Wednesday, June 15, 2022

Which Hearing Loss Is Progressive And Associated With Aging

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Can You Repeat That Hearing Loss In Adults

What is age-related hearing loss?

Hearing loss affects an estimated 30 million people in the United States. Statistical data regarding the incidence of hearing loss from the NIH can be found here.

Untreated or unrecognized, it can cause social isolation, worsening dementia, job loss, disability and depression. HL can slowly worsen over decades or occur suddenly in one ear requiring urgent medical intervention. Slowly progressive HL is usually age-related but the pace of loss is determined by many factors including genetics, noise exposure, smoking, and underlying diseases such as diabetes. Following is a brief review of how we perceive sound, the types of hearing loss, how testing is done and when to seek help.

Social And Cultural Aspects

People with extreme hearing loss may communicate through sign languages. Sign languages convey meaning through manual communication and body language instead of acoustically conveyed sound patterns. This involves the simultaneous combination of hand shapes, orientation and movement of the hands, arms or body, and facial expressions to express a speaker’s thoughts. “Sign languages are based on the idea that vision is the most useful tool a deaf person has to communicate and receive information”.

This Article Will Demonstrate Which Hearing Loss Is Progressive And Associated With Aging

Our senses are responsible for our effective communication with the outside world, hence enabling us to interact with outers, be socially connected to the world, and satisfy our human and aesthetic needs of appreciating nature, art, music, and all combined. This fact suggests that a possible injury or disfunction of our senses will automatically have an impact on the way we function as human beings.

As hard as it can be to voice the health problems connected to our senses, out of all changes that occur with aging in our sensory organs, hearing deterioration or loss can probably be considered one of the most expected, common, and even accepted ones.

Of course, being an important part of how we consume the information from the outside world hearing serves various significant functions: it controls the system of communication through speech, indicates possible potential detrimental events that occur outside of our visual field, and serves for our aesthetic functional needs such as an appreciation for music, nature and more.

Acknowledging the wide scope of impact hearing has on our well being, with consequences for our social, psychological, and functional prosperity, core operational features of this sense, the way it works and serves us, and possible dangers for its successful functioning should be well understood, acknowledge, and properly taken care of.

Defining Age-Related Hearing Loss:

How Do We Hear?

Correlation of Aging And Hearing Loss:

How to Prevent Hearing Loss?

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The Mechanisms Of Aging In The Central Auditory System

The age-associated changes reported in cochlear nucleus and the auditory cortex have also been a focus of research. As Figure 1 shows afferent auditory fibers from the cochlea terminate at the cochlear nucleus complex which includes the anteroventral cochlear nucleus , posteroventral cochlear nucleus , and dorsal cochlear nucleus . First stage of centralized auditory processing occurs at the CN complex . AVCN and PVCN carry out the spectral analysis of the auditory signal and AVCN and DCN process the localization cues . Both animal and human models have been used to investigate the underlying patho- physiological changes of the central auditory system associated with aging. The alterations in animal models from the CN to the auditory cortex are discussed first.

Figure 1. Schematic diagram of the auditory pathway. This schematic diagram represents ipsi and contralateral auditory pathways from cochlea to the auditory cortex. Main nuclei of the central auditory pathway, namely Superior Olivary Complex , Dorsal and Ventral Cochlear Nuclei , Lateral lemniscus , Inferior Colliculus , Medial Geniculate body , and Primary Auditory Cortex are shown in the figure.

Evidence From Animal Studies

Evidence From Human Studies

Central auditory pathway changes due to healthy aging process
Changes in the central auditory pathway due to ARHL

Routine Screening: The Us Preventive Services Task Force Report

Aging Hearing Loss: Causes And Treatments

Because only 41% of US adults aged 70 years and older report having had a hearing examination in the past 5 years , screening primary care patient populations to identify and refer likely candidates for hearing intervention to diagnostic hearing evaluation has intuitive appeal. However, the US Preventive Services Task Force stated that, because of insufficient evidence, it is unable to recommend guidelines for or against routine screening for asymptomatic adults over 50 years of age for age-related hearing loss .

The USPSTF report recommends trials to evaluate the effect of screening in patients older than 70 years. Targeting older age groups would likely result in a greater number of confirmed cases owing to higher prevalence and may result in greater use of hearing aids if conclusions from this sample of military veterans can be generalized. However, some data suggest that younger people adapt more easily to hearing aids . The Task Force also recommended expanding the aim of the randomized controlled trials to demonstrate not just greater uptake, use, or satisfaction with hearing aids, but improvements in health outcome measures such as emotional functioning, social functioning, communication ability, and cognitive functioning. To fully document benefit, investigators must ensure that any effective patient screening evolves in parallel with management strategies that provide measurable value.

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Presbycusis In The Elderly

Age-related hearing loss, known as presbycusis, is a gradual and progressive diminishing of the sense of hearing in older people. It is a very common condition after the age of 65 years and starts as early as the 50s. Presbycusis does not occur overnight and will not lead to deafness within a short period of time. Instead the hearing apparatus within the year becomes less sensitive over years and decades. Although presbycusis hes a medical condition, it is not considered to be a disease as such. Rather it is seen as a physiological change associated with aging.

Hearing Loss Faqs: All Your Concerns Addressed

Q. What is the first sign of hearing loss?

A. Most patients suffering from hearing loss initially complain that individuals are mumbling or speaking too quickly. Hearing loss is often accompanied by Tinnitus . A buildup of cerumen, medication, exposure to loud sounds and deafness will all cause ringing within the ears, or similar symptoms. The ringing could be constant or occasional, however it’s typically the primary sign of deafness.

Q. What causes hearing loss?

A. The most common causes of hearing loss are as follows:

  • Aging
  • Ototoxic drugs
  • Diabetes

Hearing loss can happen due to many factors, but some of the major contributors are age and exposure to noise. Loss of hearing due to age is quite common, the hearing senses begin to weaken around the age of 40 and it gets worse until you reach the age of 80.

Excessive exposure to noise is a consequence of living in disruptive surroundings or voluntarily listening to loud music through earphones, at live concerts, or through a stereo for a long time can contribute to permanent loss. Some of the other causes that can lead to permanent hearing loss include-

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The Consequences Of Untreated Hearing Loss

Untreated hearing loss can lead to cognitive degeneration and emotional disorders such as dementia, self imposed social isolation and depression, according to a recent study from the National Institute of Aging. The risk for these disorders increases with increasing levels of hearing loss for every 10 decibels of hearing loss, the probability of developing severe cognitive deficits increases by 20 percent.

Another recent study by Dr. Frank Lin MD, PhD, at the Johns Hopkins School of medicine found a strong link between untreated hearing loss and the development of dementia. A study by Johns Hopkins experts, found that older adults with hearing loss are more likely than their peers with normal hearing to require hospitalization & suffer from periods of inactivity and depression.

Mounting evidence of serious consequences resulting from untreated hearing loss underscore why hearing loss should not be considered merely an annoying part of aging, but an important issue for public health.

The consequences of untreated hearing loss are covered in depth, here.

Pathophysiology Associated With Presbycusis

Age-Related Hearing Loss (Presbycusis)

Presbycusis is a bilateral loss of auditory sensitivity that progresses from high to low frequencies with ageing. However, the rate of hearing decline is not linear and is highly variable, and the variance in hearing level is only weakly associated with age . These observations suggest that age-related changes do not occur uniformly and that more than one pathological process may be acting upon the auditory system. This variety may also be taken as indirect evidence of the complex interaction of genetic and environmental factors in the aetiology of presbycusis. Adding to the complexity, both the peripheral and central auditory pathways can be affected in presbycusis.

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Hearing Aids And Other Devices

A hearing aid is defined by the Food and Drug Administration as a wearable sound- amplifying device that is intended to compensate for impaired hearing. The goal of treatment with well-fitted hearing aids is to improve the audibility of even soft speech or music and other sounds while ensuring that sounds do not become uncomfortably loud. Hearing aids can be sophisticated instruments with a variety of customizable features that contribute to their high costs whether performance improves with higher-cost devices is uncertain. A variety of noncustomized devices, termed hearing assistive technologies, are also available they include amplified telephones, visual technologies such as captioning, video conferencing, and visual or vibrotactile alerts. Hearing aids are regulated by the FDA, and state laws may restrict access to them. The devices are sold through audiologists and hearing-aid dispensers. The costs of services related to hearing-aid fitting are often bundled with the cost of the device, so the specific costs of the services and the technology are not transparent.

Hair Cell Decay From Aging

The figure is from a research study by Dr. Li-Korotky Age-Related Degeneration of the Organ of Corti in Two Genotypes of Mice. This study used a mouse model to gain insights into human hair cell degeneration due to aging. The left half of the figure shows banks of healthy hair cells lining the Cochlea. The right half of the figure shows hair cell damage.

This particular research examined hair cell degeneration in mice with different gene structures, leading to different hearing loss results as the mice aged. A scanning electron microscope reveals hair cell damage due to aging.

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Burden Of Hearing Loss

The Global Burden of Disease Study measured years lived with disability and found that hearing loss is the fourth leading cause of disability globally. In the United States, the prevalence of hearing loss doubles with every 10-year increase in age. Approximately half of persons in their seventh decade and 80% who are 85 years of age or older have hearing loss that is severe enough to affect daily communication. Because of the aging population in this and other developed countries, hearing loss is likely to become an increasingly prevalent disability.

Dementia And Cognitive Impairment


In some individuals, difficulties experienced during comprehending speech in noisy backgrounds or competing speakers could be related to central auditory processing difficulties rather than peripheral hearing deficits . Results from a number of longitudinal studies suggest that CAP in the absence of severe peripheral hearing loss is associated with high incidence of cognitive decline and dementia due to AD . These studies have demonstrated that individuals with central auditory dysfunction were at a significantly increased risk for incident dementia with hazard ratios ranging from 9.9 to 23.3 . Gates et al. reported that the relative risk of developing cognitive decline or dementia was twice higher for those with bilateral poor CAP scores as measured by Synthetic Identification-Ipsilateral Competing Message scores compared to those with unilateral poor SSI-ICM scores. Furthermore, impaired central auditory functions have been observed five to ten years prior to an official AD diagnoses .

Wayne and Johnsrude proposed a new framework with a common cause phenomena approach, where age-related changes of the brain result in decline of sensory and cognitive abilities. According to this hypothesis, the changes in sensory abilities increase the demand on the already strained cognitive system resulting in functional cognitive impairment .

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Progression Of Hearing Loss

The difference in hearing thresholds was large . Pure-tone thresholds at baseline were worse for higher than for lower frequencies, and thresholds worsened with each age category . The prevalence of age-related hearing impairment according to the WHO at baseline was 48.5%. The prevalence rose with each age category . At the follow-up, this was 61.4% .

Fig. 1.

Average pure-tone thresholds of the study population at baseline. Thresholds shown for three age categories. HL, hearing level.

Figure 2 shows the mean threshold at baseline in relation to the mean threshold at follow-up, again displayed for the three age categories. All participants left and above of the drawn line showed progression of hearing loss. An increase in hearing thresholds progressive hearing loss was present for 512 participants . The average decline of hearing loss was 0.29 dB/year in the low frequencies and 1.35 dB/year in the high frequencies. The progression was significantly associated with the baseline thresholds. For the lower frequencies an effect estimate of 0.07 dB per 4 years of follow-up was found and for the higher frequencies an effect estimate of 0.06 dB per 4 years of follow-up , after correcting for age, sex and the other determinants. In other words, for approximately every 16 dB elevation of the baseline threshold, 1 dB less progression in the follow-up period was expected.

Fig. 2.

Impact Of Hearing Loss

The impact of hearing loss is not simply measured in decibels. Hearing loss is an individual experience, and how the individual copes will depend on a great many factors, including early versus late onset, the progressive nature of the loss , the severity of the loss, communication demands, and personality . Regardless of the combination of these presenting factors, hearing loss has been linked to feelings of depression, anxiety, frustration, social isolation, and fatigue.

Several studies have documented the impact of untreated hearing loss. An often cited survey was commissioned by the National Council on Aging in 1999 . This nationwide survey of nearly 4,000 adults with hearing loss and their significant others showed significantly higher rates of depression, anxiety, and other psychosocial disorders in individuals with hearing loss who were not wearing hearing aids. This survey looked at the positive benefits of amplification and showed that hearing aid use positively affected quality of life for both the hearing aid wearer and his or her significant other. These findings were consistent with the findings of a large randomized controlled study which found that hearing loss was associated with decreased social/emotional, communication, and cognitive function in addition to increased depression for subjects who were unaided as compared to those who received hearing aids. These conditions were improved after hearing aids were fit .

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How Can I Best Learn To Cope With Age

You may ask your family or other loved ones to help you make it easier to live with hearing loss. Sharing about your hearing loss with others can help you find support to cope with the condition.

You can better manage your hearing loss by:

  • Informing friends, family and communication partners of your hearing loss.
  • Asking family and friends to face you when they speak.
  • Being specific when youre telling someone how they can help you better understand. For example, let them know that they need to get your attention before they start talking or that you use facial cues to help you understand, so you need them to look at you when speaking.
  • Avoiding places with lots of ambient noise, such as restaurants or venues with live music.
  • Turning off the television or radio when you arent listening to them.
  • Wearing hearing aids or using other devices as directed by your provider.
  • Showing appreciation for when someone goes out of their way to help you.

Genetic Predisposition To Arhl

Mayo Clinic Minute: Can you slow down age-related hearing loss?

The human genome contains roughly 70 K+ channel-encoding genes . Many of these genes play essential roles in normal physiological processes, including those involved in hearing, as evidenced by the clinical appearance of syndromic and/or non-syndromic hearing loss with genetic variation. As ARHL has a delayed onset and progressive nature, it is plausible to hypothesize that genetic variation may directly contribute to an inter-individual variability and susceptibility to ARHL or to other indirect processes of aging such as metabolic status. One way to test this is to perform statistical analyses in the form of association testing to identify genetic regions or variants, in either genes of interest or across the entire genome, to identify associations with ARHL. This type of analysis has not been performed for all of the genes encoding the channels discussed in this review. However, in the following section, we summarize the current body of genetics knowledge for our selected K+ channels and make connections to ARHL.

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Progressive Hearing Loss In Children

Progressive hearing loss in children can manifest with vague symptoms, such as behavioral issues or speech problems. There are many causes of childhood hearing loss, including infections, certain medications, and neurological disorders.

If you suspect your child is losing their sense of hearing, discuss your concerns with their pediatrician. Hearing tests can determine whether your child’s hearing really is diminishing and if so, other tests can be done to determine why so the appropriate treatment can be started as soon as possible. This may involve strategies aimed at improving hearing and speech, as well as management of the underlying cause of the progressive hearing loss.

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