AS THE SOUNDS FADE AWAY
AS we age, none of us can escape the degradation of our bodies. Agerelated hearing loss, or presbycusis, which refers to gradual hearing loss caused by the natural ageing of the auditory system, is one of them.
Audiologist Nurul Huda Anuar explains that presbycusis occurs gradually without the patient’s realisation until the later stages. It affects higher pitch sounds initially, such as bird chirps and telephone rings.
Presbycusis is inevitable for most people, being the third most common physical condition among the elderly after arthritis and heart conditions. While there are no official statistics published on the prevalence of hearing loss among the elderly in Malaysia, Nurul Huda refers to the 2005 article Hearing Impairment in the Elderly published in the Medical Journal of Malaysia, and a 2006 survey by the Malaysian Public Health Institute.
These publications report that around 30% of Malaysians above the age of 60 have some degree of hearing loss as compared to the worldwide prevalence of 14%-46%, and age-related hearing loss affects one-fifth of the total population in Malaysia.
Observing the subtlety
“Generally, age-related hearing loss will take years to drop five to 10 decibels. It is very rare for a patient to have a significant loss in hearing ability overnight,” says Nurul Huda.
She attributes this fact to the reason many elderly people are unaware they are living with hearing loss.
She details three groups of signs and symptoms the elderly and their loved ones can look out for to determine if there are possibilities of hearing loss at any stage:
Social signs
> Frequently asking for repetition.
> Difficulty understanding speech, more noticeable in group conversations as opposed to one-toone conversations or in the presence of competing noises, such as in noisy restaurants.
> Difficulty understanding phone conversations.
> Listening to the TV or radio at higher volumes than normal. > Muffled hearing.
> Ringing or hissing in ears (tinnitus).
Emotional signs
> Associate listening as a stressful and involuntary task.
> Feeling embarrassed or nervous meeting new people or engaging in conversations.
> Preferring to withdraw and isolate from social situations. Physical signs
> Tiredness > Exhaustion > Reduced alertness
Presbycusis occurs gradually without the patient’s realisation until the later stages, says nurul Huda.
Action for prevention
If you notice hearing loss signs and symptoms in yourself or your loved ones, Nurul Huda advises a visit to an ear, nose and throat (ENT) specialist or an audiologist as the first point of action.
“A visit to these experts is highly recommended and specific audiology tests will be conducted to diagnose the degree of hearing loss,” she says.
If hearing loss is indeed diagnosed, preventative steps or treatment will be prescribed depending on the stage of the condition. Unfortunately for people living with presbycusis, the condition is irreversible as it is usually a sensorineural (inner ear or nerve-related) hearing disorder.
Therefore, Nurul Huda asserts the importance of scheduled screening programmes to identify hearing loss in a person.
Nurul Huda adds that there are also preventive and risk-reducing steps for hearing loss that can be taken during childhood.
“Vaccinations against diseases such as rubella, mumps and measles are crucial during infancy because the secondary effects from these illnesses can lead to hearing loss.
“A newborn hearing screening is strongly recommended for babies before one month old. Children are encouraged to be screened again later on for any childhood-acquired hearing loss.
“This is important to identify hearing problems early as it can affect the child’s speech and language development, social skills and education,” she says.
Living your best life
At the end of the day, elderly people will experience some level of hearing loss. Nurul Huda
explains that early diagnosis and better understanding of the nature of hearing loss in each case is important in deciding on appropriate clinical management.
At the moment, there is no medication to treat presbycusis. However, there are ways to help cope with hearing loss, especially in the form of amplification devices such as hearing aids and bone-anchored hearing aids.
“Many patients are unaware of how important amplification devices are in helping you cope with your daily lifestyle,” she says.
With proper fitting and fine-tuning, various amplification devices and hearing aids have been proven to help patients cope with hearing loss, improve hearing clarity and delay natural progression of hearing loss over time.
Hence, these devices can reduce communication problems and social difficulties faced by patients. She advises patients to talk to an audiologist for their best options.
It is very rare for a patient to go completely deaf from presbycusis, especially if they have the support of the right amplification devices with proper follow-up appointments to fine-tune and maintain function of the device.
However, since other external factors like recurrent chronic ear infection may add to the loss, there are coping strategies that can be
implemented to help the patient continue life independently, such as sign language and lip reading.
“It is common for even people with normal hearing to automatically lip-read when they are in noisy environments. Most people will use visual cues to assist understanding of a conversation whenever there are challenges to effective listening,” says Nurul Huda.
Awareness and prevention
As we live our daily lives, it is almost impossible to totally avoid direct exposure to constant loud noise, especially when it is work-related.
Nurul Huda is appreciative that Malaysia has well-established guidelines on occupational safety, whereby workers are required to use personal protective equipment when coming in contact with unavoidable occupational noises.
Nevertheless, we still need to be aware of other loud noises in our life and seek to avoid or if not regulate our frequency in those situations.
“If you use headphones or earphones, make sure to monitor the duration and volume of exposure to your ears. If head
phones usage is inevitable, consider the 80-90 rule. Do not listen to music through headphones at 80% of your device’s volume level for more than 90 minutes continuously.
“When attending functions such as weddings, clubs or concerts, try to avoid direct exposure to the source of noise, which are the speakers most of the time,” Nurul Huda advises.
To summarise hearing loss prevention, Nurul Huda lists three terms – distance, sound and a healthy lifestyle.
“A general rule of determining if the sound is too loud for your ears is when you find yourself raising your voice to talk to someone next to you. Studies have also suggested large doses of caffeine, smoking and alcohol can indirectly cause adverse effect on your hearing. Hence, try to avoid these triggers to reduce your risk of hearing loss.”