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Care of the Aging Patient: From Evidence to Action |

Hearing Deficits in the Older Patient “I Didn't Notice Anything”

James T. Pacala, MD, MS; Bevan Yueh, MD, MPH
JAMA. 2012;307(11):1185-1194. doi:10.1001/jama.2012.305.
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Hearing loss is common in older adults. Patients, clinicians, and health care staff often do not recognize hearing loss, particularly in its early stages, and it is undertreated. Age-related hearing loss or presbycusis, the most common type of hearing loss in older adults, is a multifactorial sensorineural loss that frequently includes a component of impaired speech discrimination. Simple office-based screening and evaluation procedures can identify potential hearing disorders, which should prompt audiologic referral to confirm the diagnosis with audiometric testing. The mainstay of treatment is amplification. For many older adults, accepting the need for amplification, selecting and purchasing a hearing aid, and getting accustomed to its use is a daunting and often frustrating process. There are numerous barriers to hearing aid use, the most common of which is dissatisfaction with its performance across a range of sonic environments. Newer digital hearing aids have many features that improve performance, making them potentially more acceptable to users, but they are expensive and are not covered by Medicare. Hearing aids have been demonstrated to improve hearing function and hearing-related quality of life (QOL), but evidence is less robust for improving overall QOL. Depending upon the etiology of the hearing loss, other medical and surgical procedures, including cochlear implantation, may benefit older adults. Older adults with multiple morbidities and who are frail pose specific challenges for the management of hearing loss. These patients may require integration of hearing assessment and treatment as part of functional assessment in an interdisciplinary, team-based approach to care.

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Figure 1. Audiogram of Patient With Age-Related Hearing Loss
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Mrs N's audiogram shows the typical downward sloping pattern, reflecting hearing loss at progressively higher sound frequencies seen in age-related hearing loss. Bone conduction coordinates, which would also be shown in a routine audiogram, are omitted for clarity; in age-related hearing loss, the patterns of bone and air conduction would be very similar. Speech sounds are shown as common sounds at volume level. The shallow U-shaped pattern sometimes referred to as the “speech banana” shows how high-frequency hearing loss primarily affects the ability to hear consonant sounds.36

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Figure 2. Types of Hearing Aids
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Ratings are based on clinical experience and review of available evidence. Open fit means that the earpiece does not occlude the ear canal. In closed fit types, the canal is completely occluded. The price estimates reflect 2011 prices for the majority of models in each type offered by most vendors; highest-end models can cost as much as $6000. Prices are for a single hearing aid device except for the price of the invisible-in-canal type, which is an annual price reflecting replacement with a new device every 4 months (3 devices per year). It is usually recommended that hearing aids be replaced approximately every 5 years, but many patients wear them for longer periods.




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