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 eardrum may thicken, but the most significant changes take place in the cochlea, such as loss of sensory cells and degenerative changes in the nerve fibers that carry information from the sensory cells to the brain.
These are the main types of hearing loss and their causes.
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 blocks the ear canal and prevents sound from entering. Your primary healthcare provider can diagnose and remove the wax if there is an excessive build-up. It is normal for all ears to have some wax as this helps to protect the outer ear canal.
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 eardrum. None of these causes are very common in older people. One condition that affects older individuals and causes 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 changes or damage to the hair cells and/or nerves in the cochlea. The main cause is age but excessive noise exposure and ototoxicity (damage to the inner ear caused by drugs or chemicals) can contribute as well.
Other causes of sensorineural hearing loss include genetics or blood vessel problems (including those related to diabetes).
More rarely, sensorineural hearing loss may be related to:
- occupational and environmental factors such as chemical exposures
- certain autoimmune diseases
- nerve tumors
- infections such as herpes and influenza
- cigarette smoking
Older adults with the following conditions are more likely to experience hearing loss:
- cerebrovascular disease (conditions that affect blood flow to the brain)
Dual sensory impairment (for example, vision and hearing loss at the same time) 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 situations such as in the presence of competing noise, competing conversation, or in environments where sound can echo. Sudden sensorineural hearing loss (loss that occurs over 72 hours) often has no identifiable cause. The primary symptom is the sensation of a full or blocked ear. If you have sudden ear blockage or fullness, contact your healthcare provider promptly to avoid any treatment delay. Treatment may include corticosteroids taken by mouth or by ear drops.
A third type, mixed hearing loss, is a combination of conductive and sensorineural hearing loss.
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 provider 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 and number combination like “4K2.” If you can’t hear the combination, it indicates that you have some hearing loss and should undergo formal testing.
Another possible symptom of hearing loss is ringing in the ear (tinnitus). Tinnitus often accompanies age-related hearing loss, but it could also be a symptom of an unrelated condition requiring medical attention. Therefore, if you experience tinnitus, you should see your primary care provider or an otolaryngologist (ear, nose, throat doctor) for an evaluation.
Medications that May Affect Hearing
There are more than 200 drugs that are known as ototoxic—meaning that they affect hearing. Often, simply stopping an ototoxic drug will restore hearing, but sometimes the damage is permanent. The first sign of hearing problems related to a medication is usually tinnitus (ringing in your ears). You may also experience some balance problems or dizziness.
Some ototoxic medications include:
- Certain antibiotics like Gentamicin
- Certain chemotherapy drugs
- High doses of aspirin, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs)
- Loop diuretics
- Antimalarial drugs
Updated: November 2016
Posted: March 2012