Ask a Health Care Professional – Hearing Loss

By Wei-Ann Bay, M.D., Chief Medical Officer, Blue Cross and Blue Shield of New Mexico

My mother is 80 years old and my father is 82, and they’ve been married for 56 years. Just like most couples they engage in the back-and-forth banter that my siblings and I listen to and smile about. One of the most commonly bantered topics is about their hearing or lack of hearing. For the longest time they put off getting hearing evaluations despite complaints of ringing in the ears and self-admission of not being able to hear conversations clearly when in a crowd. Both have recently been diagnosed with age-related hearing loss. 

What are the different types of hearing loss?

The hearing system is broken into three parts: the outer ear, or the part of the ear you see that extends to the ear drum; the middle ear, which includes the ear drum and the tiny ear bones; and the inner ear, which includes the “canals” for balancing and the nerves that go to the brain.

Three main types of hearing loss can result when any part of the hearing system does not work normally: 

  1. Conductive hearing loss occurs when there are problems in the outer or middle ear. Sounds cannot get to your inner ear. This can happen when you have ear wax, fluid in the ear, an ear infection causing swelling, an object stuck in your ear or a hole in the ear drum.
  2. Sensorineural hearing loss occurs when there is damage to the inner ear structures and nerves. This type of hearing loss can be a result of illnesses, drugs that are toxic to the nerves, brain injury, damage done by very loud noises, and age.
  3. Mixed hearing loss is a combination of conductive and sensorineural hearing loss.

What is presbycusis?

Presbycusis, also known as age-related hearing loss, is very common around the world and in the U.S. About 30-35% of adults age 65 and older have hearing loss, and it is estimated that 50% of all adults have presbycusis by the time they reach 75 years old. This is most commonly a sensorineural hearing disorder.

Age-related hearing loss occurs over many years and affects both ears. Common complaints include not being able to hear high-pitched sounds, having a hard time hearing in crowded places, or ringing in the ears, which is also called tinnitus. If you have age-related hearing loss, you may not hear the alarms and alerts on a timer, the ringing of a phone or birds chirping. Words from others can sound mumbled. Tinnitus may sound like ringing, buzzing, hissing or roaring.

What are the other risk factors associated with age-related hearing loss?

Besides age, several factors can affect the onset and severity of presbycusis. These include but are not limited to exposure to loud noises, use of drugs (e.g., antibiotics or cancer drugs) that are toxic to the hearing nerves, infections, smoking, high blood pressure, diabetes and genetics. 

What should I do if I have hearing problems?

If you think you might have hearing loss or someone mentions you have a hearing problem, please make an appointment to get evaluated. Sudden hearing loss is especially concerning, so see your health care provider right away. Your health care provider will do a physical exam to look in your ear, perform a quick hearing test and perhaps order other testing, such as blood tests. The test that confirms the diagnosis of hearing loss is called an audiogram. This test is performed in a soundproof room, and the audiologist tests hearing at different sound frequencies to determine if the patient can hear the sound. Other tests include testing for word discrimination and testing of the ear drum’s response to changes in air pressure.

How is age-related hearing loss treated?

Restoring hearing can decrease isolation and improve quality of life, safety and mental health. Hearing aids can treat age-related hearing loss. There are many options today, and it may take time to find the right pair. Working closely with your ear doctor and audiologist will help you get the right type of hearing aid that is comfortable for you. Hearing aids can also help with tinnitus, but other therapies, such as biofeedback, retraining therapy and cognitive behavioral therapy may also be helpful.

If you have a health question that you would like to be considered in Ask a Health Care Professional, please email [email protected]. BCBSNM will select questions that may appear. Questions will not be personally answered. The opinions expressed in this column are solely those of the author and not necessarily those of BCBSNM. This column is not intended to be a substitute for professional medical care. 

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