Hearing

Hearing loss is very common with aging and is one of the most correctable yet often unrecognized problems. It contributes significantly to social isolation. About 25% of people between 65 and 74 years of age and 50% of people age 75 or older report difficulty hearing. Unfortunately, although 65% of those age 85 and older report hearing difficulty only 8% use a hearing aid or other assistive listening device. After age 60 there appears to be a 10dB reduction in hearing sensitivity each decade. Older men are more likely to have hearing loss than older women and people with Alzheimer's disease have a higher rate of hearing impairment than others.

Age-related Changes in the Ear

A number of age-related changes occur in the ear. Membranes in the middle ear, including the eardrum, become less flexible with age. In addition, the small bones in the middle ear, the ossicles, become stiffer. Both these factors somewhat decrease hearing sensitivity but are not thought to cause significant impairment. Changes also occur in the inner ear but it is unclear whether is it aging or exposure to environmental noise that causes these problems that result in hearing loss.

Changes in the middle ear with advancing age also contribute to a weakening sense of balance. The vestibular system is responsible for our sense of balance. The vestibular apparatus begins to degenerate with age in a similar way to the hearing apparatus. Equilibrium becomes compromised and older individuals may complain of dizziness and find it difficult to move quickly without losing their balance.

Presbycusis

Presbycusis-- literally "old man's hearing"-- is the most common form of hearing loss with aging. It is characterized by a decrease in perception of higher frequency tones and a decrease in speech discrimination. The magnitude of presbycusis varies widely and it is hard to determine how much of the hearing loss is due to aging and how much is due to exposure to environmental noise, ototoxic drugs, or chronic age-related conditions such as hypertension and diabetes.

Beginning around age 55, most older adults experience a loss in threshold sensitivity to pitch as the very high frequencies are lost. The higher frequency consonants, such as t, p, k, f, s and ch, are no longer heard due to the sensitivity loss in the high frequencies. In addition, elders have more difficulty in understanding speech, especially when there are competing sounds such as background noise.

Tinnitus

Tinnitus refers to a chronic ringing, buzzing, tinkling, humming or other noise in the ears that only the individual can hear. Nearly 36 million Americans have tinnitus. Tinnitus is more common among older adults because it may represent a lifetime of exposure to loud noise. Treatable causes of tinnitus include high blood pressure, wax in the ear canal, or some medications (e.g., aspirin, antibiotics, antidepressants). Tinnitus may also be a symptom of ear infection, allergy or thyroid problems. If a cause can be identified then tinnitus may be curable. More often though the cause of tinnitus is unclear. Although there are no effective drug therapies, you can do several things which may help:

Diagnosis of Hearing Impairment.

Unfortunately, older adults are not routinely screened for hearing loss by health care providers. It is relatively quick and easy to administer a hearing test using an audiometer. This test assesses the magnitude and pattern of the hearing impairment as well as the type of hearing loss (e.g., conductive, sensory, or central).

Signs of Hearing Impairment

Other people, particularly women and children, are hard to understand. People do not seem to speak clearly-- it sounds as if they are mumbling. Background noise makes it even harder to hear. Certain sounds seem loud or annoying. A background hissing or ringing is heard. Social events such as parties, concerts, or watching television are less enjoyable because you can't hear as well. You find yourself straining to understand what others are saying.

Treatment

About one in three older adults have their hearing reduced by up to 35% because of the accumulation of ear wax which blocks the sound. This is one of the most treatable causes of hearing loss; health care professionals can remove excess ear wax. Another common cause of hearing loss among older adults is medications, especially antibiotics or diuretics which can cause permanent hearing impairment.

A hearing aid amplifies the intensity of sound and can be an effective way to improve the hearing of most older adults. Nearly 2 million older people own hearing aids. Unfortunately, less than 30 percent of those people actually use the hearing aids, many for only a few hours per week. Many older people dislike hearing aids because room noises can be very distracting when they are amplified.

Fortunately, recent technological advances are improving the quality of the experience which may make them more acceptable. In addition, hearing aids are becoming smaller and which helps to remove the stigma of using them. Digitally programmable hearing aids allow individuals to adapt their hearing needs to different social contexts. However, hearing aids are quite expensive and most heath insurance plans, including Medicare, do not cover the cost.