All about age-related hearing loss (presbycusis)
Our lives are full of sounds: the voices of our family and friends, the music we love, the traffic we loathe and the rainstorms that lull us to sleep. But after years and years of noise, the mechanisms inside our ears that allow us to hear, and hear well, can start to wear down.
Losing your hearing, or seeing a loved one lose their hearing, can be very distressing. And while age-related hearing loss happens gradually, the realization that you can’t hear as well as you used to can hit suddenly.
But the good news is that there are plenty of treatment options available for age-related hearing loss – also called presbycusis – to keep you hearing and living your life to the fullest.
What is presbycusis?
Presbycusis, which derives from the Greek words for “old” and “hearing,” is the medical term for age-related hearing loss.
Your ear is responsible for absorbing sound waves and turning them into electrical impulses, which your brain can then interpret. As we get older, the parts of our ear involved in this process begin to deteriorate, mainly the cochlea inside the inner ear.
Age-related hearing loss is not to be confused with noise-induced hearing loss, though the two can occur simultaneously and are both types of sensorineural hearing loss. Where age-related hearing loss is caused by aging, noise-induced hearing loss is caused by exposure to loud sounds over time that damage the ear, no matter how old you are.
Causes of age-related hearing loss
Age-related hearing loss typically arises from the inner ear, which contains the cochlea. The cochlea is a spiral-shaped, hollow bone filled with fluid. When sound waves enter the inner ear, they cause the fluid inside the cochlea to ripple, which in turn moves tiny hair-like cells, called stereocilia, attached to the cochlea’s inner surface. Think of ribbons of seaweed on the ocean floor flowing with the tides.
The movement of these tiny stereocilia cells creates electrical impulses which are sent to the brain. Our brain then translates these electrical impulses into sound. Exposure to sound over the course of a lifetime, and the normal process of aging, can damage the stereocilia, causing them to deteriorate and die off.
With fewer stereocilia cells, the electrical impulses they create aren’t as strong or as numerous as they need to be to properly communicate sound to the brain.
Risk factors for presbycusis
Hearing loss is a normal part of getting older, and it usually begins for most people in their 60s. However, there are certain factors that can exacerbate and accelerate age-related hearing loss:
- Genetics: While nearly everyone experiences some degree of hearing loss as they get older, some people can have a genetic predisposition for early onset presbycusis or a more rapid decline in hearing.
- Medications: Certain medications can be “ototoxic”, or bad for your ears and hearing ability. These ototoxic medications can cause tinnitus and problems with balance, in addition to making presbycusis worse. Common ototoxic medications include chemotherapy drugs, aminoglycoside antibiotics and NSAIDS.
- Hypertension and diabetes: Conditions that affect your blood pressure, like hypertension and diabetes (among others), can impact your hearing, as the tiny hair cells inside the cochlea rely on a healthy blood supply.
Symptoms of age-related hearing loss
The symptoms of age-related hearing loss are very similar to those of other types of hearing loss. But age-related hearing loss is always gradual and always occurs equally in each ear.
The very gradual progression of presbycusis means that your friends and loved ones may be the first to notice a change in your hearing. But some of the most common symptoms of presbycusis you may notice include:
- Struggling to hear while having a conversation with more than one person, especially in crowded, bustling places.
- Having trouble differentiating between common consonant sounds like s, h, f, th and sh.
- Voices seem muffled, especially the higher-pitched voices of women and children.
- Difficulty hearing high-pitched tones, like the microwave beeping, birds chirping, the phone ringing or someone’s voice on the other end of the phone.
- Experiencing tinnitus, which is ringing, roaring or hissing sounds in the ears.
- Needing the television or radio turned up louder than others may need to hear comfortably.
It’s important that you address presbycusis right away, because letting it go untreated for a long period of time can cause more severe hearing loss and eventually lead to a decline in quality of life.
How age-related hearing loss is diagnosed
If you think you may be experiencing presbycusis, a good first step is to talk with your primary care doctor. They can perform a physical exam of your ears using an otoscope, which is a lighted, magnifying device. Sometimes, hearing loss is caused by an overabundance of earwax in the ear canal. This is one form of conductive hearing loss, and it can usually be resolved through earwax removal.
Your primary care doctor may refer you to an audiologist, an expert who focuses on ear health and hearing, for a hearing test. A hearing test will allow your audiologist to assess your current hearing ability and recommend the best treatment option for you.
Or if you need more advanced care for an underlying condition that may be contributing to hearing issues, your primary care doctor can connect you with an ear, nose and throat (ENT) doctor.
Treatment options for age-related hearing loss
Hearing aids are the first and usually best treatment option for age-related hearing loss, followed by cochlear implants for more advanced cases. Many other available treatment options act as beneficial enhancements to hearing aids and cochlear implants.
In addition to hearing aids and cochlear implants, there are several other treatment options for people with age-related hearing loss so they can better hear the world around them.
Assistive listening devices
- Hearing loop systems: A hearing loop is a network of wiring built into the floor or ceiling of an indoor space. The wires pick up sounds from the area – typically through a microphone – and transmit them directly to hearing aids and cochlear implants that are within a certain range and tuned to telecoil or “T” mode. The hearing loop helps deliver clearer sound that is isolated from background noise. While many places haven’t yet implemented hearing loops, there is a growing number of concert venues, theaters, lecture halls, transit centers and government buildings with hearing loops installed.
- FM systems: An FM system includes both an amplification device and a receiver that attaches to a cochlear implant or hearing aid. When the amplification device is worn by someone else, typically around their neck, their voice comes through clearer in the receiver. FM systems are commonly used in learning environments, with a teacher or lecturer wearing the amplification device, but an FM system can be used anytime you want to hear someone else’s speech better. Similar devices are called one-to-one communicators.
- Infrared systems: An infrared system can change sound waves into light waves and transmit them to a headset receiver, or directly into a hearing aid or cochlear implant. This can be especially useful when watching television with others, as the volume can be set at a comfortable level for everyone and still be heard by those with a hearing impairment through the assistance of the infrared system.
- Personal amplifiers: A personal amplifier is a device that makes all nearby sounds louder and transmits them into a receiver. The receiver can be attached to standard headphones or earbuds. Some types of personal amplifiers are manufactured to appear identical to hearing aids. However, personal amplifiers can’t and shouldn’t replace hearing aids. While personal amplifiers amplify all sound, hearing aids are tuned to amplify only the specific frequencies that you are struggling to hear. This is better for the health of your hearing in the long run.
Augmentative and alternative communication devices
- TDD machines: A telecommunications device for the deaf (TDD), also called a TTY (teletypewriter) machine, is a device that allows you to send text messages over a phone landline. These devices are especially useful when it comes to contacting emergency services. Most modern cell phones are equipped with TDD and TTY capabilities.
- Speech-to-text: There are several devices and apps available that can take speech and turn it into text in real time. These transcription services allow people who are hard of hearing to effectively participate in conversation and interact with others in the moment.
Some people with age-related hearing loss may find it useful to have training in speechreading, also commonly known as lip reading. Speechreading can help you recognize spoken words based on the mouth movements of the speaker. An audiologist or speech therapist can provide training and resources for speechreading.
How to prevent age-related hearing loss
Because presbycusis is a normal part of aging, there isn’t really a way to prevent it. Once those tiny stereocilia in the cochlea start to deteriorate, they do not regrow or recover. However, you can lessen the impact of age-related hearing loss – and slow its onset and progression – by protecting your ears throughout your life with a few preventive measures.
- Wear adequate ear protection, like earplugs or earmuffs, in noisy places
- Keep the volume low when listening to music or other sound through earbuds or headphones
- Manage diabetes and keep blood pressure low
Talk to your primary care doctor about hearing loss concerns
If you suspect you may be experiencing presbycusis, a conversation with your primary care doctor about your symptoms is a great place to start. If you need a hearing test, our compassionate audiologists can test your hearing and get you started with treatment options.