Hearing Loss in the Elderly

Dr. Sonika Kanotra

drsonika.kanotra@gmail.com

As we observe the International Day of Older Persons on 1st October 2026, it is appropriate to draw attention to an important but often neglected problem-hearing loss in the elderly.

Growing old brings many changes. While declining vision, wrinkles and aching joints are readily accepted, hearing loss is often ignored or dismissed as an inevitable part of ageing. Yet it can seriously affect communication, independence, emotional well-being and quality of life. According to the World Health Organization, about 30% of people above the age of 60 have hearing loss and the proportion increases with advancing age.

Age-Related Hearing Loss

Age-related hearing loss, known as presbycusis, usually develops gradually and affects both ears. It is more common in males than females and in those less literate. Heredity plays a role, but environmental, medical, and lifestyle factors can influence its onset and severity. These include long-term exposure to excessive noise, diabetes, hypertension, smoking, excessive alcohol consumption and certain medicines that can damage hearing.

The problem is often most noticeable in noisy surroundings. A person may say, "I can hear you, but I cannot understand what you are saying." This is because hearing involves not only detecting sound but also the brain's ability to process and understand speech.

Warning Signs

Hearing loss is often noticed by family members before the affected person recognises it. Common warning signs include

* Frequently asking people to repeat themselves.

* Increasing the television or mobile-phone volume, missing doorbells, telephone rings, or alarms.

* Complaining that people are mumbling.

* Difficulty following conversations in noisy surroundings and withdrawing from social gatherings.

* Tinnitus, or ringing and buzzing in the ears, as well as giddiness, may also occur.

Many hearing-impaired elderly people speak louder than usual because they cannot adequately monitor their own voice. In some forms of hearing loss, soft sounds are difficult to hear while loud sounds become uncomfortably loud. This explains the apparently contradictory complaint: "I am not deaf. Don't shout!"

Effects Extend Beyond the Ears

Imagine sitting at a family gathering and repeatedly asking, "What did you say?" After a while, embarrassment and frustration may cause the person to stop participating altogether.

Untreated hearing loss may gradually cause an elderly person to withdraw from family gatherings, religious functions and social activities. Loneliness, frustration, anxiety, loss of confidence and depression may follow.

Hearing impairment has also been associated with cognitive decline and dementia. Several mechanisms may contribute, including the additional mental effort required to understand degraded sound, reduced social interaction and decreased cognitive stimulation. Worsening of hearing loss in old age has also been associated with an increased risk of falls.

There are important practical consequences. An elderly person who cannot properly hear instructions from a doctor, pharmacist or caregiver may misunderstand information about medicines or treatment leading possibly to adverse consequences.

When unable to follow conversations, some elderly people may even become suspicious, mistakenly believing that others are talking about them, ridiculing them or hiding something from them. This may result in insecurity and mistrust.

The Family Also Suffers

Hearing loss affects the whole family. Repeatedly having to repeat sentences can cause frustration and fatigue. Family members may unconsciously begin speaking excessively loudly, sometimes resulting in vocal strain, throat discomfort and hoarseness.

When conversation becomes difficult, family members may gradually communicate less with the elderly person. This can unintentionally create emotional distance and further increase isolation.

Not All Hearing Loss Is Due to Ageing

An important message is that not every hearing problem in an elderly person is permanent or due to ageing. Impacted earwax, fungal infections, middle-ear fluid usually following a common cold, ear infections and other treatable conditions may cause hearing impairment. The natural mechanism by which wax moves out of the ear canal may also become less efficient with age, allowing wax to accumulate.

Therefore, an elderly person with hearing difficulty should have the ears examined by an ENT specialist rather than simply assuming it to be a consequence of old age.

Hearing Testing Is Simple

After examination, an ENT specialist may advise pure-tone audiometry, performed by a trained audiologist. Through headphones, sounds of different frequencies and intensities are presented to determine the type and degree of hearing loss. Depending upon the condition, additional investigations such as speech audiometry and impedance audiometry may be required.

Age-related hearing loss is generally gradual. Sudden hearing loss, however, requires urgent medical assessment. Rapidly progressive hearing loss or hearing loss associated with dizziness, severe ear pain, ear discharge or neurological symptoms should also receive prompt medical attention.

Hearing Aids-Removing the Stigma

Once treatable causes have been excluded or managed, hearing aids may be prescribed. Unfortunately, stigma remains one of the greatest barriers to hearing rehabilitation. Some elderly people believe that wearing a hearing aid makes them look old or disabled. This attitude must change.

People with severe to profound hearing loss who receive inadequate benefit from properly fitted hearing aids may require evaluation for a cochlear implant. Assistive devices such as television headphones, amplified telephones, louder doorbells and flashing-light alert systems may also help. Video calling instead of voice calling helps the person understand better by observing lip movements.

Affordable hearing rehabilitation remains an important public-health need. Providing free or subsidised hearing aids to economically disadvantaged elderly people deserves serious consideration.

The Family Has a Vital Role

In India, respect for elders is a cornerstone of our culture. Yet sometimes we fail to recognise their silent struggle with hearing loss.

* Talk face-to-face in good light so that facial expressions and lip movements are visible.

* Speak clearly and at a moderate pace. Do not shout, as excessive loudness may distort speech.

* Avoid speaking while turning away or covering your mouth.

* Minimise background noise by lowering the television or radio and switching off noise-making motors, coolers, fans, etc., during conversation.

* Be patient and allow adequate time for comprehension and response.

* Confirm important instructions by asking the person to repeat what you said, particularly regarding medicines and appointments.

* Encourage prescribed hearing aids and reassure the elderly person that using one is no different from wearing spectacles.

Can Presbycusis Be Prevented?

Age-related hearing loss cannot always be completely prevented because neither ageing nor genetic susceptibility can be eliminated. However, additional hearing damage can often be reduced by avoiding the insults that accelerate it.

* Avoid prolonged exposure to loud music, machinery, firecrackers and other excessive noise, and use appropriate hearing protection in noisy environments.

* Never insert cotton buds, matchsticks, toothpicks, hairpins or similar objects into the ear canal. They can push wax deeper, injure the ear canal or damage the eardrum and lead to infection.

* Persistent itching, ear pain or ear discharge should be evaluated medically.

* Earwax should be removed only when necessary and preferably by a healthcare professional.

* Smoking should be avoided and excessive alcohol consumption discouraged.

* Blood pressure, blood sugar and cholesterol should be appropriately controlled.

* A balanced diet rich in vegetables, fruits, whole grains, legumes and nuts and low in excessive salt and sugar should be encouraged.

* Regular physical activity, including yoga where appropriate, adequate sleep, stress management and remaining socially and mentally active contribute to overall well-being. Yoga may help physical fitness, balance and relaxation, although it should not be considered a treatment for established hearing loss.

* Unnecessary medicines should be avoided, and potentially ototoxic drugs should be taken only when absolutely medically indicated.

Hearing Better Means Living Better

Hearing keeps us connected with our families and society. Age-related hearing loss should therefore never simply be dismissed with the words, "It is just old age." Early recognition, examination for treatable causes, proper hearing assessment, appropriate hearing aids and strong family support can dramatically improve an elderly person's independence and quality of life.

Most importantly, an elderly person who repeatedly asks us to repeat ourselves is not necessarily being difficult-they may simply be struggling to hear.

On this International Day of Older Persons, 1st October 2026, let us remember: Helping our elders hear better is helping them remain connected, confident and independent-and ultimately helping them live better.

(The author is Prof.& Head E.N.T. Deptt. GMC Jammu.)