An Aged Loss

The prevention and progression of age-related hearing loss.

The notion that hearing loss occurs with age is nothing new. In fact, it's a long, sometimes over-played idea. Turn on any television show or movie featuring a recurring character who is a senior citizen, for example, and it's likely that it won't be long before a hearing-related joke is made. Images of ear trumpets and dialogue bubbles filled with "Eh?" or "What?" connected to octogenarians are comic classics as well.

But in reality, age-related hearing loss (presbycusis) is no laughing matter. It is a real and, yes, common condition that many senior citizens struggle with. Fortunately, with appropriate attention and care, the progression of presbycusis can be - hopefully - stalled. And with even more attention and care to the ears of younger generations, prevention is a possibility, too.

The Loss
Age-related hearing loss occurs, most commonly, as a result of changes to the inner ear. "As individuals age, what happens is that the metabolic engine for the inner ear changes. . . . This affects the hair cells in the inner part of the ear," explained Barbara Weinstein, PhD, professor and executive officer of the AuD program, graduate center at CUNY (The City University of New York). The inner ear degenerates and, with that degeneration, the ability to hear certain pitches lessens. Noise levels decrease to the individual suffering from presbycusis.

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), presbycusis can also occur with changes to the middle ear, as well as changes to the nerve pathways that lead to the brain. Specifically, the nerve pathways that lead to the auditory cortex, said Weinstein.

The hearing loss does not affect all sounds. "The ability to hear low-pitch sounds is not lost, so that means they [individuals with age-related hearing loss] can hear noises in the environment and vowels [for example], but they can't hear softer sounds like consonants, such as 's' and 'sh'," Weinstein described. "They can hear people talking, but they cannot make out the words. They can hear the lows, but the high frequencies are lost."

Cognitive changes can also affect age-related hearing loss. As the individual now has to focus more to hear the sounds, the act of listening requires more attention and memory. "So when you're challenged by the noise and the hearing loss, it's kind of a double whammy," Weinstein stated.

While popular media may indicate that this type of hearing loss happens to everyone as they reach a certain age, that's not exactly true. The NIDCD estimates that 30-35 percent of individuals between 65 and 75 suffer from presbycusis, while 40-50 percent of individuals over the age of 75 have age-related hearing loss. Weinstein, on the other hand, estimated that approximately 60 percent of individuals over 70 have hearing loss related to age.
Both are estimations and that alone may account for the discrepancies. However, there may be another reason: lack of reporting.

"There is no requirement to screen for hearing loss," said Weinstein. "There is no recommendation even to screen for hearing loss among people who do not complain about hearing loss." And how many people complain?

"Older people in general under report how they're feeling. They tend to exaggerate and say that they're feeling better than they are," she said. "With older people, they might have mild hearing loss, [but only about] half will admit having problems. As you get moderately severe [hearing loss], that's when people start to admit that they're having trouble.

"As people get more severe hearing loss with age, medical conditions, environmental conditions, they're more likely to say it."

Progression & Treatment
Unaddressed (i.e., unreported), age-related hearing loss is most likely to increase in severity. However, there are actions that can be taken to help slow if not stop the progression of presbycusis. The simplest step is ear plugs. "Once your hearing is degenerating, if you protect your ears with ear plugs, that can help," said Weinstein.

So can hearing aids. Weinstein explained that when individuals wear a hearing aid in one ear but not the other, hearing will worsen in the unaided ear. "If you test people five years later," she said of individuals with one hearing aid, "the ear without the hearing aid dropped." However, hearing aids are not the most popular option. "Only 20-25 percent of individuals with hearing loss using hearing aids," she continued. "The other 80 percent could benefit from [alternate] assistive technology."

The aim behind assistive technologies for hearing loss is to increase the signal over the noise. Essentially, the technologies are designed to allow the individuals to not only hear the person speaking but have the opportunity to process and respond to the words as well. Take, for example, personal amplifiers.

"The signal comes from the speaker and goes wirelessly into the ear, and that really helps," Weinstein said. The help not only applies to the individual's hearing but his/her quality of life too, she added. Weinstein relayed a personal anecdote, describing a friend's mother who at age 100 got a personal amplifier. It helped her communicate with her family for only about $120, she said. Weinstein's friend's mother lived to be 106 years old.

Amplifiers can even be purchased and used through smartphones. "They have amplification apps that people could use, or you could buy an external amplifier."

Weinstein suggests different devices depending on the hearing loss and where/when it is most relevant. "Some people have situational hearing loss. There are devices for the television, and devices for the telephone. They work wonderfully.

"The really important message is that for situational difficulties, there are solutions."

But solutions must be sought.

Consequences Outside of Hearing
If the above-described or alternative actions aren't taken, hearing loss will continue to increase. But that's not the only thing that may worsen.

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"Hearing loss is associated with increased burden of illness, increased hospitalization," Weinstein listed. "Hearing loss is associated with falls. . . . If older people [with hearing loss] are in a noisy environment, they're more prone to fall and/or not understand because they have to put so much concentration in." Weinstein further explained that the risk of falling down the stairs can also increase when individuals with presbycusis attempt, for example, to descend/ascend while talking.

"If you pick up that somebody is susceptible to falls, screen for hearing loss," she said.

Beyond the physical, mental health can also be affected. "Individuals with hearing loss, particularly older individuals, can suffer from depression. Additionally, individuals who have a cognitive impairment are more likely to have hearing loss. When doctors are screening for cognitive impairment, it's really important to make sure they can hear the questions."

It's also important to be aware of the risk of isolation. Hearing loss can lead to social isolation, which can increase the likelihood of cognitive impairments or, at the very least, hasten the progression, particularly in diseases such as dementia.

Fortunately, there are steps that can be taken to prevent presbycusis and all that follows. Prevention starts young - with protection. Just as ear plugs can stem the severity of presbycusis once it has developed, they can also help stave off the condition. Individuals are advised to cover or plug their ears when in noisy environments and not to listen to extremely loud noises.

Weinstein also suggests taking care of yourself. "Someone with diabetes should control that diabetes," she said by way of example. "Hearing is a modifiable condition that you can treat. There are factors that are modifiable as well - avoid noisy situations, maintain a healthy diet and exercise."

And doctors - doctors need to be aware of the likelihood of hearing loss. Don't wait for an individual to complain, particularly as he/she continues to age. Screen for hearing loss and if it is present: "Just refer these people."

Sue Coyle is a freelance writer.

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