue with family members?
  • Do you have difficulty hearing the TV or radio and the levels for you are often too loud for others?
  • Do you feel that any challenge with your hearing limits your personal or social life?
  • Do you have difficulty hearing family or friends when you are all having a conversation in a restaurant?

Adapted from: Newman, C.W., Weinstein, B.E., Jacobson, G.P., & Hug, G.A. (1990). The Hearing Handicap Inventory for Adults [HHIA]: Psychometric adequacy and audiometric correlates. Ear Hear, 11, 430-433.

What should I do if I struggle to hear clearly?
Hearing problems can be serious. The most significant thing you can do if you think you have a hearing problem is to solicit advice from a health care provider. There are multiple kinds of professionals who can help you and you might want to begin with your primary care physician, an otolaryngologist, an audiologist, or a hearing aid specialist. Each has a distinct type of training and area of expertise and each can be an essential part of your hearing health care.

An otolaryngologist (oh-toe-lair-in-GAH-luh-jist) is a physician who specializes in diagnosing, managing, and developing treatments for diseases that affect ear, nose, throat, and neck. An otolaryngologist occasionally called an ENT, will attempt to determine why you’re having difficulty hearing and offer treatment alternatives. They can also introduce you to another hearing professional, such as an audiologist.
An audiologist (aw-dee-AH-luh-jist) has functional training in recognizing and determining the type and measurement of hearing loss. Some audiologists may be licensed to fit hearing aids.
A hearing aid specialist is a person who is accredited by your state to manage and evaluate primary hearing tests, offer to counsel, as well as fit and test hearing aids.

What treatments and devices can help?
Your treatment will be based on the severity of your hearing loss, so some methods will work better for you than others. There are plenty of devices and aids that help you hear better when you have hearing loss. Here are the most common ones:

There are five types of hearing aids. Behind-the-ear (BTE), Mini BTE, In-the-ear (ITE), In-the-canal (ITC) and Completely-in-canal (CIC)

Hearing aids are computerized devices you wear in or on the back of your ear, these devices aid in amplifying sounds. To obtain the hearing aid that works well for you, you may have to test them and use more than one. Be certain to ask for a trial period with your hearing aid and understand the terms and stipulations of the trial time. Work with your hearing aid provider until you feel comfortable with placing on/in and removing the hearing aid from your ear, adjusting the volume level, and swapping in and out the batteries. Hearing aids are ordinarily not included by health insurance companies, however, some do. Medicare does not cover the cost of hearing aids for adults; however, diagnostic evaluations are covered if a physician requests them to assist in developing a treatment plan.

Cochlear (COKE-lee-ur) implants are miniature electronic devices surgically embedded in the inner ear that help accommodate a sense of sound to people who are very deaf or hard-of-hearing. If your hearing loss is severe, your physician may recommend a cochlear implant in one or both ears.

Bone anchored hearing systems bypass the ear canal and middle ear and are created to use your body’s natural capability to transmit sound through bone conduction. The sound processor picks up sound, transforms it into vibrations, and then relays the vibrations through your skull bone to your inner ear.

Assistive listening devices incorporate telephone and cell phone magnifying devices, smartphone or tablet “apps,” and closed-circuit systems (hearing loop systems) in places of worship, playhouses, and auditoriums.

Speechreading or lip reading is another option that aids people with hearing problems following conversational speech. People who use this technique pay close attention to others when they speak by watching the speaker’s mouth and body movements. Specialized trainers can help you to learn how to lip read or speech read.