Octogenarian Pista D from Hyderabad loves being a hands-on grandmother. In fact, she can’t sit idle. Apart from helping her daughter with cooking and spending time with her grandchildren, the 88-year-old says she is “making the most of my time despite age-related ‘hiccups’”. Pista developed hearing loss – “a slow process which occurred with the passage of time” — when she was in her seventies. The specialists treating her said she had developed nerve weakness in her ears because of which her auditory system was not working in the usual way. This is a common cause of hearing loss among elderly.
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Causes of hearing loss
Hearing loss in elders is a natural process — caused by cell degeneration in the inner ear.
Dr Sangeetha TS, consultant, ENT, Gleneagles Global Health City, Chennai, tells Happiest Health that age-related hearing loss, known as presbycusis, happens gradually when a person gets older. “It occurs due to the degeneration process, which is part and parcel of ageing,” she says. “It affects the inner ear and the auditory nerve (nerve for hearing) of the elderly. The common cause of hearing loss in elders is age-related deafness.”
Dr Deviprasad D, professor and head of the department, ENT, Kasturba Medical College, Mangaluru, Karnataka, says that with ageing several parts of the body and certain cells tend to lose their function – “especially in the inner ear”. “People who have diabetes, blood pressure, kidney or liver issues are prone to developing age-related hearing loss a little earlier than their counterparts,” he says.
Signs, symptoms of hearing loss
Pista, like many other senior citizens, was experiencing a constant buzz in her ears before she was diagnosed with age-related hearing loss.
It is usually the family members who first spot hearing impairment in an affected person.
“The usual complaint of the family would be that the affected person finds it difficult to watch TV with normal volume, asks for words to be repeated during conversations and [seems] unable to understand and discriminate speech,” says Dr Sangeetha.
Dr Deviprasad says the buzzing sound in the ear is called tinnitus (a type of hearing loss). “It is also a symptom of hearing loss,” he says.
Social withdrawal is another symptom. “Since older people find it difficult to hear and communicate effectively, they avoid meeting people, especially in a group,” says Dr Nishanth Singh, ENT surgeon, Regency Hospital, Kanpur, Uttar Pradesh. “They feel embarrassed and uncomfortable in a crowd.”
Coping with hearing loss
Dr Sangeetha says hearing loss among the elderly can be managed with advanced technologies – for example, with quality digital hearing aids having advanced features like noise cancellation and a Bluetooth connection. “There are also cosmetic hearing aids which are not visible,” she says.
Dr Deviprasad says since hearing loss is a natural process, the general population needs to be aware that with age the hearing threshold will come down, just like the vision of the eyes. “Awareness about age and hearing loss is important,” he says. “With awareness comes acceptance. A person can’t live in denial and maintain that the condition is manageable, and they can hear well. It doesn’t help. At a certain point they need help. They need to accept the reality. If they don’t do that, they will slowly withdraw themselves from others and become lonely.”
Treatment of hearing loss
In Pista’s case, an ENT specialist had suggested she start using a hearing aid. But she didn’t since she felt uncomfortable using it.
“Elders having hearing loss need hearing aids,” says Dr Sangeetha. “However, in case of severe hearing loss, senior citizens might need surgical intervention.”
A cochlear implant (an electronic device) is for those who are not able to benefit from a hearing aid, says Dr Singh.
Dr Deviprasad says in the initial stage having multivitamins and cutting down on calories help. “Hearing loss can’t be prevented as ageing is a physiological process,” he says. “However, it can be prevented from occurring at an early age by managing diabetes and hypertension, and by avoiding being in noisy spaces.
“When a person is suffering from cold or cough, the ear should not be affected. A person should avoid using earbuds and other things that might result in damaging the eardrums.”
Dr Singh says a healthy diet and exercises can help postpone hearing loss. “When a person [following a healthy lifestyle] develops late hearing loss, the intensity also reduces,” he says. “Exercises which improve the blood circulation in the body can be done under supervision.”
Hearing loss due to infection or trauma, known as acquired hearing loss, can be avoided by getting prompt treatment, whereas ageing deafness is unavoidable, says Dr Sangeetha.
Family or friends should ensure timely medical intervention and consultation, says Dr Singh.
Avoid isolation by effective communication
Pista and her family members communicate through gestures, facial expressions and by speaking louder.
“Elders with hearing aids usually manage well,” says Dr Sangeetha. “However, those with profound deafness need lip reading along with loud communication to understand speech.”
Dr Deviprasad says if someone feels uncomfortable with hearing aids, the other way to communicate with them is through gestures, facial expressions and lip reading. “Conversations should take place in a positive environment,” he says. “It should be more of one to one or going close to the person or the person speaking will have to use amplifying device like a mic.”
Dr Singh emphasises the need to be considerate with the elderly. “Family and friends should make the elderly person feel inclusive by interacting with them regularly,” he says. “Another way to communicate with them is by going near to them and talking. The background noise has to be eliminated while communicating, as excessive noise in the background drops the audibility of the person.”
In fact, there is a difference between hearing a sound and understanding it. “The issue among the elderly age group is more to do with understanding speech,” says Dr Deviprasad. “Half of them can hear the sound when someone is speaking. However, they can’t make out of what exactly is being said. In fact, senior citizens with hearing issues are unable to distinguish or discriminate speech. It happens due to the weakness of nerves that transmits sound from the inner ear to the brain.”
Diagnosis of hearing loss
Experts say examination of the outer ear is not exactly enough for a diagnosis of the issue.
“It is only when we get an audiogram done that we get to know how much hearing capacity of a person has been affected and the type and extent of hearing loss,” says Dr Deviprasad. “The hearing threshold can be checked through an audiometry test. It is done by audiology and speech language pathology, where the experts assess the hearing ability of a person. Thereafter, depending on the pattern and type of hearing, a hearing-aid trial is done. Once a person is comfortable with the device, the best suitable device is provided to the person.”
Hearing aids
Hearing aids are available in various models and sizes. Digitalised hearing aids are better in terms of clarity and fine-tuning, says Dr Sangeetha.
Dr Deviprasad says hearing aids are custom-made. “The commonly used one is the behind-the-ear device, where the speaker is placed in the ear canal and everything else comes with the wire, which is placed behind the ear,” he says.
Hearing conditions differ when a person is alone or speaking on a phone or part of a gathering. “Automatic devices play an important role in such scenarios,” says Dr Deviprasad. “Sometimes, these devices might require fine-tuning. During the initial days, people wearing hearing devices need to visit an audiologist to reset their device, so that they can fine-tune it and make it most optimally utilised.”
A person doesn’t need a hearing aid when they are asleep or, say, alone and reading something. It is advisable not to wear a hearing aid when not needed.
Also, hearing aids are not for treating the problem but to amplify the sound.
Types of hearing loss
Dr Deviprasad says hearing loss can be divided into two types depending on the area of the ear involved.
“The ear is divided into outer ear, middle ear and inner ear,” he says. “If there is any problem in the outer and middle ears that person will develop a problem due to the conduction of the sound, which is called conductive hearing loss. If the problem is in the inner ear (the coil and the nerve) — called the cochlea — then we call that sensorineural hearing loss.”
According to the US’ National Institute on Ageing, conductive hearing loss occurs when sound waves cannot reach the inner ear. This may be due to earwax build-up, fluid or a punctured eardrum. Dr Singh says conductive hearing loss can be corrected through surgeries and medical treatment.
Sensorineural hearing loss occurs due to damage to the inner ear or the auditory nerve. Dr Singh says it can be partially corrected through surgeries and using a hearing aid. In this type, the person can hear the noise, but speech differentiation becomes difficult.
