Age-related hearing loss (Hearing Loss)

Age-Related Hearing Loss (Presbycusis) – Treatment Options

Introduction
Age-related hearing loss, also known as presbycusis, is the gradual decline in hearing ability that occurs with aging. It typically affects both ears and primarily involves difficulty hearing high-pitched sounds and understanding speech in noisy environments. The condition results from degeneration of sensory hair cells in the cochlea, loss of auditory nerve fibers, and age-related changes in the central auditory pathways. Patients often report difficulty following conversations, turning up the volume on devices, and experiencing social withdrawal. While presbycusis is irreversible, treatment focuses on improving communication and quality of life.

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1. Hearing Aids

• First-line management for most patients.

• Modern digital hearing aids can be customized to amplify specific frequencies.

• Styles include behind-the-ear (BTE), in-the-ear (ITE), in-the-canal (ITC), and completely-in-canal (CIC) devices.

• Features such as noise reduction, directional microphones, and Bluetooth connectivity enhance usability.

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2. Assistive Listening Devices (ALDs)

• Useful for specific situations where hearing aids are insufficient.

• Examples:

  • FM systems: Transmit sound directly from a microphone to the listener’s receiver.

  • Amplified telephones, TV listening devices, alerting systems (vibrating alarms, flashing doorbells).

• Helpful for patients reluctant to use or not fully benefiting from hearing aids.

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3. Cochlear Implants

• Considered for patients with severe-to-profound sensorineural hearing loss who do not benefit adequately from hearing aids.

• The implant bypasses damaged hair cells by directly stimulating the auditory nerve.

• Improves speech perception, particularly in noisy environments.

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4. Communication Strategies and Rehabilitation

• Auditory training and speech-reading (lip-reading) to improve communication.

• Environmental modifications: Reducing background noise, ensuring good lighting, and facing the speaker during conversations.

• Family education: Encouraging clear speech, slower pace, and repetition when necessary.

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5. Medical and Preventive Measures

• Regular audiologic evaluation to monitor progression and adjust treatment.

• Management of comorbidities: Hypertension, diabetes, and vascular disease may worsen presbycusis.

• Avoidance of ototoxic drugs (aminoglycosides, cisplatin, loop diuretics) when possible.

• Hearing protection in noisy environments to prevent further damage.

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6. Psychological and Social Support

• Hearing loss can lead to social isolation, depression, and cognitive decline.

• Referral to support groups, counseling, or cognitive training may help adaptation.

• Integration of hearing care with broader geriatric health management.