Experiencing hearing loss is one of the most well – known normative changes with age (Aldwin & Gilmer, 2004). A visit to any housing complex for older adults will easily verify this point; you will quickly notice that television sets and radios are turned up fairly loud in most of the apartments. Yet you don’t have to be old to experience significant hearing problems. When he began to find it dif­ficult to hear what was being said to him, President Bill Clinton obtained two hearing aids. He was 51 years old at the time, and he attributed his hear­ing loss to too many high school bands and rock concerts when he was young. His situation is far from unique. Loud noise is the enemy of hearing at any age. You probably have seen people who work in noisy environments wearing protective gear on their ears so that they are not exposed to loud noise over extended periods of time.

But you can do serious damage to your hearing with short exposure too; in 1988, San Francisco punk rock bassist Kathy Peck was performing with her all­female punk band “The Contractions” at the Oakland Coliseum and played so loudly that she had ringing in her ears for 3 days and suffered permanent hearing loss. As a result, she founded Hearing Education and Awareness for Rockers (HEAR; http://www. hearnet. com) shortly thereafter to educate musicians about the need to protect their ears (Noonan, 2005). You don’t need to be at a concert to damage your hearing, either. Using headphones or earbuds, especially at high vol­ume, can cause the same serious damage and should be avoided. It is especially easy to cause hearing loss with headphones or earbuds if you wear them while exercising; the increased blood flow to the ear during exercise makes hearing receptors more vulnerable to damage. Hearing loss from this and other sources of loud noise is on the increase in younger adults, mean­ing that hearing loss is likely to increase among older adults in the future (Agrawal, Platz, & Niparko, 2008).

The cumulative effects of noise and normative age- related changes create the most common age-related

hearing problem: reduced sensitivity to high-pitched tones, called presbycusis, which occurs earlier and more severely than the loss of sensitivity to low – pitched tones (Agrawal et al., 2008). Research indi­cates that by the late 70s, roughly half of older adults have presbycusis. Men typically have greater loss
than women, but this may be because of differential exposure to noisy environments. Hearing loss usu­ally is gradual at first but accelerates during the 40s, a pattern shown clearly in Figure 3.4.

Presbycusis results from four types of changes in the inner ear (Gulya, 1995): sensory, consisting of

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Figure 3.4 Gender differences in hearing loss. Notice that the changes in men are greater.

Source: J. M. Ordy, K. R. Brizzee, T. Beavers, & P. Medart. Age differences in the functional and structural organization of the auditory system in man. In J. M. Ordy & K. R. Brizzee (Eds.), Sensory systems and communication in the elderly. Copyright © Lippincott, Williams & Wilkins, 1979.

Physical Changes 81

atrophy and degeneration of receptor cells; neural, consisting of a loss of neurons in the auditory pathway in the brain; metabolic, consisting of a diminished supply of nutrients to the cells in the receptor area; and mechanical, consisting of atrophy and stiffen­ing of the vibrating structures in the receptor area. Knowing the cause of a person’s presbycusis is impor­tant, because the different causes have different impli­cations for other aspects of hearing (Whitbourne, 1996a). Sensory presbycusis has little effect on other hearing abilities. Neural presbycusis seriously affects the ability to understand speech. Metabolic presby­cusis produces severe loss of sensitivity to all pitches. Finally, mechanical presbycusis also produces loss across all pitches, but the loss is greatest for high pitches.

Because hearing plays a major role in social communication, its progressive loss could have an equally important effect on people’s quality of life. Dalton and colleagues (2003) found that people with moderate to severe hearing loss were signifi­cantly more likely to have functional impairments with tasks in daily life (e. g., shopping). In addition, they were more likely to have decreased cognitive functioning. Clearly, significant hearing impair­ment can result in decreased quality of life.

Loss of hearing in later life can also cause numer­ous adverse emotional reactions, such as loss of inde­pendence, social isolation, irritation, paranoia, and depression. Much research indicates hearing loss per se does not cause social maladjustment or emotional disturbance. However, friends and relatives of an older person with hearing loss often attribute emotional changes to hearing loss, which strains the quality of interpersonal relationships (Whitbourne, 1996a). Thus, hearing loss may not directly affect older adults’ self-concept or emotions, but it may negatively affect how they feel about interpersonal communication. By understanding hearing loss problems and ways to overcome them, people who have no hearing loss can play a large part in minimizing the effects of hearing loss on the older people in their lives.

Fortunately, many people with hearing loss can be helped through two types of amplification systems and cochlear implants, described in Table 3.3. Analog hear­ing aids are the most common and least expensive, but they provide the lowest-quality sound. Digital hearing aids include microchips that can be programmed for different hearing situations. Cochlear implants do not amplify sound; rather, a microphone transmits sound to a receiver, which stimulates auditory nerve fibers directly. Although technology continues to improve,

none of these devices can duplicate your original equipment, so be kind to your ears.