Last Updated: April 30, 2015
Hearing loss is one of the most common conditions affecting
older adults. Roughly a third of Americans age 65 to 74, and 50% of
those 75 and older have hearing loss.
Hearing loss comes in many forms. It can range from a mild loss
in which a person misses certain high-pitched sounds, such as the
voices of women and children, to a total loss of hearing. It can be
hereditary or it can result from disease, trauma, certain
medications or long-term exposure to loud noise.
Types of Hearing Loss
There are two general categories of hearing loss:
- Sensorineural Hearing Loss: This occurs when
there is damage to the inner ear or the auditory nerve. This type
of hearing loss is permanent.
- Conductive Hearing Loss: This occurs when
sound waves cannot reach the inner ear. The cause may be earwax
build-up, fluid, or a punctured eardrum. Medical or surgical
treatment can usually restore conductive hearing loss.
One form of hearing loss, presbycusis, comes on gradually as a
person ages. Presbycusis can occur because of changes in the inner
ear, auditory nerve, middle ear or outer ear. Some of its causes
are aging, loud noise, heredity, head injury, infection, illness,
certain prescription drugs and circulation problems such as high
Presbycusis commonly affects people over 50, many of whom are
likely to lose some hearing each year. Having presbycusis may make
it hard for a person to tolerate loud sounds or to hear what others
Tinnitus, also common in older people, is the ringing, hissing
or roaring sound in the ears frequently caused by exposure to loud
noise or certain medicines. Tinnitus is a symptom, not a disease,
so it can accompany any type of hearing loss.
Tinnitus can also be a sign of other important health problems,
such as allergies and problems in the heart and blood vessels.
Tinnitus can come and go, or it can persist or stop altogether.
Some people may not want to admit they have trouble hearing.
Older people who can't hear well may become depressed
or withdraw from others to avoid feeling frustrated or embarrassed
about not understanding what is being said. It is easy to
mistakenly call older people confused, unresponsive, or
uncooperative just because they don't hear well.
Causes & Prevention
Hearing loss happens for many reasons. In otosclerosis, which is
thought to be a hereditary disease, an abnormal growth of bone
prevents structures within the ear from working properly. A severe
blow to the head also can cause hearing loss. Another cause is the
ear infection otitis media, which can lead to long-term hearing
loss if it is not treated.
Hearing loss can also result from taking certain medications.
"Ototoxic" medicines damage the inner ear, sometimes permanently.
Some antibiotics are ototoxic. Even aspirin can cause problems, but
they are temporary. Check with your doctor if you notice a problem
while taking a medication.
The ear infection otitis media is most common in children, but
adults can get it, too. You can help prevent otitis media by
washing your hands frequently. Also, get a flu
shot every year to help stave off flu-related ear infections. If
you still get an ear infection, see a doctor immediately before it
becomes more serious.
Do you take medication? If so, ask your doctor if your medicine
is ototoxic, or damaging to the ear. Ask if other drugs can be used
instead. If not, ask if the dose can be safely reduced. Sometimes
it cannot. However, your doctor will help you get the medicine you
need while trying to reduce unwanted side effects.
Symptoms & Diagnosis
Some people may have a hearing problem without realizing it.
Others might think they have a problem, but are too embarrassed to
tell their doctor, friends, or family. You can help identify a
possible hearing problem by asking yourself some key questions and,
if necessary, having your hearing checked by a doctor.
If a hearing loss is ignored or untreated, it can get worse. But
a hearing loss that is identified early can be helped through
treatment, such as hearing aids, certain medicines, and
Ask yourself the following questions. If you answer "yes" to
three or more of these questions, you could have a hearing problem
and may need to have your hearing checked by a doctor.
- Do I have a problem hearing on the telephone?
- Do I have trouble hearing when there is noise in the
- Is it hard for me to follow a conversation when two or more
people talk at once?
- Do I have to strain to understand a conversation?
- Do many people I talk to seem to mumble or not speak
- Do I misunderstand what others are saying and respond
- Do I often ask people to repeat themselves?
- Do I have trouble understanding the speech of women and
- Do people complain that I turn the TV volume up too high?
- Do I hear a ringing, roaring, or hissing sound a lot?
- Do some sounds seem too loud?
If you think that you have a hearing problem, schedule an
appointment with your family doctor. In some cases, he or she can
identify the problem and prescribe treatment.
Your doctor may refer you to an otolaryngologist. This doctor
and surgeon has special training in problems of the ear, nose,
throat, head, and neck.
An otolaryngologist will try to find out why you have a hearing
loss and offer treatment options. He or she will ask you for your
medical history, ask if other family members have hearing problems,
do a thorough exam, and prescribe any needed tests.
Your doctor may also recommend that you visit an audiologist. An
audiologist is a health professional who can identify and measure
hearing loss. The audiologist will use a device called an
audiometer to test your ability to hear sounds of different pitch
The tests that an audiologist performs are painless.
Audiologists do not prescribe drugs or perform surgery. If you need
a hearing aid, an audiologist can help you choose the right
Treatment & Research
Your doctor can recommend strategies to help reduce the effects
of a hearing loss. Scientists are studying ways to develop new,
more effective methods to treat and prevent hearing loss.
Many people who have a hearing loss wear a hearing aid. A
hearing aid is an electronic, battery-operated device that makes
sounds louder to the wearer. Unfortunately, only 20% of people who
could benefit from a hearing aid actually wear one.
Hearing aids come in many shapes, sizes, and styles. Some
hearing aids fit inside the outer ear or the ear canal, while
others fit behind the ear.
Hearing aids can be analog or digital. Some analog aids are
custom-built to meet a person's hearing needs. More advanced analog
models can be adjusted with a computer to suit a number of
environments, such as a room with a lot of background noise.
Digital hearing aids use a computer chip to process sounds, and
are the most flexible in adjusting to different environments. They
are also the most expensive.
An audiologist can help you determine if a hearing aid, or even
two hearing aids, is the right treatment for you. Wearing two
hearing aids may help balance sounds, improve your understanding of
words in noisy situations, and make it easier to locate the source
Other devices also can help you hear in certain listening
environments. TV listening systems help you enjoy television or
radio without being bothered by other sounds around you. Some
hearing aids can be plugged directly into TVs, stereos,
microphones, and personal FM systems to help you hear better.
Some telephones work with certain hearing aids to make sounds
louder and remove background noise. And some auditoriums, movie
theaters, and other public places are equipped with special sound
systems that send sounds directly to your ears.
Alerts such as doorbells, smoke detectors, and alarm clocks can
give you a signal that you can see or a vibration that you can
feel. For example, a flashing light can let you know someone is at
the door or on the phone.
If your hearing loss is severe and of a certain type, your
doctor may suggest that you talk to an otolaryngologist -- a
surgeon who specializes in ear, nose, and throat diseases -- about
a cochlear implant.
A cochlear implant is a small electronic device that the surgeon
places under the skin and behind the ear. The device picks up
sounds, changes them to electrical signals, and sends them past the
non-working part of the inner ear and on to the brain.
A cochlear implant does not restore or create normal hearing.
Instead, it can help people who are deaf or who have a severe
hearing loss be more aware of their surroundings and understand
speech, sometimes well enough to use the telephone.