hearing loss and deafness
ear, nose, and throat disorders
Hearing Loss
Older people typically have a progressive decrease in hearing, called Presbycusis . Hearing impairment is present in over one third of people over 65 and in over half of those over 75. Even so, doctors should evaluate older people with hearing loss because the cause may not be aging. Some people may have a tumor, a neurologic or autoimmune disorder, or an easily correctable cause of hearing loss. Even mild hearing loss makes understanding speech difficult and causes older people with hearing loss to exhibit certain common behaviors. An older person with mild hearing loss may avoid conversations. Understanding speech may be particularly difficult if there is background noise or more than one person is talking, such as in a restaurant or at a family gathering. Constantly asking others to talk louder can frustrate both the listener and the speaker. People with hearing loss may misunderstand a question and give an apparently bizarre answer, leading others to believe they are confused. They may misjudge the loudness of their own speech and thus shout, discouraging others from conversing with them. Thus, hearing loss can lead to social isolation, inactivity, loss of social support, and depression. In a person with Dementia , hearing loss can make communicating even more difficult. For people affected by dementia, correcting a hearing loss makes dementia easier to cope with. Correcting hearing loss has clear physical and psychosocial health benefits. Presbycusis is age-related hearing loss. It probably results from a combination of age-related deterioration and the effects of a lifetime of noise exposure and genetics. Hearing loss usually affects the highest sound frequencies first, usually beginning at about age 55 to 65 (sometimes sooner). The loss of high-frequency hearing makes speech particularly hard to understand, even when the overall loudness of speech seems normal. That is because certain consonants (such as C, D, K, P, S, T) are high-frequency sounds. These consonant sounds are the most important for speech recognition. For example, when the words “shoe,” “blue,” “true,” “too,” or “new” are spoken, many people with presbycusis can hear the “oo” sound, but they cannot recognize which word has been spoken because they cannot distinguish the consonants. Affected people typically think the speaker is mumbling. A speaker attempting to speak louder usually accentuates vowel sounds (which are low frequency), doing little to improve speech recognition. Excessive background noise makes speech comprehension particularly difficult. Screening older people for hearing loss is important because many do not notice it themselves. Family members or doctors can ask the person a series of questions using a screening tool such as the Hearing Handicap Inventory for the Elderly–Screening Version, which asks: Does a hearing problem cause you to feel embarrassed when you meet people? Does a hearing problem cause you to feel frustrated when talking to a family member? Do you have difficulty hearing when someone whispers? Do you feel handicapped by a hearing problem? Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors? Does a hearing problem cause you to attend religious services less often than you would like? Does a hearing problem cause you to have arguments with family members? Does a hearing problem cause you difficulty when listening to the television or radio? Do you feel that any difficulty with your hearing hampers your personal or social life? Does a hearing problem cause you difficulty when in a restaurant with relatives or friends? For each question, a “no” answer = 0 points, “sometimes” = 2 points, and “yes” = 4 points. A score over 10 suggests significant hearing loss, and follow up with a hearing specialist is recommended. 