SOURCE: Cunningham LL, Tucci DL. N Engl J Med 2017;377;25:2465-2475.

The burden of hearing loss in later life may surprise some. According to Cunningham and Tucci, half of persons 60-69 years of age and 80% of those ≥ 85 years of age suffer sufficiently severe hearing loss that affects daily communication. Age-related hearing loss (presbycusis) generally is bilateral and typified by high-frequency (> 2,000 Hz) sound deficits. Causes include death of cochlear sensory hair cells with aging (termed “sensory presbycusis”) and “metabolic presbycusis,” which is characterized by impaired function of the stria vascularis (vascular ligament to the cochlear duct).

In addition to straightforward causes of hearing loss (e.g., external canal occlusion with cerumen, noise-induced hearing loss, trauma, ototoxic meds), there are strong associations between cardiovascular risk factors (smoking, diabetes mellitus, obesity) and hearing loss, although the mechanisms by which these associations might be causative are not clear.

The sudden loss of hearing (defined as onset within ≤ 72 hours) is considered an otologic emergency, requiring prompt evaluation. Only a few patients with identified hearing loss take advantage of hearing aids (< 15%), perhaps daunted by issues like cost (> $1,000), potential stigma associated with wearing a hearing-assistive device, or comfort. Disconcertingly, in contrast to most developed nations, the U.S. government does not provide economic subsidies for hearing aids. In Denmark, which provides assistance, approximately half of affected persons use hearing aids.