Presbyacusis (Hearing Loss of Older People)

What is the ear like and how do we hear?

What is presbyacusis?

Presbyacusis (sometimes written presbycusis) is the medical term for hearing loss that occurs in older people as they age. It is the commonest cause for hearing loss in people over 55. (Less common causes of hearing loss in older people include infections and injury to the inner ear.)

The hearing loss comes on gradually, often over several years. Both ears are usually affected equally. It is usually high frequency (high-pitched) sounds that are most affected. For example, you may find it difficult to hear the telephone ringing or birds singing. You may not be aware of your hearing loss at first. You may only realise that your hearing is becoming poor when you have difficulty using the telephone or following a conversation in a group or noisy room. Friends or family may comment about the television being loud or having to repeat themselves more often to people with hearing loss.

Why does it happen?

Most people will tend to lose some of their hearing to a greater or lesser extent as they become older. Over half of people over the age of 60 have some degree of hearing loss. The exact cause of presbyacusis is not known. The inner ear (cochlea) contains nerve cells that convert sound into nervous impulses which are sent to the brain. It is thought that most people develop presbyacusis because these nerve cells don't seem to work as well and they become damaged.

It is probably a number of different things that contribute to this damage and it seems to be part of the ageing process. A number of things have been suggested as possible causes for the damage:

• Arteriosclerosis - hardening and narrowing of the blood vessels that supply blood to the cochlear which means that less blood gets through. You may also have heart disease, high blood pressure or diabetes.
• Exposure to noise over the years.
• Exposure to stress over the years.
• Exposure to drugs or chemicals over the years.
• Smoking.
• Being overweight.
• There may also be some hereditary (inherited) reasons for presbyacusis.

When a sufficient number of nerve cells are damaged, this is when you notice hearing loss. Most people do not go completely deaf. The severity of the hearing loss varies from person to person of the same age.

Can it be prevented?

There is little that can be done to prevent this age-related process. It is possible that being exposed to a lot of loud noise over long periods may make hearing loss worse when you are older. For example, if you work in a noisy factory, you should wear ear protection.

Plugs of ear wax may make any hearing loss worse. Therefore, from time to time it may be worthwhile having your ears checked for wax. Wax can usually be cleared out to allow the hearing to be as good as possible. See separate leaflet called 'Ear Wax' for details.

Do I need any investigations?

Your doctor may suggest that they examine your ear to look for any problems such as ear wax or problems with your ear drum that may be contributing to your hearing loss. Your doctor may also refer you to an audiology clinic or Ear, Nose and Throat (ENT) unit for assessment. A hearing test is performed to confirm the diagnosis and assess your level of deafness.

What is the treatment for presbyacusis?

When there is a mild degree of hearing loss, most people manage well in normal situations of everyday life and may not need any treatment. Asking people to speak more clearly may be all that is required. However, eventually, you may need a hearing aid. Hearing aids are provided by the NHS. A mould of the outer ear is made if a hearing aid is prescribed. Generally it is worn behind the ear and is not very noticeable.

Will my hearing go back to normal with a hearing aid?

Although modern hearing aids are excellent, they cannot make hearing fully normal. Modern hearing aids are a lot better in quality and also a lot smaller than they used to be. It must be stressed that it does take time to get used to wearing a hearing aid. After several years of dulled hearing it may take a while to become used to the amplified sound. In time, most people get used to hearing aids and find them of great benefit. It is important that hearing aid users are fully instructed on how to use and look after their aid.

Are there any alternatives to hearing aids?

In addition, there are a variety of other devices which can help if you have hearing loss (whether you use a hearing aid or not). These include:

• Telephone amplifiers for ordinary telephones.
• Specially designed telephones for people with hearing loss.
• Devices to let you know when your telephone or doorbell are ringing.
• Lights and devices to let you know when smoke detectors, alarm clocks, etc, are activated.
• Equipment to help you listen to the TV, radio, stereo, etc.

Some people also find that lip reading or hearing dogs help.

If you have severe hearing loss, sometimes a hearing aid may not be enough to help improve your hearing. Or, you may have worn a hearing aid for a number of years, but because your hearing continues to worsen, the hearing aid may no longer be effective. Your doctor may suggest that you consider having a cochlear implant. This is an electronic device that is used to help people with severe hearing loss. The external part of the device is called an external speech processor. A microphone around the ear picks up sounds. These sounds are then converted into electrical signals. These signals are transmitted through the skin to an internal implant inside the cochlear. This implant allows the hearing nerve to be stimulated despite the fact that the cochlear cells are damaged. The brain picks up signals from the hearing nerve and you hear.

Further information

RNID Information Line

19-23 Featherstone Street, London EC1Y 8SL
Telephone: 0808 808 0123 Textphone: 0808 808 9000 Fax: 020 7296 8199
Web: www.rnid.org.uk
Can give you information about hearing aids and equipment.

RNID Products

1 Haddonbrook Business Centre, Orton Southgate, Peterborough PE2 6YX
Telephone: 01733 361199 Textphone: 01733 238020 Fax: 01733 361161
Web: www.rnid.org.uk
Sell a range of equipment for deaf and hard of hearing people.

British Society of Hearing Aid Audiologists (BSHAA)

Web: www.bshaa.co.uk
The professional body which represents the interests of the private hearing aid profession. Their website includes information aimed at the general public about hearing aids, the different types, how they work, etc. Their website also includes a directory of BSHAA members who are available to offer you advice on hearing loss and ways of overcoming it.