Most causes of hearing loss in older people can be categorized into two main groups:

• Conductive hearing loss
• Sensorineural hearing loss

Conductive hearing loss involves abnormalities of the external or middle ear, such as earwax, ear infection, a ruptured eardrum, fluid in the middle ear, or tumor. Another possibility is otosclerosis. Here abnormal bone deposits occur on the bones of the middle ear. White women aged 15-45 may have a higher risk of developing this condition. Treatment involves wearing a hearing aid or having stapes surgery.

Sensorineural hearing loss involves abnormalities of the inner ear or the nerve pathways to the brain. Hearing loss related to aging, called presbycusis, is one of the most common causes of hearing loss in the US. It is characterized by high-frequency hearing loss (trouble hearing high-pitched sounds) that develops gradually in both ears. Other causes include exposure to loud noises, drug side effects, and health conditions, like cardiovascular disease.

Treatment of sensorineural hearing loss often consists of using some sort of device (a hearing aid) to amplify sound. In certain cases, a cochlear implant may be needed to restore hearing. If a tumor is compressing the nerve and causing the hearing loss, surgical removal of the tumor can sometimes improve the hearing.

Devices to Improve Hearing

A number of medical devices and treatments are available to help improve hearing. These include:

• Hearing aids
• Assistive listening devices
• Cochlear implant

Hearing aids are small electronic devices that are worn in or behind your ear. They amplify sound as it enters your ears. There are two main types:

• Analog hearing aids are the most common and least expensive type. These aids amplify speech and background noise alike, converting them into electrical signals. Some programmable models offer settings for different listening environments.
• Digital hearing aids are more costly. These devices transform sound waves into digital signals. The computer chip is usually programmed to selectively amplify speech and suppress background noise. This type of hearing aid offers the greatest flexibility for programming and adaptability to individual needs.

Assistive listening devices consist of a variety of devices that can be used as alternatives or supplements to hearing aids. An inexpensive option is to have the speaker talk into a microphone that is hooked up to the listener’s headphones. Other devices can connect the listener directly to the sound system in a TV, radio, stereo, or public place, such as a theater or church.

Cochlear implants are reserved for people with severe hearing loss. This device is a receiver about the size of a quarter that is surgically implanted just under the skin behind one ear. The receiver sends a sound signal to the brain. The person also wears a small external microphone behind one ear and a speech processor that fits in a pocket or on a belt.

Helping Yourself to Hear Better

It is essential to tell your friends, family, and colleagues that you have difficulty hearing so they can help you. Ask them to face you when speaking. Also, ask them to use these communication tips from the National Institute of Health:

• Speak more clearly and a little louder than normal. Do not shout since it can distort your speech. Talk at a reasonable speed and do not exaggerate sounds.
• Stand in good lighting. Do not hide your mouth, eat, or chew gum.
• Use facial expressions or gestures to give useful clues.
• Reduce background noise during conversations. In public places, try to talk away from noisy areas.
• Repeat yourself if necessary, using different words or shorter sentences.
• Try to be patient. Stay positive and relaxed and ask how you can help.

Health and Safety Issues

Talk to your doctor to find out what you can do to prevent further hearing-related problems. For example, exposure to loud noise can worsen many types of hearing damage. Ask about limiting loud noise and wearing earplugs or protectors when noisy environments are unavoidable. Also inquire about safety precautions you can take in situations that involve auditory cues, such as driving or crossing streets. Getting the medical care you need can help you learn better ways to cope with your hearing loss.