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Presbycusis

DEFINITION

Presbyscusis is the technical name for the common type of hearing loss that comes with age. Hearing lss is very common as we get older, with half of people over the age of 75 having some degree of hearing loss. Many factors contribute to age-related hearing loss especially heredity (inherited diseases from the family) and being exposed to loud noises over time. Sometimes something as simple as a foreign object or earwax building up in the ear canal can lead to loss of hearing. Hearing is much more complex than it seems. Sound waves make their way from the environment to the ear where those waves are translated into a nerve signal that is sent to the brain and interpreted as a sound. The ear is made up of three different areas called the outer ear, the middle ear and the inner ear. The outside of the ear which is visible on the head is called the pinna and is the beginning of the outer ear. The pinna is designed to help funnel sound into the ear and make its way down to the eardrum (tympanic membrane). At the eardrum, the middle ear begins. The middle ear is where the three smallest bones in the body (the hammer, anvil and stirrup) are located. The sound waves passing through the eardrum cause these tiny bones to vibrate and amplify the sound which is passed to a structure called the cochlea in the inner ear. The cochlea is snail-shaped and filled with fluid and thousands of tiny hairs. As the vibrations in the middle ear bones move to the fluid in the cochlea, those tiny hairs in move back and forth. The hairs are attached to nerves which create an electric signal based on the movement of the hairs and pass the sound to the brain. Hearing loss can occur at any place in the three areas of the ear. At the outer ear, earwax can build up and cause a blockage or a foreign object can get stuck. Hearing loss due to obstruction of the outer ear is good because it can usually be reversed by removing the obstruction. Sometimes, hearing loss comes from the middle ear due to damage to the tympanic membrane (eardrum), hardening of the middle ear bones so they cannot move (otosclerosis), or a even something like a tumor. Most often, hearing loss comes from the inner ear. Listening to loud noises can cause the little hairs as well as the nerves in the inner ear to become damaged. Ageing and heredity also contribute to these hairs and nerves becoming less mobile and less functional. Higher pitched noises usually become difficult to hear first. Also, picking out sounds like conversation from background noise may be more challengine. Risk factors for presbycusis include older age, genetics (or heredity), loud noises from jobs (like construction or working with other loud machinery), recreational noises (like loud music or explosions), certain medications (like gentamicin or chemotherapy), or even some diseases (like meningitis). Unfortunately, this type of hearing loss cannot be reversed. However, learning to live in a way that enhances the hearing you have left and thinking about assistive devices can both be helpful. Hearing loss can have a serious impact on quality of life. People with hearing loss are more likely to have depression and anxiety. Most people do not seek help until they have had hearing loss for quite some time, often withdrawing from friends and family or other social outlets. However, people who seek help for their hearing loss generally report an improved sense of well-being, better outlook on life, as well as closer relationships and higher self-confidence.

SYMPTOMS
Difficulty hearing conversations, muffled sounds, difficulty hearing over background noise, asking others to repeat what they have said, increasing the volume on the television or radio, avoiding social situations

DIAGNOSIS
Diagnosis of presbycusis or hearing loss begins with a careful history and physical exam by your doctor. Your doctor will look in your ears in order to make sure you don’t have anything blocking the ear canal and that the eardrum (tympanic membrane) does not have a hole or an infection. Your doctor will also do a basic test of your hearing in each ear including using a tuning fork which produces a sound when hit. Your doctor will test your hearing with the tuning fork both next to each ear and by touching the metal tuning fork to your head to see how all areas of your ear are working. The next step in hearing is to go to audiology to have your hearing tested. For audiology, a headset is placed on the ears through which a range of tones are presented to each ear. You will raise your arm each time you hear a noise. Through the test some of the noises will be quiet and difficult to hear, even in those with perfect hearing. This testing can help determine your specific hearing deficits.

TREATMENT
Getting treatment for loss of hearing can be very important for personal well-being. The type of treatment you get depends on the severity of the hearing deficit. If earwax is present, your doctor will soften it with oil then remove it with a small scooping device. Some non-invasive recommendations for improving hearing include positioning yourself in a place nearest to the sound, choosing locations for meetings with reduced background noise, decreasing background noise yourself by turning off the tv or radio, and asking others to speak loudly and clearly. If needed, an audiologist can help fit you with a hearing aid that is right for you. Larger hearing devices are available at electronics stores or even advertised on television which fit over the ear. Some hearing devices are very small and almost invisible but, naturally, are more expensive. For those with very severe hearing loss, sometimes a cochlear implant is possible. The cochlear implant replaces parts of the inner ear which are not working and is placed. A specialized physician called an otolaryngologist or ENT (ear nose and throat) doctor does these types of surgery. Even if you already have some degree of hearing loss, working to preserve what you have left will help your hearing in the future. Always protect your ears around loud noises, including at work. You can also protect your ears from loud noises by avoiding recreational activities with a lot of noise like hunting or listening to loud music.

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