For many Long Islanders, hearing loss is an inevitable part of the aging process.
Older adults often struggle to hear and participate in conversations with their loved ones, leading to feelings of isolation and depression. Interventions such as hearing aids and cochlear implants can significantly improve many seniors’ quality of life. But unfortunately, many seniors suffer in silence.
“For a variety of reasons, only about 30% of the people who could benefit from hearing aids are wearing them,” says Mary Bradley, AuD, director of speech and hearing at Stony Brook Medicine.
AGE-RELATED HEARING LOSS
Also called presbycusis, age-related hearing loss develops gradually as a person ages.
“For people in their 30s, there’s a 1% chance of hearing loss, which increases to 3% in the 40s, 11% in the 50s and 25% in the 60s,” says Andrea Vambutas, MD, chair of the Department of Otolaryngology at Long Island Jewish Medical Center, North Shore University Hospital and the Zucker School of Medicine at Hofstra/Northwell.
“Everyone is different,” Bradley says. “Age-related hearing loss has a genetic component; some people will develop hearing issues younger, while others can be in their 80s and hear fine. But 55% of people age 75 and older have a disabling hearing loss that requires intervention.”
Age-related hearing loss is a form of sensorineural hearing loss, which generally stems from damage to the inner ear. It cannot be prevented or cured, but it can be rehabilitated with devices such as hearing aids and cochlear implants. Hearing loss can also result from other causes, including exposure to loud noises, ear infections, fluid buildup in the ears from colds or allergies, earwax buildup, trauma, certain medications or abnormal bone growth. As Bradley notes, some people with age-related hearing loss may have another condition on top of it that is compounding their issue, but that could be treated medically or surgically to improve their hearing to a degree.
“Age-related hearing generally affects both ears equally,” Vambutas adds. “If there is asymmetry — if one ear is much worse than the other — it requires a medical workup. The hearing loss might not be related to the aging process.”
When adults have age-related hearing loss, they typically perform worse on the high-frequency portion of the hearing test, Vambutas says. In conversations, high-frequency hearing loss impacts the ability to hear certain consonant sounds, like “s,” “h” and “f.” “If you go to a loud restaurant with Grandma, and you’re talking about a cat, she may think you’re talking about a hat,” Vambutas says. “People with hearing loss often try to substitute in the information that they are missing.”
COMPLICATIONS OF HEARING LOSS
Hearing loss can lead to feelings of isolation, loneliness and loss of self-esteem.
“There are higher rates of depression in people with hearing loss,” Vambutas says. “Most significantly, hearing loss increases risk of dementia. The increased risk is directly correlated to the degree of hearing loss.”
On a positive note, “studies have shown that when people get rehabilitation with hearing aids or cochlear implants, they’re reducing their risk of dementia,” she adds.
Hearing loss can also threaten the ability of seniors to safely drive or remain in their homes, since it’s harder to hear warning sounds such as horns or smoke alarms.
HEARING AIDS AND COCHLEAR IMPLANTS
The first-line treatment for age-related hearing loss is hearing aids, which are small electronic devices that amplify sound and can be programmed based on your individual hearing loss. There is a wide range of hearing aids on the market, at varying prices and levels of quality.
“People with greater degrees of hearing loss generally need a better-quality hearing aid,” Vambutas says. “Over-the-counter hearing aids have been approved for mild to moderate hearing loss; this improves access, since people can purchase them without seeing a doctor. A lot of companies have gotten into the space; for instance, the AirPods Pro2 features a hearing aid function. There are also hearing screenings that you can do on your phone, such as the Mimi Hearing Test, which is available in the app store, or the AirPods Pro hearing test.”
However, an ear, nose and throat doctor (ENT) or an audiologist can provide a more advanced hearing test and recommend a hearing aid that is appropriate for the type and severity of your hearing loss.
Unlike glasses, which can restore 20/20 vision, hearing aids do not restore perfect hearing, and they typically require an adjustment period.
“If people are counseled properly about what to expect, they generally have success with hearing aids,” Bradley says.
A person’s score on the speech discrimination portion of the hearing test can be a good predictor of how they will fare with a hearing aid.
“In this part of the test, you’re given a set of words and asked to give them back,” Valmutas says. A good score on this part of the test portends a more positive hearing aid experience, she says.
But many people who could benefit from hearing aids are not availing themselves of them.
“They’re very costly. Some can cost upwards of about $6,000 for one hearing aid,” Bradley says. Medicare does not cover hearing aids, and only some private insurers provide coverage.
“A lot of seniors are on a fixed budget, and a hearing aid is a large financial outlay for someone who is struggling to make rent and buy food,” Valmutas says. “This is compounded by the fact that some seniors speak poorly of hearing aids. Some patients will say, ‘My friend says they’re terrible.’”
Some older adults may avoid wearing hearing aids because they find change to be difficult, Bradley says.
Patients who do not benefit adequately from hearing aids may be a candidate for cochlear implants, which are small, complex electronic devices that include an external portion that sits behind the ear and a second portion that is surgically placed under the skin. Unlike hearing aids, which amplify sound to help you hear, cochlear implants bypass the damaged portions of the ear and directly stimulate the auditory nerve.
“Cochlear implants can be life-changing for the right candidate,” Bradley says. Unlike hearing aids, Medicare covers them for patients who meet certain criteria.
