Hearing Impairment

What is hearing impairment?

Hearing impairment, also known as hearing loss, is the partial or total inability to hear. This could occur in one or both ears. Hearing loss can be temporary or permanent.

Hearing impairment in seniors

While everyone loses hearing ability with age, the amount and type of hearing loss is variable. Loss of hearing is one of the most common conditions affecting older and elderly adults.

It is on record that approximately one out of every three person in the United States between the ages of 65 and 74 experiences hearing impairment. This usually results in loneliness and depression because they won’t be able to communicate properly with others. Having trouble hearing can make it hard to understand and follow a doctor’s advice, hear phones ring, doorbells and smoke alarms among others.

It will interest you to know that hearing impairment in seniors most often affect both ears equally.

Signs and symptoms of hearing loss

  • Speech and sounds not coming out properly as they should
  • Struggling to understand words in a crowded or noisy place
  • Difficulty hearing consonants
  • Always asking people to talk more slowly and loudly
  • Always having to play the television and radio to loudly
  • Avoiding or withdrawing from conversations
  • Avoiding social gatherings
  • Not hearing something if the person is out of your range of vision

Most times, you are probably unaware of your hearing problem and it is up to a family member to inform you and your health care provider that you may be experiencing partial or full loss of hearing.

An easy way to know if you’re having hearing problems is through the “whisper test.” Have someone stand about two feet away and whisper a letter and number combination like “4K2.” If you have trouble hearing the combination, it indicates that you have some hearing loss and should undergo formal testing.

Another possible symptom of hearing loss is ringing in the ear (tinnitus). Tinnitus often accompanies age-related hearing loss, but it could also be a symptom of an unrelated condition requiring medical attention.  Therefore, if you experience tinnitus, you should see your primary care provider or an otolaryngologist (ear, nose, throat doctor) for an evaluation.

Types of hearing loss

These are the main types of hearing loss and their causes.

Conductive Hearing Loss

In this case, your hearing is muffled.  It is typically caused by a build-up of ear wax in the ear. This blocks the ear canal and prevents sound from entering. Your healthcare provider can diagnose and remove the wax if there is an excessive build-up. Meanwhile, it is normal for all ears to have some wax as this helps to protect the outer ear canal.

Other causes of conductive hearing loss include infections in the skin lining the ear canal, fluid in the middle ear, arthritis that affects the bones of the ear, or a hole in the eardrum. None of these causes are very common in older people though. One condition that affects older individuals and causes conductive hearing loss is Paget’s disease of bone.

Sensorineural Hearing Loss 

This is mostly peculiar to older adults. It is typically caused by changes or damage to the hair cells and/or nerves in the cochlea. The main cause is age but excessive exposure to noise and ototoxicity (damage to the inner ear caused by drugs or chemicals) can cause it as well.

Other causes of sensorineural hearing loss include genetics or blood vessel problems (including those related to diabetes).

More rarely, sensorineural hearing loss may be related to:

  • occupational and environmental factors such as chemical exposures
  • certain autoimmune diseases
  • nerve tumors
  • infections such as herpes and influenza
  • cigarette smoking

Older adults with the dementia, diabetes and cerebrovascular disease are more likely to experience hearing loss:

Dual sensory impairment (for example, vision and hearing loss at the same time) is a significant problem for at least 30% of older adults.

One type of sensorineural hearing loss, called “central hearing loss,” occurs when you are unable to understand speech in situations such as in the presence of competing noise, competing conversation, or in environments where sound can echo. Sudden sensorineural hearing loss (loss that occurs over 72 hours) often has no known cause. The primary symptom is the sensation of a full or blocked ear. If you have sudden ear blockage or fullness, contact your healthcare provider promptly to avoid any treatment delay. Treatment may include corticosteroids taken by mouth or by ear drops.

Mixed hearing loss

This is a combination of conductive and sensorineural hearing loss.

Causes of hearing impairment

Loss of hearing in adults can either be inherited from parents or acquired through illness, ototoxic (ear damaging) drugs, exposure to loud noise, tumors, head injury, or the natural aging process. Hearing impairment may occur by itself or with tinnitus (ringing in the ears).

Some causes of hearing loss in adults are described below:

  • Otosclerosis is a disease affecting the middle ear. It disrupts the movement of the tiny bones in the middle ear. Otosclerosis can cause a conductive type of hearing loss. This condition can be corrected surgically.
  • Ménière’s disease affects the inner ear. The cause of Ménière’s disease has not been discovered yet. It usually begins between the ages of 30 and 50. Someone suffering from Ménière’s disease will often have a combination of sensorineural hearing loss, dizziness (vertigo), ringing in the ear (tinnitus), and sensitivity to loud sounds. This type of hearing loss can be managed by a doctor and audiologist. Some people with Ménière’s disease experience mild symptoms, but for others the symptoms are much worse. In this case hearing ability comes and goes and, if not taken care of, could lead to permanent loss of hearing ability.
  • Autoimmune inner ear disease. This hearing loss is fast and dramatic. It should be treated as soon as possible. With immediate medical treatment, the hearing loss from this disease can be reduced.
  • Ototoxic medications can cause hearing loss. Some drugs known to be ototoxic are: Aminoglycoside antibiotics (such as streptomycin, neomycin, or kanamycin), salicylates in large quantities (aspirin), loop diuretics (lasix or ethacrynic acid), and drugs used in chemotherapy regimens (cisplatin, carboplatin, or nitrogen mustard)
  • Ear splitting noise can result in permanent loss of hearing. This is called noise-induced hearing loss. Listening to loud noise for long periods of time can cause damage to the hair cells in the inner ear. Hearing loss caused by noise usually develops gradually and painlessly. A single exposure to an extremely loud sound such as an explosion can cause a sudden loss of hearing. This is called acoustic trauma.
  • Auditory neuroma is an example of a tumor that causes hearing loss. Symptoms can include hearing loss or ringing in one ear accompanied by a feeling of fullness. Treatment for acoustic neuroma is medical.
  • Injury to the head can lead to traumatic brain injury (TBI), fractures in the skull, a hole in the eardrum, and damage to the middle ear structures, resulting in hearing loss.
  • Presbycusis is a sensorineural hearing loss that occurs gradually as you age. The condition affects both ears over time.  Speech begins to sound unclear because the ability to hear high pitch sounds is the first to go. Rhyming mistakes can occur—for example, the high-pitched sound /t/ in the word tin is heard as /f/ in the word fin, causing confusion: “The roof is made of tin” is heard as “The roof is made of fin.”

Care and treatment of hearing impairment

Some causes of hearing loss can be treated medically or surgically. However, most hearing loss in older adults is treated with strategies to improve communication, amplify the sound (such as hearing aids), or both.

Hearing Assistance Technologies

These devices include:

  • Microphones and transmitters which you have to put close to the source of the sound so as to transmit the sound to a receiver and headphones or earpieces, usually wirelessly.
  • Personal pocket devices amplify sounds closest to you, such as conversation, while blanking out background noise. The devices are about the size of a business card, with about 100 hours of battery life. You could clip it onto your belt, slip it into a pocket, or wear it around your neck, where it transmits the sound to headphones or ear buds.
  • Telephone ringers, increases the volume of telephone rings, or make the phone vibrate or flash a light when calls come in. Text telephones are also available. Most are free to people who are deaf or have severe hearing loss.

Other hearing assistance devices include closed-caption televisions, and vibrating and flashing devices such as alarm clocks and timers, smoke alarms, doorbell alerts, and motion sensors. You can find many of these items through state agencies for people with hearing loss, or online stores.

Hearing Aids

Hearing aids are very common amplification devices. They are made to improve your ability to hear and understand words said around you or to you. It’s advisable to use hearing aids in both ears because that helps you identify where the sound is coming from – and most importantly, improves understanding in noisy situations.

If only one ear is working perfectly, you may only be eligible for one hearing aid, but there are now a variety of options for persons with single-sided deafness. It is not advisable to wait until the loss is severe—getting a hearing aid early on can help you adjust to its use and can reduce the psychological impact related to hearing loss.

Although it is possible to buy hearing aids from many sources, including online, you should also work with an audiologist or other healthcare professional trained in audiology.  This way, you can make sure you get the right hearing aid for your needs and be sure they are fitted and adjusted correctly.

Some people can’t tolerate the feeling of something close to their ears. Most have to try to get used to that feeling.  However, open-fit hearing aids for those with mild to moderate hearing loss do reduce this sensation. Others may have so much damage that they still can’t understand speech.  However, counseling that teaches communication strategies and aural rehabilitation in addition to hearing aids can improve chances of success.

Many older adults purchase hearing aids without using them or use occasionally. Some of the reasons include:

  • Those with arthritis find it difficult fixing the hearing aids to their ears because of their condition
  • It could amplify the background noise
  • Some do think the aid is not necessary and they can do without it
  • Those suffering from memory loss will most likely forget to use it
  • Most Medicare doesn’t cover hearing aids or other listening devices so the cost could be a problem.

Background noise is another problem. Traditional hearing aids increase all sound, so noises like rattling papers, running water, or other conversations can be very distracting. Newer technologies use multiple microphones and digital signal processing to filter out background noise, which can significantly enhance your ability to understand speech in noise and increase your satisfaction with the hearing aid. The majority of hearing aids today are digital and most include features to promote understanding in difficult listening situations.

Cochlear Implants

A cochlear implant is an electronic device surgically implanted in your ear. It bypasses the damaged cochlear hair cells and transmits sensory impulses directly to the cochlear nerves.  Cochlear implants are used only in people with severe to profound hearing loss whose hearing doesn’t improve with hearing aids. Cochlear implants don’t restore normal hearing, but they can help you hear environmental sounds, understand speech better, and use a telephone.  They can even restore the enjoyment of music for many people.

Having cochlear implant surgery requires extensive testing before surgery and training after surgery. The cochlear implant is activated 4 weeks after surgery. Patients typically achieve optimal hearing and understanding of speech within 6–12 months. General health, rather than age, is an important predictor of health outcomes after cochlear implantation. Most Medicare programs and insurance companies cover the procedure.

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