Hearing Loss in Seniors: Causes, Symptoms, and Management

Overview

Age-related hearing loss, also called presbycusis, is a gradual, permanent loss of hearing that occurs as you get older. It is one of the most common chronic conditions affecting older adults: 1 in 3 people in the U.S. between ages 65 and 74 have hearing loss, and nearly half of adults over 75 have difficulty hearing. While presbycusis cannot be reversed, early diagnosis and management can significantly improve your ability to communicate and maintain your quality of life.

Signs & Symptoms

• Trouble hearing high-pitched sounds, such as children's voices, phone rings, or microwave beeps
• Frequently asking people to repeat themselves or speak louder
• Turning up the volume on the TV, radio, or phone to levels that are louder than others find comfortable
• Difficulty following conversations in noisy environments, like restaurants, family gatherings, or group events
• Persistent ringing, buzzing, or roaring in the ears (tinnitus)
• Feeling like other people are mumbling or speaking unclearly
• Avoiding social situations or withdrawing from conversations because of hearing difficulty

Causes & Risk Factors

Presbycusis is most often caused by gradual damage to the tiny, sensitive hair cells in your inner ear that convert sound waves into signals your brain can understand. These hair cells do not regrow once they are damaged, so the hearing loss is permanent. Several factors can contribute to or worsen age-related hearing loss:

• Natural aging changes to the inner ear and auditory nerve
• Long-term exposure to loud noises (from work, hobbies like woodworking, or loud music) without hearing protection
• Use of ototoxic medications (medicines that can damage hearing, including some antibiotics, chemotherapy drugs, and high doses of aspirin)
• Underlying medical conditions such as high blood pressure, diabetes, heart disease, or autoimmune disorders
• Family history of hearing loss
• Untreated ear wax buildup or chronic ear infections

Diagnosis

If you notice changes in your hearing, start by visiting your primary care provider. They will perform a physical exam of your ears to check for reversible causes like ear wax impaction, ear infections, or fluid buildup. If no obvious cause is found, they will refer you to an audiologist (a hearing specialist) for a formal hearing test. This painless test involves wearing headphones and responding to sounds of different volumes and pitches, and will identify the type and severity of your hearing loss.

Treatment & Management

Treatment for hearing loss depends on its type and severity. For most cases of age-related sensorineural hearing loss, hearing aids are the first line of treatment. Modern hearing aids are small, discreet, and can even connect to smartphones or TVs to stream audio directly. For severe hearing loss that does not improve with hearing aids, cochlear implants (small electronic devices that bypass damaged parts of the ear to send sound signals directly to the auditory nerve) may be an option. Additional management strategies include:

• Assistive listening devices: Amplified phones, TV streaming systems, flashing doorbell or smoke alarm alerts, and personal microphones can make daily activities easier.
• Manage underlying health conditions: Keeping high blood pressure, diabetes, and other chronic conditions under control can help slow further hearing loss.
• Communication tips: Ask people to face you when speaking, reduce background noise when possible, and let conversation partners know if you are having trouble following along.
• Avoid further ear damage: Wear ear protection in loud environments, and avoid using cotton swabs in your ears, which can push wax deeper and cause impaction.

Living With It

Adjusting to hearing loss can feel overwhelming at first, but small changes can help you stay connected and engaged in the activities you love. It is normal to feel frustration, embarrassment, or sadness about hearing changes – talking to a counselor or joining a support group for people with hearing loss can help you cope. Let friends and family know about your hearing loss so they can adjust their communication style to support you, and don't be afraid to ask for repeats or clarification during conversations. Regular follow-up appointments with your audiologist will help you adjust your hearing aids or management plan as your hearing changes over time.