A Comprehensive Guide to Hearing Loss14 minute read

14 minute read


Updated for January, 2019

Hearing loss is one of the biggest public health issues facing the elderly. About 25 percent of those between 65 and 74 suffer from some form of hearing loss, according to the National Institute on the Deafness and Other Hearing Disorders. That number increases to about 50 percent for those over 75.

Hearing loss is a broad term to cover any form of disabling hearing issue that affects how well you can hear things.

Hearing loss is a broad term to cover any form of disabling hearing issue that affects how well you can hear things. This can mean that there is a structural issue within your ear that causes your hearing to be affected, or maybe there are issues deep inside your ear connected to the nerves that create these issues. Millions of people are born with hearing problems, but many more develop hearing loss as they age.

Hearing loss can occur at many levels, from very mild to severe to not being able to hear anymore, which is known as deafness. No matter the form of hearing loss you’re living with, there are some important parts of the ear you need to know. We’ll work from the outer ear inward.

These parts of the ear include:
Ear Anatomy

  • Auditory canal: Known as your ear canal, it moves sound from the outside through to your eardrum.
  • Eardrum: This vibrates when you hear sound, sending the waves to the ossicles.
  • Ossicles: These are three little bones—known informally as the hammer, the anvil, and stirrup—that transfer sound to the cochlea. They’re the smallest bones in the human body, but damaging them can cause severe hearing loss.
  • Cochlea: A fluid-filled, spiral-like membrane that transforms sound waves to signals that get passed on to the brain.
  • Vestibulocochlear nerve: The nerve that sends sound waves to the brain, it has two parts: the vestibular nerve (relates to balance and your equilibrium) and the cochlear nerve (relates to hearing).

Now that we know the parts of the ear, let’s dig into what happens when they are affected.

There are two main forms of hearing loss

Conductive hearing loss. This occurs when you have issues with the outer ear and middle ear, which include the ear canal, eardrum, and ossicles. It’s the less common form of hearing loss, and even though it can develop into a permanent issue, it is more easily treatable than the other.

Sensorineural hearing loss. This is the most common type of hearing loss. Sensorineural hearing loss means that something is wrong with the nerve-related parts of your ear, like the cochlea and vestibulocochlear nerve, which send sound waves to the brain.

Hearing loss reveals itself in many forms. In fact, they can creep up so slowly that you may not even notice you have hearing loss until it starts to take a significant toll on you.

Hearing loss reveals itself in many forms. In fact, they can creep up so slowly that you may not even notice you have hearing loss until it starts to take a significant toll on you.

Grandchild yelling into ear

Signs of Hearing Loss Include:

  • Difficulty hearing conversation, both in person and over the phone
  • Needing to turn the volume up on the television to extremely loud levels
  • Difficulty hearing softer-speaking people
  • Needing people to speak louder and slower to help you process the information
  • Trouble hearing consonants (according to the Mayo Clinic)
  • Tendency to think people are mumbling
  • Exiting conversations because it’s hard to keep up

The symptoms of hearing loss manifest themselves in more physical, potentially painful, ways. These symptoms can often coincide with illnesses like the common cold and other infections, and they include:

  • A constant ringing sound in one or both ears
  • Nausea
  • Dizziness
  • Vomiting
  • A pain in and around the ear
  • A buildup of fluid, sort of feeling like there’s water in your ear

These symptoms may point to different forms of hearing loss. For instance, leaking fluid may indicate conductive hearing loss as there could be a buildup of fluid within the canal. On the other hand, a constant pain or ringing can mean that there’s an infection deep inside the ear.

Hearing loss can begin to really affect your daily life when it develops into disabling hearing loss.

Hearing loss can begin to really affect your daily life when it develops into disabling hearing loss. This occurs in adults when they incur a loss of hearing 40 decibels (dB), a unit of sound. For instance, a normal conversation occurs at about 60 dB, according to the NIDCD. Someone with disabling hearing loss needs more than 100 dB—about the loudness of max volume on a music player—to hear a conversation without any aid.

The different levels of hearing loss are categorized as follows:

Mild Hearing Loss
Loss of 21 to 40 dBs, difficulty hearing sounds like a human breathing

Disabling Hearing Loss
Loss of 40 to 55 dBs, difficulty hearing in-person conversations

Moderately Severe Hearing Loss
Loss of 56 to 70 dBs, difficulty hearing televisions at moderate volume

Severe Hearing Loss
Loss of 71 to 90 dBs, difficulty hearing loud traffic

Profound Hearing Loss
Loss of more the 90 dBs, it’s difficult to hear loud engines and orchestras (in a pit) at this point

Not being able to hear or having difficulty hearing normal sounds like the door opening, a simple conversation, or the television on a normal volume can really start to affect how elderly people experience their daily lives.

Not being able to hear or having difficulty hearing normal sounds like the door opening, a simple conversation, or the television on a normal volume can really start to affect how elderly people experience their daily lives.

Social Aspects

Having difficulty hearing can cause issues in your social life. To put it simply, it’s hard to interact with people on a fluid basis when you can’t understand what they’re saying. This can force seniors into reducing how much they interact with their friends and family.

Isolation can cause a slew of health issues for elderly people, including an increased rate or mortality, the advancement of cognitive diseases like Alzheimer’s, and depression, which has its own list of health problems, too. Once they’re isolated inside, it becomes difficult to hear a lot of practical goings-on in your living space, too.

Old Men Talking

Practical Aspects

Hearing loss can make it difficult to hear simple, practical things like someone knocking on the door, the door opening, the phone ringing, the television at a moderate volume, and a busy street. Most importantly, hearing loss can prevent you from hearing other people.

In all of these instances, someone’s life can be put in danger. Let’s say there’s an intruder that enters your home, and you need to notify authorities. Hearing loss could make it difficult for you to know that they’re even there until you see them.

Also, when you’re out and about on the town, hearing loss could put you in danger when you’re crossing the street, as you may not know a car is coming around the corner until the driver blares the horn. It may also increase the rate at which you fall because you’re not quite as aware of the sonics of your surroundings.

Economic Aspects

Hearing loss can make working incredibly difficult. Let’s say you have a job as a receptionist or telemarketer in your older years as a way to keep a steady income. Not being able to hear and understand the conversations you have on the phone can put you out of work. The World Health Organization predicts that hearing loss’s economic impact is higher than $750 billion, between the amount of money that gets poured into treating it and the money lost by people with hearing loss not being able to work to their full potential.

Testing for hearing loss is done in a series of ways.

The first part of the hearing loss treatment process is getting diagnosed with the right form of hearing loss. The earlier you’re able to detect you’re suffering from hearing loss, the better. Unfortunately, many elderly people will wait an average of seven years between the time they first realize their hearing might be impaired and the time they get treatment. The moment you realize it’s more difficult to hear than it has been, you should be looking into doctors or audiologists for help.

Testing for hearing loss are done in a series of ways, including:

Some doctors will ask you a routine series of questions like “do you struggle to hear the television at its normal volume?” or “do you ask people to speak up or repeat themselves in normal conversation?” Answering yes to questions like this helps doctors understand what they’re dealing with. Physical test: Doctors will primarily inspect your ear to see if there’s anything they can see from the outside that’s causing hearing loss, like a buildup of fluid. Tuning fork tests: Doctors will hold pronged forks near your ear and strike them, causing them to make sound at varying frequencies. Depending which ones you can hear or not can let them know how well you can hear. According to the Mayo Clinic, these tests can also reveal what part of the ear you may be having issues with due to the vibrations given off by the tuning forks.

Audiometry Tests
Audiologists may conduct a thorough test called a “pure-tone audiometry”with an audiometer, which helps specifically detect how hard of hearing you may be. The test is conducted with headphones, and doctors control what type of sounds are played at what frequencies. These tests are more than 90 percent accurate and help pinpoint exactly what may be wrong.

Once these tests are conducted, doctors will develop a treatment plan for your hearing loss. As we mentioned before, the conductive hearing loss issues (fluid buildup, other outer and middle ear issues) will be dealt with first in order make the sensorineural issues a bit easier to handle. In any case, all of these treatments are done to help elderly people live independently longer while not suffering the dangerous side effects of hearing loss like isolation and decreased awareness of your surroundings.

Because it typically gets treated first, let’s discuss treatments for conductive hearing loss:

Remove the Fluid
Whatever is blocking your ear—wax, blood, or some other leaking fluid—doctors will try and clear the inner canal to help sound travel to the back of the ear better.

Various prescriptions and ear flushes can help clear out the outer parts of the ear, largely focusing on thinning out whatever is blocking the sound and draining it out. Surgery: If simpler procedures and medication don’t work in cleaning up your inner ear, surgery may be required. This is especially true if you have a tumor that’s causing the issue.

Once those issues are dealt with, treatments for sensorineural issues include (this is where the in-depth technology and treatment come in):

Hearing Aids

This is one of the most popular, effective, and useful treatments for issues deep inside the ear. Sometimes, these are recommended for people with conductive hearing loss, too. Aids don’t eventually “fix” whatever is wrong with your ear; they simply bring the sound from the outside to the inner parts of your ear that are still working and can send these signals to the brain. Hearing aids come in many different shapes and styles depending on how hard of hearing you are. Some rest behind your ear to capture sound, some rest deep in your ear, and others receive the sound within the ear canal. There are even apps on your phone that allow you to control the sounds and volume associated with hearing aids. Talk to an audiologist to see which fit may be best for your situation.

Hearing Aid Fitting

Cochlear Implants

Cochlear implants don’t quite work how hearing aids do. They’re a bit more of an intricate process, so they’re typically reserved for patients who have severe hearing loss in one or both ears. Whereas hearing aids amplify sound, cochlear implants aims straight for the vestibulocochlear nerve for stimulation with the goal of bypassing everything else that’s wrong with the ear. The implants are more like prosthetics that help the ear work how they should again.


Personal sound amplification products (or PSAPs) are similar to hearing aids, but are around 50 to 75 percent less expensive. That being said, they don’t work as well or address all the problems of hearing loss, but they’re still certainly helpful. They have hit a snag with the Food and Drug Administration, where they can’t be advertised as products that improve hearing—because they don’t. They amplify sound while not canceling out a lot of distortion and other noise hearing aids do. But there are groups lobbying the FDA to allow these products to be advertised as such.

Amplification Systems/Speakers/Headphones

No, we’re not talking about something associated with a live concert. However, an elderly person who is hard of hearing can be helped by a system with a speaker or amplifier on it that helps bring out dialogue without completely distorting everything else coming out of the television. Wireless headphones and headsets can work with this, too. They make it so that a fuller sound enters your ears rather than something that is uncomfortably loud for everyone. These systems don’t always help every part of life that’s affected by hearing loss, but they’re certainly helpful in social settings within the home.

Hearing loss, in most cases, is a condition that develops over a lifetime, which means prevention lasts a lifetime. However, if you’ve begun to feel the effects of hearing loss in an older age, that doesn’t mean there aren’t steps you can take to give your ears the best conditions possible.

Let’s take a look at some of the preventative lifestyle choices:

1. Wear protection

This is the most obvious preventative step that doesn’t always get taken seriously. Prolonged exposure to sound over 85 dBs, such as loud stereos, concert halls, and loud traffic, is not healthy for your ears. This doesn’t mean you need to walk around the city all day every day with ear plugs, but this is especially important for people who work around loud noises and places like airports, sports venues, gun ranges, and concert venues. Popular ear protection includes ear plugs, larger headphones, and noise-cancelling headphones, which help give your ears a much-needed break.

2. Turn down the volume

Turn Down the Volume

You don’t need to be listening to music and the television at its loudest volume all of the time. Sure, there’s a time and place to turn the knob up, especially when a lot of people are in the room with chatter ablaze, but loud televisions and stereos can damage your ears. Try and keep the volume around half its highest point unless it’s really needed. This is especially true for when you’re wearing headphones.

3. Buy products that aren’t as loud

Simply put, purchase products that don’t aim to blow the speakers out when you turn it up a little. Various products have maximum decibel volumes, and all it takes is a little research to find out which products have manageable and healthier volumes.

If you have any questions regarding hearing loss, such as the different forms and the treatment process, contact an audiologist or your primary care physician.