Hearing loss affects approximately one-third of adults 61 to 70 years of age and more than 80 percent of those older than 85 years. Men usually experience greater hearing loss and have earlier onset compared with women. The most common type is age-related hearing loss; however, many conditions can interfere with the conduction of sound vibrations to the inner ear and their conversion to electrical impulses for conduction to the brain. Screening for hearing loss is recommended in adults older than 50 to 60 years. Office screening tests include the whispered voice test and audioscopy. Older patients who admit to having difficulty hearing may be referred directly for audiometry. The history can identify risk factors for hearing loss, especially noise exposure and use of ototoxic medications. Examination of the auditory canal and tympanic membrane can identify causes of conductive hearing loss. Audiometric testing is required to confirm hearing loss. Adults presenting with idiopathic sudden sensorineural hearing loss should be referred for urgent assessment. Management of hearing loss is based on addressing underlying causes, especially obstructions (including cerumen) and ototoxic medications. Residual hearing should be optimized by use of hearing aids, assistive listening devices, and rehabilitation programs. Surgical implants are indicated for selected patients. Major barriers to improved hearing in older adults include lack of recognition of hearing loss; perception that hearing loss is a normal part of aging or is not amenable to treatment; and patient nonadherence with hearing aids because of stigma, cost, inconvenience, disappointing initial results, or other factors.
At least 28 million U.S. adults have hearing loss.1 After hypertension and arthritis, it is the most common chronic health problem in older persons.2 The impact of hearing loss on society will increase as baby boomers age, because the age-specific prevalence of hearing loss and the number of older persons are increasing.3
Normal conversations use frequencies of 500 to 3,000 Hz at 45 to 60 dB. After 60 years of age, hearing typically declines by about 1 dB annually. Men usually experience greater hearing loss and earlier onset compared with women.4 Hearing loss of 25 dB or more affects about 37 percent of adults 61 to 70 years of age, 60 percent of adults 71 to 80 years of age, and more than 80 percent of adults older than 85 years.5,6 No evidence supports a threshold age for the onset of hearing loss.7
Hearing loss impacts communication and functional ability, and is strongly associated with decreased quality of life, cognitive decline, and depression.3,8 Despite its prevalence and morbidity, hearing loss is underrecognized and undertreated.3 It may be underrecognized because it is a slowly developing problem or because of the belief that hearing loss is a normal part of aging. Undertreatment may result from poor appreciation of options for hearing enhancement, or patient resistance or inability to use hearing aids and assistive listening devices. Cost and social stigma are major factors in the diagnosis and management of hearing loss.