What are the treatment options for age-related hearing loss?

Treatment Options for Age-Related Hearing Loss

Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with age-related hearing loss (ARHL), and should refer patients for cochlear implantation evaluation when they have persistent hearing difficulty with poor speech understanding despite appropriate amplification. 1

Screening and Initial Evaluation

1. Screening: All patients aged 50 years and older should be screened for hearing loss during healthcare encounters 1

   • Simple screening methods include whispered voice test or asking about hearing difficulties 2
   • If screening is positive, proceed to further evaluation

2. Initial Examination:

   • Otoscopic examination to identify cerumen impaction, infection, or other abnormalities 1
   • Audiometric testing to confirm type and degree of hearing loss 1
   • Assessment of sociodemographic factors that may affect treatment access 1

3. Referral for Specialized Assessment:

   • Urgent referral for sudden sensorineural hearing loss (loss of 30 dB or more within 72 hours) 3
   • Referral for significant asymmetric hearing loss, conductive/mixed hearing loss, or poor word recognition 1

Treatment Algorithm

Step 1: Address Reversible Causes

• Remove cerumen impaction if present (irrigation or curettage) 3
• Discontinue or reduce ototoxic medications when possible 3
• Treat any underlying ear infections or other medical conditions

Step 2: Amplification and Assistive Devices

• Hearing Aids: First-line treatment for most patients with ARHL 1

  • Must be properly fitted by an audiologist for optimal benefit
  • Regular follow-up to ensure proper fit and function

• Assistive Listening Devices:

  • For specific listening challenges (TV, telephone, alerting to warnings) 1
  • Can be used alone or in conjunction with hearing aids

Step 3: Advanced Interventions

• Cochlear Implants: For patients with persistent hearing difficulty despite appropriate hearing aid use 1
  • Strong recommendation for evaluation when speech understanding remains poor with hearing aids 1

Step 4: Communication Strategies and Rehabilitation

• Patient and family education about communication techniques 1
  • Face the person when speaking in good lighting
  • Speak clearly and at a moderate pace
  • Minimize background noise
  • Rephrase rather than repeat when not understood
  • Provide important information in writing

Follow-up and Monitoring

• Assess if communication goals have been met and if hearing-related quality of life has improved within 1 year 1
• Re-evaluate hearing at least every 3 years in patients with known hearing loss 1
• More frequent assessment if changes in hearing are reported

Impact of Untreated Hearing Loss

Untreated ARHL significantly affects:

• Communication: Limits understanding, affecting relationships at home, work, and healthcare settings 1
• Safety: Increases risk of accidents and injuries due to reduced situational awareness 1
• Cognition: Associated with accelerated cognitive decline and increased dementia risk 1
• Quality of Life: Contributes to social isolation, depression, and reduced independence 1

Common Pitfalls to Avoid

1. Delayed intervention: Many patients wait 7-10 years before seeking help, during which time cognitive decline may accelerate 1
2. Inadequate fitting: Poorly fitted hearing aids lead to non-adherence and abandonment 3
3. Overlooking cochlear implant candidacy: Many patients who could benefit from cochlear implants are never referred for evaluation 1
4. Ignoring communication strategies: Amplification alone is insufficient; communication strategies are essential components of treatment 1
5. Neglecting follow-up: Regular reassessment is necessary as hearing loss typically progresses over time 1

ARHL affects approximately one-third of adults 61-70 years and over 80% of those older than 85 years 2, making it a significant public health concern that requires proactive management to maintain quality of life and cognitive function.