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General Principles in Older Adults

Hearing loss is highly prevalent in older individuals and is often overlooked as a potential contributor to morbidity in this population. In the United States, an estimated 26.7 million adults 50 years of age or older suffer from bilateral hearing loss of 25 dB (decibels) or greater, and up to 79% of adults age 80 years and older may suffer from hearing loss. It is likely that many of these individuals could be adequately treated with current technology; however, evidence suggests that this population is vastly undertreated. For example, in the United States, only 14.2% of adults 50 years of age or older with hearing loss use hearing aids. The rate is similar in England and Wales (17.3%) despite having a health care system that covers the cost of hearing aids.

Hearing loss affects an individual’s ability to communicate effectively, but it is often perceived as a normal part of aging, both by patients and health care providers. However, current evidence supports the contrary. Recent studies show that hearing loss is independently associated with incident dementia, accelerated cognitive decline, poorer neurocognitive functioning, and increased falls and gait disturbances. Such significant negative outcomes warrant heightened vigilance by providers in addressing and treating hearing loss in their patients.


Age-related hearing loss in older adults represents the sequelae of multiple insults that can progressively damage the cochlea over time. Although many of these factors cannot be modified (eg, intrinsic aging of the cochlea, sex, genetic predisposition), several factors (eg, noise exposure, ototoxic medication use) can be controlled and are discussed below.

Clinical Findings

Signs & Symptoms

Patient interview—

Patients are often unaware of their hearing impairment, especially when it progresses gradually over many years. It is useful to ask a patient if they have difficulty hearing in large groups or in loud, crowded venues, or if they often ask people to repeat what they have said. The interviewee may note that she can hear people but that other people mumble too much or are just speaking too softly. Answers to these questions can provide clues to the provider about the presence of hearing loss. If the patient is aware of the hearing loss, the time course and nature of the progression can give vital information about the etiology. It is important to ask about tinnitus (ringing), ear pain (otalgia), ear drainage (otorrhea), dizziness (vertigo, disequilibrium), other neurologic deficits, and cranial neuropathies. A history of intense and/or prolonged noise exposure, ear trauma, head trauma, ear surgery, or ear infections (even remotely as a child or young adult) are necessary components of any interview.

Family member/friend interview—

Often, the insightful person or the impetus for the hearing loss-related office visit is a family member ...

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