Some people may not admit they are having trouble hearing. But, if ignored or untreated, these problems can get worse. Older people who can’t hear well may become depressed or withdraw from others to avoid the frustration or embarrassment of not understanding what is being said. They may become suspicious of relatives or friends who they believe "mumble" or "don't speak up” on purpose. It’s easy to mistakenly call older people confused, unresponsive, or uncooperative just because they don’t hear well.

If you have a hearing problem, you can get help. See your doctor. Special training, hearing aids, certain medicines, and surgery are some of the choices that could help people with hearing problems.

Common Signs of Hearing Problems
See your doctor if:

• words are hard to understand,
• another person’s speech sounds slurred or mumbled, especially if it gets worse when there is background noise,
• certain sounds are overly annoying or loud,
• a hissing or ringing in the background is heard,
• TV shows, concerts, or parties are less enjoyable because you can’t hear much.

Diagnosis of Hearing Problems
Hearing loss can be caused by exposure to very loud noises over a long period of time, viral or bacterial infections, heart conditions or stroke, head injuries, tumors, certain medicines, heredity, or changes in the ear that happen with aging.

If you have trouble with your hearing, see your family doctor. In some cases, the diagnosis and treatment can take place in his or her office. Or you may be referred to an otolaryngologist (oto-larin-GOL-o-jist). This doctor has special training in the ear, nose, and throat and other areas related to the head and neck. He or she will take a medical history, ask if other family members have hearing problems, do a thorough exam, and order any needed tests.

An audiologist (aw-dee-OL-o-jist) is a health professional who can identify and measure hearing loss. He or she may work with the otolaryngologist. The audiologist will use a device called an audiometer to test your ability to hear sounds at different pitches and loudness. The tests are painless. Audiologists do not prescribe drugs or perform surgery.

Types of Hearing Loss
Presbycusis (prez-bee-KU-sis) is the most common hearing problem in older people. In fact, people over age 50 are likely to lose some hearing each year. Presbycusis is an ongoing loss of hearing linked to changes in the inner ear. People with this kind of hearing loss may have a hard time hearing what others are saying or may be unable to stand loud sounds. The decline is slow. Just as hair turns gray at different rates, presbycusis develops at different rates.

Tinnitus (ti-NI-tus) is also common in older people. Tinnitus is a symptom associated with a variety of hearing diseases and disorders. People with tinnitus have a ringing, roaring, or hear other sounds inside the ears. It may be caused by ear wax, an ear infection, the use of too much aspirin or certain antibiotics, or a nerve disorder. Often, the reason for the ringing cannot be found. Tinnitus can come and go; or it can stop altogether.

Conductive hearing loss happens in some older people when the sounds that are carried from the ear drums (tympanic membrane) to the inner ear are blocked. Ear wax in the ear canal, fluid in the middle ear, abnormal bone growth, or a middle ear infection can cause this loss. Sensorineural (sen-so-ree-NU-ral) hearing loss happens when there is damage to parts of the inner ear or auditory nerve. The degree of hearing loss can vary from person to person. Sensorineural hearing loss may be caused by birth defects, head injury, tumors, illness, certain prescription drugs, poor blood circulation, high blood pressure, or stroke.

If Someone You Know Has A Hearing Problem

• Face the person and talk clearly.
• Stand where there is good lighting and low background noise.
• Speak clearly and at a reasonable speed; do not hide your mouth, eat, or chew gum.
• Use facial expressions or gestures to give useful clues.
• Reword your statement if needed.
• Be patient, stay positive and relaxed.
• Ask how you may help the listener.
• Set up meetings so that all speakers can be seen or can use a microphone.
• Include the hearing impaired person in all discussions about him or her to prevent feelings of isolation.

Tips to Recognize Hearing Loss
See your doctor if you have:

• Dfficulty hearing over the telephone;
• Trouble following a conversation when two or more people are talking at the same time;
• Others complaining that you make the TV too loud;
• To strain to understand conversations;
• Problems hearing because of background noise;
• The sense that others seem to mumble; or
• Difficulty understanding women and children talking.

If You Have Trouble Hearing

• Tell others that you have trouble hearing.
• Ask others to face you, speak more slowly and clearly, and not to shout.
• Pay attention to what is being said and to facial expressions or gestures.
• Let the person talking know if you do not understand what is being said; ask for the statement to be repeated or reworded.

Hearing Aids
If you are having trouble hearing, the doctor may suggest using a hearing aid. This is a small device that you put in your ear to make sounds louder. Before buying a hearing aid, you must get a written medical evaluation or sign a waiver saying that you do not want a medical evaluation.

There are many kinds of hearing aids. An audiologist will consider your hearing level, ability to understand speech, comfort in using the controls, and concern for how it looks. He or she will then suggest a specific design, model, and brand of hearing aid that best suits your needs.

When you buy a hearing aid, remember you are buying a product and a service. You will need fitting adjustments, directions to use the aid, and repairs during the warranty period.

Be sure to buy a hearing aid that has only the features you need. The most costly product may not be the best model for you, while the one selling for less may be just right. Be aware that the controls for many hearing aids are tiny and can be hard to adjust. This often gets easier with practice. Find a hearing aid dealer (called a dispenser) who has the patience and skill to help you during the month or so it takes to get used to the new hearing aid.

For More Information

More information about hearing loss is available from the following groups.

American Academy of Otolaryngology-Head and Neck Surgery, Inc. (AAO HNS)
One Prince Street
Alexandria, VA 22314
703-836-4444
703-519-1585 (TTY)

AAO-HNS is an organization of medical doctors who specialize in care of the ear, nose, throat, head, and neck. Contact AAO-HNS for physician referrals. Send a stamped, self addressed business envelope to receive single copies of AAO-HNS publications.

American Speech Language Hearing Association (ASHA)
10801 Rockville Pike
Dept. AP
Rockville, MD 20852
ASHA Helpline: 1-800-638-8255 (Voice/TTY)

ASHA is a nonprofit organization of professionals concerned with communication sciences and disorders. ASHA offers information about hearing aids or hearing loss and communication problems in older people. They can provide a list of certified audiologists and speech language pathologists.

American Tinnitus Association (ATA)
P.O. Box 5
Portland, OR 97207
1-800-634-8978

ATA provides information about tinnitus and makes professional referrals. ATA supports a nationwide network of self-help groups for people with tinnitus and their families. Public information includes information about prevention and treatment.

Self Help for Hard of Hearing People, Inc. (SHHH)
7910 Woodmont Avenue
Suite 1200
Bethesda, MD 20814
301-657-2248
301-657-2249 (TTY)

SHHH is an international volunteer organization composed of people who are hard of hearing, their relatives, and friends. SHHH provides self help programs and referrals to local chapters. Contact them for a list of available publications.

National Information Center on Deafness (NICD)
Gallaudet University
800 Florida Avenue, NE.
Washington, DC 20002
202-651-5051
202-651-5052 (TTY)

NICD provides fact sheets, resource listings, and reading lists on all aspects of deafness and hearing loss including educational programs, vocational training, sign language programs, legal issues, technology, and barrier free design.

National Institute on Deafness and Other Communication Disorders (NIDCD)
National Institutes of Health
31 CENTER DR MSC 2320
BETHESDA, MD 20892-2320
NIDCD Information Clearinghouse: 1-800-241-1044
1-800-241-1055 (TTY)

NIDCD conducts and supports biomedical and behavioral research and training and the dissemination of information on disorders of hearing, balance, smell, taste, voice, speech, and language. The NIDCD Clearinghouse offers information to health professionals, patients, industry representatives, and the public.

For more information about health and aging contact:

The National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)

From: National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
1994