What are the treatment options for decreasing hearing loss in older adults?

Treatment Options for Decreasing Hearing Loss in Older Adults

Hearing aids are the primary effective treatment for age-related hearing loss in older adults, improving hearing-specific quality of life, communication, and social functioning. 1

Diagnosis and Assessment

• Hearing loss should be confirmed with a pure-tone audiogram before treatment is initiated 2
• Screening tests that can identify objective hearing loss include:
  • Clinical examinations (whispered voice, finger rub, watch tick tests) 2
  • Single or multiple-item questionnaires like the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) 2
  • Handheld audiometers 2

Treatment Options

Hearing Aids

• Hearing aids are the primary intervention for mild to moderate sensorineural hearing loss in older adults 1
• Evidence shows hearing aids provide:
  • Large beneficial effect on hearing-specific health-related quality of life 1
  • Small beneficial effect on general health-related quality of life 1
  • Large beneficial effect on listening ability 1
• Both basic-level and premium-level hearing aids provide similar improvements in speech understanding and quality of life 3
• Adherence to hearing aid use is higher among those with self-perceived hearing impairment or greater magnitude of hearing loss 2

Communication Strategies and Assistive Listening Devices

• Communication strategies for partners and healthcare providers include:
  • Face the person at the same level in good lighting 2
  • Speak clearly and naturally, getting attention before speaking 2
  • Minimize background noise and avoid speaking from another room 2
  • Provide important information in writing 2

Addressing Modifiable Factors

• Identify and treat cerumen impaction, which can be potentially curative when present 4
• Evaluate and potentially reduce use of ototoxic medications 4
• Refer patients with conductive hearing loss or sensorineural loss that doesn't improve with hearing aids to an otolaryngologist 4

Benefits Beyond Hearing Improvement

Treating hearing loss can provide multiple benefits:

• Improved communication with family, friends, and healthcare providers 2
• Enhanced safety through better situational awareness and ability to hear warnings 2
• Improved daily functioning and reduced risk of falls 2
• Potential reduction in cognitive decline and dementia risk 2
• Decreased social isolation and improved mental health outcomes 2

Important Considerations and Pitfalls

• Many older adults resist seeking treatment due to social stigma or fear of losing independence 2
• Financial barriers exist as hearing aids are often not covered by Medicare and many private insurance companies 2
• Patient education should address physical and cognitive barriers to understanding teaching materials 2
• Consider factors that might affect adherence to treatment, such as living alone, financial vulnerability, or lack of support systems 2
• Sudden sensorineural hearing loss (loss of 30 dB or more within 72 hours) requires prompt otolaryngology referral 4

Special Populations

• Cochlear implants can be helpful for those with refractory or severe hearing loss that doesn't respond to conventional hearing aids 4
• Patients with asymmetrical hearing loss should undergo imaging (CT or MRI) to rule out other pathologies 4