July, 2011 Aging Changes in Hearing

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All About Hearing Loss in the Elderly

Hearing TestGet your exam annually!

Is your loved one having problems hearing you?  Do you have to keep repeating?

The cause may be an simple as having ear wax removed from the ear or it may signal other changes that are happening as a result of aging.

Beginning at 40, people experience changes to hearing as a result of aging.  By 50, aging adults may experience balance and equilibrium changes as a result of the diminished blood supply to the ear.  A diminishing  number of sensory cells contributes to balance issues especially after 70 years of age.

There are several different forms of hearing loss.  High frequencies may be the first sounds to disappear.  Later, low frequencies cannot be heard but since most adults speak in the mid-range, this may not impact normal activities.  This loss of hearing at the high and low range is called Presbycusis.  Men  experience greater hearing loss than women and aging adults who have lived in a city incur greater noise levels than someone in the country.  Long term exposure to high noise levels contribute to Presbycusis.

Some aging adults have a condition called Tinnitus.  That is where there is a constant background noise in one or both ears.  It is sometimes called ‘ringing in the ears’.    It may also sounds like whistling or hissing.  Tinnitus has several known causes, such as high blood pressure, ear infection, cardiovascular disease, meningitis or obstruction of the external auditory meatus of the ear.

Dizziness and Vertigo are sensations caused by the ear.  In dizziness, there is a sensation of unsteadiness or a feeling of disorientation to space.  Vertigo is described as an illusion of movement or spinning.  These two terms are often used to describe the same condition but there is a difference.  Ninety (90%) percent of older adults who visit a geriatric clinic complain of dizziness and vertigo.  There can be several causes, i.e. inflammation in the inner ear or in the nerve fibers of the vestibulocochlear nerve.

Wax build-up is another condition experienced by aging adults.  As blood vessels become more clogged and inflexible; cartilage becomes more rigid and there is less fluid in the ear, wax may build up impairing hearing.  It is recommended that a baseline hearing test be done by the age of 50 and then annually thereafter.

Do I need a hearing aid?

Some early signs of hearing loss are that it seems like everyone is mumbling, or speech is easy to hear, but difficult to understand.

Analog and digital are the two types of hearing aid signal processing; however, almost all hearing aids these days use digital sound.  Digital hearing aids are essentially a blank computer chip and the hearing aid program is written by the audiologist based on the patient’s hearing loss, the physical properties of the ear canal, and the individual listening needs of the patient.  Digital hearing aids are very flexible and should be “fine tuned” once the patient has had sufficient time to wear them in multiple listening environments.

Behind-the-ear (BTE) hearing aids are typically the most flexible, most durable and most powerful hearing instruments available.  They fit securely and discreetly behind the ear and are held in place with an ear mold, which is in the ear canal.  BTE hearing aids do not interfere with the use of glasses and most people find they are the most comfortable type of instrument to wear on a daily basis.  Custom made in-the-ear hearing aids are also available, but often have less available options, less power and sometimes require more maintenance and repair than behind the ear hearing aids.

Typical problems hearing aid wearers encounter include: annoying whistling, noisy environments becoming too loud, and difficulty with speech clarity or word understanding (i.e., things are loud enough, just not clear enough).  If an individual is experiencing any difficulties with their hearing aid(s), the best thing to do is contact his or her audiologist!  Most of these problems can be fixed with a simple adjustment, and many of the problems people had in the past with hearing aids, such as the whistling, are virtually eliminated with new digital hearing aids.

When is surgery indicated?

There are a small number of individuals for whom hearing aids do not work or are not appropriate.  In these instances, a surgical procedure, such as a cochlear implant or bone anchored hearing aid (BAHA) may be a better option.  With a cochlear implant, a tiny electrode array is inserted in the inner ear (cochlea) and the individual hears via electrical stimulation instead of traditional amplified sound.  A BAHA is often used for individuals with single sided deafness or conductive hearing loss.

Written by Diane Keefe, Geriatric Care Manager, Caring for Mom Together, and Lara Noble, Audiologist, The Center for Hearing and Speech.

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