Sound Advice for Aging Ears

Sound Advice for Aging Ears

"Are you mumbling, or are my ears going?" Although hearing loss is the third leading chronic disability affecting adults, it frequently goes unnoticed, and the person with the hearing problem is often the last one to realize it. Although there may be some sounds you'd prefer to tune out, such as car alarms and infomercials, there are likely many others you wouldn't want to miss, such as those that enable you to chat with your favorite people and enjoy your favorite songs and movies.

That's why, as you get older, it's important to be aware of how your hearing may change, how to assess your hearing accurately, and how to prevent and treat hearing loss. Doing so will help ensure that you stay connected to family and friends and continue to be fully engaged in your daily life, which are key factors in keeping your RealAge young.

A Simple Hearing Self-Assessment
Give your ears a quick check by asking yourself some of the questions that your doctor might ask if he or she were trying to determine if you have a hearing problem. Select yes or no in response to each question below. Answer all of the questions, and if you normally wear a hearing aid, answer the way you hear with the hearing aid.

1. Do you find that family and friends seem to mumble so that you can't fully understand them?

2. Do you have a difficult time hearing people speak when there is a lot of background noise, such as the chatter of voices; traffic or outdoor noises; or the sound of the radio, music, or TV?

3. Do you frequently ask people to repeat themselves?

4. Do people ever mention that you listen to the television or radio with the volume really high?

5. Do you have trouble hearing people speak on the phone?

6. Is it difficult to hear when someone speaks softly or in a whisper?

7. Has anyone ever told you that he or she thinks you may have a hearing problem?

If you answered "Yes" to 1 or fewer questions. Due to the small number of positive responses you gave to these questions, your healthcare provider might surmise that the presence of a hearing problem is unlikely, should he or she ask you similar questions. However, your answers to these questions do not represent a clinically valid diagnosis and there are other questions your healthcare provider might ask when assessing your symptoms.

If you answered "Yes" to 2—4 questions. Due to the number of positive responses you gave to these questions, your healthcare provider might surmise that there could be a problem with your hearing, should he or she ask you similar questions. Your answers suggest you might be experiencing a small to moderate degree of hearing loss. However, your answers to these questions do not represent a clinically valid diagnosis and there are other questions your healthcare provider might ask when assessing your symptoms.

If you answered "Yes" to 5 or more questions. Due to the number of positive responses you gave to these questions, your healthcare provider might surmise that there is a strong possibility you could have a hearing problem, should he or she ask you similar questions. Your answers suggest you may have significant hearing issues. However, your answers to these questions do not represent a clinically valid diagnosis and there are other questions your healthcare provider might ask when assessing your symptoms. Make an appointment with a healthcare professional if you would like to have your hearing evaluated.

Only a hearing specialist can make an accurate diagnosis after conducting an in-depth hearing evaluation. Read on to learn how you could have a hearing loss and not know it, as well as how to keep your ears healthy.

Why You Might Not Notice
People with mild hearing problems often fail to notice them, and even when they do notice, nearly half of those people wait at least 2 years before seeking help. Isolation can slowly begin to envelop people as they miss out on more and more of the sounds, conversations, and noises of daily life.

Although hearing is the quickest of the five senses -- your ears need to work very fast to perceive tones, pitches, and volumes -- the loss of this speedy sense usually happens quite slowly, causing hearing losses to go undetected. It may take decades for some people to notice the degree to which their hearing has been progressively compromised.

Other reasons people may overlook hearing lapses are:

  • Hearing loss is selective. Initially you may have difficulty hearing high-pitched sounds but still hear normally at lower pitches. That's why you might hear one person's voice better than another's or feel that some sounds get through while others don't. In addition, you could have difficulty distinguishing only certain consonant sounds and blends, such as S or a soft C, F, CH, SH, or H.
  • You can't feel or see a hearing loss. The good news and the bad news of typical hearing-loss patterns is that they usually don't produce any physical sensations, such as pain. Hearing loss doesn't hurt -- which is good -- but without pain signals, you aren't alarmed enough to do something about the hearing loss, which is bad because the hearing loss goes untreated. Also, people suffering from hearing losses have no outward physical signs of the condition, making it easy to ignore.

How the Ear Works
So how can you tell whether your hearing is normal? The first step is to educate yourself about all the different ways that hearing can go bad. Taking a closer look at your ears and how they work can help reveal the difference between normal hearing and impaired hearing.

Ears collect sounds, process them, and send signals to the auditory regions of your brain. There are three major sections to the ear: the outer ear, the middle ear, and the inner ear. Each section serves a distinct function, and each is vulnerable to its own problems and disorders.

In order to hear and process sounds properly, all parts of your ears must work together to transfer information to your brain. Any time the normal path of sound is interrupted or impeded in some way, hearing may be impaired. An interruption can occur at any section of the ear -- the outer, middle, or inner ear -- and hearing losses are classified based on where the interruption occurs.

Problems with the Middle and Outer Ear
When hearing loss occurs due to problems with the outer or middle ear, it is usually classified as a conductive loss -- the outer or middle ear cannot properly conduct sound, resulting in reduced sound volume and imperfect hearing. Fortunately, conductive hearing loss is usually temporary and often can be corrected with proper treatment. Treatment will depend on the cause, and there can be many different reasons for conductive hearing loss.

Causes of Conductive Hearing Loss
Impacted Earwax
Cause: Everyone produces a certain amount of earwax, which helps protect the ear canal from dirt and infection. But too much wax can lead to a blockage and impaired hearing. Problems associated with the accumulation of wax are one of the most common reasons people seek medical treatment for their ears.

Treatment/prevention: In most cases, wax can be removed at home by placing a few drops of mineral oil, baby oil, glycerin, or over-the-counter wax-softening drops in the ear. If repeated home-care attempts fail, a physician can prescribe stronger eardrops. He or she also may attempt to remove stubborn wax using irrigation, suction, or a syringe.

Never use a cotton swab to remove earwax. It's likely to pack more wax in. Also, people with a history of middle ear infections, swimmer's ear, or a hole in the eardrum should not treat impacted earwax themselves. 

Cause: Otitis media, a common infection of the middle ear, is more prevalent in children, but adults can suffer from it as well. A variety of viruses and bacteria can cause these infections, and people often get them after having a cold. Whatever the cause, a buildup of fluid in the middle ear cavity can lead to hearing loss. Although it is usually temporary, left untreated it may lead to permanent hearing loss, especially as a person gets older.

Treatment/prevention: Frequent hand washing is an easy way to avoid viruses and related respiratory complications that can lead to otitis media. If you experience pain, itching, or drainage from the ear, or if you have a fever, nausea, and diarrhea, call your healthcare provider. This type of infection is usually treated with antibiotics.

Perforated Eardrum
Cause: Head trauma or infection can cause a hole or rupture in the eardrum, which impairs hearing. The size and location of the hole affect the degree of hearing loss. A swift blow to the ear with a cupped hand, an explosion or gunshot near the ear, or a foreign body like a rogue cotton swab also can perforate the eardrum. And trauma to the ear or head can cause the tiny bones in the middle ear (ossicles) to fracture or become disjointed. This can break the chain of sound conduction to the inner ear, causing irregular hearing, like echoes or murmurs.

Treatment/prevention: Most perforations heal on their own within a few weeks, but larger perforations may require surgery or patching by a physician.

Problems with the Inner Ear
Damage to or death of the hair cells of the inner ear or the nerve pathways to the brain accounts for 90% of all hearing loss. Known as sensorineural hearing loss or nerve deafness, this is the most common cause of progressive hearing loss. Experts estimate that 23% of people over 65 suffer from sensorineural hearing loss.

Individuals with this impairment not only have trouble hearing faint sounds but also complain of difficulty understanding speech or hearing speech clearly. This type of hearing loss is usually permanent; human cochlea cannot regenerate the sensory receptor hair cells.

However, some people with this type of hearing loss benefit greatly from hearing aids. And adults with severe hearing loss due to cochlear problems or age-related disease may be considered candidates for a cochlear implant -- a small, complex electronic device that can be surgically implanted to help restore some hearing.

Also, scientists are currently exploring gene manipulation, gene therapy, and stem cell transplantation as possible ways to repair or replace damaged cochlear hair cells in humans.

Causes of Sensorineural Hearing Loss
Age-Induced Hearing Loss
Cause: Most sensorineural hearing loss stems from age-related changes to the ear. As people grow older, changes to the inner or middle ear or to the nerve pathways leading from the ear to the brain cause a gradual but steady loss of hearing, known as presbycusis. There is some debate over why these inner ear changes happen with age, but it may be because the structures within the ear gradually lose blood flow over time.

Symptoms of Age-Related Hearing Loss:

  • Others' speech sounds mumbled, slurred
  • High-pitched sounds are harder to understand
  • Background noise makes listening difficult
  • Certain sounds seem overly loud or annoying
  • There is ringing, hissing, or roaring in the ears (tinnitus)

Treatment/prevention: Although there is no way to prevent or slow down age-related hearing loss, you can avoid compounding the problem by taking good care of your ears, treating wax buildup properly, and protecting your ears from further damage, such as from excessive noise. Also, certain chronic health conditions, such as heart disease, diabetes, or high blood pressure, can provoke changes in the blood supply to the ear and potentially lead to hearing loss. So managing these conditions or preventing them with a healthy lifestyle will help protect your hearing as well.

Noise-Induced Hearing Loss
Cause: Excessively loud noise can cause irreparable damage to the hair cells of the inner ear. Noise-induced hearing loss can result from one-time exposure to a sudden loud noise, like a gunshot or an explosion, or from long-term exposure to raised noise levels in the home or workplace.

Treatment/prevention: In order to protect your ears from noise, you should know when they’re in danger. Loudness or intensity of sound is measured in units called decibels (dB). A normal conversation falls somewhere near 60 dB, while city traffic chimes in at about 80 dB. Anything over 85–90 dB could damage your ears. Prolonged exposure to sound levels above 90dB can lead to permanent hearing loss.

Protect your ears with earplugs or earmuffs during noisy activities, and turn down the volume on the stereo and television to the lowest level necessary.

Medication-Induced Hearing Loss
Cause: Certain medications, including antibiotics, chemotherapy medications, anesthetics, heart medications, and mood-altering drugs, are known to be damaging, or ototoxic, to the ears. Problems caused by an ototoxic medication tend to develop quickly. Ringing in the ears (tinnitus), hearing loss, and vertigo are usually the first signs.

Treatment/prevention: Usually the symptoms of medication-induced hearing loss are temporary, and hearing returns to normal once the person stops taking the medication. However, some medications can cause permanent damage to the inner ear, resulting in permanent hearing loss even if you stop taking the medication, so speak with your healthcare provider about alternative medications if you are concerned about ototoxicity.

Researchers are now exploring whether administering antioxidant drugs along with certain medications can protect the inner ear from medication-induced hearing loss. If you have concerns about your hearing, or you experience hearing loss due to a medication, discuss your prescription and over-the-counter medications with your physician or pharmacist.

Listen Up!
The longer you live, the greater the chances you will experience some reduction in your ability to hear. One in three people over 60 and half of people over 85 have hearing loss.

If you or the people who love you suspect you may have developed a hearing problem, don’t let it diminish your quality of life by failing to seek treatment. Ignoring a potential problem could lead to irreversible damage to your ears and take a toll on your RealAge. Research shows that an untreated hearing condition can disrupt family life, reduce your productivity in the workplace and at home, and cause a wide range of social and emotional problems, all of which could contribute to isolation, feelings of depression, or other conditions that make your RealAge older. Failing to address hearing loss can also impact your personal safety and your earning potential.

If you believe that sounds are not as loud as you need them to be, or if speech sounds muffled to you and you have difficulty understanding others, following conversations, finding the source of a sound, or distinguishing sounds in your everyday environment, have your ears checked by your primary care provider or by a medical ear specialist, such as an otologist or otolaryngologist.

He or she can check for wax in the ear canals, infection, or other treatable conditions. If hearing loss is suspected, your health professional may do initial screening tests in the office. If these initial tests suggest or reveal hearing loss, a more thorough hearing test or audiologic evaluation may be done to assess whether you have hearing loss and how to treat it.

Help is Available
If you already have a diagnosed hearing problem, help is available. There are hearing aids and assistive listening devices to fit every lifestyle, and there are surgical procedures, such as cochlear implants, to treat severe losses.

Also, comprehensive treatment programs such as individual or group aural rehabilitation can improve daily life by helping people cope with every facet of living with a hearing loss. These programs teach people how to make productive use of residual hearing, how to improve communications, and how to use hearing aids and cochlear implants most effectively.

With proper training, instruction, and treatment, people can live full, productive, and engaged lives, regardless of the degree of their hearing loss.

Medically reviewed in March 2020.

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