Aging and Your Ears

Some things improve with age, like wine. And some things don’t, like hearing. So, what exactly changes in our ears and auditory system as we get older? And is there anything that can be done to preserve our hearing for as long as possible?

Presbycusis

Presbycusis is the medical term for age-related hearing loss. Over 25% of people aged 65 years and older have some degree of hearing impairment, and by the time you reach 75 years old, this prevalence increases to 33%.

Hearing impairment in older people usually affects the higher pitches – you might start to miss the trill of birdsong in the early morning but can still hear your husband snoring away next to you in bed very well (maybe too well). Other symptoms of presbycusis include:

• Difficulty discerning conversation against background noise
• Needing to turn up the volume on the TV or for music
• Missing higher frequency noises, such as a ringing phone or the doorbell
• Having to often ask people to repeat themselves

It’s easy to say that age-related hearing loss is caused by, well, age, but why does age afflict our hearing so? As we get older, physiological changes occur to certain parts of the auditory system. This includes the anatomical parts of the ear as well as the nerve pathways that carry neural signals from the ear to the brain. However, age is also associated with a number of other fun things, which subsequently can impact hearing.

• The risk of certain medical conditions increases with age, such as type 2 diabetes and hypertension (high blood pressure). Not only can some of these disease processes directly affect hearing, but their treatments may also have ototoxic effects, meaning they cause damage to parts of the ear.
• Noise-induced damage to the tiny sensory hair cells of the ear, cilia, is cumulative. This means the more years of life you’ve tucked under your belt, the more cilia you’ve killed off at the same time, particularly if you were into rock concerts during your younger years (or still are).

Other risk factors for presbycusis include having a family history of age-related hearing loss or tobacco smoking.

Tinnitus

Tinnitus is the perception of noise in the absence of an external source. In other words, it’s all in your head, literally. Though it can present in many different ways, including buzzing, clicking, or roaring, the most common is a ringing sound.

Tinnitus can range from being a faint intrusion that’s easily ignored to an incessant noise that may cause anxiety or depression. The sounds may be high or low pitched, loud or soft, constant or come and go. Both adults and children can experience tinnitus.

In most cases, tinnitus is associated with some degree of hearing loss. And as we learnt above, one of the risk factors for hearing loss is older age, making tinnitus more common in older adults. However, there is also some evidence that aging is a risk factor for tinnitus independent of hearing loss. The interaction between age and tinnitus is complex and still not well-understood, but could involve age-related changes to the cochlea in the inner ear or even age-related cognitive decline.

Other risk factors for tinnitus tend to increase with age, similar to presbycusis:

• Requiring certain medications, including anti-cancer drugs, aspirin, certain antibiotics, and ibuprofen
• Earwax accumulation, which is more likely in older adults as earwax becomes harder, drier, and less able to clear itself out
• Excessive noise exposure, which is cumulative over time
• Cardiovascular disease, including hypertension and atherosclerosis (hardening of the blood vessels), which are more common in older age

Balance Disorders

Imagine you’re on the deck of a ship – even a pirate ship, if you wish – and the vessel is rocking and swaying its way across the seven seas. This might be fun at first, but imagine the rolling waves continue relentlessly, and quickly, sailing this pirate ship loses its appeal. This may be a rather dramatized representation of a dizziness or balance disorder, but hopefully it has managed to set the mood.

Approximately one-third of adults over the age of 65 will suffer from a balance issue or dizziness at some point in their lives. In older people, the most common causes of imbalance are:

• Age-related balance and postural instability, which relates to a decline in functions such as muscle strength and proprioception
• Benign paroxysmal positional vertigo, a dizzying issue of the inner ear
• Vestibular neuritis, inflammation of the inner ear most commonly caused by a viral infection
• Meniere’s disease, involving tinnitus, hearing loss, and dizziness

Although multiple parts of the body work together for balance, including the visual and musculoskeletal systems, the vestibular system of the inner ear also plays an important role. The vestibular system consists of three fluid-filled semicircular canals of the inner ear, a collection of otoliths (tiny calcium particles), and a neural pathway connecting the brainstem to the cerebellum of the brain.

Like every other part of our bodies, the vestibular system is subject to the ravages of age. We find the otoliths don’t function as well, there’s a decline in the number of inner ear hair cells, and reaction times of the vestibular system may slow down.

Keeping Your Ears Healthy with Age

There’s not much you can do to delay your birthday every year, but there are steps you can take to minimize the effect of age on your ears.

1. Protect your hearing
   Wear well-fitted protective earplugs or ear muffs when in environments with excessive noise. This includes the gun range, mowing the lawn, and those rockin’ rock concerts.

2. Get regular hearing checks
   Early intervention with the right hearing aids fitted by an audiologist can ensure you stay looped into all those interesting conversations, and even potentially ward off dementia.

3. Work with your doctors to check your medications aren’t exacerbating hearing loss or tinnitus
   In some cases, there may be no alternative to a medication that may be causing ototoxicity (and ridding a body of cancer is arguably more important than preserving hearing). However, if you’re worried a certain drug is causing you hearing issues, talk to your prescribing physician.

4. Manage impacted earwax
   A GP or ENT (ear, nose, throat) doctor can help you to flush out any built-up earwax. Though it may be tempting to deal with it at home with a cotton bud, hair pin, or some other long, thin object, the risk is you either push the earwax in further, pop your own eardrum, or give yourself a good scratch (and have you ever tried putting a bandage inside your ear canal?).

Given that the function of your ears doesn’t age well like a good wine, it’s best to take good care of them when they’re still young.