Hearing Loss in Older Adults

Aka: Hearing Loss in Older Adults

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II. Epidemiology

  1. Hearing declines by 1 dB per year after age 60
  2. Incidence Hearing Loss of 25 dB or more
    1. Age 60 to 70 years: 37%
    2. Age 71 to 80 years: 60%
    3. Age over 85 years: 80%
  3. References
    1. Gates (1990) Ear Hear 11(4):247-56

III. Causes: Hearing Loss in Older Adults

  1. Conductive Hearing Loss
    1. External auditory canal obstruction
      1. Cerumen Impaction
      2. Large exostoses
      3. Osteomas
    2. Tympanic Membrane disorder
      1. Tympanosclerosis
      2. Tympanic Membrane Perforation
    3. Middle ear disorder
      1. Otitis Media with Effusion
      2. Otosclerosis
      3. Cholesteatoma
      4. Ossicle Chain Disruption
      5. Glomus tumors
  2. Sensorineural Hearing Loss
    1. Sudden Sensorineural Hearing Loss
    2. Age-Related Hearing Loss
    3. Noise-Induced Hearing Loss
    4. Ototoxic Medications
    5. Temporal Bone Fracture
    6. Meniere's Disease
    7. Acoustic Neuroma

IV. Risk Factors: Age-Related Hearing Loss

  1. Alcohol Abuse
  2. Family History of early Hearing Loss
  3. Progestin use
  4. Ototoxic Medications
  5. Male gender
  6. Loud noise exposure
  7. Medical conditions
    1. Diabetes Mellitus
    2. Renal Failure
    3. Atherosclerosis
    4. Head Injury
    5. Immunosuppression

V. Screening

  1. Screening Tools
    1. Hearing Handicap Inventory for the Elderly
    2. Audiogram
    3. Whispered Voice Testing
    4. Hearing Impairment Severity Scale
  2. USPTF Recommendations
    1. http://www.uspreventiveservicestaskforce.org/uspstf/uspshear.htm

VI. History

  1. See Hearing Loss
  2. Unilateral, sudden onset Hearing Loss
    1. Conductive Hearing Loss due to localized cause (see above)
    2. Idiopathic Sudden Sensorineural Hearing Loss
  3. Grandual onset
    1. Age-Related Hearing Loss
    2. Otosclerosis
    3. Acoustic Neuroma
  4. Exposures
    1. Ototoxic Medications
    2. Infections (e.g. Otitis Media, Otitis Externa, Meningitis)
    3. Closed Head Injury
    4. Tympanic Membrane Perforation
    5. Loud noise exposure (noice induced Hearing Loss)
  5. Associated symptoms
    1. Focal neurologic deficit
      1. Cerebrovascular Accident
      2. Closed Head Injury
    2. Meniere's Disease
      1. Tinnitus
      2. Vertigo
      3. Nausea

VII. Exam

  1. See Hearing Loss
  2. See Otoscopy
  3. See Tuning Fork Tests (Weber Test, Rinne Test)

VIII. Management

  1. See Home Modifications for Hearing Impaired Patients
  2. See Communication with Hearing Impaired Patients
  3. Sensorineural Hearing Loss
    1. Immediately evaluate Sudden Hearing Loss
      1. See Idiopathic Sudden Sensorineural Hearing Loss
    2. Audiology evaluation for Assistive Devices
      1. Hearing Aid
      2. Cochlear Implants
  4. Conductive Hearing Loss
    1. Cerumen Impaction is most common (30% of cases)
    2. Chronic Serous Otitis Media
      1. Consider nasopharyngeal mass obstructing eustachian tube

IX. References

  1. Walling (2012) Am Fam Physician 85(12): 1150-6 [PubMed]
  2. Yueh (2003) JAMA 289(15):1976-85 [PubMed]

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