Age-Related Hearing Loss: Causes, Treatments and Healthy Aging

Hearing loss that occurs as a natural part of the aging process is known as presbycusis or age-related hearing loss. It is an extremely common condition, affecting about 30-35 percent of adults between ages 65 and 75 and almost 50 percent of those over age 75. As the population continues to age, age-related hearing loss is becoming a major public health concern.

How Hearing Works

Age-related hearing loss occurs for a number of reasons. To understand what leads to presbycusis, it helps to first understand how hearing works. Sound waves enter the ear canal and cause the eardrum to vibrate. These vibrations travel to the inner ear where fluid and tiny hair cells help convert vibrations into electrical signals that travel to the brain.

As we age, various changes occur that damage these hearing mechanisms in the inner ear and interfere with the conversion of sound vibrations into signals to the brain. Some key causes include:

  • Oxidative stress – Cellular damage from exposure to damaging free radicals builds up over time, including damage to the hair cells in the cochlea. This can lead to cell death and hearing loss.
  • Loss of blood flow – The stria vascularis, a tiny blood vessel important for inner ear function, deteriorates with age which reduces blood flow to key hearing structures.
  • Loss of hair cells – The hair cells in the cochlea become damaged and die off faster than the body can replace them. This significantly affects our ability to convert sound vibrations.
  • Age-related health issues like heart disease or diabetes can also accelerate damage to hearing structures. In addition, environmental exposures such as excessive noise contributes substantially to age-related hearing problems.

Symptoms of Hearing Loss

Hearing loss can occur for many reasons, including age-related hearing loss, noise-induced hearing loss, earwax buildup, ear bone changes, and adverse reactions to medications. The symptoms can range from mild to severe depending on the type and degree of hearing loss. Common symptoms include:

Difficulty Hearing Conversations – One of the first signs is struggling to understand conversations, especially when there is background noise present. Consonant sounds like s, h, f may be hard to decipher. As hearing declines, all speech may sound mumbled or slurred. 

Turning up the TV or Radio Volume – In order to properly hear television, music or radio, the volume often needs to be increased higher than other family members prefer.

Problems Hearing in Noisy Environments – Settings with lots of background noise like restaurants, meeting halls or crowded rooms become exceptionally difficult for listening and communicating. The cacophony of sounds gets mixed together making voices impossible to isolate.

Frequently Asking Others to Repeat Themselves  – People with hearing loss frequently ask friends, family and colleagues to repeat questions and statements directed at them, particularly if the speaker is at a distance or not directly facing the listener. Misunderstandings in conversational speech become more common.

Difficulty Hearing High-Pitched Sounds – Typically, the high-frequency sounds from consonants are affected first, but as hearing loss worsens, lower-frequency vowels become harder to recognize too. Voices may sound more monotonous.

A Feeling of Being Off-Balance or Dizziness – The inner ear is critical for body balance as well as hearing, so moderate or severe hearing losses can cause vertigo, falling, and poor balance particularly in older adults.

If experiencing any symptoms of hearing loss, it is important to schedule a hearing exam. Hearing professionals can suggest treatment plans including hearing aids, cochlear implants, assistive listening devices as well as ways to better manage conversations and noisy locales. Addressing hearing loss quickly and completely is key to preserving quality of life.


While many cases of age-related hearing loss cannot be reversed or cured, several treatment options do exist to improve hearing ability.

Hearing Aids: Hearing aids are small battery-powered hearing devices consisting of a microphone, amplifier, and speaker. They make sounds louder and help improve speech understanding and communication. Newer hearing aids can be adjusted via smartphone to accommodate different noise environments.

Cochlear Implants: For those with severe hearing loss who get little benefit from traditional hearing aids, cochlear implants may be an option. Cochlear implants bypass damaged inner ear components and stimulate the hearing nerve directly. Signals are picked up by an external microphone and processor before being transmitted to an internal receiver and electrodes in the cochlea to stimulate hearing nerve fibers.

Assistive Listening Devices: Other helpful devices include auditory loop systems that directly transmit sounds to hearing aids via magnetic fields to reduce background noise interference. There are also personal amplifiers, amplified telephones, alerting devices, captioned telephones, and smartphone apps.

Healthy Aging for Hearing Health

One of the most important things people can do to stave off age-related hearing problems is to protect their hearing early and avoid overexposure to harmful noise. Safe noise limits are sounds under 70-80 A-weighted decibels (dBA) for no more than 8 hours, or 85-88 dBA for less than 4 hours.

It is also vital to maintain overall health by managing medical conditions properly and making healthy lifestyle choices. Some tips include:

  • Control high blood pressure through diet, exercise, stress reduction techniques, and medication as needed. High blood pressure can lead to inner-ear damage. 
  • Properly manage diabetes and prediabetes to reduce injury to small blood vessels like those in the inner ear.
  • Refrain from smoking to maximize blood flow to the cochlea.
  • Follow a Mediterranean-style diet high in fruits, vegetables, whole grains and omega-3s. Key nutrients protect hearing structures while foods that provoke inflammation can damage hearing.
  • Exercise regularly as physical activity benefits circulation including blood flow to the cochlea.
  • Get regular hearing tests to monitor age-related hearing capability and quickly address substantial declines.

While modest hearing loss is expected with healthy aging, implementing preventative strategies early and promptly treating significant declines can go a long way in preserving hearing and quality of life. Advances in hearing aids, cochlear implants and other technologies also continue to expand treatment options. Committing to healthy aging allows people to stay socially engaged and more fully participate in work and leisure activities for many years to come.

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