Hearing

Hearing loss is common among older adults, and some de­gree of impairment is almost inevitable with advancing age. It has been reported that 30% of independent indi­viduals older than 65 years and about half of those older than 85 years have a hearing impairment.^27–29

Presbycusis, or the hearing loss of old age, is charac­terized by a gradual, progressive onset of bilateral and sym­metric sensorineural hearing loss of high-frequency tones (see Chapter 55). The hearing deficit often has both a peri­pheral and a central component. Speech discrimination, or the ability to distinguish among words that are near-homonyms or distinguish words spoken by several differ­ent speakers, often is impaired.²⁷ Accelerated speech and shouting can increase distortion and further compound the problem. When speaking to hearing-impaired older adults, it is helpful to face them directly so that they can observe lip movements and facial expressions. Speech should be slow and direct. Loudness can be irritating. Rephrasing misunderstood messages also can improve un­derstanding of the spoken word. Hearing aids can be ef­fective for various levels of hearing loss and may greatly improve the ability to hear and communicate. However, the usefulness of a hearing aid may be limited if the hear­ing deficit is multifactorial, with both a central and a peri­pheral component. In one study of hearing in the elderly, it was suggested that speech audiometry is a good indica­tor of real hearing difficulties faced by older adults and may be more valuable than pure-tone audiometry. Hear­ing deficits with age are not always limited to an increased detection threshold; both include other aspects of hearing, such as sound, comprehension of speech, and noise dis­crimination, as noted earlier.²⁸

Cerumen (i.e., ear wax) impaction in the external auditory canal also is commonly seen in older adults and can impair hearing. The cerumen glands, which are modi­fied apocrine sweat glands, atrophy and produce drier cerumen. This may be partially responsible for more fre­quent cerumen impactions in the older adult population