An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Listen Up

Although common, age-related hearing loss doesn’t have to remain a burden

 Listen Up

Much like being forced to invest in reading glasses, hearing loss can also be a factor during the aging process. According to the Hearing Loss Association of America (HLAA), about 48 million Americans suffer some degree of hearing loss. And while sitting in the front row for years at concerts may certainly play a role in hastening diminished hearing years later, some hearing loss is just what happens as we age. It’s called presbycusis, and it’s a condition that afflicts one in three adults age 65 and older.

“Most people lose a little hearing as they age, specifically in the higher frequencies,” says Michael Byrd, M.D., an assistant professor of otorhinolaryngology-head and neck surgery at The University of Texas Health Science Center at Houston (UTHealth) Medical School. “There are some hereditary factors at play, too. If you have a family history of hearing loss, you could be set up for potentially losing your hearing. Usually the people who have that component begin to lose it much earlier in life.”

Regardless of the cause, hearing loss — reported by the HLAA as the third most common physical condition after arthritis and heart disease — is an insidious ailment that usually develops slowly over time and has far reaching effects on the sufferer’s quality of life. It can also create stress for family and friends.

How hearing works

Our hearing is the result of a complicated and miraculous process in which sound is transmitted through the auditory canal, where it hits the ear drum. The ear drum vibrates and activates what Byrd describes as a “lever system” in the middle ear comprising three bones attached to the cochlear (inner ear). The cochlear houses hair cells and fluid. When the vibration from the ear drum is transmitted through the lever system, it creates a fluid vibration. That vibration of fluid moves the hair cells, allowing the signal to be transmitted from the hair cells to the cochlear nerves and to the brain.

“We lose hearing of the higher frequencies first,” Byrd says. “The reason for that is the hair cells begin to wear out, and we lose the cells responsible for producing high frequency hearing ability.”

The most common symptoms of possible onset of hearing loss include having difficulty hearing on the phone or having to turn up the TV volume frequently, difficulty following the conversation when two or more people are talking, trouble hearing with a noisy background and having to ask people often to repeat themselves.

Causes of hearing loss

While losing the ability to hear is just one of the traits of advancing age, consistent exposure to loud noises can certainly hurt your hearing. Several physiological factors can also play a part in causing or accelerating hearing loss.

“From a genetic standpoint, more men are affected by hearing loss than women, and African Americans are less likely to be affected,” says Carmel Dyer, M.D., professor and director of Geriatric and Palliative Medicine at UTHealth Medical School. “If given in very high doses, certain medications — specifically antibiotics and diuretics — can lead to hearing loss, as can some vascular diseases that restrict blood flow to the brain.”

Byrd says middle ear infections can also lead to sensorineural hearing loss, also known as nerve-related hearing loss.

“Sometimes viral infections can knock out hearing. We also worry about Meniere’s disease, which is basically excess fluid in the inner ear,” Byrd says.

Byrd says the hearing screening process begins by talking with patients about their medical history and lifestyle and asking if they have noticed having trouble hearing conversations or needing to ask people to repeat themselves frequently. Next, an audiologist, using a series of “beeps,” performs a test to determine how well the person can hear certain frequencies.

Technology to the rescue

Even if you stopped subjecting your hearing to loud concerts or began religiously using ear plugs when mowing the lawn years ago, time will still likely find a way to reduce your ability to hear. With baby boomers making up a huge chunk of the population, the incidence of hearing loss is likely to soar in the coming years.

Fortunately, the same technology that’s helping to change virtually every aspect of our lives is also providing hearing loss sufferers with more effective hearing aids and other devices that can vastly improve hearing.

“The volume of patients we see in our practice with hearing loss due to aging has increased greatly, and sales of hearing aids have increased year to year as well,” Byrd says. “When I started practicing in 2006, the number of older people we saw with sensorineural hearing loss was probably 30 to 40 percent. Now, probably 70 percent of older people we see have some sort of hearing loss. That’s a direct result of people living longer.”

While hearing aids of yesteryear were bulkier and of the analog variety, new hearing aids utilize digital technology, which makes them far more capable of adapting to the specific hearing loss issues of the wearer. Because the newer hearing aids are much smaller, Byrd says they are a better fit esthetically for people who may have been turned off by the stigma of wearing them. While the old style of hearing aids provided amplification of all frequencies, the new digital aids can be programmed to amplify frequencies that the particular patient requires.

“Hearing aids help to bring balance to the patient’s world. They adjust to the wearer’s environment so they don’t have to constantly turn the volume up or down,” says Allison Boggess, Au.D., of the UTHealth Audiology program. “But they are expensive and a lot of insurance companies and Medicare won’t cover them. You’re looking at a cost of anywhere from a couple thousand dollars to more than six or seven thousand dollars.”

Dyer cautions that the new hearing aids, which have a life span of only about three to five years, should not be viewed as a “cure” for hearing loss, and that they work better for some people than others.

“It’s not like putting on glasses that can correct your vision to 20-20,” Dyer says. “All hearing aids can do is help improve your hearing. They can’t restore it to perfect hearing.”

Dyer adds that many patients have experienced improved hearing by using what’s called personal amplifiers. These are devices about the size of an iPod that come with earphones to help people better understand conversation. They cost significantly less than hearing aids — as little as $50. She says there are numerous, low-cost options — such as TV listening devices — on the market.

Hearing aids may also help people afflicted with tinnitus, a condition in which they suffer from a constant ringing or roaring sound in their ears. Many people diagnosed with hearing loss also suffer from tinnitus, and the new hearing aids can be programmed to help eliminate frequencies that exacerbate the condition.

For patients with profound hearing loss — and for whom hearing aids do not sufficiently work — cochlear implants may offer some relief. They consist of internal and external components, with the internal component being surgically inserted under the skin behind the ear. A wire is then inserted into the inner ear. The external element looks like a behind-the-ear hearing aid and is connected to the internal component through the skin. The implants convert sounds into electrical currents that stimulate the auditory nerves and bypass the defective inner ear.

“With cochlear implants, the patient is hearing electronically, not acoustically, like with hearing aids,” Boggess says. “They work through electrical stimulation, so patients with implants require a great deal of counseling to help the brain determine what to make of these new signals. Even patients with regular hearing aids require counseling on what to expect because every brain responds differently to the amplification.”

Role of family and friends

Even though better treatment options are now available, many people remain in denial about their hearing loss or simply learn to live with it. But ignoring hearing loss can lead to a host of conditions, such as decreased brain function, depression and increased social isolation, and it can also be a risk factor for memory impairment.

“On average, people wait about seven years from the time they find out they have hearing loss to when they do something about it. But people can become socially withdrawn, and they risk cognitive decline, especially older people,” Boggess says. “This is caused by the fact that they are not receiving that auditory input, so the brain shuts off.

“It’s not uncommon for couples to come in and say they’re close to divorce because of their own or their spouse’s hearing loss. It’s such a gradual decline that sometimes your spouse may be the first one to notice,” she adds. “I’ve seen couples where she says, ‘He’s not listening to me!’ But he probably is listening; he just can’t understand what’s being said.”

Family and friends of hearing loss patients can also be subjected to stress, but Dyer says there are things that those dealing with the sufferer can do to help alleviate the situation.

“People will need to be patient because they’ll have to repeat things several times. It’s important to speak slowly to the person, separate their words and use shorter words,” Dyer says. “It’s very important that they get the person to go to their doctor regularly so they can just look in their ears. Lots of times it’s just a case of the ear canal being blocked with wax, and as we get older, the wax becomes thicker. We can remove the wax, and it may make a big difference.”

Protect what you’ve got

Some degree of hearing loss may be unavoidable the older we get, yet, it still makes sense to take steps to protect the hearing you have. These steps include wearing hearing protection if you are exposed to excessive noise and quitting smoking to negate its effects on blood circulation. Eating a healthy diet and getting plenty of exercise also helps to maintain vascular health. Byrd says a key to maintaining good hearing lies in limiting the amount of time spent exposed to high volume.

“I tell people that if you go to a concert, limit the consecutive exposure to loud noise by taking breaks periodically,” Byrd says. “It’s the exposure over time that does damage.”

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