Sound Aging (Presbycusis): Maintaining Hearing Health to Age Gracefully

Presbycusis refers to age related hearing loss. As we age, our body begins to degenerate. This also includes the auditory structures that help us to hear. The degeneration of the auditory system may start as early as 40 years of age, depending upon a number of factors including genetics, exposure to noise over the years and susceptibility of the auditory system to damage. However, most cases with presbycusis go unnoticed at first. This is because presbycusis presents itself very gradually, and progresses slowly over the years. The incidence of individuals having presbycusis increases with age. One in three individuals above 65 years of age have age related hearing loss.

The presence of presbycusis is diagnosed by conducting a detailed hearing evaluation. It is characterized by a bilateral symmetric sloping sensorineural hearing loss. Conductive component may also be present sometimes. Poor speech identification scores, especially in presence of noise further points towards presbycusis.

Individuals who have presbycusis have difficulty hearing high pitched sounds such as cooker whistles, door bell ringing, etc., and discriminating high frequency speech sounds such as ‘s’, ‘f’ or ‘th’. This is because, the higher frequencies (>2kHz) are affected more than lower frequencies. The loss at higher frequencies is quite handicapping as it results in difficulty understanding speech in the presence of background noise. Vowels are centered around the lower frequencies and have higher energy and intensity. On the other hand, most consonants are composed largely of high frequency, and are lower in intensity. Due to the presence of high frequency hearing loss, consonants are poorly perceived in individuals with presbycusis. Speech is understood by obtaining information from consonants and vowels. The information from vowels alone does not suffice and therefore affects speech discrimination abilities. With the noise also being largely composed of low frequency signals, the perception of speech becomes poorer. As the condition progresses, the lower frequency thresholds also become poorer.

In addition to this, individuals with presbycusis have low tolerance to loud sounds than normal. So, individuals with presbycusis are often very annoyed or offended when they’re yelled at or spoken to very loudly. This is the result of recruitment, which occurs due to degeneration of the cochlear structures. Poor speech understanding and intolerance to loud sounds affects the individual’s social life. As they cannot communicate well, individuals with presbycusis are often socially withdrawn and isolated. This may also lead to depression.

Intolerance to loud sounds complicates fitting of hearing aids. The simultaneous elevation of the threshold needed to hear quiet sounds, and the reduction of tolerable loud sounds, results in a narrowing of the individual's dynamic range. Hence, careful upper output limits must be set to maintain comfort levels during hearing aid fitting.

What can you do about it?

1. Get it checked - It is very important that you get your hearing checked regularly. The American Speech-Language-Hearing Association has advised that individuals over 50 years of age should have complete audiometric testing every three years. Age related hearing loss most often goes undiagnosed because of negligence and failure to acknowledge the presence of hearing loss itself. In such cases, caretakers must carefully observe for subtle signs of hearing loss such as keeping the TV volume high, difficulty talking over the phone, difficulty understanding speech when many people are talking at once, etc.

2. Protect and preserve your hearing – Avoid exposing your ears to very loud music/noise. Use ear plugs or earmuffs in noisy environments.

3. Hearing aids – In case you have been diagnosed with hearing loss, you don’t have to worry. Hearing aids amplify the lost sound, and help you with better hearing.

4. Cochlear implants - For individuals who are so severely affected by presbycusis that conventional amplification strategies are no longer effective, cochlear implantation offers hope to restore hearing. Cochlear implantation involves the placement of an electrode array within the inner ear to bypass the damaged cochlea and stimulate the remaining cochlear neurons directly with electrical stimulation.

5. Keep communicating – Isolating yourself from the society just because you may have hearing loss could affect your cognition and neural networks. Regular and normal communication with close ones could help keep your brain and mind occupied, and also maintain a good mental and emotional health.

Early detection of hearing loss helps your audiologist plan better management. Chronic negligence towards hearing loss could affect functions of the brain. Several studies suggest that untreated hearing loss may accelerate cognitive decline, and sometimes lead to cognitive illnesses such as dementia. Untreated hearing loss can also affect the overall mental and emotional health of the individual with presbycusis, as well as those around them. Hence, hearing health is an important part of maintaining your aging body and mind.

Healthy hearing is a healthy body and healthy mind.