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What is hearing loss with aging?

The normal decrease in hearing ability that occurs with age is referred to as presbycusis. Men seem to experience the problem more frequently and more severely than women.

What causes hearing loss with aging?

As the years pass, the hearing apparatus is subjected to a continuing barrage of sounds, all of which travel through the ear canal to the middle ear. Here the eardrum and several tiny bones called ossicles transmit vibrations to the cochlea, a structure that looks like a snail shell and contains fluid. The cochlea is lined with thousands of cells that have microscopic protruding hairs. These hairs vibrate in response to sound, stimulating the auditory nerves. The nerves then send signals to the areas of the brain that are responsible for perceiving sound.

Over time, the hair cells begin to function less efficiently, and the result is hearing loss, or presbycusis. The process can be speeded by subjecting the ears to loud noise. In fact, extremely loud sounds may cause immediate and sometimes permanent damage. In most cases, chronic exposure to the kinds of noises that are common in the modern environment brings on and sometimes accelerates the normal hearing loss associated with aging. For example, rock 'n' roll musicians, printing press operators, and people who work with other very noisy machinery often experience hearing loss at an early age.

How is hearing loss with aging diagnosed and treated?

A physical examination and a variety of special tests to pinpoint the type and extent of hearing loss are the basis of diagnosis.

Treatment may include using a hearing aid to amplify sound. Conventional hearing aids amplify all incoming sound frequencies equally, but a person with presbycusis may need increased amplification of high-frequency sounds, such as the human voice, than of low-frequency sounds, such as the

hum of an air conditioner. Digital hearing aids have recently been developed, using computer circuitry to analyze incoming sounds for frequency, rhythm, and loudness. This information is then used to enhance speech sounds and suppress back­ground noise and extremely loud sounds.

Many people with presbycusis can also be helped by auditory training, in which they learn to make the most of auditory and nonauditory clues. When hearing is so impaired that none of these methods is successful, the next approach may be to try a cochlear implant. This electronic substitute for the damaged hair cells in the cochlea is surgically implanted directly in the ear.

What can I do myself?
The most important thing is to protect the ears from loud noises. Avoid using head sets to listen to loud music. Persons who must work with noisy machinery should wear protective devices over their ears. Even wearing earplugs in noisy environments, such as when riding the subway or running a vacuum cleaner or blender, can help.

If hearing loss is already apparent, it may help to have face-to-face conversations at close range (a distance of no more than 3 feet). That way, lip movements, facial expressions, and gestures can all provide clues for following the conversation. In group situations, sit where people can be seen clearly, and ask each person to raise a finger and pause for a moment to identify themselves before speaking.

At meetings or lectures, come early and take a seat up front. In movies, concerts, or theaters, ask whether devices for sound amplification are available.

When should I see my doctor?
If it has become difficult to

follow conversations or the sounds of language are indistinct, a medical consultation is in order. Anyone over the age of 65 should have a yearly physical examination that includes a hearing test.

What will the doctor do?
The doctor checks for various causes of hearing loss, such as an accumulation of earwax or the presence of an infection. If nothing is found, a specialist may perform additional tests. These tests could include a tympanogram to see if there are conductive problems in the eardrum and middle ear, an acoustic reflex test to check reactions to loud noises, an audiogram to measure ability to hear pure tones and speech, and audiometry to see how well the ear distinguishes sounds at various frequencies. X-rays and other laboratory tests may also be performed.

The course of hearing loss with aging

The severity of this problem varies greatly from person to person. Some people have serious hearing loss by age 60, while others may scarcely be affected at age 90.

Is hearing loss with aging dangerous?
Not in itself, but hearing loss can lead to dangerous situations, such as the inability to hear the warning honk of an approaching automobile. It can also diminish the pleasure of conversing with family and friends and make social situations needlessly stressful.