All you need to know about hearing loss

What is age-related hearing loss?

Age-related hearing loss, or "presbycusis," is the gradual loss of hearing that occurs in most of us as we grow older. Approximately one in three people in the United States between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing. This makes presbycusis one of the most common conditions affecting older and elderly adults.

 

Having trouble hearing can make it hard to understand and follow a doctor’s advice, respond to warnings, and hear phones, doorbells, and smoke alarms. Hearing loss can also make it hard to enjoy talking with family and friends, leading to feelings of isolation.

Age-related hearing loss most often occurs in both ears and affects them equally. Because the loss is gradual, if you have age-related hearing loss you may not even realize that you’ve lost some of your ability to hear.

 

There are many causes of age-related hearing loss. Most commonly, it arises from changes in the inner ear as we age, but it can also result from changes in the middle ear, or from complex changes along the nerve pathways from the ear to the brain. Certain medical conditions and medications may also play a role.

How do we hear?

​Hearing is one of our five senses. It is a complex process that depends on a series of events that change sound waves in the air into electrical signals in our brain. The ear is fully developed at birth and responds to a wide range of sounds that are both soft and loud, low pitch and high pitch. So, how do we hear?

  1. Sound waves from the environment around us enter the outer ear (the part that you can see) and travel through the ear canal, which leads to the eardrum.

  2. The eardrum vibrates from the incoming sound waves and sends these vibrations to three tiny bones in the middle ear. These bones are called the malleus, incus, and stapes (you may have heard them called the hammer, anvil, and stirrup - that is because they look like miniature ones). These are the smallest bones in our entire body!

  3. The bones in the middle ear are connected to the cochlea in the inner ear, which is shaped like a snail and filled with fluid. When the middle ear bones move, this in turn causes the fluid to move.

  4. This fluid movement causes movement of special structures in the cochlea known as "hair cells." These hair cells are not like the hairs on your head. These hair cells are special sensory cells that release chemicals to create an electrical signal that is sent through our auditory nerve to our brain, where it is interpreted as a sound that we recognize and understand.

Why do we lose our hearing as we get older?

Credit: Yoshiyuki Kawashima

 

Many factors can contribute to hearing loss as you get older. It can be difficult to distinguish age-related hearing loss from hearing loss that can occur for other reasons, such as long-term exposure to noise.

 

Noise-induced hearing loss is caused by long-term exposure to sounds that are either too loud or last too long. This kind of noise exposure can damage the sensory hair cells in your ear that allow you to hear. Once these hair cells are damaged, they do not grow back and your ability to hear is diminished.

 

Conditions that are more common in older people, such as high blood pressure or diabetes, can contribute to hearing loss. Medications that are toxic to the sensory cells in your ears (for example, some chemotherapy drugs) can also cause hearing loss.

 

Rarely, age-related hearing loss can be caused by abnormalities of the outer ear or middle ear. Such abnormalities may include reduced function of the the eardrum or reduced function of the three tiny bones in the middle ear that carry sound waves from the tympanic membrane to the inner ear.

Most older people who experience hearing loss have a combination of both age-related hearing loss and noise-induced hearing loss.

Can I prevent age-related hearing loss?

At this time, scientists don’t know how to prevent age-related hearing loss. However, you can protect yourself from noise-induced hearing loss by protecting your ears from sounds that are too loud and last too long. It’s important to be aware of potential sources of damaging noises, such as loud music, firearms, snowmobiles, lawn mowers, and leaf blowers. Avoiding loud noises, reducing the amount of time you’re exposed to loud noise, and protecting your ears with ear plugs or ear muffs are easy things you can do to protect your hearing and limit the amount of hearing you might lose as you get older.

What should I do if I have trouble hearing?

​Hearing problems can be serious. The most important thing you can do if you think you have a hearing problem is to seek advice from a healthcare provider. There are several types of professionals who can help you. You might want to start with your primary care physician, an otolaryngologist, an audiologist, or a hearing aid specialist. Each has a different type of training and expertise. Each can be an important part of your hearing health care.

  • An otolaryngologist (oh-toe-lair-in-GAH-luh-jist) is a doctor who specializes in diagnosing and treating diseases of the ear, nose, throat, and neck. An otolaryngologist, sometimes called an ENT, will try to find out why you’re having trouble hearing and offer treatment options. He or she may also refer you to another hearing professional, an audiologist.

  • An audiologist (aw-dee-AH-luh-jist) has specialized training in identifying and measuring the type and degree of hearing loss. Many audiologists are licensed to fit hearing aids.

  • A hearing aid specialist is someone who is licensed by your state to conduct and evaluate basic hearing tests and fit and test hearing aids. You must be examined by a physician before you can be fitted for a hearing aid, although federal law allows you to sign a waiver if you don’t wish to be examined before you purchase an aid.

What treatments and devices can help?

Your treatment will depend on the severity of your hearing loss, so some treatments will work better for you than others. There are a number of devices and aids that help you hear better when you have hearing loss. (Source: NIH/NIDCD)

  • Hearing aids are electronic instruments you wear in or behind your ear. They make sounds louder. To find the hearing aid that works best for you, you may have to try more than one. Hearing aids are generally not covered by health insurance companies, although some do. Medicare does not cover hearing aids for adults; however, diagnostic evaluations are covered if they are ordered by a physician for the purpose of assisting the physician in developing a treatment plan.

  • Cochlear (COKE-lee-ur) implants are small electronic devices surgically implanted in the inner ear that help provide a sense of sound to people who are profoundly deaf or hard-of-hearing. If your hearing loss is severe, your doctor may recommend a cochlear implant in one or both ears.

  • Bone anchored hearing systems transmit sound without the use of the ear canal and middle ear. They are designed to use your body’s natural ability to transfer sound through bone conduction. The sound processor picks up sound, converts it into vibrations, and then sends the vibrations through your skull bone to your inner ear.

  • Assistive listening devices include telephone and cell phone amplifying devices, smart phone or tablet “apps,” and closed-circuit systems (hearing loop systems) in places of worship, theaters, and auditoriums.

  • Lip reading or speech reading is another option that helps people with hearing problems follow conversational speech. People who use this method pay close attention to others when they talk by watching the speaker’s mouth and body movements. Special trainers can help you learn how to lip read or speech read.

Can my friends and family help me?

​You and your family can work together to make living with hearing loss easier. Here are some things you can do:

  • Tell your friends and family about your hearing loss. The more friends and family you tell, the more people there will be to help you cope with your hearing loss.

  • Ask your friends and family to face you when they talk so that you can see their faces. If you watch their faces move and see their expressions, it may help you to understand them better.

  • Ask people to speak louder, but not shout. Tell them they do not have to talk slowly, just more clearly.

  • Turn off the TV or the radio when you aren’t actively listening to it.

  • Be aware of noise around you that can make hearing more difficult. For example, when you go to a restaurant don’t sit near the kitchen or near a band playing music. Background noise makes it hard to hear people talk.

Working together to hear better may be tough on everyone for a while. It will take time for you to get used to watching people as they talk and for people to get used to speaking louder and more clearly. Be patient and continue to work together. Hearing better is worth the effort.