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Hearing aids are a very common device used by those with ARHL. They are wearable electronic devices that make sounds louder, typically behind the ear but some are worn inside the ear. They can be more affordably purchased over the counter for a price of around $300 to $2,000 per pair. However, in the long-term better quality prescription hearing aids may be purchased for $3000 to $8000 per pair. Insurance is not likely to cover the entire cost of hearing aids for the elderly with ARHL, as many states' insurance plans only cover the cost for children with hearing loss. Most insurance plans with hearing aid coverage will provide for up to 85% of the cost. If someone with ARHL chooses not to utilize hearing aids, this can lead to long term consequences of mental deterioration and dementia as their condition progresses, and social isolation and depression over time.

Sources: https://www.seniorliving.org/hearing-aids/cost/#:~:text=Prescription%20hearing%20aids%20can%20cost,dollars%20to%20%243%2C000%20per%20pair.&text=*%20Prices%20will%20vary%20by%20location%20and%20provider

https://www.nidcd.nih.gov/health/age-related-hearing-loss#:~:text=Treatment%20will%20depend%20on%20the,auditoriums%2C%20and%20places%20of%20worship

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Hearing Aid Prices | How Much Do Hearing Aids Cost in 2025?

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Many of today’s more advanced hearing aids can fully restore your sense of hearing, but these devices can come with a high price tag. According to the President’s Council for Science & Technology,1 you should plan to spend around $2,300 per hearing aid. If you need a uni…

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Assistive Devices: Telecommunication & Alerting Devices

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Assistive Devices: Telecommunication & Alerting Devices

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To accommodate for age-related hearing loss, sometimes assistive devices such as telecommunication and alerting devices are necessary. Telecommunication devices take audio, such as a phone call, and convert the speak to a text. This allows someone experiencing hearing loss to continue communicating via telephone. Alerting devices can also help by using light, sound, and/or vibration to alert someone experiencing hearing loss. Alerting devices help to draw attention to a doorbell ring, phone ring, or smoke detector.

These services are now provided free because of Title IV of the ADA put it into law. Therefore, it is no longer has to be a concern if someone's insurance covers the assistive device.

However, if someone doesn't take advantage of these services, they put themselves at risk of isolation and may even put themselves in dangerous situations. They will struggle to communicate via phone and may not hear their smoke detector go off.

Sources:

ADA: ADA Requirements: Effective Communication | ADA.gov

NIH: Assistive Devices for People with Hearing or Speech Disorders | NIDCD

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Last updated:

The Department of Justice published revised final regulations implementing the Americans with Disabilities Act (ADA) for title II (State and local government services) and title III (public accommodations and commercial facilities) on September 15, 2010, in the Federal Register. These requirements, or rules, clarify and refine issues that have arisen over the past 20 years and contain new, and updated, requirements, including the 2010 Standards for Accessible Design (2010 Standards).

Overview

People who have vision, hearing, or speech disabilities ("communication disabilities") use different ways to communicate. For example, people who are blind may give and receive information audibly rather than in writing and people who are deaf may give and receive information through writing or sign language rather than through speech.

The ADA requires that title II entities (State and local governments) and title III entities (businesses and nonprofit organizations that serve the public) communicate effectively with people who have communication disabilities. The goal is to ensure that communication with people with these disabilities is equally effective as communication with people without disabilities.

This publication is designed to help title II and title III entities ("covered entities") understand how the rules for effective communication, including rules that went into effect on March 15, 2011, apply to them.

The purpose of the effective communication rules is to ensure that the person with a vision, hearing, or speech disability can communicate with, receive information from, and convey information to, the covered entity.

Covered entities must provide auxiliary aids and services when needed to communicate effectively with people who have communication disabilities.

The key to communicating effectively is to consider the nature, length, complexity, and context of the communication and the person's normal method(s) of communication.

The rules apply to communicating with the person who is receiving the covered entity's goods or services as well as with that person's parent, spouse, or companion in appropriate circumstances.

Auxiliary Aids and Services

The ADA uses the term "auxiliary aids and services" ("aids and services") to refer to the ways to communicate with people who have communication disabilities.

For people who are blind, have vision loss, or are deaf-blind, this includes providing a qualified reader; information in large print, Braille, or electronically for use with a computer screen-reading program; or an audio recording of printed information. A "qualified" reader means someone who is able to read effectively, accurately, and impartially, using any necessary specialized vocabulary.

For people who are deaf, have hearing loss, or are deaf-blind, this includes providing a qualified notetaker; a qualified sign language interpreter, oral interpreter, cued-speech interpreter, or tactile interpreter; real-time captioning; written materials; or a printed script of a stock speech (such as given on a museum or historic house tour). A "qualified" interpreter means someone who is able to interpret effectively, accurately, and impartially, both receptively (i.e., understanding what the person with the disability is saying) and expressively (i.e., having the skill needed to convey information back to that person) using any necessary specialized vocabulary.

For people who have speech disabilities, this may include providing a qualified speech-to-speech transliterator (a person trained to recognize unclear speech and repeat it clearly) , especially if the person will be speaking at length, such as giving testimony in court, or just taking more time to communicate with someone who uses a communication board. In some situations, keeping paper and pencil on hand so the person can write out words that staff cannot understand or simply allowing more time to communicate with someone who uses a communication board or device may provide effective communication. Staff should always listen attentively and not be afraid or embarrassed to ask the person to repeat a word or phrase they do not understand.

In addition, aids and services include a wide variety of technologies including 1) assistive listening systems and devices; 2) open captioning, closed captioning, real-time captioning, and closed caption decoders and devices; 3) telephone handset amplifiers, hearing-aid compatible telephones, text telephones (TTYs) , videophones, captioned telephones, and other voice, text, and video-based telecommunications products; 4) videotext displays; 5) screen reader software, magnification software, and optical readers; 6) video description and secondary auditory programming (SAP) devices that pick up video-described audio feeds for television programs; 7) accessibility features in electronic documents and other electronic and information technology that is accessible (either independently or through assistive technology such as screen readers).

Real-time captioning (also known as computer-assisted real-time transcription, or CART) is a service similar to court reporting in which a transcriber types what is being said at a meeting or event into a computer that projects the words onto a screen. This service, which can be provided on-site or remotely, is particularly useful for people who are deaf or have hearing loss but do not use sign language.

The free nationwide telecommunications relay service (TRS), reached by calling 7-1-1, uses communications assistants (also called CAs or relay operators) who serve as intermediaries between people who have hearing or speech disabilities who use a text telephone (TTY) or text messaging and people who use standard voice telephones. The communications assistant tells the telephone user what the other party is typing and types to tell the other party what the telephone user is saying. TRS also provides speech-to-speech transliteration for callers who have speech disabilities.

Video relay service (VRS) is a free, subscriber-based service for people who use sign language and have videophones, smart phones, or computers with video communication capabilities. For outgoing calls, the subscriber contacts the VRS interpreter, who places the call and serves as an intermediary between the subscriber and a person who uses a standard voice telephone. The interpreter tells the telephone user what the subscriber is signing and signs to the subscriber what the telephone user is saying.

Video remote interpreting (VRI) is a fee-based service that uses video conferencing technology to access an off-site interpreter to provide real-time sign language or oral interpreting services for conversations between hearing people and people who are deaf or have hearing loss. The new regulations give covered entities the choice of using VRI or on-site interpreters in situations where either would be effective. VRI can be especially useful in rural areas where on-site interpreters may be difficult to obtain. Additionally, there may be some cost advantages in using VRI in certain circumstances. However, VRI will not be effective in all circumstances. For example, it will not be effective if the person who needs the interpreter has difficulty seeing the screen (either because of vision loss or because he or she cannot be properly positioned to see the screen, because of an injury or other condition). In these circumstances, an on-site interpreter may be required.

If VRI is chosen, all of the following specific performance standards must be met:

real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication;

a sharply delineated image that is large enough to display the interpreter's face, arms, hands, and fingers, and the face, arms, hands, and fingers of the person using sign language, regardless of his or her body position;

a clear, audible transmission of voices; and

adequate staff training to ensure quick set-up and proper operation.

Many deaf-blind individuals use support service providers (SSPs) to assist them in accessing the world around them. SSPs are not "aids and services" under the ADA. However, they provide mobility, orientation, and informal communication services for deaf-blind individuals and are a critically important link enabling them to independently access the community at large.

Effective Communication Provisions

Covered entities must provide aids and services when needed to communicate effectively with people who have communication disabilities.

The key to deciding what aid or service is needed to communicate effectively is to consider the nature, length, complexity, and context of the communication as well as the person's normal method(s) of communication.

Some easy solutions work in relatively simple and straightforward situations. For example:

In a lunchroom or restaurant, reading the menu to a person who is blind allows that person to decide what dish to order.

In a retail setting, pointing to product information or writing notes back and forth to answer simple questions about a product may allow a person who is deaf to decide whether to purchase the product.

Other solutions may be needed where the information being communicated is more extensive or complex. For example:

In a law firm, providing an accessible electronic copy of a legal document that is being drafted for a client who is blind allows the client to read the draft at home using a computer screen-reading program.

In a doctor's office, an interpreter generally will be needed for taking the medical history of a patient who uses sign language or for discussing a serious diagnosis and its treatment options.

A person's method(s) of communication are also key. For example, sign language interpreters are effective only for people who use sign language. Other methods of communication, such as those described above, are needed for people who may have lost their hearing later in life and do not use sign language. Similarly, Braille is effective only for people who read Braille. Other methods are needed for people with vision disabilities who do not read Braille, such as providing accessible electronic text documents, forms, etc., that can be accessed by the person's screen reader program.

Covered entities are also required to accept telephone calls placed through TRS and VRS, and staff who answer the telephone must treat relay calls just like other calls. The communications assistant will explain how the system works if necessary.

Remember, the purpose of the effective communication rules is to ensure that the person with a communication disability can receive information from, and convey information to, the covered entity.

Companions

In many situations, covered entities communicate with someone other than the person who is receiving their goods or services. For example, school staff usually talk to a parent about a child's progress; hospital staff often talk to a patient's spouse, other relative, or friend about the patient's condition or prognosis. The rules refer to such people as "companions" and require covered entities to provide effective communication for companions who have communication disabilities.

The term "companion" includes any family member, friend, or associate of a person seeking or receiving an entity's goods or services who is an appropriate person with whom the entity should communicate.

Use of Accompanying Adults or Children as Interpreters

Historically, many covered entities have expected a person who uses sign language to bring a family member or friend to interpret for him or her. These people often lacked the impartiality and specialized vocabulary needed to interpret effectively and accurately. It was particularly problematic to use people's children as interpreters.

The ADA places responsibility for providing effective communication, including the use of interpreters, directly on covered entities. They cannot require a person to bring someone to interpret for him or her. A covered entity can rely on a companion to interpret in only two situations.

1. In an emergency involving an imminent threat to the safety or welfare of an individual or the public, an adult or minor child accompanying a person who uses sign language may be relied upon to interpret or facilitate communication only when a qualified interpreter is not available.

2. In situations not involving an imminent threat, an adult accompanying someone who uses sign language may be relied upon to interpret or facilitate communication when a) the individual requests this, b) the accompanying adult agrees, and c) reliance on the accompanying adult is appropriate under the circumstances. This exception does not apply to minor children.

Even under exception (2) , covered entities may not rely on an accompanying adult to interpret when there is reason to doubt the person's impartiality or effectiveness. For example:

It would be inappropriate to rely on a companion to interpret who feels conflicted about communicating bad news to the person or has a personal stake in the outcome of a situation.

When responding to a call alleging spousal abuse, police should never rely on one spouse to interpret for the other spouse.

Who Decides Which Aid or Service Is Needed?

When choosing an aid or service, title II entities are required to give primary consideration to the choice of aid or service requested by the person who has a communication disability. The state or local government must honor the person's choice, unless it can demonstrate that another equally effective means of communication is available, or that the use of the means chosen would result in a fundamental alteration or in an undue burden (see limitations below). If the choice expressed by the person with a disability would result in an undue burden or a fundamental alteration, the public entity still has an obligation to provide an alternative aid or service that provides effective communication if one is available.

Title III entities are encouraged to consult with the person with a disability to discuss what aid or service is appropriate. The goal is to provide an aid or service that will be effective, given the nature of what is being communicated and the person's method of communicating.

Covered entities may require reasonable advance notice from people requesting aids or services, based on the length of time needed to acquire the aid or service, but may not impose excessive advance notice requirements. "Walk-in" requests for aids and services must also be honored to the extent possible.

Limitations

Covered entities are required to provide aids and services unless doing so would result in an "undue burden," which is defined as significant difficulty or expense. If a particular aid or service would result in an undue burden, the entity must provide another effective aid or service, if possible, that would not result in an undue burden. Determining what constitutes an undue burden will vary from entity to entity and sometimes from one year to the next. The impact of changing economic conditions on the resources available to an entity may also be taken into consideration in making this determination.

State and local governments: in determining whether a particular aid or service would result in undue financial and administrative burdens, a title II entity should take into consideration the cost of the particular aid or service in light of all resources available to fund the program, service, or activity and the effect on other expenses or operations. The decision that a particular aid or service would result in an undue burden must be made by a high level official, no lower than a Department head, and must include a written statement of the reasons for reaching that conclusion.

Businesses and nonprofits: in determining whether a particular aid or service would result in an undue burden, a title III entity should take into consideration the nature and cost of the aid or service relative to their size, overall financial resources, and overall expenses. In general, a business or nonprofit with greater resources is expected to do more to ensure effective communication than one with fewer resources. If the entity has a parent company, the administrative and financial relationship, as well as the size, resources, and expenses of the parent company, would also be considered.

In addition, covered entities are not required to provide any particular aid or service in those rare circumstances where it would fundamentally alter the nature of the goods or services they provide to the public. In the performing arts, for example, slowing down the action on stage in order to describe the action for patrons who are blind or have vision loss may fundamentally alter the nature of a play or dance performance.

Staff Training

A critical and often overlooked component of ensuring success is comprehensive and ongoing staff training. Covered entities may have established good policies, but if front line staff are not aware of them or do not know how to implement them, problems can arise. Covered entities should teach staff about the ADA's requirements for communicating effectively with people who have communication disabilities. Many local disability organizations, including Centers for Independent Living, conduct ADA trainings in their communities. The Department's ADA Information Line can provide local contact information for these organizations.

For more information about the ADA, please visit ADA.gov or call our toll-free number.

ADA Information Line 800-514-0301 (Voice) and 1-833-610-1264 (TTY) M-W, F 9:30 a.m. - 12:00 p.m. and 3:00 p.m. - 5:30 p.m., Th 2:30 p.m. - 5:30 p.m. (Eastern Time) to speak with an ADA Specialist. Calls are confidential.

For people with disabilities, this publication is available in alternate formats.

The Americans with Disabilities Act authorizes the Department of Justice (the Department) to provide technical assistance to individuals and entities that have rights or responsibilities under the Act. This document provides informal guidance to assist you in understanding the ADA and the Department's regulations.

This guidance document is not intended to be a final agency action, has no legally binding effect, and may be rescinded or modified in the Department's complete discretion, in accordance with applicable laws. The Department's guidance documents, including this guidance, do not establish legally enforceable responsibilities beyond what is required by the terms of the applicable statutes, regulations, or binding judicial precedent.

Duplication of this document is encouraged.

Originally issued:

Last updated:

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This publication is designed to help title II and title III entities understand how the rules for effective communication apply to them.

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Age-related hearing loss is problem that affects many people as they age. This is why we chose this focus problem and why it's important to be educated on the topic.

Source: NIH

Age-Related Hearing Loss (Presbycusis)

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A Quick Intro to Age-Related Hearing Loss

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A Quick Intro to Age-Related Hearing Loss

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Source: YouTube

Age-Related Hearing Loss: What You Should Know

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Johns Hopkins Bloomberg School of Public Health

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Age-Related Hearing Loss: What You Should Know

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Among the elderly, it affects especially those who are male, have lighter skin color, and those who face cardiovascular disease risk factors as it can increase injury to cochlear blood vessels.

Source:

https://www.nejm.org/doi/full/10.1056/NEJMcp2306778

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Causes: Long-term exposure to loud noise (such as music or work-related noise)

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Causes: Long-term exposure to loud noise (such as music or work-related noise)

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Many things can effect age related hearing loss but one of the main factors is long-term exposure to loud noise (such as music or work-related noise) in your inner ear that help you to hear.

Loud noises can damage the hair cells in the inner ear and the hearing nerve as well which is what leads to hearing loss over time.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/presbycusis

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Aging and Hearing Hearing Loss

What is presbycusis?

Age-related hearing loss (or presbycusis) is the gradual loss of hearing in both ears. It's a common problem linked to aging. One in 3 adults over age 65 has hearing loss. Because of the gradual change in hearing, some people are not aware of the change at first. Most often, it affects the ability to hear high-pitched noises such as a phone ringing or beeping of a microwave. The ability to hear low-pitched noises is usually not affected.

What causes age-related hearing loss?

There may be many causes for age-related hearing loss. It most most often occurs because of changes in the following locations:

Other things that affect age-related hearing loss:

Continuous exposure to loud noise (such as music or work related noise)

Loss of hair cells (sensory receptors in the inner ear)

Inherited factors

Various health conditions, such as heart disease or diabetes

Side effects of some medications, such as aspirin and certain antibiotics

When Grandpa Can't Hear Words at a Noisy Holiday Gathering, Too Many Brain Cells May Be Firing at Once, Say Researchers

What are the symptoms of age-related hearing loss?

The following are the most common symptoms of age-related hearing loss:

Speech of others sounds mumbled or slurred

High-pitched sounds, such as "s" or "th" are hard to distinguish

Conversations are difficult to understand, particularly when there is background noise

Men's voices are easier to hear than women's

Some sounds seem overly loud and annoying

Tinnitus (ringing in the ears) may occur in one or both ears

The symptoms of age-related hearing loss may look like other conditions or medical problems. Always consult your health care provider for a diagnosis.

How is age-related hearing loss diagnosed?

Your health care provider will use an otoscope, which is a lighted scope, to check in the outer ear canal and to look at the ear drum. He or she will look for damage to the ear drum, blockage of the ear canal from foreign objects or impacted ear wax, inflammation or infection.

You may be referred to a hearing specialist, audiologist, to have an audiogram. An audiogram is a test in which sounds are played through headphones, to one ear at a time. You are asked to respond if you are able to hear each sound. If a person can't hear certain tones this suggests there has been some degree of hearing loss.

How is age-related hearing loss treated?

Your health care provider will figure out the best treatment based on:

How old you are

Your overall health and medical history

How sick you are

How well you can handle specific medications, procedures, or therapies

How long the condition is expected to last

Your opinion or preference

Treatment options for age-related hearing loss may include the following:

Hearing aid(s)

Assistive devices, such as telephone amplifiers or technology that converts speech to text

Training in speech-reading (to use visual cues to determine what is being said)

Techniques for preventing excess wax in the outer ear

What are the complications of age-related hearing loss?

If your hearing loss is significant enough, you may need some type of hearing aid or other aids to communicate with others.

What can I do to prevent age-related hearing loss?

The most important way to prevent age-related hearing loss is to protect your hearing.

Living with age-related hearing loss

If you have hearing loss, your health care professional can refer you to specialists in hearing loss, such as an:

Otolaryngologist. This is a doctor who specializes in diseases and conditions of the ears, nose, and throat.

Audiologist. This is a health care professional who specializes in testing hearing problems and managing hearing problems.

Key points

Age-related hearing loss is a gradual hearing loss in both ears. It is a common problem associated with aging.

If you have sudden hearing loss, see your health care provider right away as this may be the development of a serious hearing problem.

Avoiding constant or continuous exposure to loud noises can help protect your hearing and prevent gradual hearing loss.

It is not a reversible condition so prevention is important.

Next steps

Tips to help you get the most from a visit to your health care provider:

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you.

At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.

If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your provider if you have questions.

Age-Related Hearing Loss (Presbycusis)

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Age-related hearing loss (presbycusis) is the gradual loss of hearing in both ears. It's a common problem linked to aging.

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Members of minority groups may not receive an adequate level of healthcare or education on the disease due to socioeconomic restraints. These groups can struggle to receive care for age-related hearing loss, because it may not be within their budget and/or they aren't aware of the different treatments available. This makes diagnosis, treatment, and prevention very difficult since the groups aren't aware of the services they lack and there are socioeconomic barriers keeping them from the necessary resources for ARHL.

Source: NIH

Racial/Ethnic and Socioeconomic Disparities in Hearing Health Care Among Older Americans - PMC

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Racial/Ethnic and Socioeconomic Disparities in Hearing Health Care Among Older Americans

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Hearing impairment is highly prevalent, but little is known about hearing health care among older minority adults. We analyzed nationally representative, cross-sectional data from 1,544 older adults ≥70 years with audiometry and hearing care data…

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Diet is thought to prevent and/or lessen the effects of age-related hearing loss. Foods like legumes, fish, broccoli, garlic, whole grains, dark chocolate, and bananas are examples of foods which may help. Also, vitamins such as magnesium, zinc, vitamins (A, B, C, & E), and Omega-3 fatty acids are also beneficial. Adding these foods to one's diet can be made easy with the assistance of a patient's audiologist and/or general practitioner. They can give recommendations to help them make these lifestyle changes using difference strategies. Strategies could be simply adding these foods to their diet or supplementing out other foods. Overall, changes to a patient's diet have a difficulty level of 3 on a scale of 1-10.

Source: Elder Care Alliance

What To Do To Improve Hearing | Elder Care Alliance

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Age-related hearing loss can occur due to many other factors associated with aging.

Medication: Medication which elderly people take can impact their hearing. For example, Viagra and certain cancer medication may affect hearing.

Illness: The effects of certain illnesses can affect a person's hearing. For example, meningitis can damage a person's cochlea (auditory organ in the inner ear).

source: Mayo Clinic

Hearing loss - Symptoms and causes - Mayo Clinic

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Individuals with ARHL have a "30-40% accelerated rate" of cognitive decline. Impairments with mental reasoning are likely to occur sooner than with those without ARHL or a form of hearing aid, as hearing loss demands higher cognitive load and neurological overcompensation. In the long-term, this can result in dementia and issues with language, concentration, and executive function.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC3869227/#:~:text=The%20magnitude%20of%20these%20associations,to%20individuals%20with%20normal%20hearing.

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Assistive technology includes alerting systems and assistive listening devices (text to speech, sound amplifiers, etc.). These are types of devices (not including hearing aids or cochlear implants) which augment sounds for safety and communication. These are used for treatment of age-related hearing loss by increasing safety and one's socialation capabilities. One difficulty could be the price of these assistive devices if they are not covered by insurance or government programs.

Source:

HLAA

https://www.hearingloss.org/find-help/hearing-assistive-technology/Links to an external site.

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A person experiencing age-related hearing loss can have difficulty hearing consonants, difficulty hearing words, and difficulty hearing when there is background noise. These are just a few of the immediate symptoms that someone might experience.

Source: Mayo Clinic

Hearing loss - Symptoms and causes - Mayo Clinic

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Symptoms: Having to Adapt to Hearing-Loss

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Symptoms: Having to Adapt to Hearing-Loss

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Loss of hearing isn't the only symptom of hearing loss. This loss of hearing can result in individuals needing to turn up the volume of tv's and radios especially high, having to ask others to speak louder and clearer, and shying away from social settings. These are symptoms which can signify a person is losing their hearing and, in turn, is having to make adaptations to their everyday life.

Source: Mayo Clinic

Hearing loss - Symptoms and causes - Mayo Clinic

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The anatomical structures involved in age-related hearing loss are the outer ear, middle ear, and inner ear. The outer ear consists of the pinna and the ear canal. The middle ear, separated from the outer ear by the eardrum, includes the malleus, incus, stapes, and auditory tube. The inner ear includes the cochlea and the semicircular canals.

Source: Mayo Clinic

Hearing loss - Symptoms and causes - Mayo Clinic

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Anatomical Structure Affected by Age-Related Hearing Loss: Inner Ear

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Anatomical Structure Affected by Age-Related Hearing Loss: Inner Ear

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The video above is a deep dive into the anatomical structures within the inner ear. These structures described in the video include the cochlea, cochlea canal, spiral lamina, vestibular, semicircular canals, membranous labyrinth, spiral organ of cordy, sakyo, and utricle.

Vibrations travel through the inner ear as follows:

The vibration travels through to the fluid-filled chambers of the cochlea, then the hair cells along the cochlea create electrical impulses out of the vibration, and finally these electrical impulses travel across the auditory nerve to the brain.

The inner ear plays a big role in hearing, and unfortunately this is where hearing loss begins. The inner ear contains the structures which take a lot of wear (i.e. damaged hair cells), so this results in damage to the inner ear.

Source: Mayo Clinic

Hearing loss - Symptoms and causes - Mayo Clinic

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Dr.G Bhanu Prakash Animated Medical Videos

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Inner ear Anatomy Animation : Cochlear component, Vestibular component, Semi-circular component

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The main cause of age related hearing loss is gradual wear and tear to tiny sensory cells called hair cells in the cochlea.

Another thing to look at would be your environment and lifestyle factors as that will affect your hearing tremendously in the end. Another large factor to consider is your genetics because this issue can unfortunately be hereditary.

https://rnid.org.uk/information-and-support/hearing-loss/types-of-hearing-loss-and-deafness/age-related-hearing-loss/#:~:text=The%20main%20cause%20of%20age,organ%20in%20the%20inner%20ear).

-Kierra Blundell

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Age-related hearing loss

Age-related hearing loss is caused by changes that happen over time to the inner ear. It's also known as presbycusis and is the most common cause of hearing loss.

Most of us will experience some level of hearing loss as we get older. This type of hearing loss tends to affect both ears, and increases as you get older.

There is currently no way to restore hearing after age-related hearing loss. But many people find hearing aids to be a huge help.

The main cause of age-related hearing loss is gradual wear and tear to tiny sensory cells called 'hair cells' in the cochlea (your hearing organ in the inner ear).

Your hearing might start to get worse with age. This can make high-pitch sounds, such as some voices, difficult to hear.

It might also be harder to hear certain speech sounds. This can make it hard to understand what people are saying.

You may be experiencing hearing loss if you:

think other people sound like they're mumbling

ask people to repeat things for you often

have difficulty understanding what is being said in noisy places

find it hard to keep up with group conversation

get tired from having to concentrate so much

find other people think your TV or music is too loud

often have difficulty hearing on the telephone.

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Age-related hearing loss is caused by changes that happen over time to the inner ear. It's also known as presbycusis and is the most common cause of hearing loss. Most of us will experience some level of hearing loss as we get older. This type of hearing loss tends to affect both ears, and increases [...]

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Video on causes of age related hearing loss 

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Video on causes of age related hearing loss 

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-Kierra Blundell

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Cognitive Decline: Memory can deplete and concentration can weaken. Those with ARHL are more likely to develop dementia.

Depression: ARHL can cause the elderly to harbor feelings of embarrassment and frustration about their condition. They can face criticism from others who do not understand their struggles. This can cause them to become isolated and lonely.

Source: https://www.nia.nih.gov/health/hearing-and-hearing-loss/hearing-loss-common-problem-older-adults#health-effects-of-hearing-loss

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Hearing loss is a common problem caused by loud noise, aging, disease, and genetic variations. About one-third of older adults have hearing loss, and the chance of developing hearing loss increases with age. People with hearing loss may find it hard to have conversations with friends and family. They may also have trouble understanding a doctor's advice, responding to warnings, and hearing doorbells and alarms.

Some people may not want to admit they have trouble hearing. Hearing problems that are ignored or untreated can get worse. If you have a hearing problem, see your doctor. Hearing aids, special training, certain medications, and surgery are some of the treatments that can help.

Signs of hearing loss

Read and share this infographic about the six signs of hearing loss.

Some people have a hearing problem and don't realize it. You should see your doctor if you:

Have trouble understanding what people are saying over the telephone

Find it hard to follow conversations when two or more people are talking

Often ask people to repeat what they are saying

Need to turn up the TV volume so loud that others complain

Have a problem understanding speech because of background noise

Think that others seem to mumble

Can't understand what's being said when children and people with higher pitched voices speak to you

Types of hearing loss

Hearing loss comes in many forms. It can range from a mild loss, in which a person misses certain high-pitched sounds, to a total loss of hearing.

Sudden hearing loss

Sudden deafness, also known as sudden sensorineural hearing loss, is an unexplained rapid loss of hearing. It can happen to a person all at once or over a period of a few days. It should be considered a medical emergency. If you or someone you know experiences sudden hearing loss, visit a doctor immediately.

Age-related hearing loss

Age-related hearing loss, also called presbycusis, comes on gradually as a person grows older. It seems to run in families and may occur because of changes in the inner ear and auditory nerve, which relays signals from the ear to the brain. Presbycusis may make it hard for a person to tolerate loud sounds or to understand what others are saying.

Age-related hearing loss usually occurs in both ears, affecting them equally. Because the loss is gradual, people with presbycusis may not realize they have lost some of their ability to hear.

Tinnitus

Tinnitus is also common in older people. It is typically described as ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It can come and go. It can be heard in one or both ears, and it may be loud or soft. Tinnitus is sometimes the first sign of hearing loss in older adults. It can accompany any type of hearing loss.

Tinnitus is a symptom, not a disease. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. It can also be a sign of other health conditions, such as high blood pressure or allergies. Tinnitus can also occur as a side effect of certain medications.

Causes of hearing loss

Loud noise is one of the most common causes of hearing loss. Noise from lawn mowers, snow blowers, or loud music can damage the inner ear and result in permanent hearing loss. Loud noise also contributes to tinnitus. You can prevent most noise-related hearing loss by turning down the sound on your devices, moving away from loud noise, or using earplugs or other ear protection.

Earwax or fluid buildup can also cause hearing loss by blocking sounds that are carried from the eardrum to the inner ear. If wax blockage is a problem, your doctor may suggest mild treatments to soften earwax.

A ruptured eardrum can also cause hearing loss. The eardrum can be damaged by infection, pressure, or putting objects in the ear, including cotton-tipped swabs. See your doctor if you have ear pain or fluid draining from an ear.

Health conditions common in older people, such as diabetes or high blood pressure, can contribute to hearing loss. Ear infections caused by viruses and bacteria (also known as otitis media), a heart condition, stroke, brain injury, or a tumor may also affect your hearing.

Hearing loss can also result from taking certain medications that can damage the inner ear, sometimes permanently. These medications may be used to treat serious infections, cancer, or heart disease. They also include some antibiotics, and even aspirin at some dosages. If you notice a problem while taking a medication, check with your doctor.

Genetic variations can cause hearing loss as well. Not all inherited forms of hearing loss are evident at birth. Some forms can show up later in life. For example, otosclerosis, which is thought to be a hereditary disease, involves the abnormal growth of bone that prevents structures within the ear from working properly.

Health effects of hearing loss

Hearing loss can affect cognitive health. Studies have shown that older adults with hearing loss have a greater risk of developing dementia than older adults with normal hearing. Cognitive abilities (including memory and concentration) decline faster in older adults with hearing loss than in older adults with normal hearing. A recent analysis of several studies found that people who used hearing restorative devices (such as hearing aids and cochlear implants) had a lower risk of long-term cognitive decline compared to people with uncorrected hearing loss.

Older people who can't hear well may become depressed or withdrawn from others because they feel frustrated or embarrassed about not understanding what is being said. Sometimes, older people are mistakenly thought to be confused, unresponsive, or uncooperative because they don't hear well. These circumstances can lead to social isolation and loneliness.

Hearing loss, even small amounts, is also linked to an increased risk for falls. It also can affect public as well as personal safety, such as the ability to drive safely, when warning sounds are harder to hear.

How to cope with hearing loss

If you notice signs of hearing loss, talk with your doctor. If you have trouble hearing, you should:

Let your family and friends know you have a hearing problem.

Ask people to face you and to speak louder and more clearly. Ask them to repeat themselves or reword what they're saying.

Pay attention to what is being said and to facial expressions or gestures.

Let the person talking know if you do not understand what was said.

Find a good location to listen. Place yourself between the speaker and sources of noise or look for quieter places to talk.

The most important thing you can do if you think you have a hearing problem is to seek professional advice. Your family doctor may be able to diagnose and treat your hearing problem. Or your doctor may refer you to other experts, like an otolaryngologist (ear, nose, and throat doctor) or an audiologist (health professional who can identify and measure hearing loss).

Devices to help with hearing loss

Many types of assistive devices are available to help people with hearing loss. These devices can amplify sounds, provide alerts, and help you communicate with others. For example, alert systems work with doorbells, smoke detectors, and alarm clocks to send visual signals or vibrations. Devices that use keyboards, touch screens, or text-to-speech technology can help you give and receive information more effectively. Learn more about the wide range of assistive devices available for people with hearing loss from the National Institute on Deafness and Other Communication Disorders.

Hearing aids are electronic, battery-run assistive devices that make some sounds louder. There are two main ways to get a hearing aid: by prescription or over the counter.

An audiologist or hearing aid specialist can prescribe hearing aids for people with significant or complicated hearing loss. Prescription hearing aids require a medical exam, and then the health care professional will fit and adjust the device.

Hearing aids have recently become available without a prescription. Over-the-counter hearing aids, which are sold in stores and online, may help people with mild to moderate hearing loss.

Before buying a hearing aid, find out if your health insurance will cover part of the cost.

A cochlear implant is a different type of assistive device that can help people who are profoundly deaf or hard of hearing. Whereas hearing aids make sound louder so damaged ears can hear it, cochlear implants create electric signals that the brain recognizes as sound. The implant requires surgical placement and hearing therapy.

If you are experiencing hearing loss, talk with your doctor about assistive devices that may be available to help.

How to talk with someone who has hearing loss

Here are some tips you can use when talking with someone who has a hearing problem:

In a group, make a point to include people with hearing loss in the conversation.

Find a quiet place to talk to help reduce background noise, especially in restaurants and at social gatherings.

Stand in good lighting and use facial expressions or gestures to give clues.

Face the person and speak clearly. Maintain eye contact.

Speak a little louder than normal, but don't shout.

Try to speak naturally and at a reasonable speed.

Do not hide your mouth, eat, or chew gum while speaking.

Repeat yourself if necessary, using different words.

Try to make sure only one person talks at a time.

Be patient. People with hearing loss may also be frustrated by their condition. Stay positive and relaxed.

Ask how you can help.

You may also be interested in

For more information

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

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Hearing Loss: A Common Problem for Older Adults

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Learn about the types of hearing loss in older adults, devices that can help, and tips for coping with hearing loss.

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Physicians can examine ears with otoscopes, which are small tools that can fit in the ear canal to magnify and illuminate the inner ear for closer analysis. They may find inflammation, swelling, blockage, or lack of hair cells that would indicate presbycusis.

Sources: https://my.clevelandclinic.org/health/diseases/5840-age-related-hearing-loss#diagnosis-and-tests

https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=85&ContentID=P00463

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What are symptoms of presbycusis?

The most obvious symptom is not being able to hear as well as you used to. Presbycusis symptoms develop gradually. You may be developing age-related hearing loss if you:

Can't hear certain high-pitched sounds like birds singing or alarms.

Always need to increase the volume on your cell phone, television, computer or tablet.

Have tinnitus.

Have trouble understanding what people are saying when you're in a crowded room or a noisy place like a restaurant.

What causes presbycusis?

Presbycusis is a type of sensorineural hearing loss, or hearing loss that happens when something damages your inner ear. Risk factors for presbycusis include:

A family history of hearing loss: Age-related hearing loss can run in families. If some of your family members developed hearing loss as they grew older, chances are you'll have the condition, as well.

Ototoxicity: This is inner ear damage that may be a side effect of certain medications.

Noise exposure: Research shows people with noise-induced hearing loss often develop more severe age-related hearing loss.

Research suggests there's a relationship between some medical conditions and age-related hearing loss, including:

What are complications of this condition?

Presbycusis does more than take away your ability to hear. If you have trouble hearing, you may feel anxious about talking to others because you strain to understand what they're saying. Research shows having presbycusis increases your risk of developing:

Social isolation.

Mental health issues like anxiety disorder or depression.

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Presbycusis (age-related hearing loss) is the most common reason people lose their hearing. Symptoms develop gradually. There's no cure, but hearing aids may help.

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An audiologist may use an audiometer test, where sounds and tones are played through earphones. The patient can express what they can and cannot hear, demonstrating what volumes and frequencies are in their hearing range.

Sources:

https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=85&ContentID=P00463

https://www.mayoclinic.org/diseases-conditions/hearing-loss/diagnosis-treatment/drc-20373077

# data[].attributes.attachment_link.readable_text
What is presbycusis?

Age-related hearing loss (presbycusis) is the slow loss of hearing in both ears. It's a common problem linked to aging. About 1 in 3 adults between the ages of 65 and 74 have hearing loss.

This hearing loss happens slowly. So some people are not aware of the change at first. Most often, it affects the ability to hear high-pitched noises, such as a phone ringing or a microwave beeping. The ability to hear low-pitched noises is often not affected.

What causes age-related hearing loss?

There may be many causes for age-related hearing loss. It most often occurs because of changes in the following areas:

Other things that affect age-related hearing loss:

Long-term exposure to loud noise (such as music or work-related noise)

Loss of hair cells (sensory receptors in the inner ear) that help you to hear

Inherited factors

Some health conditions, such as heart disease or diabetes

Side effects of some medicines, such as aspirin, chemotherapy medicines, and certain antibiotics

Being white

Lower income level

Infections

What are the symptoms of age-related hearing loss?

Each person's symptoms may vary. Some of the most common symptoms include:

Other people's speech sounds mumbled or slurred

Having trouble hearing high-pitched sounds

Having trouble understanding conversations, often when there is background noise

Men's voices are easier to hear than women's

Some sounds seem very loud and annoying

A ringing sound (tinnitus) in one or both ears

The symptoms of age-related hearing loss may seem like other health problems.

If sudden hearing loss occurs, it's important to contact your healthcare provider right away. Your provider will do a medical exam and a hearing exam as soon as possible to help find the cause and type of your sudden hearing loss. Based on your diagnosis, your provider will discuss possible treatments.

How is age-related hearing loss diagnosed?

Your healthcare provider will use a lighted scope (otoscope) to check in the outer ear canal and to look at the eardrum. They will look for damage to the eardrum, blockage of the ear canal from foreign objects or impacted earwax, and inflammation or infection.

You may be referred to a hearing specialist (audiologist) to have an audiogram. For this test, sounds are played through headphones, to one ear at a time. You are asked if you can hear each sound. If you can't hear certain tones this may mean there has been some hearing loss.

How is age-related hearing loss treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment options for age-related hearing loss may include:

Hearing aids

Assistive devices, such as telephone amplifiers or technology that changes spoken words to text

Training to use visual cues to figure out what is being said (speech reading)

Methods to prevent too much wax in the outer ear

What are possible complications of age-related hearing loss?

If your hearing loss is significant enough, you may need some type of hearing aid or other aids to communicate with others.

Hearing loss in older adults can:

Cause problems with receiving and understanding important information, such as financial, health, and legal information.

Limit the person's interaction with family, friends, and agencies. This can result in loneliness, isolation, and depression.

Cause the person to avoid important meetings, such as medical follow-ups, because of embarrassment over the hearing problem.

Pose a safety risk if the hearing loss is severe enough. For instance, if sounds, such as car horns or smoke alarms, can't be heard.

What can I do to prevent age-related hearing loss?

The most important way to prevent age-related hearing loss is to protect your hearing.

Keep the volume of earbuds and headsets at a safe level

Stay away from loud noises and reduce noise exposure

Get timely care for health problems, such as ear infections

Wear ear plugs or special fluid-filled earmuffs (to prevent more damage to hearing)

Living with age-related hearing loss

If you have hearing loss, your healthcare professional can refer you to specialists in hearing loss, such as an:

Otolaryngologist. This is a doctor who specializes in diseases and conditions of the ears, nose, and throat. They are sometimes called an ENT.

Audiologist. This is a healthcare professional who specializes in testing and managing hearing problems.

In addition to getting medical follow-up, you can also:

Tell family and friends about the problem so they can help you cope.

Ask people to face you when they talk so you can see their faces. Watching expressions and facial movements can help you understand the conversation better.

Explain to people that they don't have to speak slowly or shout, just speak louder.

Turn off the TV when you are not watching.

Be aware of the impact of your environment on your hearing. In a restaurant, don't sit next to a band or the kitchen. Background noise makes hearing more difficult.

Key points about age-related hearing loss

Age-related hearing loss is the slow loss of hearing in both ears.

It's a common problem that happens with aging. About 1 in 3 adults between the ages of 65 and 74 have hearing loss.

The hearing loss happens slowly. So some people are not aware of the change at first.

Staying away from constant or continuous exposure to loud noises can help protect your hearing and prevent gradual hearing loss.

It's not a reversible condition so prevention is important.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your provider if you have questions.

Medical Reviewers:

# data[].attributes.attachment_link.title
Content - Health Encyclopedia - University of Rochester Medical Center

# data[].attributes.attachment_link.description
Age-related hearing loss (presbycusis) is the slow loss of hearing in both ears. It’s a common problem linked to aging. About 1 in 3 adults between the ages of 65 and 74 have hearing loss.

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Acute treatment age related hearing loss (hearing aids) 

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Acute treatment age related hearing loss (hearing aids) 

# data[].attributes.body
Although there are many options to improve your hearing, Hearing aids are the best acute symptom management for age-related hearing loss. This is because they provide immediate amplification of sounds, helping individuals hear better in various environments. They also improve speech understanding, reduce strain, and enhance overall communication, allowing users to maintain social interactions and daily activities despite gradual hearing decline. There is so many good things about hearing aids including they’re customizable, discreet, and help maintain social connections, mental health, and safety by amplifying important sounds in daily life especially high pitch sounds which seems to be the largest problem.

-Kierra Blundell

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Hearing Loss Aging and Hearing

What is presbycusis?

Age-related hearing loss (presbycusis) is the slow loss of hearing in both ears. It's a common problem linked to aging. About 1 in 3 adults between the ages of 65 and 74 have hearing loss.

This hearing loss happens slowly. So some people are not aware of the change at first. Most often, it affects the ability to hear high-pitched noises, such as a phone ringing or a microwave beeping. The ability to hear low-pitched noises is often not affected.

What causes age-related hearing loss?

There may be many causes for age-related hearing loss. It most often occurs because of changes in the following areas:

Other things that affect age-related hearing loss:

Long-term exposure to loud noise (such as music or work-related noise)

Loss of hair cells (sensory receptors in the inner ear) that help you to hear

Inherited factors

Some health conditions, such as heart disease or diabetes

Side effects of some medicines, such as aspirin, chemotherapy medicines, and certain antibiotics

Being white

Lower income level

Infections

When Grandpa Can't Hear Words at a Noisy Holiday Gathering, Too Many Brain Cells May Be Firing at Once, Say Researchers

What are the symptoms of age-related hearing loss?

Each person's symptoms may vary. Some of the most common symptoms include:

Other people's speech sounds mumbled or slurred

Having trouble hearing high-pitched sounds

Having trouble understanding conversations, often when there is background noise

Men's voices are easier to hear than women's

Some sounds seem very loud and annoying

A ringing sound (tinnitus) in one or both ears

The symptoms of age-related hearing loss may seem like other health problems.

If sudden hearing loss occurs, it's important to contact your healthcare provider right away. Your provider will do a medical exam and a hearing exam as soon as possible to help find the cause and type of your sudden hearing loss. Based on your diagnosis, your provider will discuss possible treatments.

How is age-related hearing loss diagnosed?

Your healthcare provider will use a lighted scope (otoscope) to check in the outer ear canal and to look at the eardrum. They will look for damage to the eardrum, blockage of the ear canal from foreign objects or impacted earwax, and inflammation or infection.

You may be referred to a hearing specialist (audiologist) to have an audiogram. For this test, sounds are played through headphones, to one ear at a time. You are asked if you can hear each sound. If you can't hear certain tones this may mean there has been some hearing loss.

How is age-related hearing loss treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment options for age-related hearing loss may include:

Hearing aids

Assistive devices, such as telephone amplifiers or technology that changes spoken words to text

Training to use visual cues to figure out what is being said (speech reading)

Methods to prevent too much wax in the outer ear

What are possible complications of age-related hearing loss?

If your hearing loss is significant enough, you may need some type of hearing aid or other aids to communicate with others.

Hearing loss in older adults can:

Cause problems with receiving and understanding important information, such as financial, health, and legal information.

Limit the person's interaction with family, friends, and agencies. This can result in loneliness, isolation, and depression.

Cause the person to avoid important meetings, such as medical follow-ups, because of embarrassment over the hearing problem.

Pose a safety risk if the hearing loss is severe enough. For instance, if sounds, such as car horns or smoke alarms, can't be heard.

What can I do to prevent age-related hearing loss?

The most important way to prevent age-related hearing loss is to protect your hearing.

Keep the volume of earbuds and headsets at a safe level

Stay away from loud noises and reduce noise exposure

Get timely care for health problems, such as ear infections

Wear ear plugs or special fluid-filled earmuffs (to prevent more damage to hearing)

Living with age-related hearing loss

If you have hearing loss, your healthcare professional can refer you to specialists in hearing loss, such as an:

Otolaryngologist. This is a doctor who specializes in diseases and conditions of the ears, nose, and throat. They are sometimes called an ENT.

Audiologist. This is a healthcare professional who specializes in testing and managing hearing problems.

In addition to getting medical follow-up, you can also:

Tell family and friends about the problem so they can help you cope.

Ask people to face you when they talk so you can see their faces. Watching expressions and facial movements can help you understand the conversation better.

Explain to people that they don't have to speak slowly or shout, just speak louder.

Turn off the TV when you are not watching.

Be aware of the impact of your environment on your hearing. In a restaurant, don't sit next to a band or the kitchen. Background noise makes hearing more difficult.

Key points about age-related hearing loss

Age-related hearing loss is the slow loss of hearing in both ears.

It's a common problem that happens with aging. About 1 in 3 adults between the ages of 65 and 74 have hearing loss.

The hearing loss happens slowly. So some people are not aware of the change at first.

Staying away from constant or continuous exposure to loud noises can help protect your hearing and prevent gradual hearing loss.

It's not a reversible condition so prevention is important.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your provider if you have questions.

Age-Related Hearing Loss (Presbycusis)

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Age-related hearing loss (presbycusis) is the gradual loss of hearing in both ears. It's a common problem linked to aging.

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This video further brings awareness to the impacts of hearing loss among adults over 60 years old, and how effects like lower IQ, socialization issues, and healthcare costs can seem to have a "domino effect" on their health.

Source:https://www.youtube.com/watch?v=R2iffWpxXgo

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The Health Impacts of Age-Related Hearing Loss (CC)

# data[].attributes.body
People struggling with age-related hearing loss have a harder time socializing, because having a normal conversation is more difficult. Conversation don't feel as natural as it used to since they may need to ask people to repeat themselves, speak louder, or slower. This can be overwhelming for someone experiencing hearing loss, especially when they may also have to deal with background noise. Once someone with hearing-loss starts avoiding socialization, this puts them at a higher risk of developing different disorders and problems. Dementia, poor eating habits, lack of exercise, depression, poor sleep, and heart disease can occur once someone avoids socialization.

Source: Johns Hopkins

https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-hidden-risks-of-hearing-loss

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The social & emotional impact of hearing loss.

# data[].attributes.subject
The social & emotional impact of hearing loss.

# data[].attributes.body
This is an additional video which helps explain the consequences hearing-loss can have on a person's social life and emotional wellbeing.

Source: YouTube

The social & emotional impact of hearing loss.

# data[].attributes.attachment_link.title
The social & emotional impact of hearing loss.

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Long term consequences of balance/ walking issues or likely hood of falling with ARHL

# data[].attributes.subject
Long term consequences of balance/ walking issues or likely hood of falling with ARHL

# data[].attributes.body
Age-related hearing loss can contribute to balance and walking issues, increasing the likelihood of falls. Hearing loss may reduce spatial awareness and the ability to detect environmental sounds, making it harder to adjust to changes in terrain or avoid obstacles. Additionally, it can affect coordination and increase the risk of accidents. Over time, these issues can lead to a loss of independence, a decline in physical activity, and a higher risk of injury due to falls. Proper management and interventions can help mitigate these risks.

https://www.sciencedirect.com/science/article/pii/S0966636224005137#:~:text=Hearing%20loss%20(HL)%20is%20prevalent,of%20falls%20in%20older%20individuals.

-Kierra Blundell

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Acute treatment age related hearing loss (Assistive devices) 

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Acute treatment age related hearing loss (Assistive devices) 

# data[].attributes.body
There are five general types of assistive listening devices: audio induction (also called a hearing) loop, FM system, infrared system, personal amplified system and Bluetooth systems. The best assistive listening device depends on an individual needs, but FM systems are often considered highly effective due to their versatility, range, and ability to work in various settings like classrooms or theaters for example. They transmit clear sound over long distances, even in noisy environments, providing better clarity and convenience for users which is one thing people with age related hearing loss really struggle with.

https://mn.gov/deaf-hard-of-hearing/assistive-technology/assistive-listening-devices/#:~:text=There%20are%20five%20general%20types,amplified%20system%20and%20Bluetooth%20systems.

-Kierra Blundell

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Interesting in hearing better in group settings? You may want look into FM and DM systems. Using microphones and receivers (including hearing aids), these systems help you hear better and reduce background noise. Common in school settings, they help filter out unwanted noise.

Both systems improve the signal-to-noise ratio, explains clinical audiologist Sarah Sparks, Au.D, founder of Audiology Outside the Box PLLC in Washington, DC.

"They take sound that is farther away and bring it closer to the listener," Sparks says.

Find out more about how these systems work, along with who might consider taking advantage of them, when FM/DM systems are ideal for use, and more.

What exactly are FM/DM systems?

Teachers or other speakers can wear a
remote microphone that transmits sound
via FM/DM signals to a person's hearing
aid or similar device.
Photo courtesy of Oticon

The FM stands for "frequency modulation" and DM stands for "digital modulation."

Here's how it works: The speaker uses a microphone, while the listener wears a receiver. The receiver can be a simple pair of headphones, ear-level receivers that deliver the sound into the ears, or a hearing device, such as cochlear implants or hearing aids, Sparks explains.

An FM or DM system "is not a substitute for a hearing aid," says Rhee Nesson, AuD, founder of Hearing Doctors of New Jersey -but these devices are often added to hearing aids, she says.

FM vs. DM

If you see "FM" and think "radio" you're on the right track-this type of system uses FM radio signals designated by the FCC to transmit sound, Nesson says.

DM systems use similar digitized signals, and tend to have better sound quality while avoiding potential for interference (think: the staticky sound of another FM station coming through), Sparks says.

"My own experience of using DM systems is that their sound quality is significantly clearer than that of FM systems, which reduces the challenges of the listening situation," Sparks, who is deaf, notes.

Note: While they use different signals, perhaps since they operate fairly similarly, and FM has been around for a while, both systems are often referred to as FM. Audiologists and hearing instrument specialists prefer the term "remote microphone hearing assistive technology" (RM-HAT), since it's inclusive of both types of systems.

Who benefits from using one? / Who should consider using FM/DM systems?

There's a wide range of people who might benefit from using an FM/DM system:

Students

FM/DM systems are often used with children who are deaf or hard of hearing.

"Children that don't have hearing loss sometimes would benefit from an FM system as well," Nesson says-that includes both children with an auditory processing disorder or students with difficulty hearing when there is background noise.

"For children in schools, these systems are often included in IEPs and 504 plans," Sparks says. These plans put in place legally binding required accommodations to help kids with hearing loss.

Hearing aid candidates

At panel conversations, church, concerts, and other situations where hearing may be a challenge, adults who are hearing aid candidates might take advantage of these devices.

"Sometimes, asking for accessibility devices like FM and DM can be the beginning of a person's journey toward having their hearing tested and being fit with appropriate hearing devices," Sparks says.

Adults with hearing aids in crowded settings

If you are fitted with hearing aids, using an FM/DM system can help reduce background noise. So in tricky hearing environments-such as a loud restaurant-having your dining companion wear a microphone can help. Your hearing aid manufacturer likely sells its own clip-on microphone device.

More: Wear hearing aids? Here's why you may want a remote microphone

Anyone, really

Even people with no difficulty hearing can benefit when FM/DM microphones are connected to loudspeakers and used in auditoriums, Sparks points out-that includes people with ADHD or auditory processing disorders, and non-native speakers. "Having a clearer and more accessible sound signal can help with understanding of the message," she says. This also reduces listening fatigue.

It's more common for kids to use FM/DM systems. "But that's not because adults don't benefit!" Sparks says-she notes that adults might have to put in some legwork, asking for them to be provided.

"Because of the stigma that is attached to reduced hearing sensitivity, many adults are hesitant to request these types of accommodations for work and university-level education," she notes.

How do they work?

The simple version is as stated above: A microphone and receiver are paired up. But of course, there's a bit more to it than that.

There are several types of microphones that can be used with these systems:

Table-top microphone: When placed in the center of a table, these mics will pick up all the voices at the table. These are suitable for conference rooms or quiet restaurants. Some feature omnidirectional sound, picking up sounds in all directions. Others "might have a pointing option where the accelerometer in the microphone allows it to change directionality and pick up sound in the direction that it is pointing, but then return to omnidirectional mode when it is flat on a table," Sparks says.

Clip-on or lapel microphones: These hang around a person's neck on a lanyard or are clicked to the speaker's shirt at chest-level. Make sure they're within six inches of the speaker's mouth for the strongest possible speech signal.

Handheld: This type of microphone can be passed around.

Boom microphone: These microphones hang off the ear, positioned about three inches away from the face. Picture the style of microphone that pop singers or customer service representatives wear.

"For some DM systems, multiple types of microphones can be linked to each other within a single system so that listeners can hear from different speakers at different times," Sparks says.

Then, there's the receiver end:

Ear-level receivers: "Ear-level receivers can be attached to hearing aids and cochlear implant processors so that deaf and hard of hearing people can receive the sound signal directly," Sparks says. Sometimes referred to as a "hearing aid boot," ear-level receivers are the most integrated solution for people who wear hearing aids. Children with hearing loss wear these receivers in school. But, they're also available for people without hearing problems, Sparks says.

Neckloop receivers: This type of receiver, also called an induction loop, is worn around the neck and transmits the signal to your hearing aids via electromagnetic energy. This receiver requires the use of telecoil in your hearing aids. Or, for people with typical hearing, they can be attached to headphones, Sparks says.

Loudspeakers: Sounds can also be transmitted to loudspeakers throughout a space.

Body-worn receiver: Body-worn receivers can be slipped into a pocket or clipped to a waistband. Although bulkier, they are portable. Paired with traditional headphones, they are a perfect solution for someone who does not wear hearing aids, or is temporarily without hearing aids during a repair. Physicians often use this type of receiver to talk with patients who have hearing loss but don't wear hearing aids.

Plus, some systems can be paired with other technology-for instance, Sparks pairs her DM system with her laptop and uses it during video chats.

Where you can use FM/DM systems

Movie theaters and other venues often
have accessibility systems for people
with hearing loss.

These can easily be used in many locations, including:

Theaters and auditoriums: Many large auditoriums have the capabilities to provide excellent sound quality without interference. FM technology in a movie or theater setting allows you to use your hearing aid with an FM receiver, and the signal goes straight through to the device so that the sound is clear. For those who don't wear hearing aids, FM systems paired with traditional headsets may be available for you to wear during the show. Don't be shy-ask at the box office.

Classrooms and lecture halls: Some classrooms use a sound-field amplification system so that all children may benefit from an amplification of the teacher's voice. A sound-field amplification system uses a microphone to amplify the speaker's voice through a loudspeaker system that is positioned strategically in the classroom. This way all students can benefit from the amplification, and kids with hearing loss are freed from the burden of wearing a special receiver.

Restaurants: Once you have the equipment, you can use either a tabletop microphone or one that's worn by the speaker during meals.

These systems are useful whenever there's background noise and you want to listen to one other person, Sparks says. In some cases, ADA accessibilty laws may stipulate that FM/DM systems are provided.

How much do they cost?

FM systems can be purchased online, in electronics stores and through your local hearing healthcare professional. If you don't know how to get started or what device might work best for you, talk to your hearing care practitioner, and ask for a demonstration.

"An audiologist would be able to tell a person which receiver is most appropriate for their needs," Sparks says. You'll also need the microphone (which often can pair with several different receivers).

Be prepared for a wide price range with these devices, which can cost as low as $150 or be several thousand dollars.

Madeleine Burry is a Brooklyn-based freelance writer and editor. She's written about health for several online publications, including Women's Health, Prevention, Health, Livestrong and Good Housekeeping. You can follow her on Twitter @lovelanewest. Read more about Madeleine.

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Personal FM systems reduce background noise, improve clarity and reduce listening fatigue. Find out if this tried-and-true technology can help you or your child hear better.

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Cochlear implants generally cost between $30,000 and $50,000, including surgery, device, and follow-up care. Insurance coverage varies, but many plans do offer partial or full coverage for medically necessary implants. Without treatment, untreated hearing loss can lead to significant social isolation, difficulty communicating, and cognitive decline, potentially affecting job performance and overall quality of life. Over time, the impact of untreated hearing loss may become more severe, making treatment more difficult and expensive.

https://www.babyhearing.org/devices/cochlear-implant-cost#:~:text=How%20much%20do%20cochlear%20implants,provide%20coverage%20for%20cochlear%20implants.

-Kierra Blundell

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Mental health counseling is extremely helpful for those experiencing hearing loss. This kind of counseling attempts to provide patients with coping mechanisms to help with the emotional struggles of hearing loss. This can include ways to deal with isolation and embarrassment that can come with hearing loss. The main goal of this counseling is to help patients find meaning in their lives and even meaning in their ailment.

The professional best equipped to provide this form of counseling is a counselor, phycologist, psychiatrist, or therapist familiar with hearing loss and the struggles that accompany it.

Source: NCOA

https://www.ncoa.org/article/can-hearing-loss-affect-mental-health-in-older-adults/

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Support group programs for those with ARHL can help people to find community with others who face similar struggles. They can communicate and provide comfort to one another so that they can work through the problems that come with hearing loss. Ultimately, this can create a sense of confidence and reassurance so that they socialize more often with loved ones, reduce depression, and experience a better quality of life. Social workers and mental health counselors can lead this rehabilitation.

Sources:

https://pmc.ncbi.nlm.nih.gov/articles/PMC4459777/#:~:text=The%20purpose%20of%20group%20audiologic,situations%20(Hogan%2C%202001).

https://pmc.ncbi.nlm.nih.gov/articles/PMC5849471/

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Do Group Audiologic Rehabilitation Activities Influence Psychosocial Outcomes?

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To attempt to determine whether group audiologic rehabilitation (AR) content affected psychosocial outcomes. A randomized controlled trial with at least 17 participants per group was completed. The 3 treatment groups included a communication…

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What type of professional would be able to deliver the treatment

# data[].attributes.subject
What type of professional would be able to deliver the treatment

# data[].attributes.body
The two psychosocial rehabilitations we chose were mental health counseling and group therapy. In mental health counseling multiple different fields could treat it. For example, psychiatrists, psychologists, social workers, counselors, and psychiatric nurses. The most common one would be a counsellor because that is what many people will be comfortable with. Group therapy is very similar although the professionals that would treat this consist of a clinical psychologist, psychiatrist, social worker, psychiatric nurse, or marriage and family therapist. Picking the right professional will all depend on what you are comfortable with and what is moat available to you!

-https://www.nami.org/about-mental-illness/treatments/types-of-mental-health-professionals/

By:Kierra Blundell

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National Institute of Mental Health (NIMH)

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Learn about psychotherapies (talk therapy) such as what it is, considerations when looking for a therapist, & resources for finding help & more information.

# data[].attributes.body
Speech reading is a form of speech rehibition for those experiencing hearing loss. Speech reading is the reading of visual ques to read a person's lips. This can be used in combination with assistive devices (like telephone amplifiers) to improve one's speech abilities. Speech reading helps with the long-term social isolation which can accompany hearing loss. Hearing loss can make holding conversations difficult which can cause social isolation. So, speech reading is one way to help someone with hearing loss regain their confidence while speaking to others.

Otolaryngologists are specialists who can help a patient learn to speech read, and audiologists help to distribute assistive devices.

Source: Johns Hopkins

https://www.hopkinsmedicine.org/health/conditions-and-diseases/presbycusis

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The most common treatment for someone with hearing loss is auditory rehabilitation therapy. This therapy focuses on improving the individual's ability to understand and process speech, often using hearing aids, speechreading, or auditory training exercises. It is designed to address the communication challenges caused by hearing impairment, such as difficulty understanding conversations or following complex discussions. A Short-term effect would include increased awareness of sounds. Although a long-term effect may include improved speech comprehension and better communication skills which is key in day to day life. The professional to treat this would be a an audiologist or speech-language pathologist. They will use customized plans to meet the individual's unique needs.

https://www.nidcd.nih.gov/health/who-can-i-turn-help-my-hearing-loss

https://www.mayoclinic.org/diseases-conditions/hearing-loss/symptoms-causes/syc-20373072

-Kierra Blundell

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Cognitive rehabilitation for people with ARHL consists of memory, attention, and speed of processing training. Puzzles and visual memory games may be used to improve neural responses. This can treat cognitive decline and combat the long-term risk of dementia in those with hearing loss. Audiologists and neuropsychologists can deliver this treatment.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC6088475/#:~:text=Computer%2Ddelivered%20cognitive%20training%20may,improving%20cognition%20in%20this%20population.

# data[].attributes.attachment_link.readable_text
Abstract

This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray literature (e.g., OpenGrey) identified relevant articles published up to January 25, 2018. Randomized controlled trials (RCTs) or repeated measures designs were included. Outcome effects were computed as Hedge's g and pooled using random-effects meta-analysis (PROSPERO: CRD42017076680). Nine studies, five auditory training, and four cognitive training met the inclusion criteria. Following auditory training, the pooled effect was small and statistically significant for both working memory ( g = 0.21; 95% CI [0.05, 0.36]) and overall cognition ( g = 0.19; 95% CI [0.07, 0.31]). Following cognitive training, the pooled effect for working memory was small and statistically significant ( g = 0.34; 95% CI [0.16, 0.53]), and the pooled effect for overall cognition was large and significant ( g  = 1.03; 95% CI [0.41, 1.66]). However, this was dependent on the classification of training approach. Sensitivity analyses revealed no statistical difference between the effectiveness of auditory and cognitive training for improving cognition upon removal of a study that used a combined auditory-cognitive approach, which showed a very large effect. Overall certainty in the estimation of effect was "low" for auditory training and "very low" for cognitive training. High-quality RCTs are needed to determine which training stimuli will provide optimal conditions to improve cognition in adults with hearing loss.

Keywords: rehabilitation, intervention, working memory, transfer of learning, hearing aid

Introduction

Ageing is associated with a gradual decline in hearing ( Liu & Yan, 2007) and cognitive function ( Bishop, Lu, & Yankner, 2010). Approximately 500 million people live with hearing loss globally, and this figure is expected to rise with the ageing population ( Wilson, Tucci, Merson, & O'Donoghue, 2017). Prevalence of dementia (including Alzheimer's disease) has increased rapidly in recent years and is currently the second leading cause of death in Australia ( Australian Bureau of Statistics, 2017). Estimates suggest that more than 30% of older adults live with moderate hearing loss ( Lin et al., 2013), which may be associated with, or compounded by, progressive cognitive decline ( Loughrey, Kelly, Kelley, Brennan, & Lawlor, 2017; Taljaard, Olaithe, Brennan-Jones, Eikelboom, & Bucks, 2016). Hearing loss is the highest modifiable midlife risk factor for dementia in later life ( Livingston et al., 2017). Early management or prevention of hearing loss ( World Health Organization, 2017) and cognitive decline ( Shah et al., 2016) are more cost-effective than delayed treatment; have been reported as patient, family, and clinician priorities for research ( Henshaw, Sharkey, Crowe, & Ferguson, 2015b); and are likely to improve quality of life for older adults.

Cross-sectional and longitudinal studies report increased risk of mild cognitive impairment, all-cause dementia, and Alzheimer's disease among older adults with hearing loss ( Jayakody, Friedland, Eikelboom, Martins, & Sohrabi, 2017a; Lin et al., 2011a, 2011b, 2013). Improvements in cognition have been suggested following management with hearing aids ( Dawes et al., 2015) and cochlear implants ( Jayakody et al., 2017b; Mosnier et al., 2015). However, meta-analytic evidence of 33 studies showed that for individuals with treated and untreated hearing loss, cognitive function (e.g., attention, short-term memory, executive function) was poorer compared with adults with normal hearing ( Taljaard et al., 2016). Hearing impairment was also associated with worse performance across all cognitive domains ( Taljaard et al., 2016). These results provide evidence of an association between hearing loss and cognitive decline in older adults. Despite amplification with hearing aids being shown to be effective at improving listening abilities, and hearing- and health-related quality of life for adults with hearing loss ( Ferguson et al., 2017), more research is needed to determine the therapeutic potential of additional or alternative techniques (e.g., auditory training or cognitive training) to elicit optimal conditions for neural plasticity and associated improvements in cognitive function.

Auditory training refers to active engagement with sounds, whereby trainees learn to make distinctions between sounds presented systematically ( Schow & Nerbonne, 2006). Traditionally, the goal of auditory training is to improve (bottom-up) sensory refinement of (often speech) sounds. However, there is a growing body of literature assessing auditory training-related top-down (cognitive) control processes important for listening, particularly in challenging listening situations ( Ferguson & Henshaw, 2015; Pichora-Fuller & Levitt, 2012). Cognitive training refers to engagement with standardized, cognitively challenging tasks, to improve (or "exercise") different cognitive functions ( Lampit, Hallock, & Valenzuela, 2014). Both approaches aim to exploit neural plasticity to improve function. There are also some training programs available that combine auditory and cognitive stimuli, for example, the Earobics program ( Ingvalson, Young, & Wong, 2014).

The concept of neural plasticity is of most importance for older adults who frequently experience gradual neurodegeneration as part of normal ageing ( Cabeza, Anderson, Locantore, & Mcintosh, 2002). Neural plasticity is the adaption of anatomical structures (e.g., neurons, glial cells, synapses) and physiological processes (e.g., auditory perception, memory consolidation) following active engagement in an activity requiring the use of perceptual or cognitive resources ( Cai, Chan, Yan, & Peng, 2014; Tremblay, 2007). When an individual acquires new knowledge/skills in response to training, the information can either strengthen existing neural pathways and networks or lead to the creation of new neural circuits and synapses ( Wall, Xu, & Wang, 2002). During computer-delivered auditory training and cognitive training, an individual is exposed to repeated stimuli and required to practice activities that train auditory perception ( Tremblay, 2007) and cognitive abilities ( Shah, Weinborn, Verdile, Sohrabi, & Martins, 2017). Active engagement in training may therefore produce plastic changes in the brain by exposing older adults to novel stimuli and leading to improvements in auditory or cognitive function.

To determine whether auditory or cognitive training is effective, researchers can examine improvements in the tasks that are trained (on-task learning) and the transfer of learning to untrained (off-task) outcomes ( Ferguson, Henshaw, Clark, & Moore, 2014), with the latter holding the most promise for real-world benefits that extend beyond the training task (e.g., general cognitive performance or practical skills for daily living; Henshaw & Ferguson, 2014). The efficacy of home-based interventions is also reliant on participant adherence to training ( Chisolm et al., 2013). After all, an intervention can only ever be effective if it is used. It is therefore important that researchers report, and systematic reviews summarize, the extent to which participants adhere to auditory and cognitive training regimes and whether these interventions initially elicit on-task learning that transfers to improvement in off-task cognitive outcomes.

There has been a steady increase in research examining the potential of home-based computer-delivered auditory training for improving speech perception (and potentially cognition) in adults with hearing loss. Initial research reported beneficial effects of computer-delivered auditory training on speech perception and cognition in people with hearing loss ( Sweetow & Henderson Sabes, 2006), and the methodological parameters of the intervention (home-based, remotely monitored) appealed to researchers and clinicians ( Henshaw, Clark, Kang, & Ferguson, 2012). The increased popularity of these interventions led Henshaw and Ferguson (2013a) to review the evidence. Although most of the 13 studies reported improved speech intelligibility postintervention, only one study included standardized cognitive outcome measures, and the overall quality of evidence for studies included in the review was weak ( Henshaw & Ferguson, 2013a). The authors concluded a need for well-designed and well-conducted randomized controlled trials (RCTs) to provide a more reliable estimate of the therapeutic potential of computer-delivered auditory training for improving auditory perception and cognitive function in those with hearing loss ( Henshaw & Ferguson, 2013a). Since that review, more high-quality RCTs ( Ferguson et al., 2014; Saunders et al., 2016) and other studies (e.g., Ferguson & Henshaw, 2015; Henshaw & Ferguson, 2014; Krishnamurti, Tingle, Bannon, & Armstrong, 2015) have examined computer-delivered auditory training and its effects on outcomes including cognition, but findings are mixed; therefore, a systematic review and meta-analysis of the results is warranted.

Computer-delivered cognitive training improves (on-task) cognition in healthy older adults ( Lampit et al., 2014) and in people with mild cognitive impairment ( Hill et al., 2016) and Parkinson's disease ( Lawrence, Gasson, Bucks, Troeung, & Loftus, 2017). Preliminary evidence in hearing loss suggests that computer-based cognitive training may improve (on-task) working memory ( Bansal, 2014; Oba, Galvin, & Fu, 2013), executive function, verbal memory, and attention in cochlear implant recipients ( Bansal, 2014). Research has also shown an association between cortical areas that contribute to auditory perception and performance of specific cognitive abilities (e.g., attention and working memory) in those with hearing loss. Anderson, White-Schwoch, Parbery-Clark, and Kraus (2013b) compared the beneficial effects of auditory-based cognitive training ("Brain Fitness") with an active control group and reported improved neural response timing to speech in noise and improved short-term memory and speed of processing posttraining. Reviews by Akeroyd (2008) and Lunner, Rudner, and Ronnberg (2009) also suggested that working memory is most frequently associated with an individual's improved speech recognition in noise and response to hearing aid processing of speech. Computer-delivered cognitive training may therefore improve cognition and auditory perception by training cognitive domains (e.g., working memory) associated with improved processing of speech in people with hearing loss.

To summarize, older adults frequently experience hearing loss and cognitive decline, and research shows a behavioral and potential pathophysiological association between the two. Home-based computer-delivered auditory training and cognitive training may provide optimal conditions to elicit neural plasticity and improve cognitive function in older adults with impaired hearing. However, the original systematic review by Henshaw and Ferguson (2013a) examined only auditory training interventions, and only one study included cognitive outcomes, which did not permit a meta-analysis of results. Moreover, there is no published systematic review or meta-analysis of cognitive training for improving cognition in adults with hearing loss. It therefore remains unclear whether auditory training or cognitive training is most efficacious for improving cognition in this population.

The primary aim of this systematic review and meta-analysis is to determine if auditory training or cognitive training can improve cognitive function in adults with hearing loss. The secondary aims are to determine which intervention is most efficacious for improving cognition in this population, whether beneficial effects are seen for on-task (trained) and off-task (untrained) outcomes, and whether participants adhere to an intervention with limited supervision.

Methods

Search Strategy

This systematic review was conducted in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) statement (see Supplementary Table 1; Moher, Liberati, Tetzlaff, & Altman, 2009) and was prospectively registered with PROSPERO (ID: CRD42017076680). Key terms were systematically searched in online databases (e.g., MEDLINE, Scopus) for published articles, gray literature (e.g., OpenGrey), and completed trials in preparation for publication (e.g., Clinicaltrials.gov). Search parameters were from first date of publication to January 25, 2018 and limited to adult participants and English language (see Supplementary Table 2). Reference lists of published articles were also searched.

Study Selection

Studies were included in the systematic review if they (a) recruited adult participants with postlingual hearing loss with or without hearing aids or cochlear implants, (b) evaluated home-based computer-delivered auditory training or cognitive training, (c) used an RCT or repeated measures design, and (d) used primary outcomes measured by standardized neuropsychological tests of cognitive function. For the purposes of this review, interventions were classified as either auditory or cognitive training based on the underlying training task constructs. Two lead authors (B. J. L. and D. M. P. J.) screened article titles and abstracts in line with selection criteria and identified preliminary articles for inclusion. Both authors then independently screened selected articles to determine the final studies for inclusion. Disagreements were resolved through discussion.

Data Extraction

The data extracted from each study included participants, interventions, comparisons, outcomes, and study design (PICOS; Moher et al., 2009). Participant adherence to a training intervention was also extracted. Cognitive outcomes were categorized in accordance with neuropsychological handbook recommendations ( Strauss, Sherman, & Spreen, 2006) and following methods from previous reviews of cognitive training ( Hill et al., 2016) and cognition/hearing loss in older adults ( Taljaard et al., 2016). Only three studies reported outcomes beyond those immediately postintervention. One cognitive training study reported outcome results at 1 month ( Oba et al., 2013) and another at 2 weeks and 6 months ( Henshaw & Ferguson, 2013b) postintervention; this difference in follow-up time did not permit examination of a pooled intervention effect. One auditory training study reported outcomes at 6 months postintervention ( Saunders et al., 2016). Corresponding authors were contacted when study information, participant characteristics, and necessary data to compute an effect size were not reported.

Quality of Evidence

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence ( Schünemann, Brozek, Guyatt, & Oxman, 2017). The GRADE system evaluates the quality of evidence across studies for each outcome included in a systematic review and is summarized by an overall "certainty of evidence" grading. Gradings range from "very low" to "high" and represent the extent of certainty in an outcome result as a reliable estimate of an intervention's true effect ( Schünemann et al., 2017).

Statistical Analysis and Publication Bias

Data analysis was completed using Comprehensive Meta-Analysis version 3.3.070 ( Borenstein, Hedges, Higgins, & Rothstein, 2011). For studies that used RCT designs, the change score method from pre- to postintervention was used to calculate the absolute magnitude of change between intervention and control groups. For repeated measures designs, pre- and postintervention means and standard deviations and the correlation between these scores were used to calculate the degree of change during the intervention. When studies did not report means and standard deviations, t statistics and probability levels for between-group tests were used to compute effect sizes ( Ray & Shadish, 1996). Effect sizes for each outcome were then computed as Hedge's g ( Borenstein et al., 2011). For studies that reported multiple conceptually related outcomes for individual cognitive domains, effect sizes were calculated by computing the mean effect within each domain and adjusting the mean variance by 0.8 to correct for intercorrelation among outcome. Domain effect sizes and adjusted variances were then pooled using a random-effects model, with 95% confidence intervals ( Borenstein et al., 2011; Hedges & Vevea, 1998). Mixed effects Q tests for between-groups analysis of variance was used to compare auditory training and cognitive training pooled effects ( Borenstein et al., 2011). Egger's regression asymmetry test and Fail-Safe N were used to assess publication bias ( Egger, Smith, Schneider, & Minder, 1997; Rosenthal, 1979).

Heterogeneity and Sensitivity Analyses

Cochrane's Q and I ² statistics were used to examine heterogeneity. A difference between an observed and true effect is measured by a statistically significant Q statistic (Huedo-Medina, Sánchez-Meca, Marín-Martínez, & Botella, 2006). However, the Q statistic may overestimate this difference in small sample sizes. If Q was statistically significant, the I ² statistic estimated the percentage of variation across the samples due to heterogeneity. I ² values of 0% to 40% (low), 41% to 60% (medium), and 61% to 100% (high) were used to categorize levels of heterogeneity ( Moher et al., 2009). For pooled effect estimates with statistically significant heterogeneity, sensitivity analyses were conducted to examine whether removing studies with anomalous characteristics (e.g., intervention type, participant subgroups) would account for the heterogeneity and impact pooled effects.

Results

Search Results

In total, 3,317 titles and abstracts were systematically screened in online databases. Fifty-three studies were retrieved for full-text evaluation. Forty-four were excluded as they did not include standardized neuropsychological outcomes measuring cognition (30), were not a home-based training intervention (7), did not include auditory or cognitive training (1), were a case-control design (2), were a review article (2), did not include participants with only postlingual hearing loss (1), or were a duplicate sample (1). Figure 1 provides the PRISMA flow chart for search results.

Figure 1.

PRISMA flow chart of search results.

PRISMA = Preferred Reporting of Systematic Reviews and Meta-Analyses.

Study Characteristics

Nine studies involving 620 participants met inclusion criteria (see Tables 1 and 2). Participants were typically older adults (age Myears = 64.81, SD = 5.14) with mild to severe hearing loss. Intervention and control group sample sizes ranged from 8 to 89 participants ( M = 51.67, SD = 25.99). Four studies included participants using hearing aids ( Henshaw & Ferguson, 2013b, 2014; Saunders et al., 2016; Sweetow & Henderson Sabes, 2006), one included cochlear implant recipients ( Oba et al., 2013), three included participants with no amplification ( Anderson, White-Schwoch, Choi, & Kraus, 2013a; Anderson et al., 2013b; Ferguson et al., 2014), and one did not report this information ( Krishnamurti et al., 2015).

Five studies examined auditory training ( Ferguson et al., 2014; Henshaw & Ferguson, 2014; Krishnamurti et al., 2015; Saunders et al., 2016; Sweetow & Henderson Sabes, 2006) and four examined cognitive training ( Anderson et al., 2013a, 2013b; Henshaw & Ferguson, 2013b; Oba et al., 2013). Six studies were RCTs ( Anderson et al., 2013a, 2013b; Ferguson et al., 2014; Henshaw & Ferguson, 2013b; Saunders et al., 2016; Sweetow & Henderson Sabes, 2006), and three adopted repeated measures designs ( Henshaw & Ferguson, 2014; Krishnamurti et al., 2015; Oba et al., 2013). For one completed clinical trial ( Henshaw & Ferguson, 2013b, final publication pending), data were obtained from the authors at the point of upload to clinicaltrials.gov (Ref: NCT01892007). Saunders et al. (2016) reported data for four groups, comparing two forms of LACE™ auditory training with a placebo training group and a control group. Results for Saunders et al. (2016) were therefore reported as four individual effect estimates.

Neuropsychological tests of cognitive function were used heterogeneously across studies. Refer to Table 3 for a summary of outcomes used to measure changes in cognition among included studies.

Quality of Evidence

According to the GRADE criteria ( Schünemann et al., 2017), the certainty of evidence for improved overall cognition was "low" following auditory training (see Table 4) and "very low" following cognitive training (see Table 5). Certainty in evidence was most frequently downgraded due to methodological bias within studies, variability between study designs and interventions, heterogeneity within pooled effect estimates, and the small number of published studies available for inclusion in this review.

Adherence to Training

Percentage of participants who completed a recommended duration of auditory or cognitive training was used to assess adherence ( Henshaw & Ferguson, 2013a). Six out of nine studies reported participant adherence. Sweetow and Henderson Sabes (2006) reported 73% of participants (65/89) completed the auditory training intervention, which involved 5 × 30-min training sessions per week for 4 weeks. Henshaw and Ferguson (2014) did not report the percentage of participants who completed the intervention but did state the average time spent completing auditory training was 197.8 min, which was less than the predetermined 210 min intervention. Ferguson et al. (2014) reported 80% (35/44) of participants completed the auditory training intervention. Saunders et al. (2016) reported 85% of their LACE-DVD group (58/68) completed the intervention, but this figure was self-reported adherence, and 84% of their LACE-C group (42/50) adhered with the full auditory training intervention. Oba et al. (2013) stated that 100% of participants ( N = 10) completed the full cognitive training schedule. Henshaw and Ferguson (2013b) provided raw data indicating that 100% of participants, who were supported and monitored by their communication partner, completed their 5-week (25-session) cognitive training intervention. Three studies did not report adherence to training ( Anderson et al., 2013a, 2013b; Krishnamurti et al., 2015), but Anderson et al. (2013a, 2013b) stated that participants were regularly contacted or monitored during the intervention to ensure they adhered to training parameters.

Auditory and Cognitive Training: Improvements for Trained Tasks

All auditory training studies, excluding one ( Saunders et al., 2016), reported statistically significant improvement on the auditory tasks participants completed during interventions (see Table 1). Of the cognitive training studies, Henshaw and Ferguson (2013b) and Oba et al. (2013) reported statistically significant improvement on trained intervention tasks (see Table 2), whereas Anderson et al. (2013a, 2013b) did not report participant performance on training tasks.

Auditory and Cognitive Training: Improvements in Outcomes

The overall effect of auditory training on cognitive outcomes in adults with hearing loss was small and statistically significant, with no heterogeneity (see Table 6). The effect of auditory training on working memory was also small and significant, whereas executive function and attention/processing speed were small and not significant. The pooled effect for cognitive training improving overall cognitive function in adults with hearing loss was large and statistically significant, with a large degree of heterogeneity (see Table 6). For individual cognitive domains, working memory was small and significant, short-term memory and attention/processing speed were large but not significant, and executive function was small, not significant and favored the control group. There was a statistically significant difference between the overall pooled effects for auditory training ( g = 0.19) and cognitive training ( g = 1.06) for improving cognitive function ( Q = 5.74, p  = .02).

On-Task and Off-Task Cognitive Outcomes

All cognitive outcomes contributing to the significant pooled effect of auditory training improving overall cognition were classified as off-task (untrained), indicating that auditory training provides a small transfer of learning to untrained cognition (see Table 6). For cognitive training, however, five pooled outcomes were classified as off-task and three pooled outcomes as on-task, given their substantial overlap with tasks that were trained (see Table 6). Compared with the studies that included on-task cognitive outcomes ( Anderson et al., 2013a; Henshaw & Ferguson, 2013b; Oba et al., 2013), the off-task and untrained outcomes unique to Anderson et al.'s (2013b) intervention demonstrated the largest improvement following training.

Publication Bias

Publication bias statistics were calculated for statistically significant pooled effects including more than two studies. For the effect of auditory training on overall cognitive function, Egger's regression was statistically significant ( p  = .02), indicating the presence of publication bias, and 25 studies with nonsignificant results would be needed to render this effect zero.

Egger's regression was significant ( p = .04) for the effect of auditory training on working memory, and Rosenthal's Fail-Safe N indicated that 11 nonsignificant results were needed to undermine the significant effect. For the effect of cognitive training on overall cognition, Egger's regression was not significant ( p  = .18), and 160 nonsignificant results would be needed to render this effect zero.

Sensitivity Analyses

Oba et al. (2013) included participants with cochlear implants, Henshaw and Ferguson (2013b) included participants using hearing aids, and Anderson et al. (2013b) reported very large effects. Three sensitivity analyses were therefore conducted to determine if removing these studies would account for the heterogeneity within the overall pooled effect of cognitive training for cognition (see Table 7). Following removal of Oba et al. (2013) and Henshaw and Ferguson (2013b), pooled effects remained large with a large and significant degree of heterogeneity. Whereas removal of Anderson et al. (2013b) reduced the pooled effect to small while remaining significant and with no heterogeneity, and there was no longer a significant difference between the overall effect of auditory training ( g = 0.19), and this changed effect of cognitive training ( g = 0.32) for improving cognitive function ( Q = 1.35, p  = .25).

Discussion

The present study is the first systematic review and meta-analysis to provide pooled effect estimates of both auditory training and cognitive training for improving cognitive function in adults with hearing loss. The primary aim of cognitive training is to improve cognitive function, but given the relationship between listening and cognition, this type of training might have consequential benefits for adults with hearing loss. The primary aim of auditory training is to improve auditory skills, but recent evidence suggests there may improvements in cognition ( Ferguson & Henshaw, 2015). Here, we are looking at how effective each type of training is on cognition for this population.

When auditory training studies were combined, there were small but significant transfer of learning effects favoring improved working memory and overall cognition. The beneficial effect of auditory training on cognition may be explained by the Ease of Language Understanding model ( Rönnberg et al., 2013) within the Scaffolding Theory of Ageing and Cognition ( Goh & Park, 2009). The Ease of Language Understanding model suggests that working memory (a primarily frontal function) is a cognitive resource responsible for an individual's successful use of attention when listening to speech, processing and interpretation of hearing aid signals, and potential hearing impairment impacting their long-term memory ( Rönnberg et al., 2013). The Scaffolding Theory of Ageing and Cognition suggests that older adults experience a decline in cortical function as part of normal ageing, and the ageing brain recruits (scaffolds) additional cognitive resources from frontal regions to compensate for functional deficits ( Goh & Park, 2009). Older adults with hearing loss may therefore recruit additional (frontal) cognitive resources to compensate for diminished auditory perception and to support their attention and working memory capacity during auditory training. Auditory training may provide a small consequential improvement in working memory and overall cognition, which are trained during tasks that require the concomitant use of auditory perception and cognitive resources by adults with hearing loss.

When separated into individual cognitive domains, which resulted in a small number of studies, auditory training pooled effects reduced to nonsignificance for executive function and attention/processing speed. These nonsignificant effects may be the result of a Type II error, with small to moderate effect sizes reported for individual domains, but only two (or fewer) studies were included in these pooled effects. Nonetheless, home-based computer-delivered auditory training appears to provide a small improvement in cognitive function in adults with hearing loss.

When cognitive training studies were combined, there was a large and statistically significant improvement in overall cognition, driven by both on- and off-task learning. When separated into individual cognitive domains, pooled effects reduced to nonsignificance for executive function, short-term memory, and attention/processing speed. However, there was a high degree of heterogeneity across studies, which was eliminated on removal of Anderson et al (2013b). This raises some important questions about how the training in this study was classified. Anderson et al. (2013b) used a cognitive training program ("Brain Fitness") that primarily targeted working memory, attention, and executive skills but used auditory stimuli. Interestingly, this auditory-cognitive training approach provided very large improvements in cognitive function, primarily driven by improvements in attention as measured by the Integrated Visual and Auditory Continuous Performance Test. Removing this large effect from the overall pooled effect meant that cognitive training was no longer significantly more effective than auditory training at improving overall cognition. Oba et al. (2013) trained participants using an adapted Visual Digit Span task to improve working memory and reported on-task improvement on the Visual Digit Span task posttraining. Henshaw and Ferguson (2013b) used the working memory platform Cogmed™ and showed statistically significant improvements in performance for trained working memory tasks (on-task). These cognitive training findings are supported by evidence from meta-analyses in healthy older adults ( Lampit et al., 2014; Pronk et al., 2011) and in older adults with mild cognitive impairment ( Hill et al., 2016) and Parkinson's disease ( Lawrence et al., 2017), which also demonstrate improved performance on on-task (trained) outcomes and off-task outcomes, but only when they are structurally similar to those trained during computer-delivered cognitive training. Older adults with impaired hearing may experience cognitive decline ( Jayakody et al., 2017a; Lin et al., 2013), but the ageing brain can maintain neural plasticity ( Hill, Kolanowski, & Gill, 2011) and its ability to strengthen and modify neuronal connections (i.e., synaptogenesis) leading to positive changes in response to training. Cognitive training provides a set of tasks that involve repeated use at increasing difficulty, which induces a stimulation-focussed improvement in domains trained during an intervention ( Kim & Kim, 2014). Cognitive training interventions for adults with hearing loss are relatively novel, but results from this meta-analysis suggest some therapeutic potential for improving working memory and overall cognition.

Findings from this review suggest both auditory and cognitive training are effective for improving cognition in adults with hearing loss. By design, cognitive training is more targeted and provides a more intensive stimulation of cognitive abilities, whereas auditory training may improve cognition by training auditory perception that also involves the use of cognitive resources. We may therefore expect cognitive training to be more beneficial for improving cognition. As discussed, the large pooled effect of cognitive training in this review was primarily driven by effects reported by Anderson et al. (2013b) who used a training paradigm involving cognitive tasks and auditory stimuli. It is therefore possible that an integrated (cognitive/auditory and auditory) training program may be most beneficial for improving cognition in adults with hearing loss ( Ferguson & Henshaw, 2015). It is important to note, however, that the auditory training program (LACE™) developed by Sweetow and Henderson Sabes (2006) adopts a similar structure by involving auditory tasks with a cognitive component. It is therefore somewhat difficult to delineate the classification of auditory training programs that involve cognition with cognitive training programs that involve auditory perception, and the pooled effects reported in this review should be interpreted with this caveat in mind.

There were insufficient studies to explore factors (e.g., intervention length, adherence to training) that may account for the large degree of heterogeneity within the overall effect of cognitive training on cognition. Furthermore, by combining all study outcome measures for a given cognitive domain for input into the meta-analysis, the benefits of training shown by individual study outcome measures may be lost. For example, Ferguson et al. (2014) showed auditory training-related improvements for divided attention that employed executive control processes, but not for single attention that does not. Removal of Oba et al.'s (2013) participants with cochlear implants or Henshaw and Ferguson's (2013b) participants with hearing aids had no significant impact on the pooled effect, but removing Anderson et al.'s (2013b) large effect sizes reduced heterogeneity to nonsignificance and the effect to small (remaining significant). The large effects reported by Anderson et al. (2013b) may be the consequence of their integrated intervention (as noted earlier) combined with their longer training schedule of 40 hr (5 sessions × 8 weeks), compared with the other studies involving between 3.5 and 10 hr of training. Shorter and fewer training sessions have been argued to provide optimal conditions to elicit improvement following auditory training ( Molloy, Moore, Sohoglu, & Amitay, 2012) and cognitive training ( Lampit et al., 2014). Conversely, findings from this review suggest that a longer cognitive training intervention (several weekly 1-hr sessions over multiple months) may be more beneficial for improving cognitive function in adults with hearing loss. It is also important to note that Anderson et al. (2013b) supported large neuropsychological improvements in cognition with improvements in objective measures of neural timing, which provides evidence of neural plasticity in the ageing brain in response to training. There is, however, a limitation to this interpretation of the results. The subset of participants reported by the author's other study ( Anderson et al., 2013a) did not demonstrate improved cognition following the same training parameters, and this variability in results led to a decrease in certainty in the evidence for cognitive training.

The overall certainty of evidence in support for auditory training and cognitive training improving overall cognition was "low" and "very low," respectively ( Schünemann et al., 2017). Certainty in evidence was most frequently downgraded due to methodological bias within studies, variability between study designs and interventions, heterogeneity within pooled effect estimates, and the small number of published studies available for inclusion in this review. Nonetheless, three included studies were rigorous RCTs ( Ferguson et al., 2014; Henshaw & Ferguson, 2013b; Saunders et al., 2016). We recommend future researchers follow these examples by conducting high-quality RCTs in accordance with the Consolidated Standards of Reporting Trials guidelines for nonpharmacological interventions ( Schulz, Altman, & Moher, 2010) and have sample sizes that are sufficient to provide adequate statistical power for reliable interpretation of results.

Participant adherence to a home-based intervention with limited supervision is of paramount importance when determining the efficacy of a novel therapeutic technique. Among studies in this review, more than 80% of participants adhered to full training schedules, but most trials did not report factors that contributed to adherence (or nonadherence) during interventions. Participants are more likely to adhere to a home-based intervention if there is regular participant-investigator contact, they are intrinsically motivated and engaged in training activities, they believe cognitive function/intelligence is malleable, and when they report belief in the efficacy of the training program to improve their hearing ability or cognitive function ( Ferguson & Henshaw, 2015; Henshaw, Mccormack, & Ferguson, 2015a; Jaeggi, Buschkuehl, Shah, & Jonides, 2014; Sweetow & Henderson Sabes, 2010). Although adherence was high among studies in this review, real-world evidence shows that less than 30% of patients complete auditory training when recommended by an audiologist ( Sweetow & Henderson Sabes, 2010). Future studies need to report and explore factors that contribute to adherence to ensure home-based interventions are designed to maintain adherence to training schedules and consequently increase our understanding of the efficacy of auditory and cognitive training interventions.

There are several limitations to this review. Only nine studies met inclusion criteria, five auditory training and four cognitive training, and several individual domain pooled effects were supported only by one or two studies. There was, however, no significant heterogeneity within the overall effect for auditory training, providing initial confidence in the current estimate of auditory training improving cognition in adults with hearing loss. Sensitivity analyses also showed that the overall pooled effect for cognitive training improving cognition remained robust and statistically significant following removal of methodologically heterogeneous studies. With these considerations in mind, however, we recommend findings from this review to be regarded as preliminary evidence, and a follow-up meta-analysis should be conducted as more trials become available. This review also included repeated measures designs, reducing certainty in the evidence. Any future meta-analysis should attempt to include only well-designed RCTs to provide Class I evidence in support of (or to potentially refute) the therapeutic potential of auditory training and cognitive training for improving cognition in adults with hearing loss.

Recommendations for Future Research

Future studies should explore the potential of auditory training combined with cognitive training for improving cognition in adults with hearing loss. Work by Anderson et al. provides promising evidence in support of using an integrated cognitive training program (e.g., Brain Fitness) that requires the use of cognitive abilities and auditory perception to complete training activities ( Anderson et al., 2013a, 2013b). With the increasing ageing population, clinical trials need to examine whether an integrated auditory-cognitive training paradigm has the potential to simultaneously improve or potentially halt neural degeneration associated with hearing loss and cognitive decline among older adults.

All auditory training studies, excluding one ( Sweetow & Henderson Sabes, 2006), that met inclusion criteria for Henshaw and Ferguson's (2013b) original review were excluded from this review for not including a measure of cognitive function. There is increasing evidence showing adults with better hearing demonstrate better cognitive function across all domains ( Taljaard et al., 2016), and findings from this review suggest auditory and cognitive training may improve cognition in adults with hearing loss. Future studies need to include cognitive outcomes while consulting compendiums of neuropsychological tests for thorough descriptions and recommendations for the use of cognitive measures with older adults ( Lezak, Howieson, & Loring, 2004; Strauss et al., 2006). More than half of the studies included in this review did not assess or report a measure of baseline cognitive status (e.g., Montreal Cognitive Assessment, Wechsler Adult Intelligence Scale battery). As part of normal ageing, older adults may experience mild cognitive decline which will impact their performance during auditory and cognitive training. Future studies need to include baseline measures of cognitive status to identify participants with or without mild cognitive impairment and whether to include or exclude participants following predefined selection criteria. It will also be useful to explore the potential of these interventions among older adults with hearing loss and with different subtypes (e.g., amnestic vs. nonamnestic) and varying degrees (e.g., mild to dementia) of cognitive decline. The beneficial effects of cognitive training may be artificially limited in older adults with normal cognitive function who experience a ceiling effect during training (i.e., no improvement beyond normal cognition), whereas individuals with cognitive deficits have the capacity to improve in response to training.

We also recommend including outcomes that assess real-world benefits and explicit examination of the long-term efficacy of auditory and cognitive training. More research is also needed to determine whether auditory and cognitive training have the potential to elicit a transfer (learning) effect which benefits older adults in their daily life. Many older adults with hearing loss and cognitive decline experience difficulties completing daily activities and are less likely to socialize ( Behera et al., 2016; Mick, Kawachi, & Lin, 2014; Saito et al., 2010). Including measures of instrumental activities of daily living ( Jekel et al., 2015), social isolation ( Mick et al., 2014), and frailty ( Morris, Howard, & Steel, 2016) will determine if these home-based interventions provide practical improvement in the daily life of older adults with hearing loss. Although not a focus of this review, only three studies reported longer term follow-up data ( Henshaw & Ferguson, 2013b; Oba et al., 2013; Saunders et al., 2016). Future studies need to include follow-up assessments (e.g., 12 months) to determine the long-term efficacy of auditory and cognitive training for cognition.

Conclusion

The current study is the first systematic review and meta-analysis to provide pooled effect estimates of auditory training and cognitive training for cognition in adults with hearing loss. Nine studies met inclusion criteria, and these preliminary results suggest that home-based auditory training and cognitive training may improve cognition. More high-quality RCTs with long-term follow-up assessments are needed to determine whether auditory, cognitive, or a combined auditory-cognitive intervention is most efficacious for improving cognitive function in adults with hearing loss.

Supplemental Material

Supplemental material for Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis by Blake J. Lawrence, Dona M. P. Jayakody, Helen Henshaw, Melanie A. Ferguson, Robert H. Eikelboom, Andrea M. Loftus and Peter L. Friedland in Trends in Hearing

Author Contributions

B. J. L. was responsible for conception, design, and execution of the project; conducted article screening, data extraction, bias assessment, and statistical analysis; and wrote the first draft of the article. D. M. P. J. assisted with article screening and provided expert review and critique of important intellectual content. H. H., M. A. F., R. H. E., A. M. L., and P. L. F. provided expert review and critique of important intellectual content.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: B. J. L., D. M. P. J., R. H. E., and P. L. F. are supported by the Ear Science Institute Australia. The contribution by A. M. L. was supported by Curtin University, and the contributions by H. H. and M. A. F. were supported by the National Institute for Health Research. The views expressed are those of the authors and not necessarily those of the Ear Science Institute Australia, Curtin University, the National Health Service, the National Institute for Health Research, or the Department of Health and Social Care.

Supplemental Material

Supplemental material for this article is available online.

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Associated Data
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Supplementary Materials

Articles from Trends in Hearing are provided here courtesy of SAGE Publications

# data[].attributes.attachment_link.title
Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis

# data[].attributes.attachment_link.description
This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray ...

# data[].attributes.body
Exercise can benefit those with ARHL by improving balance and cardiovascular health. It can reduce inflammation, helping the blood vessels in the cochlea and preserving capillaries. Light exercises like walking and stretching can help combat balancing issues and reduce injury. The difficulty to begin this change may be around a 5 out of 1-10, because although simple exercise such as walking can be easy to incorporate, other physical issues associated with old age may prevent them from exercising regularly. Audiologists and exercise physiologists can support this change.

Sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC5148246/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10733191/

# data[].attributes.body
This video emphasizes the importance of a balanced diet in maintaining overall health. It highlights the need for a variety of foods, including fruits, vegetables, lean proteins, whole grains, and healthy fats. The video also discusses the significance of portion control, staying hydrated, and limiting processed foods, sugars, and unhealthy fats in your eating habits. They stress the impact of proper nutrition on preventing chronic diseases like heart disease, diabetes, and obesity. In conclusion, the video encourages mindful eating, and consistency in making healthy dietary choices for long-term well-being.

-Kierra Blundell

https://youtu.be/c06dTj0v0sM?si=-xghf9yCIVKH9gny

# data[].attributes.body
This video "the minimum cardio needed for a healthy lifestyle" explains the essential role cardiovascular exercise plays in overall health. It recommends at least 150 minutes of moderate-intensity cardio or 75 minutes of vigorous-intensity cardio per week, as suggested by health organizations. This amount of exercise helps improve heart health, boost metabolism, manage weight, and reduce the risk of chronic diseases like diabetes and hypertension. The video also emphasizes that even short bursts of activity, like walking or cycling, can have significant benefits. Consistency, variety, and gradual progression in cardio activities are key to long-term health benefits both physically and mentally!

-Kierra Blundell

https://youtu.be/EbI0gqAm4qE?si=oKkGl-sQwBJAvsxH

# data[].attributes.attachment_link.title
The Minimum Cardio Needed For A Healthy Heart & Lungs

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With a healthier routine diet, the chances of hearing loss in old age can be reduced. Proper nutrients like magnesium, potassium, and zinc, as well as vitamins C and E, as they improve blood flow to the ears and lower inflammation and oxidative stress. Anti-inflammatory foods such as fruits, vegetables, grains, and lean meat can be helpful. Challenges may arise due to accessibility factors like cost or individual food restrictions like allergies.

Sources:

https://www.nih.gov/news-events/nih-research-matters/healthy-diets-linked-lower-risk-hearing-loss-women

https://www.healthyhearing.com/report/53053-Diet-and-hearing-loss-what-the-research-says

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Regular exercise is a great preventative measure for hearing loss. Diabetes and high blood pressure can create hearing problems and implementing regular exercise into your life is a way of combatting this. Exercise works as a preventative measure for many diseases and ailments, yet it can be difficult for some to implement. The benefits of exercise only come when practiced routinely, so some may struggle with committing to regular exercise.

Source: Cleveland Clinic

https://my.clevelandclinic.org/health/diseases/17673-hearing-lossLinks to an external site.

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There are lots of ways to reduce ARHL, although ear protection, such as earplugs or noise-canceling earmuffs are very key. They help reduce exposure to loud noises that can damage the delicate hair cells in the inner ear. By minimizing noise-induced damage over time, individuals can preserve their hearing health into older age which seems to be a big problem in seniors today.

Although, being able to promote consistent use of ear protection may bring challenges. Many people underestimate the long-term effects of noise exposure or may feel that ear protection is uncomfortable, inconvenient, or looks silly to use in public or work settings. For older adults or people in high-risk occupations, integrating ear protection into daily routines requires education on why this is so important and constant reminders of ear safety to make it a normal practice.

Source:https://www.nidcd.nih.gov/health/hearing-protectors

-Kierra Blundell

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Males are statistically more likely to develop hearing loss in old age, the ratio being almost twice as likely. A direct explanation for this is not always clear, but there are factors such as environment and genetics. Men have a lower life expectancy which can cause symptoms that come with old age to affect them more severely. They also experience cultural and social standards that contribute to their noise exposure throughout life, such as occupational norms like construction and common hobbies like riding motorcycles or shooting firearms. This brings up a special challenge for elderly men seeking treatment, as sex is a biological aspect which makes them innately vulnerable to ARHL.

Sources: https://online.aging.ufl.edu/about/articles/why-is-hearing-loss-more-common-in-men-than-women/#:~:text=Studies%20consistently%20show%20that%20men,%2C%20occupation%2C%20health%20and%20heredity

https://pmc.ncbi.nlm.nih.gov/articles/PMC7012726/#:~:text=The%20reasons%20for%20these%20sex,men%20e.g.%2C(20).

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People with less education are at a much greater risk of being negatively affected by ARHL loss because they often have limited access to healthcare resources. They may also lack awareness of the importance of early intervention. Education is linked to better health literacy, and individuals with less education may not recognize the significance of hearing loss or know how to address it effectively.

The challenges they face in prevention include limited access to hearing protection or education on how to prevent damage from environmental noise, as well as fewer opportunities to engage in regular hearing check-ups. For diagnosis, they may not seek professional help due to a lack of understanding about hearing loss or financial barriers that come with it. In terms of treatment, individuals with less education may face difficulties in affording or accessing hearing aids, or they may not fully understand how to use these devices effectively. That is why education is so important when it comes to this issue.

-Kierra Blundell

https://academic.oup.com/psychsocgerontology/article/80/3/gbae202/7986072

# data[].attributes.body
Hearing protectors include ear plugs and earmuffs. These can be simple or electronic and help to prevent age-related hearing loss or the worsening of hearing loss. One downside of hearing protection would be that they can be easily forgotten and aren't commonly used. This can make it difficult for some to get in the habit of wearing them or feel comfortable wearing them.

Source:

NIH

https://www.nidcd.nih.gov/health/hearing-protectorsLinks to an external site.

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Audiometers commonly assist with the diagnosis of ARHL, as an audiometry exams can analyze how well a patient can hear. It can play sounds to test certain amplitudes and frequencies that the patient can hear, allowing audiologists to assess their hearing capabilities and what treatments may be best for them. A possible downside to its usage is that it is mostly accessible as a hearing test done by a professional, so hearing loss may not be identified early on by those who cannot regularly afford hearing checkups.

Sources:

https://www.maico-diagnostics.com/products/audiometers?filters=%5B%2522141c58a982ae4ec9b66103c9f7041dd2%2522%5D&link=%2522%2522

https://www.ncbi.nlm.nih.gov/books/NBK559220/#:~:text=In%20general%2C%20an%20audiometry%20exam,one%20ear%20at%20a%20time

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Noise-Cancelling Headphones are very useful and use active noise cancellation technology, where microphones detect surrounding noise, and the headphones produce sound waves that counteract the unwanted noise. This technology helps prevent hearing loss by reducing exposure to loud environments. However, overuse or prolonged exposure to high volumes through headphones can damage hearing. Additionally, this may cause a sense of pressure or discomfort in some users so find what is comfortable for you.

Earplugs are also simple devices that block out sound by physically sealing the ear canal. They are primarily used to prevent hearing loss in noisy environments like concerts or construction sites. While effective in protecting hearing, earplugs may cause discomfort if worn for long also. They also need to be cleaned properly which can be a hassle. Although this is a great device, sometimes they work to well so you need to be aware of your surroundings and be very alert.

https://theconversation.com/noise-cancelling-headphones-earplugs-and-earmuffs-do-they-really-help-neurodivergent-people-230113#:~:text=Sound%20travels%20in%20waves%20into,process%20is%20called%20phase%20cancellation.

-Kierra Blundell

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Hearing Examinations for Elderly Healthcare

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Hearing Examinations for Elderly Healthcare

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Integrating hearing screenings for the older demographic into their regular primary care targets healthcare policies. It can make receiving aid for ARHL more accessible and make detection easier and sooner in its progression. This could potentially cause cost issues as policies would have to determine how hearing tests would increase healthcare cost or affect insurance coverage.

Source: https://www.ncbi.nlm.nih.gov/books/NBK569275/

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Public awareness campaigns can encourage those experiencing ARHL to seek treatment and appropriate care by targeting the individuals through PSAs, media, and community outreach events. This could possibly face challenges due to funding or resource shortages or difficulty assessing how to reach the elderly demographic.

Sources: https://www.entandaudiologynews.com/features/audiology-features/post/the-role-of-public-health-in-addressing-age-related-hearing-loss

https://pmc.ncbi.nlm.nih.gov/articles/PMC5024732/

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A measure which can be taken to help the public is the collection of data and research on age-related hearing loss. This data can then inform laws and individuals. Data collection and research are the first steps towards educating the people and improving the treatments for age-related hearing loss. One difficulty with implementing this intervention is funding. Research can be expensive when the researchers and research subjects have to be paid.

Source:

WHO

https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-lossLinks to an external site.

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Increased Training for Healthcare Professionals

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Increased Training for Healthcare Professionals

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Kierra's post

--> increasing awareness of age-related hearing loss among healthcare workers

# data[].attributes.headline
Increased training for healthcare professionals 

# data[].attributes.subject
Increased training for healthcare professionals 

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Increased training for healthcare professionals can significantly improve the recognition, diagnosis, and management of age-related hearing loss. With better education, providers are more likely to identify early symptoms, differentiate hearing loss from cognitive decline, and make timely referrals to audiologists. Training also enhances communication skills, enabling professionals to counsel patients and families effectively about hearing aids or assistive devices. It also raises awareness of the emotional and social impact on older adults. Early intervention, supported by knowledgeable care providers, can help slow progression, improve quality of life, and reduce related risks like isolation, depression, and reduced cognitive function.

https://www.ncbi.nlm.nih.gov/books/NBK385310/

-Kierra Blundell