What is Hearing Loss in the Elderly?
Hearing loss is a very common problem. According to the World Health Organization (WHO), it affects more than 400 million people all over the world. The chances of experiencing hearing loss get higher as a person ages, with the rate nearly doubling for every decade of a person’s life. Recent research suggests that about 63% of people in the U.S. who are over the age of 70 have some degree of hearing loss. As more people grow older, we expect to see more people dealing with hearing loss.
Proper examination, diagnosis, and treatment of hearing loss require health care providers to have shared definitions and understandings. It’s important to thoroughly understand the structure of the ear, the processes that can lead to hearing loss, and the study of how widespread this condition is (especially among the elderly) in order to address it properly.
What Causes Hearing Loss in the Elderly?
With age, hearing loss becomes more complicated. As individuals age, many parts of the body can begin to function differently, which can all affect one another. A lot of the time, this hearing loss is due to what we call age-related hearing loss or presbycusis. However, it’s hard to know exactly how often this occurs.
Presbycusis is defined as hearing loss in both ears that is purely caused by aging, with no other identifiable causes. To properly address hearing loss in older people, healthcare professionals must not only consider presbycusis but also other potential causes, as it’s not the only reason for hearing loss in older people.
In order to understand hearing loss, it’s important to understand that there are three main types. Conductive hearing loss happens when issues prevent sound waves from reaching the inner ear. This could be due to fluid in the middle ear, changes in bone structure in the ear, or even something as simple as a build-up of earwax blocking the ear canal. Conversely, sensorineural hearing loss is caused by problems in the transmission of sound from the inner ear to the brain and can occur due to presbycusis, exposure to loud noise, genetic conditions, or issues in the brain or more serious infections.
Risk Factors and Frequency for Hearing Loss in the Elderly
As more people are living beyond 65 years, certain health conditions prevalent in this age group are growing in importance. It’s becoming clear that one such concern is hearing loss, which is experienced by over 80% of those aged over 80. For health providers looking after the elder segment of the population, hearing loss should be a key area of consideration.
- Males are more likely to suffer from hearing loss as they grow older.
- There’s often a genetic link, with individuals with a family history usually experiencing more severe hearing loss.
- Curiously, studies show that people with less pigmented skin might encounter higher rates of hearing loss as they age.
Signs and Symptoms of Hearing Loss in the Elderly
If a person is experiencing hearing loss, they might notice signs themselves or their family and friends might pick up on it. Some signs could include struggling to understand what others are saying, needing to turn the volume up high on the TV or radio, or becoming less social.
When trying to understand the cause of the hearing loss, several factors should be taken into consideration. This includes when the symptoms started, how long they’ve been going on, and whether there are differences between the ears. Other symptoms like a feeling of fullness in the ear, ear drainage, ear pain, dizziness, ringing in the ears, and balance problems should also be assessed. It’s important to ask about exposure to loud noises, family history of hearing loss, and any substances that may be harmful to the ears.
For patients with hearing loss, a thorough examination of the head and neck, especially the eardrum, should be conducted. This may include in-office hearing tests like the tuning-fork tests, Weber and Rinne, and a simple hearing test called the finger rub test. These tests can give clues about what’s causing the hearing loss. One of the most important tests is an audiometry test, which provides a detailed evaluation of hearing ability.
Testing for Hearing Loss in the Elderly
If you’re having issues with hearing loss, the first step that your doctor will take is to get you to have an audiogram. An audiogram is essentially a detailed hearing test conducted by an audiologist, a specialist in hearing. The test is crucial for anyone who might have hearing loss.
The test, called pure tone audiometry, assesses your hearing at various pitches, from low to high. It will check how you hear sounds traveling through the air and the bones in your ear. These results will help the audiologist figure out two main things – how severe your hearing loss is and what type of hearing loss you have. There are three types: conductive (related to the structures of the ear that help conduct sound), sensorineural (related to the hearing nerve or inner ear), or a mixture of both.
As well as this, your hearing test will likely involve checking how you perceive sounds, how well you can recognize speech, and measuring how your eardrum reacts to changes in air pressure (this is called tympanometry). They also might check your acoustic reflex, which is an involuntary muscle contraction that occurs in the middle ear in response to loud sound.
Sometimes, if the doctor has specific concerns about possible causes of your hearing loss, like a benign tumor (schwannoma) or a noncancerous skin growth in the middle ear (cholesteatoma), you may need to have some imaging tests. These could be a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Both these tests provide an in-depth look at the structures in your ear and the surrounding areas, which allows the doctors to diagnose any particular conditions that might be causing your hearing loss.
Treatment Options for Hearing Loss in the Elderly
Treating and managing hearing loss in elderly people requires a careful examination and making sure we understand all possible causes. The specific treatment depends on identifying the main cause of the hearing loss. Two general categories of hearing loss are sensorineural and conductive.
Conductive hearing loss is when there’s a problem with the way sound is conducted from the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Each type of conductive hearing loss has a specific treatment. For example, if the hearing loss is due to otosclerosis, which is a condition that affects the bones in the middle ear, the typical management involves a surgery called stapedectomy. If the hearing loss results from earwax blocking the ear canal, the treatment would involve earwax removal.
Sensorineural hearing loss, on the other hand, is when there’s a problem with the sensory part of the ear, which includes the hair cells of the inner ear and the nerves that take the sound to the brain. This type of hearing loss is usually managed by using various devices to amplify sound, which requires specialized fitting, planning, and regular follow-up with a hearing specialist. There are many variety of hearing aids and sound amplification devices, including ones that go behind the ear, in the ear canal, and ones that can be implanted. The best hearing aid or device depends on several patient factors, such as the cause and degree of hearing loss, and one’s lifestyle and physical needs. Unfortunately, sometime the cost can also play a role in deciding the best treatment.
What else can Hearing Loss in the Elderly be?
For elderly people experiencing hearing loss, while Age-Related Hearing Loss (ARHL) is a common cause, there are many other possible factors that should be considered. To distinguish between ARHL and other potential causes, healthcare providers need to carry out a detailed patient history, a thorough physical examination, and a comprehensive hearing test. They can then decide on the type of hearing loss – whether it’s conductive, sensorineural, or a mix of both – and from there further diagnostic tests can be done if necessary.
If the hearing loss is conductive, it means there’s a problem somewhere between the external ear to the middle ear, which are all responsible for transmitting sound waves to the inner ear. Below are some common causes:
- Earwax blockage
- Foreign objects in the ear
- Swimmer’s ear (otitis externa)
- Middle ear infection (otitis media)
- Ear tumors
- Tear or hole in the eardrum
- Growth of skin cells (cholesteatoma)
- Stiffening or fusion of the middle ear bones (otosclerosis)
On the other hand, sensorineural hearing loss occurs when there’s a problem with the part of the ear responsible for sending sound signals to the brain – this could be the cochlea, the hearing nerve, or the brain’s sound processing mechanisms. Here are some common diagnoses for this type of hearing loss:
- Age-Related Hearing Loss (ARHL)
- Excessive noise exposure
- Harmful substance exposure
- Meniere’s disease
- Inflammation of the inner ear (labyrinthitis)
- Viral infection
- Tumors on the hearing nerve (acoustic neuromas)
- Various other issues affecting the inner ear and base of the skull
What to expect with Hearing Loss in the Elderly
Hearing loss is incredibly common in older adults and can greatly affect their quality of life. In fact, the World Health Organization ranks it as the second most impactful issue affecting seniors. The cost of caring for elderly individuals with hearing loss also has a major financial impact. In the U.S. alone, it leads to over three billion dollars in extra medical costs each year.
There’s a clear link between hearing loss in older adults and other health issues. Notably, the relationship between age-related hearing loss (ARHL) and dementia holds significant future health implications. A recent study showed that ARHL and dementia had the highest risk related to hearing loss. Besides this, studies have also shown that hearing loss in seniors is directly connected to poor mental health, with higher rates of loneliness, depression, and mental decline observed in those affected.
While there isn’t any treatment that can reverse ARHL, managing the hearing loss can improve the quality of life and social interactions. Hence, the importance of early diagnosis and management of hearing loss cannot be overstated. As many causes of hearing loss in older adults, including ARHL, are irreversible, early diagnosis, treatment, and education are crucial to providing the best help possible for patients experiencing hearing loss.
Possible Complications When Diagnosed with Hearing Loss in the Elderly
One of the main issues with hearing loss in older adults is correctly figuring out and addressing the root cause. It’s important to avoid a diagnosis being missed or delayed. If left undetected and untreated, hearing loss can significantly affect the lives of elderly people, increasing their likelihood of becoming socially isolated.
The slow and sometimes challenging nature of diagnosing hearing loss means that many elderly individuals may not receive the necessary treatment or diagnoses. Moreover, a wrong diagnosis could result in incorrect treatment or unnecessary tests, potentially causing harm from additional testing, or prolonging the impact of hearing loss.
Key Issues:
- Missed or delayed diagnoses
- Social isolation caused by untreated hearing loss
- Inappropriate treatment due to incorrect diagnoses
- Unnecessary medical tests due to incorrect diagnoses
- Deteriorating condition due to delayed treatment
Preventing Hearing Loss in the Elderly
It’s important for elderly people suffering from hearing loss to be properly informed about their condition. Some may think that hearing loss is simply something that happens with age and that there’s nothing they can do about it or that it doesn’t really affect their day-to-day life. However, when they learn about the potential treatments and how managing their hearing loss can improve their quality of life, they are in a better position to manage their hearing loss effectively.
Regular follow-ups with an audio specialist (a person who treats hearing problems) and understanding how to use hearing aids or sound enhancement devices are crucial for these devices to work correctly and provide the most benefit. It’s also important to provide advice on how to take care of the ears, including avoiding loud noises or harmful substances that can further damage hearing.
