Common Hearing Problems among the Elderly

You may notice your elderly loved ones frequently asking you to repeat yourself, or that they seem to speak too loudly or turn up the volume of the TV even in a quiet room. And if you are still concerned despite them reassuring you that everything is fine, you may be right! 

According to a recent study, hearing difficulties affect 63.7% of the elderlies in Singapore, a quarter of whom suffer from disabling-level hearing loss. Hearing impairment is considered an invisible disability, because many people are not aware of it themselves and thus, do not go for check-ups and seek treatment. Left untreated, hearing loss can cause consequences that go far beyond daily communication. It has been linked to higher risk of memory loss, cognitive decline and dementia for the seniors. 

In this article, we discuss common hearing problems among the elderlies, including age-related hearing loss, how to identify hearing loss, and what you can do to preserve your hearing in the golden years. 

1. How ageing affects hearing

Age-related hearing loss, or presbycusis, is a gradual loss of your ability to hear and intercept words as you age. To find out how hearing can worsen with age, let us briefly discuss how we hear.    

Hearing involves the ears and the brain. In our inner ear, there are delicate tiny hair cells called stereocilia which help to gather sound waves. The waves are then converted into electrical signals and sent through the auditory nerve to the brain to interpret as sound. 

For all people, young and old, these cells do not regenerate once they are damaged or dead. Ageing does not cause these cells to die faster. But as we age, the damage accumulates, leading to gradual loss of hearing ability. As the process is permanent, hearing loss cannot be reversed. 

Hearing can also be impaired due to loud noise exposure in younger years. Wearing headphones at high volume, roaring concerts, working in constantly noisy environments can cause permanent damage to the hair cells in the inner ear, resulting in hearing difficulty later in life. Medical conditions such as diabetes, high blood pressure, high cholesterol which are more common in older people, can also cause harm to the nerve pathway from the ear to the brain, affecting hearing (more about how diabetes causes hearing loss here). Other known risk factors such as family history and smoking may have a slow and subtle impact over the years, and manifest as hearing problems at an older age. 

2. How hearing difficulties affect the elderly’s quality of life

Impaired hearing makes it difficult for the elderly to enjoy simple things such as a conversation at the family dinner gathering where multiple people are talking at the same time, or at a restaurant over background noise. When they are out, they may be less alert and confident. Over time, without treatment and understanding from family and friends, they may start to withdraw from socialising, feel isolated or even depressed.

Untreated hearing loss has been found to increase the risk of:

  • Falls
  • Depression
  • Overall disease burden
  • Dementia and cognitive decline

The risk of developing dementia increases with the severity of hearing loss, doubling for people with mild hearing impairment, tripling for moderate hearing loss, and up to 5 times more common for those with severe hearing difficulty. This hidden link points to the importance of diagnosing and managing hearing loss early and preventing it from worsening. 

3. Signs and symptoms of hearing loss

The insidious progression of hearing loss makes it hard to detect. Many people only realise they have hearing issues and need treatment when their hearing ability has been severely damaged, affecting daily activities in critical ways. 

As an elderly, to detect hearing loss early, you may need to rely on others’ feedback to know if you have hearing difficulty. As family members, it is crucial to take notice and gently point it out to your elderly loved ones. Recognising that presbycusis is common and overcoming the stigma to get treatment is an important first step to preserve hearing and even cognitive ability. 

Observable signs and symptoms of hearing loss include: 

  • Frequently asking others to repeat or speak more loudly or clearly. Seniors may also develop the habit of leaning closer or turning their ears to the person who speaks.  
  • Feeling others’ speech is muffled. The elderlies can hear but are unable to decipher what has been said. 
  • Trouble hearing speech with background noise, such as when talking over a meal at coffee shops or restaurants
  • Difficulty hearing voices of women and children. Hearing loss often affects high frequency more than low frequency sound, making it difficult for seniors to understand those with higher pitched voices, typically women and children. 
  • Tendency to turn up the volume of TV, radio, speakers. If an elderly frequently complains that they can’t hear the TV well at volumes that are loud enough for others, this could indicate hearing impairment.

Some people may experience ringing sensation in the ears (tinnitus) or episodic vertigo (more about these in below section)

Five signs of hearing difficulty

Five common signs and symptoms of hearing difficulty

4. Diagnosis and treatment of hearing loss 

In Singapore, you can visit an ENT (Eyes Nose Throat) doctor to check your hearing. The doctor may send you for an audiometry evaluation, often conducted by an audiologist in a specially equipped room, to check what frequencies, pitches and sounds each of your ears can hear. Diagnosis of hearing impairment is based on the result of hearing function tests and physical examination of the structures inside the ears. Neurologic examination might also be necessary in some cases. 

The most effective treatment for hearing loss is to use hearing aids. The doctor may refer you to a hearing aid specialist to help you select the best device for your hearing, adjust it for your optimal hearing and help you get used to using it. Unlike eye glasses, embracing hearing aids in your daily life takes time and effort, not to mention, overcoming the stigma. 

The most common problem hearing aid users face is the feeling that everything is so loud when they wear the hearing aid. This is because the device helps them hear conversations more clearly, but also let in ‘unnecessary’ noises such as traffic or other background noises. For people with normal hearing, the brain performs the miraculous job of tuning out these background noises. But for people with hearing loss, the brain has forgotten how to do this job and has to relearn again. Modern hearing aids can address these issues to some extent, with functions such as noise cancellation or speech enhancer. Talk to your hearing aid specialist if the noise is uncomfortable to you. 

5. Other common ear problems that affect the elderly’s hearing

In addition to age-related hearing problems, other ear problems can occur, contributing to hearing difficulty for seniors, such as blocked ear and earache. 

Blocked ear is a common problem. It can happen due to the clogging of earwax, going up to a high altitude, or inflammation in the ear caused by a cold, flu, sinusitis or allergy. Blocked ear causes hearing difficulty but often only temporarily. It can be safely treated at home, by applying ear drops, removing earwax or popping the ears. If a blocked ear is caused by a cold or a flu, it will resolve by itself when the cold or flu goes away. However, if symptoms does not improve with home remedies, a visit to the ENT doctor is necessary. 

Earache is often a symptom of another ear problem such as an infection or injury to the ear. It can occur in children as well as in elderly people. In addition to pain, you may experience impaired hearing, headache, fluid leakage from the ear and difficulty falling asleep. It is important to visit the doctor to find out and treat the underlying cause. 

Two other common ear problems – tinnitus and vertigo – are discussed in greater details below. 

6. Tinnitus: Causes & Treatment

Tinnitus is a medical condition associated with hearing a buzzing or a ringing sound in the ears interfering with the real sounds. You may hear non-existent sounds, sometimes referred to as phantom sounds. Age-related hearing loss is one of the most common causes of tinnitus. 

Causes:

  • Age-related hearing loss
  • Tumours on the auditory nerve or in the ear
  • Damage to eardrum, or certain structures in the middle or inner ear
  • Exposure to loud sounds
  • Ototoxicity caused by medications 
  • Meniere’s disease
  • High blood pressure
  • Clogging by ear wax
  • Muscle spasm in your middle ear

Treatment:

When tinnitus is caused by another underlying medical condition, treating the primary condition often eliminates tinnitus. This may include hearing aids if the cause is presbycusis, using earplugs to reduce exposure to loud noise, removal of ear wax if the cause is clogging, discontinuation of medications that cause tinnitus, etc. 

7. Vertigo: Causes, symptoms & treatment

Vertigo or dizziness may not sound like a condition related to the ears, but in many cases it is. The classic symptom of vertigo is the feeling that the surroundings are spinning. The feeling may be subtle or intense as if one will eventually fall. Vertigo attacks can last for a few minutes, or even days, sometimes without apparent triggers. It is not a disease by itself, often a symptom of another condition.

Vertigo can be divided into peripheral and central vertigo. Peripheral vertigo is induced by any problem in the vestibular nerve or inner ear which is responsible for maintaining balance. Central vertigo is caused by brain injury or other brain-related conditions. Visit an ENT doctor for treatment if you experience vertigo symptoms. 

Causes of vertigo:

Vertigo can be caused by any disease affecting directly or indirectly the inner ear or the vestibular nerve (the nerve of the inner ear), such as:

  • Viral Infection of the vestibular nerve
  • Meniere’s disease
  • Head or neck injury causing damage to the vestibular nerve
  • Ototoxic drugs (i.e., drugs that can damage the ears)
  • Benign paroxysmal positional vertigo
  • Migraine-induced vertigo

Symptoms of vertigo:

In addition to the most commonly reported feeling that the surrounding is spinning, other symptoms include:

  • Headache
  • Vomiting
  • Nausea
  • Sweating
  • Tinnitus
  • Loss of balance
  • Abnormal eye movements
  • Hearing loss

Treatment of vertigo:

Vertigo is treated based on the underlying condition causing  the vertigo, and relieving discomfort during vertigo attacks. Medical treatment along with vestibular rehabilitation has been proved effective in treating vertigo. However, medication alone often wanes in effectiveness with repeated uses. 

8. Helping our senior loved ones overcome hearing difficulty 

Hearing loss among seniors is a challenging health issue, not only because of its prevalence yet low recognition, but also because of its linkage to devastating conditions such as dementia. 

A past National Health Survey revealed that 73.2% of Singaporeans with significant hearing loss did not think they had a problem. Chances are your elderly loved ones are not denying the problem when they tell you their hearing is fine and you see signs that it is not. They simply are not aware that it is an issue and its implications, believing it is a natural part of ageing. Family members can help by encouraging their elderlies to get their hearing checked. Project Silver Screen is a national functional check-up program for seniors conveniently located at RC/CC nationwide that you may want to introduce to your elderly loved ones. Support can also come in small daily gestures like facing the elderly when you speak, slowing down, avoiding shouting or embarrassing the elderlies when they cannot hear well. 

Another challenge that needs to be overcome is adoption of hearing aid. Among seniors who are aware and diagnosed with hearing difficulty, only a small proportion use the tool. Reasons for not adopting hearing aids vary, including the perception that it is only for deaf people, the costs involved, and the feeling that it is noisy, uncomfortable or does not work. As hearing aid is the most effective way to prevent further hearing impairment and its complications, support from family and friends is crucial to help the elderlies beat the stigma and embrace technologies in their lives. 

If the senior has underlying conditions that are risk factors for hearing loss, such as diabetes, high blood pressure, following up with doctors regularly to manage them will help to preserve hearing capability. Beware of dementia risk among seniors with moderate or severe hearing loss. Regular health check-up, including dementia screening, will be highly beneficial. With proper management and the use of medical technologies, seniors with hearing loss can enjoy an improved quality of life in their golden years.  

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