Hearing changes are normal with advancing age. I’ll admit to having a hearing issue (or “loss”) myself, although it is a result of a past major surgery. I prefer to call it “an issue” or “a loss” rather than a disability; there is something more uplifting and correctable about having “as issue” or “a loss.” The terminology is yours to pick. Nonetheless, it is annoying to my family and to me. There came a point when I could no longer call it “selective perception” without being insulting to others. I had to learn about it, what might come of it, and what could be done about it. Our purpose here is to help you to do so as well.

Incidence of Hearing Changes

The Government has estimated that by 2040, older adults will constitute about 22% of the population. More specifically, the 85 and older population is projected to more than double from 6.7 million in 2020 to 14.4 million in 2040 (a 117% increase).

Many older people have a speech, hearing, and/or hearing disorder that affects daily communication abilities. It may be something relatively mild like partial or total hearing loss in one ear (I have that), to something as broad as total hearing loss or an inability to speak resulting from a massive stroke. Older people, because of age or because of one or more medical conditions, may experience several communication disorders that compound each other.

Types of Hearing Loss

There are several broad types of hearing loss:

• Conductive: This type occurs when sound is not conducted efficiently through the outer ear canal eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss usually involves a reduction in sound level or the inability to hear faint sounds. This type of hearing loss can often be corrected medically or surgically.
• Sensorineural (SNHL): This occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. Most of the time, SNHL cannot be medically or surgically corrected. This is the most common type of permanent hearing loss. It reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or sound muffled. Some possible causes of SNHL include aging, head trauma, and exposure to loud noise.
• Mixed Conductive and Sensorineural: Sometimes, a conductive hearing loss occurs in combination with a sensorineural hearing loss. When it does, there is damage to the outer or middle ear and the inner ear or the auditory nerve. When that occurs, it is called a mixed hearing loss.

Aging and Hearing Loss

Hearing changes do not always occur with aging, but they frequently do. Therefore, you, your family, and your physician should be on the look-out for audiological issues. According to the American Speech and Hearing Association (ASHA), hearing loss is the third most frequent chronic health condition among people over 65. When hearing loss is age-related, it is generically called presbycusis.

Normal hearing loss in the aging process can be from several causes. These include:

• Excessive hair growth (within the ears!).
• Loss of cartilage in the pinna, which is the projecting part of the ear lying outside of the head.
• Stiffening of the ossicles, which are small bones in the inner ear. The stiffening causes less effective transmission of sound from the outer ear through the middle ear to the inner ear.
• Reduced elasticity of the Eustachian tubes. These connect the middle ear and the nasal passage and throat. As it loses elasticity, it tends to remain continuously open. Older people who have this condition often report that they feel like they are talking in a barrel.

Age-related changes in the inner ear (also related to balance) can cause an inability to hear high frequencies. If you have this condition, you may feel that while you can hear, you can’t understand what is being said, especially when there is background noise.

ASHA suggests that biological aging of the auditory system is most likely related to a combination of factors including genetics, diet, exposure to noise, medications, viruses, infections and systemic illnesses. While normal age-related changes are inevitable, preventive measures can be taken.

(This article was reviewed February 2024 since it was originally published in July, 2016.)