Age-Related Hearing Loss (Presbycusis)

Age Related Hearing Loss

As a part of the body’s aging process, as our muscles get weaker, our joints become more stiff, our vision starts to fail, so also there is the effect of aging on your hearing.

As we age our hearing deteriorates. There is a gradual loss of hearing, more marked after 60 years of age.

The condition of age related hearing loss is called Presbycusis – it has the following root

From Greek

Presbys – elder

Akuein – hearing

INCIDENCE

It is estimated that after the age of 55 about 50% of the population will have some form of hearing loss.

Males and Females are equally affected.

HOW DO WE HEAR?

In order to understand the pathology of age related hearing loss we need to know how sound reaches our brain.

Sound waves travel through our ear canal and reach our eardrum (Tympanic Membrane) which begins to vibrate.

Eardrum vibrations are transmitted to the three small bones in the middle ear (Ossicles) which transmit sound via the Footplate to the Inner ear (Cochlea).

The Hair Cells of the Cochlea pick up these vibrations and transmit a signal to the nerve of hearing (Acoustic Nerve). The Cochlear functioning is assisted by the Stria Vascularis, the Basilar Membrane and the Spiral Ligament.

The Acoustic Nerve transmits this signal to the Centres of the brain which uses its memory to interpret the sound- ringing of a cycle bell, cry of a baby, aeroplane taking off etc.

PATHOLOGY

There are four main types of Pathologies that would explain the gradual deterioration of hearing at the Organ (Cochlear) level

  • Loss of hair cells in the Cochlea, starting from the basal turn
  • Vascular ischaemia causing weakness of the Stria Vascularis (in the Cochlea)
  • Spiral ligament in the Cochlea degenerates causing loss of function of the basilar membrane

At the Neural level

  • Neural cause- loss of neurons leading from the inner ear (Cochlea) to the brain.

Causes of Presbycusis 

Though Presbycusis is a natural process of aging and can affect anybody there are many predisposing factors.

That is why we see hearing loss at a relatively early age of 60 or so and someone who is 90 years old and can hear well.

  • Genetics – there may be a family history of early onset hearing loss
  • Diabetics – more prone to early onset of hearing loss because of vascular ischaemia
  • Smokers
  • Exposure to loud sound – multiple exposure to loud sound – profession or leisure
  • Drugs – Ototoxic drugs – aspirin, diuretics, antibiotics, cancer drugs etc
  • Diet rich in fat may predispose to atherosclerosis
  • Nutritional Factors – Deficiencies of some Vitamins etc

FEATURES

  1. Presbycusis causes a painless, gradual, bilateral loss of hearing in the aged person.
  2. Initially there is loss of high frequency sounds – like the sound of a violin
  3. There may be accompanying Tinnitus – buzzing sound in the ear

Since the process is painless and gradual the patient may never realise the deterioration in hearing. It is usually the accompanying person- spouse or friend who notices and brings the person for a check up.

RECOGNITION OF HEARING LOSS

  1. Misses out on speech.
  2. Keep the TV volume loud.
  3. Ask persons to repeat themselves.
  4. Miss out on conversation in large gatherings when many persons are talking.
  5. Find it difficult to localise sound (asymmetrical hearing loss)
  6. Fail to hear a sound (like the ringing of a phone) which everyone else around can hear.
  7. Complain of a buzzing sound in the ear.
  8. Talk very loudly.

 

EEFECTS OF LONG TERM UNTREATED HEARING LOSS

  1. Poor Communication
  2. Social Isolation
  3. Depression
  4. Cognitive decline
  5. Frequent Falls
  6. Loss of memory
  7. Safety concerns- at home and in traffic

TREATMENT

Unfortunately, once the process of hearing deterioration starts there is not much any one can do to halt the progression.

The only option for an elderly person with Presbycusis is the use of a hearing aid/s.

HEARING AIDS

Currently Hearing Aids are marvellous pieces of technology.

Many years ago the hearing aid was a simple amplifier and many patients had problems using them.

That is no longer true – the current hearing aids are very effective in taking care of your hearing loss.

They are packed with features and specially for the elderly who attends office, court etc the newer hearing aids are like a blue tooth device with many useful features built into them.

We have seen dramatic changes in the elderly once they accept their hearing loss and begin to use hearing aids appropriate for them.

You must remember the following

  • Use a hearing aid early in the onset of your hearing loss to get the best benefit – do not delay
  • You cannot purchase a hearing aid from some online platform or use someone else’s. A hearing aid is customised to your hearing loss and is specific for you
  • Hearing aids are taken off at night or in situations when you do not need them

COCHLEAR IMPLANT

In certain situations like a bilateral profound hearing loss where hearing aids are of no value, we have no other option but to offer a Cochlear Implant.

Age related hearing loss is a natural process of hearing deterioration over a period of time in the elderly.

Maintaining a healthy life style, having a nutritious diet and most importantly avoiding exposure to loud sound helps to preserve our hearing.