Ageing and Hearing

A common complaint of older adults is difficulty hearing and understanding speech, which can result in problems following conversations, using the telephone, and detecting and locating alerting sounds. Approximately one third of adults ages 65 to 74 and nearly one half of adults 75 and older have impaired hearing. When loss of hearing for higher frequency sounds is included, nearly all individuals older than 80 have significant hearing loss. Indeed, hearing loss is among the most common chronic conditions of ageing, ranking first among men and fourth among women, after arthritis, cardiovascular disease, and cataracts. In the next few decades, the number of individuals with hearing loss will substantially increase as the population ages, as this entry describes.

Hearing loss in older adults is known as presbyacusis and results from genetic influences and the combined effects of ageing, long-term exposure to noise, ototoxic drugs, diet, trauma, and otologic and neurologic diseases. Additional risk factors may include smoking, cardiovascular disease, high blood pressure (hypertension), diabetes, and hyperlipi-demia (high cholesterol). Presbyacusis can be narrowly defined as hearing loss that increases with age and is caused by the ageing process, which likely has a genetic basis. Because environmental and disease effects on hearing accumulate over a lifetime, hearing loss caused specifically by ageing is difficult to isolate in older humans. Older animals raised [Page 20]without exposure to noise or drugs nevertheless show unique age-related anatomic and physiologic changes in their auditory peripheral and central nervous systems (CNS). These include deterioration of tissues and blood supply in the cochlear lateral wall (inner ear), some degeneration of auditory neurons, and reductions in the resting potential that supplies power to the sensory (hair) cells.

Figure 1 Thresholds for Pure Tones for Women and Men of Various Age Groups

Source: Medical University of South Carolina, Longitudinal Study of Age-Related Hearing Loss.

Age-related hearing loss in the United States has been described by several community-based epidemiological and clinical studies. Figure 1 shows the systematic increase in hearing thresholds with increasing age in women and men, beginning with reduced ability to hear high-frequency and then mid-frequency sounds, which are important for understanding speech. Thresholds for women show the progression of a generally constant hearing loss at lower frequencies to a gradually sloping loss at higher frequencies; thresholds increase steadily with age more in higher than lower frequencies. Thresholds for men show similar patterns, but with more high-frequency hearing loss, which may relate to increased noise exposure.

Epidemiological surveys also suggest a strong genetic component in age-related hearing loss, which has been confirmed by results of twin studies and data from various strains of mice. Heritability coefficients indicate that as much as 55% of the variance in hearing thresholds of older persons is genetically determined, which is similar to heritability reported for hypertension and hyper-lipidemia. The genetic component is reported to be stronger in women than men, which may be caused by a larger environmental component in men related to noise exposure. These results, along with studies of hearing in nonindustrialized societies, are consistent with the view that hearing loss in older adults results from environmental and disease factors superimposed on a genetically determined ageing process.

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