Hearing Loss
Hearing loss
Definition
Hearing loss is partial or full loss of hearing in one or both ears. There are three different types of hearing loss: conductive, sensorineural, and mixed hearing loss. Presbycusis, or age-related hearing loss, is the most common type of hearing loss.
The ear consists of three key areas: the outer ear, middle ear, and inner ear. The three different types of hearing loss affect one or more areas of the ear:
- Conductive Hearing Loss: Occurs when sound cannot pass through the outer or middle ear to reach the inner ear. This is sometimes caused by a
Percentage of people in the United States age 65 and over who reported having any trouble hearing, by sex, age, and poverty status 2006 Sex Age and poverty status Any trouble hearing source:> National Health Interview Survey, National Center for
Health Statistics, Centers for Disease Control and Prevention,
U.S. Department of Health and Human Services(Illustration by GGS Information Services. Cengage Learning,
Gale)Both sexes 65–74 31.9% 75–84 46.3% 85 and over 61.8% Below poverty 36.6% Above poverty 42.1% Men 65–74 40.8% 75–84 54.6% 85 and over 66.3% Women 65–74 24.3% 75–84 40.3% 85 and over 59.8%
buildup of earwax, an infection, deformity of the middle or outer ear, or a foreign object. Doctors can generally treat conductive hearing loss surgically or medically if treatment is sought in a timely manner. - Sensorineural Hearing Loss: Occurs when there is damage or degeneration of the nerves in the inner ear, which reduces the ability to understand what is being said. Presbycusis is the most common type of sensorineural hearing loss. However, environmental factors, such as loud noise, head or ear injury, medications, disease, tumor, or infection may also cause sensorineural hearing loss. Hearing aids are often prescribed for this type of hearing loss.
- Mixed Hearing Loss: A combination of conductive and sensorineural hearing loss. Treatment options vary.
Description
Hearing loss is common among seniors, but the development and extent of it occurs at different points in every senior's life. Many seniors are quick to admit they have hearing loss, but many do not admit to dealing with its consequences, including hearing common warning sounds, such as car horns or fire alarms. This effect can prove dangerous.
While many still do not admit to the consequences of hearing loss, a different attitude about hearing loss is developing among seniors in the late 2000s than in past generations. Celebrity seniors such as Bill Clinton and Paul Newman have been treated for hearing loss and freely admit to wearing hearing aids . It is hoped that because hearing loss is a mainstream topic, many seniors will choose to be diagnosed properly and receive treatment so they can continue to participate in an active lifestyle.
Demographics
Presbycusis, or age-related hearing loss, is the third most common condition among seniors 65 or older, according to Ann Carter. Carter was quoted in a 2007 issue of Senior Health Advisor as saying: “By age 65, 1 in 3 persons has some hearing loss. By age 75, it's nearly 1 person in 2.”
If hearing loss in seniors goes undiagnosed or misdiagnosed, it may cause difficulty communicating, depression, anxiety , and social isolation . These problems can take a toll on the senior, the family, and/or the caregiver .
It is estimated that men are more susceptible than women to developing hearing loss due to environmental factors since they are more likely to have worked around and/or had prolonged exposure to loud power tools or instruments or devices that exceed 80 decibels.
Additionally, the National Academy on an Aging Society indicates that the majority of hearing loss is “highly associated with aging” and occurs in people 65 and older, second only to those ages 45 to 64. Caucasians make up 91% of the general population that has hearing loss, while 6% are black, and 3% are other.
While many seniors with hearing loss could benefit from the use of a hearing aid, many do not or will not use one. There are a few factors accounting for this pattern:
- Hearing aids can be expensive and not all insurance plans cover them. They can sometimes be as high as $2,500 for one ear.
- The learning curve for operating one may be too high. Many hearing aids are digital and require the owner to program them. Some seniors may feel uncomfortable with or overwhelmed by the technology or the process.
- A senior may not be fully educated about the benefits of wearing a hearing aid or of the great advances that have led to excellent sound quality in many models.
Prevention
Loud noise is an environmental factor that can oftentimes be prevented, possibly reducing future hearing loss. Loud noise at a hazardous level that may contribute to or cause hearing loss is any “noise above 80–90 decibels on average over an 8-hour workday,” according to the American Hearing Aid Association (AAHA). Furthermore, AAHA states, “firearms, music, airplanes, lawnmowers, power tools and many appliances are louder than 80 decibels and potentially hazardous to hearing with prolonged exposure.”
QUESTIONS TO ASK YOUR DOCTOR
- How significant is the hearing loss?
- Is it conductive, sensorineural, or mixed?
- What is causing the loss?
- How will you treat it?
- Do I need to see an otologist, otolaryngologist, or ear, nose, and throat (ENT) doctor?
- Do I need a hearing aid?
- What will a hearing aid cost?
- Will insurance cover it?
- Will you or a specialist fit me for or recommend a hearing aid?
- Will you assist me in making adjustments to my hearing aid, if needed?
- Will my hearing improve with treatment? If so, by how much?
In addition to preventing prolonged exposure to loud noise, studies were being conducted in the 2000s to determine whether folic acid can actually slowdown the process of hearing loss. A study conducted in the Netherlands between 2000 and 2004 asked half of its participating men and women who did not currently consume folic acid to take 800 micrograms once a day for three years. After three years, those who had consumed folic acid had less lowfrequency hearing loss, though the high frequency hearing loss showed no change. While the study's results were positive, the slowing of the low frequency hearing loss was minor—less than a decibel. That has left scientists wondering if a little folic acid is good would a larger amount be better. As of 2008 the answer was unknown; more studies were needed in the United States where folic acid is already part of the daily diet of seniors because manufacturers are required to enrich flour and other items with folic acid.
Symptoms
There are several signs that may indicate hearing loss:
- Ringing or buzzing in ear (called tinnitus)
- Difficulty hearing or understanding words in a crowded or noisy room; increased ability to hear words in a quiet room
- Voices and noise sounds muffled
- Difficulty hearing or differentiating certain consonants when pronounced, such as -s and -th.
- Lack of desire to attend social settings
- Frustration or depression
When to seek medical attention
Each senior affected by hearing loss is affected at a different level. Hearing loss may occur gradually or have a rapid onset, depending on the cause. And not every symptom is so obvious to imply that hearing loss is the issue—or the only issue.
If seniors exhibit symptoms of hearing loss or notice a change in their ability to hear, they should seek a physician's opinion immediately. According to the American Hearing Aid Association, 16% of doctors routinely check for hearing loss. Therefore, a senior's (or caregiver's) due diligence for seeking treatment for hearing loss is imperative.
Treatment
The extent of the hearing loss dictates treatment options. Depending on the type and extent of hearing loss, doctors may prescribe medication to treat an ear infection, refer the patient to a doctor who specializes in conditions and diseases of the ear, recommend the patient wear a hearing aid, or perform surgery.
Once the condition has been established, it is important for seniors to do the following in order to have the most successful treatment:
- Seek the support of a physician for hearing loss and any emotional distress due to the condition
- Understand the cause and condition of their hearing loss
- Know their options in treatment, including cost for and coverage of hearing aids or surgeries
- Seek the support of friends and family members by revealing the condition of hearing loss
- Speak to their physician if they are unhappy with their hearing aid, if applicable, or if their condition changes
Prognosis
Hearing loss can be managed but not always cured. The cause for the hearing loss and the extent of the damage generally dictate the outcome.
KEY TERMS
Audiologist —A specialist who evaluates and rehabilitates patients who suffer from hearing loss.
Conductive hearing loss —Occurs when sound cannot pass through the outer or middle ear to reach the inner ear.
Decibels —A measurement of the intensity of sound perceptible ranging from zero to 130.
Hearing aid —An electronic and/or digital device worn in the ear to amplify sound.
Mixed hearing loss —A combination of conductive and sensorineural hearing loss.
Presbycusis —Age-related hearing loss usually caused from degeneration in the ear.
Sensorineural hearing loss —Occurs when there is damage or degeneration of the nerves in the inner ear which reduces the ability to understand what is being said. Generally caused by exposure to loud noise, head or ear injury, medications, disease, tumor(s), or infection.
Tinnitus —A condition in which a person may hear ringing or buzzing in one or both ears when there is no exterior ringing or buzzing present.
Caregiver concerns
Hearing loss may be so gradual that seniors do not recognize their condition. Caregivers realize it is crucial to a senior's mental and physical safety and wellbeing to understand and notice the signs of hearing loss so that a doctor may treat the senior.
Signs of hearing loss:
- Inability to recognize warning sounds, such as fire alarms, car horns, or sirens
- Appearing depressed or despondent
- Straining to hear someone over the phone or in person
- Asking people to repeat themselves
- Difficulty differentiating certain consonants when pronounced, such as -s and -th
- Misunderstanding words
- Asking people not to mumble
- Complaining they hear ringing or muffled sound when none is present
- Speaking unnecessarily loud.
- Listening to the television or radio at a high volume
- Withdrawing from social settings
- Experiencing dizziness when they wake, stand, or change head positions
Resources
PERIODICALS
Carter, Ann. “Hearing Loss.” Senior Health Advisor 2 (May 31, 2007): 1–2.
Durga, Jane, Petra Verhoef, Lucien J. C. Anteunis, Evert Schouten, and Frans J. Kok. “Effects of Folic Acid Supplementation on Hearing in Older Adults.” Annals of Internal Medicine 146 (January 2, 2007): 1–9.
OTHER
Badash, Michelle. “Hearing loss.” Mayoclinic.com. November 2007 [cited March 28, 2008]. http://www.mayoclinic.com/print/hearing-loss/DS00172/DSECTION=all&METHOD=print;.
“Hearing Loss.” umm.edu. November 8, 2005 [cited March 28, 2008]. http://www.umm.edu/ency/article/003044.htm.
Heppner, Cheryl. “Seniors and Cochlear Implants: Results and Other Considerations—1.” Northern Virginia Resource Center for Deaf and Hard of Hearing Persons (NVRC). 2006 [cited March 28, 2008]. http://www.hearinglossweb.com/res/hlorg/shhh/cn/2006/srci1.htm.
Public Health Agency of Canada. “Hearing Loss Info-sheet for Seniors.” Aging and Seniors. March 7, 2006 [cited March 28, 2008]. http://www.phac-aspc.gc.ca/seniorsaines/pubs/info_sheets/hearing_loss/index.htm.
“Understanding the 3 Basic Types of Hearing Loss.” disabled-world.com. January 16, 2006 [cited March 28, 2008]. http://www.disabled-world.com/artman/publish/hearing_loss.shtml.
ORGANIZATIONS
American Academy of Audiology, 11730 Plaza America Drive, Suite 300, Reston, VA, 20190, (703) 790-8466, (800) 222-2336, http://www.audiology.org.
American Academy of Otolaryngology—Head and Neck Surgery, One Prince Street, Alexandria, VA, 22314 3357, (703) 836-4444, http://www.entnet.org/.
American Hearing Aid Associates, 1380 Wilmington Pike, West Chester, PA, 19382, (800) 984-3272, (610) 455-3018, http://www.ahaanet.com.
American Speech-Language Hearing Association, 2200 Research Blvd., Rockville, MD, 20850-3289, (800) 638 8255, [email protected], http://www.asha.org.
National Academy on an Aging Society, 1220 L St. NW, Suite 901, Washington, DC, 20005, (202) 408-3375, (202) 842-1150, [email protected], http://www.agingsociety.org/agingsociety/index.html.
National Council on Aging, 1901 L St. NW, 4th Floor, Washington, DC, 20036, (202) 479-1200, http://www.ncoa.org.
Lauren Long Stinson