Every single reader either has a family member with PRESBYCUSIS or themself is socially limited by this malady. From the Greek presby meaning old and akustis referencing hearing, in all likelihood it is the commonest of all non-lethal senior afflictions currently affecting nearly half the population beyond the age of 70. We all recognize the stereotypical voice an octave too high in close proximity conversation or the television boom boxing at intolerable level, the viewer oblivious to the cacaphony around them. There was a time when heavy industry shouldered much of the blame for hearing impairment but protective equipment has resolved much of this issue. Today, the primary culprit is longevity with greater numbers of seniors surviving to mid eighties. Tomorrow will likely see a reversal in the age demographic as more youth insist on attaching themselves to increasingly harmful levels of noise from hand held devices but that is a separate issue for another day.
It’s a subtle painless process usually beginning after age 40 and since we rarely pay significant attention to our hearing as opposed to even minor sight changes, the probability is the process is initially ignored; however, unmonitored in its early phase, the likelihood is the changes will become permanent. The commonest presentation I observed clinically was the patient complaint they experienced difficulty with conversation one on one speech where there was interfering background noise such as in open offices for party events. I hasten to add, this is not a component of the spousal “tune out” commonly observed after decades of communal living. The diagnosis is made by means of an audiogram with regular reassessment to measure deterioration. Before this test, it is prudent to rule out other causes for hearing loss via an ENT consult. It’s important to differentiate from early Meniere syndrome where the vertigo component may be transient. Equally important to rule out prior protracted noise exposure or the prescribing of any number of medications known to generate ototoxicity.
Early in the process, treatment may involve common sense practices such as reduction in ambient sound. Long term tobacco use is a major issue. Hearing initiated with captured sound transmitted in through the outer ear resulting in vibration of the otic membrane, the ear drum. Smoking damages the Eustachian tubes by which air pressure equilibrates on the inner and outer surfaces of this apparatus. Once the reluctant patient has been persuaded to overcome the labeling as hearing impaired, many options for treatment of more advanced states are available not necessarily beginning with an actual hearing aid. Most telephone, internet equipment, televisions and other communication systems supply augmentation for the hearing challenged but this is a progressive disorder and eventually a worn device on the outer ear will be suggested. Significant advances in size and sophistication and even the cosmetics of application have occurred but still the intransigence of many seniors results in the device spending more time in the drawer than actual wear. For frustrated family members unable to address this issue, I recommend buying yourself an inexpensive stethoscope. The ear pieces are placed in the ears of your family member and you speak in a normal voice directly in to the membrane in your hand. It’s a bit of a role reversal but sometimes introducing a little levity generates increased rapport as well as reducing the decibel level while enhancing the level of communication.