Age-related hearing loss

Gradual deterioration of the ear means that for most people, deafness is an unwelcome feature of later life.

Although the degree of disability varies greatly, and some people adjust quite well to the slow decline in their hearing, for many this form of hearing loss, known as presbyacusis, causes frustration, loneliness and depression.

Presbyacusis occurs in both ears and affects over half of all people over 60 years old, making it the second most common cause of disability in older people.

The most common form of hearing loss associated with ageing results from degeneration of a part of the inner ear which contains micropscopic blood vessels. This type of hearing loss does not disproportionately affect the individual's ability to hear and understand speech. However, other changes within the inner ear associated with ageing, including the loss of the ear's tiny 'hair' cells, can have a more serious affect on the ability to understand speech. Vital components of speech sounds, usually the higher pitched consonants, which give intelligibility to speech, are missing or distorted and, for this reason, many people first experience difficulty in understanding women and children - the lower pitched male voices often being easier for them to hear and comprehend. As hearing deteriorates the ability to understand speech becomes more severely affected.

Although the main cause of presbyacusis is ageing, there are other factors to consider. Some people may have a genetic predisposition to presbyacusis, while diet and lifestyle may also have a role to play. Exposure to noise in earlier life will hasten the onset of noticeable hearing loss, and a history of middle ear disease may also contribute. Other aggravating factors include medication frequently prescribed in later life (such as diuretics), and osteoporosis.

Research has shown that hearing deterioration tends to halt at around the age of 70.

Recruitment

A common phenomenon associated with presbyacusis is recruitment. This occurs because while the threshold of hearing increases as hearing declines, the pain threshold (or level of tolerance to loudness) remains the same, resulting in a much narrower dynamic range of hearing.

A person with recruitment may experience increased difficulty understanding speech if there is more than one speaker, or if they are in a noisy environment. Moderately loud noise may also be physically uncomfortable, even painful.

What if I suspect I am affected?

If you are over sixty and have problems hearing conversations, TV, music or telephone at volumes others find comfortable, you may be suffering from presbyacusis.

Although the majority of older people are affected, a significant number find it difficult to seek advice and information on their hearing loss. Sometimes, this is because they are unwilling to accept that they have a problem. In other cases, they believe that nothing can be done to help them. However, treatments are available. Hearing aids, particularly some of the newer devices, can offer significantly improved hearing, and there are many ways that you can learn to adapt to a hearing loss. The first step towards accessing these treatments is to accept that there may be a problem and visit your family doctor.

Your family doctor will probably carry out some basic tests to determine whether or not you have a hearing loss. These may involve asking what sounds you can hear. She/he will also ask questions about the reasons why you believe that you may have a hearing loss.

If your family doctor suspects you may have a hearing-impairment, you should be transferred to a local audiology clinic or Ear, Nose and Throat (ENT) department for further tests. If it is confirmed that you have a hearing loss, the audiologist or consultant will explain what treatment options are available.

What treatments are available?

Presbyacusis is incurable, but not untreatable. For most it will be a case of appropriate hearing aids. Deafness Research UK can provide free information to help choose the type of hearing aid that is most appropriate. However, hearing aids can only provide part of the answer.

Because speech discrimination is affected, it is important that people with presbyacusis be encouraged to attend lipreading classes. With this type of hearing loss it is easy to misinterpret what is being said, and eventually a person's self-confidence can become eroded. Those affected may, as a result, begin to avoid social contact, and therefore become isolated and depressed. Lipreading classes are invaluable because not only do they help participants to develop an important skill, they also give people the chance to meet others who have similar problems with their hearing. Hard of hearing people need not feel left out of conversation in a lipreading class, and can compare coping strategies with the other students.

Assistive devices can also help. These include loop systems (to help your hearing aid work better in certain places), TV listening devices, amplified telephones, telephones that use text instead of sound, and flashing or vibrating alarm clocks and doorbells. Some of these devices are used in conjunction with a hearing aid, while others are used on their own, but they all help to prevent hard of hearing people from becoming isolated.