Patient education: Age-related hearing loss (presbycusis) (The Basics)

What is age-related hearing loss? — When people talk about age-related hearing loss, they are usually referring to a condition called "presbycusis." This condition becomes more common with age. It affects more than half of all adults by the time they reach the age of 75.

Presbycusis causes you to slowly lose your hearing in both ears. It mostly affects how well you hear high-pitched sounds. That means that a person with presbycusis might have trouble hearing a bird chirping or a phone ringing but still be able to hear a truck rumbling. Also, people with presbycusis often find that they have a hard time hearing someone speak in noisy places.

Presbycusis is just one form of hearing loss that can happen as you age. There are other conditions that affect hearing that also become more common with age. The most common of these is a condition called "tinnitus," which means you hear ringing, buzzing, hissing, or roaring in one or both ears. Sometimes presbycusis and tinnitus happen together.

What causes hearing loss? — When doctors refer to hearing loss, they often talk about:

●Sensorineural hearing loss – This type of hearing loss happens when nerves in the ear that detect sounds and send signals to the brain are damaged. Presbycusis is a type of sensorineural hearing loss.

●Conductive hearing loss – This type of hearing loss happens when sounds can't get to the inner ear because of problems in the middle or outer ear (figure 1). For example, conductive hearing loss can happen if you have too much wax in your ear and sounds are being muffled. It can also happen if you have an ear infection and parts of your ear are swollen or filled with fluid.

●Mixed hearing loss – Mixed hearing loss happens when both types of hearing loss mentioned above occur at the same time.

Should I see a doctor or nurse? — See a doctor or nurse if you realize that you are having increasing trouble hearing, or if someone close to you thinks you are having trouble hearing or understanding them.

Presbycusis occurs slowly over time, so you might not notice the changes yourself. However, if you lose hearing suddenly (over a few hours or a day), you should see a doctor or nurse right away. You might have a problem that is more serious than presbycusis. Sudden hearing loss can be caused by an infection or wax buildup in the ear. But it can also be caused by a problem in the nerve in the ear. If this is the case, you might need medicines to prevent permanent hearing loss.

Are there tests I should have? — Your doctor or nurse will probably start by looking inside your ear using a special tool called an "otoscope." That way, they can check if anything looks swollen, blocked, damaged, or infected. Then they will decide which tests you should have based on your age, medical history, other symptoms, and physical exam. If they suspect hearing loss, you will probably need a test called an "audiogram."

A hearing specialist, called an "audiologist," will do the audiogram. To do the test, you put on a headset. Then the audiologist plays sounds in one ear at a time and asks you to indicate when you hear the sounds. This test will show what type of hearing loss you have, how severe it is, and whether both ears are affected the same way.

How is hearing loss treated? — If you have presbycusis, your ear doctor (called an "otolaryngologist" or "ear, nose, and throat" doctor) will probably recommend hearing aids. But if you have other hearing problems, you might need different treatments. For instance, if you have too much wax in your ears, your doctor or nurse can remove it or teach you how to get the wax out. And if you have ringing or buzzing in your ears because of tinnitus, you might need to learn special skills to manage that problem.

●Hearing aids – You might not want to wear hearing aids because they make you feel embarrassed or because you think they don't work. But if your doctor recommends them, try to keep an open mind, even if you have tried them in the past. Hearing aid technology has gotten much better. There are now many different types of hearing aids to try. It might take a few tries to find the right type of hearing aid and the right settings, but they can really help. The key is to work with your ear doctor or audiologist until you find the best option for you. Always tell them if you have problems with the way your hearing aids sound or fit.

Can hearing loss be prevented? — Yes. Some forms of hearing loss can be prevented. To protect your hearing, the most important thing you can do is avoid loud noises. If you must be around loud noises, then always wear ear protection (such as ear plugs or headphones) that will protect your hearing.

More on this topic

Patient education: Tinnitus (ringing in the ears) (The Basics)
Patient education: Outer ear infection (The Basics)
Patient education: Ear infections (otitis media) in children (The Basics)
Patient education: Ear wax impaction (The Basics)

Patient education: Tinnitus (ringing in the ears) (Beyond the Basics)
Patient education: External otitis (including swimmer's ear) (Beyond the Basics)