Hearing loss in the elderly

• Causes
• Symptoms and signs
• Exams and Tests
• Treatment
• Outlook (Prognosis)
• Possible Complications

Compiled by Dr Bulantrisna Djelantik, Indonesia

"Presbycusis", or age-related hearing loss, is the slow loss of hearing that occurs as people get older. The hearing loss can affect life in many ways. The hearing impaired person may miss out on talks with friends and family. On the telephone, the person may find it hard to hear what the caller is saying.

Sometimes hearing problems can make someone feel embarrassed, upset, and lonely. It's easy to withdraw when they can't follow a conversation at the dinner table or in a restaurant. It's also easy for friends and family to think that someone is confused, uncaring, or difficult, when the problem may be that the person just can't hear well.

If someone has trouble hearing, there is help. The person has to see a doctor or health care provider. Depending on the type and extent of the hearing loss, there are many treatment choices that may help. Hearing loss does not have to get in the way of the ability to enjoy life.

Causes

Inside the inner ear is a small structure called Cochlea, containing rows of hair cells with tiny hairs that help us hear. They pick up sound waves and change them into the nerve signals that the brain interprets as sound. Sensori-neural hearing loss occurs when the tiny hairs inside the ear are damaged or die. The hair cells do not re-grow, so most sensori-neural hearing loss is permanent.

Most commonly, presbycusis is caused by damage to the hair cells that occur as result of aging. Beside the damaged hair cells, there could also be damage in the auditory nerve cells as well as the central auditory processing nerve cells in the brain. However, usually it is a combination with other causes, such as genes and loud noises. Listening to loud music through headphones, or working in very noisy conditions, may play a large role.

The following factors contribute to age-related hearing loss:

• Family history (age-related hearing loss tends to run in families)
• Repeated exposure to loud noises
• Heart and kidney conditions, or stroke
• Smoking (smokers are more likely to have such hearing loss than nonsmokers)

Certain medical conditions and medications also contribute to age-related hearing loss. About half of all people over age 75 have some amount of age-related hearing loss.

Symptoms and signs

Hearing loss may affect the hearing threshold, the volume at which a patient can hear sound, expressed in decibels (dB), discrimination (the ability to differentiate among various speech sounds), or both. The high frequencies of sound, expressed in hertz (Hz) may be affected first.

The loss of hearing affect both ears symmetrically occurs slowly over time. It is most difficult to hear high-frequency sounds, as someone talking. As hearing gets worse, it may become difficult to hear sounds at lower pitches.

Symptoms include:

• Difficulty hearing in noisy areas (also called the "cocktail party syndrome")
• High-pitched sounds such as "s" or "th" are hard to distinguish from one another
• Men's voices are easier to hear than women's.
• Other people's voices sound mumbled or slurred
• Family members may complain that the television is turned n too loud
• Often asks for words to be repeated
• The person avoids social situations, religious services, and movie theaters
• Music lovers may complain that music does not sound as bright
• Certain sounds seem overly loud
• Ringing in the ears