Age-related hearing loss
Hearing loss - age related; Presbycusis
Age-related hearing loss, or presbycusis, is the slow loss of hearing that occurs as people get older.
The ear consists of external, middle, and inner structures. The eardrum and the three tiny bones conduct sound from the eardrum to the cochlea.
Causes
Tiny hair cells inside your inner ear help you hear. They pick up sound waves and change them into the nerve signals that your brain interprets as sound. Hearing loss occurs when the tiny hair cells are damaged or die. The hair cells do not regrow, so hearing loss caused by hair cell damage is permanent.
There is no known single cause of age-related hearing loss. Most commonly, it is caused by changes in the inner ear that occur as you grow older. Your genes and loud noise (for example from loud concerts or music headphones) may play a role.
The following factors contribute to age-related hearing loss:
- Family history (age-related hearing loss tends to run in families)
- Repeated exposure to loud noises
- Smoking (smokers are more likely to have such hearing loss than nonsmokers)
- Certain medical conditions, such as diabetes
- Certain medicines, such as chemotherapy drugs for cancer
We often take for granted all of the sounds around us, the bark of a dog, the buzz of a bee, or the melody of our favorite symphony. Yet for many people, the world is a very quiet place. They've lost the ability to hear sounds in one or both ears. Let's talk about hearing loss. To understand how you lose hearing, you first need to know what normally happens inside your ear when you hear. Say that a fire engine roars past. First, the sound of the siren reaches your eardrum in your outer ear. Your eardrum vibrates, which moves three tiny bones in your middle ear. These bones push the sound along to the cochlea, a fluid-filled chamber in your inner ear. The cochlea is lined with tiny hairs that vibrate when the sound waves hit them. These hairs convert the sound waves into an electrical signal. That's when your brain realizes that a fire engine is headed toward you. Hearing loss can have many different causes. Loud noises, pressure changes while you're scuba diving, or a head injury can all damage the delicate structures in your ear that allow you to hear. Infections like measles, mumps, and meningitis can also damage the ear. Sometimes earwax can build up in your ear and block your hearing like a plug. As you get older, you may gradually lose your hearing, even if you don't have an illness or injury. When the damage or other problem is to your outer or middle ear, it's called conductive hearing loss. For example, your eardrum may not vibrate when you hear sound. Or, the tiny bones in your middle ear may not move sound to the inner ear. Sensorineural hearing loss is caused by a problem in the inner ear. Often it's because the tiny hair cells that move sound through the ear don't work right because of damage or disease, and stem cells in the ear can't keep up with the repair. If you have problems with both your inner and outer ear, then you have mixed hearing loss. So, how do you treat hearing loss? If you're noticing that voices sound fuzzy and you can't make out what people are saying, see your doctor for a hearing test. The doctor will examine your ears, and give you a test called audiometry to check the type and amount of hearing you've lost. You may also have imaging tests such as a CT or MRI scan if you've had a head injury. A hearing aid can amplify sounds to help you hear more clearly. Today's hearing aids are so small they're barely noticeable. If you have a buildup of earwax in your ear, an ear syringe filled with warm water can help flush it out. Sometimes surgery can be done to fix damage in your ear and improve your hearing. Don't accept hearing loss as an inevitable part of growing older. See your doctor for a hearing evaluation. Often, hearing loss that's due to a problem in your outer or middle ear can be reversed. Protect the hearing that you do have by avoiding loud noises, and wearing earplugs when you have to be exposed to loud sounds.
Symptoms
Loss of hearing often occurs slowly over time.
Symptoms include:
- Difficulty hearing people around you
- Having to raise the volume on the TV
- Frequently asking people to repeat themselves
- Frustration at not being able to hear
- Certain sounds seeming overly loud
- Problems hearing in noisy areas
- Problems telling apart certain sounds, such as "s" or "th"
- More difficulty understanding people with higher-pitched voices
- Ringing in the ears
Talk to your health care provider if you have any of these symptoms.
Exams and Tests
Your provider will do a complete physical exam. This helps find if a medical problem is causing your hearing loss. Your provider will use an instrument called an otoscope to look in your ears. Sometimes, ear wax can block the ear canals and cause hearing loss.
You may be sent to an ear, nose, and throat doctor and a hearing specialist (audiologist). Hearing tests can help determine the extent of hearing loss.
Treatment
There is no cure for age-related hearing loss. Treatment is focused on improving your everyday function. The following may be helpful:
- Hearing aids
- Telephone amplifiers and other assistive devices
- Sign language (for those with severe hearing loss)
- Speech reading (lip reading and using visual cues to aid communication)
- A cochlear implant may be recommended for people with severe hearing loss. Surgery is done to place the implant. The implant allows the person to detect sounds again and with practice can allow the person to understand speech, but it does not restore normal hearing.
Outlook (Prognosis)
Age-related hearing loss most often gets worse slowly. The hearing loss cannot be reversed and may lead to deafness.
Hearing loss may cause you to avoid leaving home. Seek help from your provider and family and friends to avoid becoming isolated. Hearing loss can be managed so that you can continue to live a full and active life.
Possible Complications
When to Contact a Medical Professional
Hearing loss should be checked as soon as possible. This helps rule out causes such as too much wax in the ear or side effects of medicines. Your provider should have you get a hearing test.
Contact your provider right away if you have a sudden change in your hearing or hearing loss with other symptoms, such as:
- Headache
- Vision changes
- Dizziness
References
Eggermont JJ. Types of hearing loss. In: Eggermont JJ, ed. Hearing Loss. Cambridge, MA: Elsevier Academic Press; 2017:chap 5.
Emmett SD. Otolaryngology in the elderly. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 13.
Kerber KA, Baloh RW. Neuro-otology: diagnosis and management of neuro-otological disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 22.
Weinstein B. Disorders of hearing. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Philadelphia, PA: Elsevier; 2017:chap 96.
Version Info
Last reviewed on: 11/29/2022
Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
