Managing Age-Related Hearing Loss

Age related hearing loss can often go undiagnosed in senior citizens, leading to adverse mental and physical effects. Dr. Sanjay Subbaiah of MS ENT Centre, Bangalore, tells us how to manage it.

Age related hearing loss among elderly is a common issue and what is more common is the hearing impairment remaining under diagnosed and untreated, leading to many adverse mental and physical effects on the person concerned.

Statistics say about 64 per thousand elderly persons in rural areas and 55 per thousand elderly persons in urban areas suffer from one or more disabilities. Most common disability among the aged persons was loco motor disability (3%), next only to hearing disability (1.5%) and blindness (1.7% in rural areas, and 1% in urban areas)1.

There are ways of managing the condition and help is available in form of hearing aids that can make lives of seniors easier. 

Image courtesy: The author

Ear is the organ for Hearing and balance. The ear is divided into, outer ear, middle ear and inner ear. The middle part consists of various muscles, bones and the ear drum. The inner ear is mainly neural. The general rule is that outer and middle ear problems are treated by medicines or surgery, whereas inner ear problems cannot be cured and damages are usually permanent. Age related changes in the ear are mainly in the inner ear causing weakness of the nerves leading to Deafness. People with certain diseases like Diabetes, Hypertension or IHD [Ischemic heart disease] are more prone for hearing loss. Since the damage is neural and permanent treatment is only rehabilitation by Hearing Aids.

Age related deafness [AD] is gradually progressive and damage is not uniform to all frequencies. This means many people will not be aware that they have AD, they will miss one or two words in a sentence, unable to understand soft speech and group discussions are confusing. Age related deafness can lead to loss of confidence, fear of meeting new people, becoming more introvert and misunderstandings. All of this can have a tremendous impact on a senior citizen leading them into depression and diminished cognitive abilities. AD can be managed by wearing suitable Hearing Aids.

Once one has decided to wear Hearing Aids [HA] , it can be confusing to select a suitable one. Start by consulting an ENT, who will make a diagnosis of AD and refer you to a competent hearing aids dispenser.

Hearing Aids (HA) are broadly divided into analogue and digital. Analogue aids are cheaper have a lot of background noise and not very popular with patients. Digital programmable hearing aids are more widely used now. These aids come with various processors and channels, simple to faster and advanced ? in short more advanced the aid, more capacity of the aid to reduce unwanted noise, which leads to better speech understanding. Obviously more advanced the aid more expensive it is. The cost of the digital HA ranges from Rs.15000/- to Rs.2,50,000/- The HA also come in various shapes:

Type of Hearing aidFeatureBTEbehind the earITEin the earCICcompletely in the canalIICinvisible in the canalRICreceiver in the canal

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Always choose the best HA for your loss, not the smallest one, because certain types of AD are best treated with RIC?s rather than CIC or IIC. In short, smaller HA are not always the best, and cost of the HA depends on the processor inside rather than the shape of the HA. People with active lifestyles involving lot of group discussions would require at least some amount of sophistication in the HA. Just remember more advanced the HA the better its capacity to reduce unwanted noise, hence it is more suitable. My advice, try to get a better HA rather than a smaller HA. All HA are tailor made to the individual, they need to take an impression of the ear canal. That means each HA is customized to the individual and the ear. Most will be ready in a couple of days.

Buying the right HA is one part, programming the HA is equally important. A good HA can be a disaster with a bad programming, hence always choose your dispenser wisely. It is not uncommon for a person to need 2 or 3 sittings of reprogramming. It might take a couple of weeks before a person gets used to the HA. Generally the costs of programming and reprogramming are included in the HA costs. That is why it is not wise to buy HA online. Most of the HA come with a 2 year warranty and generally the life of a HA is 5 to 7 years. Some well-maintained ones can last for 7 years and beyond. Some of the popular brands of HA include Phonak, Widex, Sivantos [Siemens], Unitron, Alps, GnResound, Bernafon, Starkey, Oticon and Hansiton.

All HA run on batteries which need to be replaced once in 5 days [CIC] to 21 days [BTE] i.e. smaller the HA its battery requirement is more. The cost of a strip of batteries [6 nos.] is about Rs 200. There are some companies which have an option of rechargeable batteries but they are exceptionally expensive [not advisable]. If an individual is having hearing loss in both the ears it is much better to use HA in both the ears. Adaptation and sound clarity is always better with 2 HA. Most dispensers give some discounts if you buy 2 HA. The smaller HA like IIC, CIC, ITC and RIC may get blocked with wax and need frequent changing of the wax guard. This can be learnt by the user.

It must be understood that these devices, aid in the hearing and they are not hearing replacements. Realistic expectations and a positive attitude are important for a satisfied patient.

(1 Situation Analysis Of The Elderly in India, Central Statistics Office Ministry of Statistics & Programme Implementation Government of India, June 2011)