Hearing loss in the elderly

Exams and Tests

A complete physical exam is performed to rule out medical conditions that can cause hearing loss. The health care provider will use an instrument called an "otoscope" to look into the ears. Sometimes, wax can block the ear canals and cause hearing loss.

The patient may be sent to an ear, nose, and throat doctor and a hearing specialist (audiologist). Hearing tests (audiometry, tuning forks test and speech audiometry), can help determine the extent of hearing loss. The typical audiometric test result is a bilateral mild-to-moderate hearing loss. Hearing is usually best in low frequencies and poorest in high.

Patients with central or auditory processing problems, may have a low word recognition score, because their nerve system does not faithfully reproduce the clarity of speech, regardless of loudness. These patients will have difficulty understanding conversational speech without visual cues, despite being able to hear sound with a hearing aid.

Treatment

There is no known cure for age-related hearing loss. Treatment is focused on improving everyday function. The following may be helpful:

1. Hearing aids
   • The types available are body-worn/pocket, behind the ear (BTE), in the ear (ITE), or, in the canal (ITC) types , depending on severity of the hearing loss.
   • However, less than half of elderly people with hearing loss who might benefit from hearing aids actually wear them. Patience and motivation by the hearing aid fitter and family is crucial.
   • Patients should choose a style that they will wear without embarrassment. Cosmetic concerns cannot be ignored in the fitting of hearing aids. The "open fit" BTE for the mild to moderate hearing loss is usually liked because it is convenient to wear and cosmetically almost invisible
   • Patients with symmetric hearing loss usually need binaural hearing aids (in both ears). If patients wear only one hearing aid, they cannot tell where a sound is coming from, and in difficult situations (eg, noisy ones), they cannot hear speech clearly.
   • Of course a monaural hearing aid is used if patient has financial constraints. Sometimes there is binaural interference, thought to result from prolonged deprivation or age-related changes in the central auditory system, which causes marked differences between ears in sound processing and awareness. For people with this relatively rare situation, one hearing aid may actually be better than two hearing aids.
   • Realistic expectations are key to successful treatment with hearing aids. Even the best hearing aids do not enable a patient to hear clearly in adverse listening situations, such as poor acoustics (for instance in rooms with a lot of echoing of sounds), excessive background noise, or poor visual contact between speaker and listener (eg, in poor lighting). Even with well-fitted hearing aids, patients usually need plentiful visual communication cues to maximize speech understanding.
   • A cochlear implant may be recommended for certain people with very severe hearing loss. Surgery is done to place the implant. The implant makes sounds seem louder, but does not restore normal hearing and moreover, it is very expensive.