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HOW TO ADDRESS HEARING LOSS IN OLDER ADULTS

HOW TO ADDRESS HEARING LOSS IN OLDER ADULTS
March 08
14:48 2019

xenical 120 mg orlistat reviews my company How to Address Hearing Loss in Older Adults

HOW WE HEAR IS ONE OF the many incredible things our bodies do without conscious effort from us. From enjoying the sweet nothings whispered by a loved one to hearing a car horn honk in time to step back to safety on the curb, this complex sense helps us build relationships and keeps us safe. But as with most other aspects of the body and health, it’s not uncommon for hearing to fade as we age. Indeed, the World Health Organization estimates that, worldwide, there are 164.5 million people over age 65 with disabling hearing loss.

Why can be a complicated answer, but for many people, hearing loss seems to simply be a function of age. “There are some changes that we think take place in the ear,” says Dr. Debara Lyn Tucci, professor of otolaryngology head and neck surgery at Duke University School of Medicine. “Some of them are genetic and some of them are thought to be environmental and they can interact as well,” meaning that exposure to environmental factors can exacerbate a genetic predisposition to hearing loss. In rural or isolated populations, age-related hearing loss may be less prevalent than in industrialized nations, but it seems that because cells in the body tend to break down with age, hearing loss is a mostly normal part of aging for many people.

How Do We Hear?

Before getting into how hearing can fade, it’s best to review how we hear at all. The National Institute on Deafness and Other Communication Disorders reports that the notion of hearing refers to a “series of complex steps that change sound waves in the air into electrical signals. Our auditory nerve then carries these signals to the brain,” where they are interpreted and we can appropriately react.

More specifically, sounds must travel quite a gauntlet before they can be appreciated for what they are. Sound waves enter the ear via the ear canal and create vibrations on the surface of the eardrum. These vibrations in turn are conducted to three small bones in the middle ear, called the malleus, incus and the stapes. Those bones vibrate to amplify the sounds, which then move into the cochlea. The cochlea is a snail-shaped, fluid-filled structure in the inner ear. The sound vibrations cause ripples in that fluid, triggering movement in tiny hair cells called stereocilia. In response to those vibrations, these stereocilia generate an electrical signal that’s sent to the auditory nerve. The nerve conducts that impulse into the brain where it can be interpreted. Finally, you hear a baby cry or a dog bark or any of the other millions of sounds we hear every day.

At any point along that lengthy process, the conduction of sound can be impeded or can break down, and as we age, certain elements of the system may function less effectively. Stephen Kirsch, a doctor of audiology in private practice in Santa Monica, California, says that among older adults, “hearing loss is mostly related to cellular degeneration in the cochlea.” But for some people, especially those age 85 and older, “neurologically the auditory system can potentially become very inefficient, depending on how much cognitive exercise they get. Understanding speech is a different realm than hearing sound,” Kirsch notes.

This interface between hearing sound and interpreting what it means can be a tricky aspect of restoring hearing in some people. Although an audiologist or other hearing health care provider might be able to fit you with hearing aids, it doesn’t necessarily mean you’ll automatically be able to hear better. “It’s easy for an audiologist or hearing aid professional to provide enough sound for one to hear it. But it’s up to the neurological aspect of the auditory system to process that sound into decipherable speech,” Kirsch says. “In my experience, for people who are 85 and older, how well they process speech is determined by how mentally active they are.” Keeping your brain healthy and active by reading, doing puzzles and socializing may help slow that deterioration.

Although cellular degeneration is a normal part of aging, “people with more significant hearing loss usually have other contributing factors,” than just this normal loss of cells, such as a history of infections in the middle ear, a history of noise exposure or head trauma, Kirsch says. “Even some medications can cause hearing loss,” a side effect called ototoxicity. “People who have the greatest need usually have a combination of age-related hearing loss in addition to something else,” he says.

Dementia and Hearing Loss

Protecting or restoring your hearing is about more than just being able to hear the world around you. “Some research has come out stating that untreated hearing loss is correlated to dementia,” Kirsch says. “People who don’t stimulate their brain and people who are not stimulated by flowing conversation are more likely to acquire dementia. That’s a big issue, and it’s something that we’re trying to get the word out about so that people address the hearing loss.”

Tucci agrees that there’s “a demonstrated association” between dementia and hearing loss, but it’s unclear if one causes the other. “If you look at very large data sets, people with hearing loss have a higher incidence of dementia. We don’t know if it’s causative or not. That needs to be worked out a lot better.” But it stands to reason: As hearing fades, many adults withdraw from social settings because they can’t keep up with the flow of conversation around them. This can lead to feelings of isolation and loneliness, which are also associated with increased risk of dementia.

“Psychologically and emotionally, there’s a lot going on related to hearing loss,” Kirsch says, which may negatively impact “relationships and the way people present themselves or represent themselves in situations with loved ones, strangers or on the job. It can block communication, and it can have some real effects in how they’re perceived and what kind of influence they have over others, because that’s all based on communication.”

How to Cope With Hearing Loss

If hearing loss has become a problem for you or a loved one, it’s important to know you don’t have to suffer in silence. “There are a lot of options,” to restore hearing, Tucci says, including hearing aids and cochlear implants.

Although Kirsch says that most people don’t do anything to address their hearing loss, taking advantage of a relatively simple solution like a hearing aid may make a big impact on your quality of life.

Hearing Aids

“Among the people who recognize an impairment and have a desire to improve upon it, the most common method to address it is hearing aids,” Kirsch says. “But unfortunately, only 20 percent of people with significant hearing loss actually address it, and that’s a major issue.”

If you get hearing aids, remember that they may need to be adjusted from time to time for best results because your hearing will likely continue to decline with time. “Hearing aids are a work in progress for the life of the hearing aid,” and programming it most appropriately for the degree of hearing loss if the hearing changes is an important aspect of this, he says.

Cochlear Implants

Cochlear implants are surgically implanted devices that “bypass the hair cells which are not working anymore and directly stimulate the hearing nerve,” Tucci says. You may have recently seen one of several online viral videos showing a baby born deaf hearing sound for the first time upon successful completion of a cochlear implant procedure. You might not be so quick to associate these devices with older adults, but Tucci says they can be a great option for people with certain kinds of hearing loss, no matter their age.

“If you have a very healthy older person who’s becoming isolated and may be at risk for depression and other significant health consequences of hearing loss, it really does make a lot of sense to at least consider (a cochlear implant) as a possibility,” ultimately because they work, she says. “There’s a lot of misunderstanding among the public as well as primary care doctors about how well those work. But they work extremely well – they’re miracle devices. But many patients don’t get to us for evaluation because they receive this information that they may not be effective.”

Other Technologies

Tucci says the FDA is currently rewriting guidelines to make hearing aids more accessible and affordable, so your ability to acquire such devices may become a lot easier in the near future. In the meantime, there’s an app for that. Several smartphone apps can amplify sounds or convert speech to text to make it easier to hear or understand what’s going on around you.

Who Can Help Me With Hearing Loss?

For most people who may be losing their hearing, a trip to your primary care provider is often an important first step in restoring that sense. Your primary care provider may be able to care for your hearing needs but you may also be referred to an audiologist for additional care. The Academy of Doctors of Audiology reports that “an audiologist has received an Au.D. (Doctorate in Audiology), or a Master’s or Doctoral degree from an accredited university graduate program in audiology.”

This health care professional “diagnoses hearing loss and balance disorders and treats those that can be treated by an audiologist – those that can’t be redeemed or remediated medically,” Kirsch says. This means people who have normal age-related hearing loss versus deafness that has its origins in a disease state.

Although you may see an audiologist for many age-related hearing loss issues, you may also be referred to an otolaryngologist, also sometimes called an ear, nose and throat doctor or an ENT. “Audiologists are very important health care providers and otolaryngologists are physicians who treat people with hearing loss,” Tucci says. “Otolaryngologists can evaluate you for any medical causes of hearing loss. We work closely with audiologists in our office to identify the amount and type of hearing loss to determine if someone might be a good candidate for intervention.” Similar to how ophthalmologist and optometrists often work together, audiologists and ENT frequently “work together as part of the hearing health care team,” Tucci says.

Maintaining Hearing and Preventing Further Loss

Tucci says seniors should have regular hearing tests as part of routine preventive care. A primary care provider may be able to administer such tests or refer you to an audiologist, an ENT or another hearing health care provider. “It’s an important thing even if you don’t think you have hearing loss. You should get a baseline audiogram and then follow that as recommended by the hearing health care provider,” she says.

 

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