Age-Related Hearing Loss. What Are My Options?

Presbycusis is the medical term for age-related hearing loss. It affects about half of the population by the age of 75 years and almost all of us if we are fortunate enough to live to 90 years or more.

The World Health Association (WHO) estimates that by 2025 there will be over one billion people over the age of 60 years with presbycusis and about half of those individuals will have significant impairment.

Our hearing declines gradually, so much so that many people either do not notice it right away or they develop coping mechanisms without even realizing it. Usually, people lose their hearing in the high frequencies first, which makes it difficult to understand women’s or children’s voices and be able to hear background noises such as in family gatherings or restaurants.

Hearing loss can present in many different ways, affect people differently, and is thought to be complex with many potential causes. Presbycusis is insidious because it affects our ability to communicate, and it leads to feelings of isolation, low self-esteem, loss of quality of life, and depression.

What is presbycusis and what else can be associated with it?

The hearing loss is progressive and symmetrical, meaning it usually affects both ears. Any time there is hearing loss that is markedly greater in one ear, there is a need to have the person evaluated for causes of hearing loss other than presbycusis.

Hearing loss begins in the higher frequencies and eventually affects the middle and lower frequencies. The high frequencies carry the consonant sounds, so the person perceives the sounds as softer and particularly difficult to understand. In other words, the person will be able to hear someone talking to them, but not be able to understand what is being said.

Competing for background noise is another obstacle. When high-frequency sounds are missing, it becomes more difficult to continue conversations or hear a TV in crowded environments. This is known as the “cocktail party” effect.

Another troubling sign of presbycusis is a common hypersensitivity or overreaction to loud sounds. This is part of the disordered processing of sounds in the inner ear and it is called “recruitment.” This is important to recognize because it can make finding hearing aids challenging because of a narrowing of the dynamic range in which the person can hear.

Some people begin complaining of a steady ringing or static in their ears or tinnitus. This can progress as the hearing loss worsens, but there are hearing solutions with new hearing technology that help with tinnitus.

Lastly, people can experience dizziness and become more apt to experience disequilibrium and falls with presbycusis. This exacerbates other coexisting issues of aging such as arthritis, peripheral vascular disease, and loss of vision.

What should a person who is losing their hearing do?

It may not be the person who seeks help. It may be their family members or friends who encourage a person to get checked. Encouragement to have a person’s hearing evaluated may not be as easy as it sounds, but it can avoid many issues with difficulty with communication and isolation.

Even with the newest FDA rules that recently made over-the-counter hearing aids available, it cannot be stressed enough that nothing replaces a medical evaluation by a qualified healthcare provider, such as a family doctor or internist.

Next, if there are no apparent medical reasons for the hearing loss other than presbycusis, then an evaluation by an audiologist and usually an ENT doctor is the best course of action. There are a whole host of possibilities that need to be ruled out.

For older patients, medical evaluation can also be a good excuse for assessing the person’s overall health and well-being. Most doctors and audiologists never try to force anyone to get hearing aids, but they can offer some good suggestions if the person remains stubborn about the idea.

What are my options if I have hearing loss with aging?

Each person is different. Management should be highly individualized. Unfortunately, there are no cures for presbycusis, not yet at least.

The costs and convenience of hearing solutions remain a great challenge. Only a small percentage of patients with presbycusis eventually get hearing aids or some type of effective hearing amplification.

Recently, there has been a lot of attention being given to how hearing aids can help older people with their thinking and cognition. The findings are that helping older people with both, the results can dramatically improve their quality of life.

Hearing Aids

The world of hearing aids is constantly changing and improving. Over the past 10 to 15 years, the technology which goes into hearing aids has exploded. There are many different options. Of course, there is still a stigma with wearing hearing aids, but the negative experiences are now finally being outweighed by the positives. Hearing aids have become more cosmetically appealing, less uncomfortable, easier to use, and rechargeable and they are getting better in not only reproducing specific sounds such as in the higher frequencies, but they can help with tinnitus, too.

Assisted listening devices

Other options may include assisted listening devices, which in many cases are sound amplifiers. These are popular options when they are available such as in theaters, churches, or lecture halls. Most are linked to hearing aids.

Auditory rehabilitation

This is like physical therapy, but for hearing. The right audiologist can train patients in active listening, speech reading, and communication enhancement skills. Some of these techniques are taught in group sessions, as well as individually. Even with hearing aid wearers, these methods can be especially useful. An example is simply teaching family members to speak more slowly and clearly, while they look at the person directly. Visual cues are incredibly helpful.

Cochlear implants or other hearing implants

The vast majority of patients will not be candidates for these surgeries. These are reserved for the most severely affected patients when conventional hearing aids or amplification will not be effective.

There may be a time in the future when the inner ear hair cells which are responsible for our hearing may be regenerated. This may include genetic, cellular, or pharmacotherapy solutions, but today, this is still impractical, if not science fiction.

Age-associated hearing loss is called presbycusis and is something that should be evaluated by healthcare professionals. The condition can be treated with hearing aids, assisted listening devices, and auditory rehabilitation.