Aging & Health A to Z
Causes & Symptoms
Hearing loss can be caused by physical changes in the ear, the auditory nerve, or in the ability of your brain to process sound. Sometimes, all three might be involved.
Age-Related Changes in the Ear
When you age, the outer part of the ear canal thins while earwax gets drier and stickier. This increases the risk of impacted wax. In addition, the ear drum may thickens, but the most significant changes are those that take place in the cochlear with the loss of sensory cells and degenerative changes in the nerve fibers carrying information from the sensory cells to the brain.
Conductive hearing loss. With this type of hearing loss, your hearing is muffled. It is typically caused by a build up of ear wax, which clogs the ear canal and prevents sound from entering. Your primary healthcare professional can diagnose and remove the wax if there is an excessive build-up. It is normal for all ears to have some was as this helps to protect the outer ear.
Other causes of conductive hearing loss include infections in the skin lining the ear canal, fluid in the middle ear, arthritis that affects the bones of the ear, or a hole in the ear drum, none of which are very common in older people. One condition that affects older individuals and cause conductive hearing loss is Paget’s disease of bone.
Sensorineural hearing loss. This is the most common type of hearing loss in older adults. It is typically caused by degenerative changes or damage to the hair cells and/or nerves in the cochlea,. The main cause is age but excessive noise exposure and ototoxicity (see list below) are contributory.
Other causes of sensorineural hearing loss include genetics and blood vessel problems (including those related to diabetes). More rarely, it may be related to occupational and environmental chemical exposures and certain autoimmune diseases or nerve tumors. Infections such as herpes and influenza may cause sensorineural hearing loss, as can cigarette smoking. People with diabetes and cerebrovascular disease are more prone to hearing loss. Dual sensory impairment (for example, vision and hearing loss) is a significant problem for at least 30% of older adults.
One type of sensorineural hearing loss, called “central hearing loss,” occurs when you lose the ability to understand speech in adverse listening situation such as in the presence of competing noise, competing conversation, or in reverberant environments. People with dementia are more likely than those without to have hearing loss. The hearing loss in persons with dementia is often times more severe than in those without dementia.
Signs and Symptoms of Hearing Loss
Typical signs of a hearing problem include:
- Playing the radio or TV too loudly
- Saying “what?” a lot during conversations
- Having problems communicating during parties or in restaurants
- Not hearing something if the person is out of your range of vision.
Sometimes you are so unaware of your hearing loss that it is up to a family member to tell you and your healthcare professional that you’re having problems hearing.
A simple way to tell if you’re having problems is with the “whisper test.” Have someone stand about two feet away and whisper a letter or number combination like “ADE.” If you can’t hear the combination, you have some hearing loss and should undergo formal testing. Ringing in the ear or tinnitus often accompanies ARHL but it could be a symptom of a condition requiring medical attention so if you experience this see your doctor or an otolaryngologist (ENT) doctor for an evaluation.
Medications that May Affect Hearing
There are more than 200 ototoxic drugs, meaning they affect hearing. Often, simply stopping the drug will restore the hearing, but sometimes the damage is permanent. The first sign of hearing problems related to a medication is usually tinnitus, or ringing in your ears. You may also experience some balance problems or dizziness. Ototoxic medications include:
- Certain antibiotics
- Certain chemotherapy drugs
- High doses of aspirin, acetaminophen and non-steroidal anti-inflammatories
- Loop diuretics
- Antimalarial drugs.
Updated: March 2012
Posted: March 2012