ear, nose, and throat disorders
Hearing Loss
Geriatrics Essentials: Hearing Loss
Older people typically experience a progressive decrease in hearing ( Presbycusis ). In the United States, 40% of those who are hearing impaired are older. Hearing impairment is prevalent in over one third of people over age 65 years and over half of people over age 75 years, making it the most common sensory disorder in this population. Nonetheless, hearing loss in older people should be evaluated and not ascribed simply to aging; older patients may have a tumor, a neurologic or autoimmune disorder, or an easily correctable conductive hearing loss. Also, recent research strongly suggests that hearing loss in older people can facilitate dementia, which may be mitigated by properly correcting hearing loss. Presbycusis is sensorineural hearing loss that probably results from a combination of age-related deterioration and cell death in various components of the hearing system and the effects of chronic noise exposure. Hearing loss usually affects the highest frequencies (18 to 20 kHz) early on and gradually affects the lower frequencies; it usually becomes clinically significant when it affects the critical 2- to 4-kHz range at about age 55 to 65 (sometimes sooner). The loss of high-frequency hearing significantly affects speech comprehension. Although the loudness of speech seems normal, certain consonant sounds (eg, C, D, K, P, S, T) become harder to hear. Consonant sounds are the most important sounds for speech recognition. For example, when “shoe,” “blue,” “true,” “too,” or “new” is spoken, many people with presbycusis can hear the “oo” sound, but most have difficulty recognizing which word has been spoken because they cannot distinguish the consonants. This inability to distinguish consonants causes affected people to often 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. Speech comprehension is particularly difficult when background noise is present. A screening tool is often helpful for older people because many do not complain of hearing loss. One tool is 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? Scoring is “no” = 0 points, “sometimes” = 2 points, and “yes” = 4 points. Scores > 10 suggest significant hearing impairment and necessitate follow-up. 