Hearing Loss: Does Gender Play a Role?

, University of Washington Medical Center; , University of Washington Medical Center, Virginia Merrill Bloedel Hearing Research Center


Medscape General Medicine. 1997;1(2) 

In This Article

Diagnosing Hearing Loss--Case in Point

To appreciate how a woman's hearing loss might present in a primary care practice, consider Alice Smith, an 80-year-old widow in relatively good health. She presents to your office, accompanied by her daughter, for a routine medical exam. The daughter has come with her mother because she has noticed that in the past few years her mother is increasingly "confused and disoriented." The daughter pulls you aside and asks, "Could this be a sign of Alzheimer's disease?"

You proceed to take a history from the patient and notice that she often misunderstands questions and gives inappropriate responses. You focus on questions related to her hearing, and she relates her chief complaint, saying, "I can hear people speaking, but I have difficulty making out the words." This difficulty is most noticeable when there is background noise and when talking on the telephone. Her daughter adds, "She is able to watch television but she has to turn up the volume very loud."

On further questioning you find out that Ms. Smith's hearing loss has significantly affected her quality of life; the embarrassment and frustration associated with her hearing loss have caused her to gradually withdraw from social activities. You determine that she has noticed a slowly worsening ability to hear during the past 7 years. When you ask why she did not bring her hearing loss to anyone's attention, she says, "I just assumed that losing one's hearing was part of growing older."

Ms. Smith's case illustrates several key features of presbycusis. First, the behavioral manifestations of a moderate-to-severe hearing loss are often the same as those noted with cognitive decline (confusion, disorientation, delirium, and dementia). An unrecognized hearing loss threatens the evaluation of patients for Alzheimer's disease and other causes of cognitive decline. Once a patient's hearing loss is identified and treated, cognitive deficits will often show a marked improvement.

Second, the hallmark of presbycusis is not primarily difficulty in hearing, but difficulty in making out words. This is most problematic in settings with a lot of background noise and when talking on the telephone.

Third, presbycusis significantly worsens the patient's quality of life. Presbycusis "is associated with depression, cognitive declines, reductions in physical functional status, and emotional and social handicaps."[58]

Finally, most elderly persons accept their hearing loss as an inevitable cost of growing older and believe that there is little hope for improvement. In fact, the elderly tend to wait approximately 10 years from the onset of their hearing loss before seeking help.[59]