By: Ashley Tilahun, Au.D., CCC-A, FAAA

Abstract

This case study explores the progressive management of age-related hearing loss in Mrs. Hines*, an 85-year-old woman. Diagnosed with presbycusis in 2005 by her ENT physician, Mrs. Hines initially declined the use of hearing aids despite being a candidate due to her belief that she could manage without them. Over the years, her hearing continued to slowly decline, prompting her to seek treatment in 2013 when she began experiencing significant difficulties in understanding speech and hearing in her everyday listening conditions. She was fitted with Resound Alera AL 730-D In-The-Canal (ITC) hearing aids and reported satisfaction with her improved hearing. Follow-up evaluations in 2018 and 2021 indicated stable hearing, although she opted for an upgrade to Starkey Livio AI 1600 ITC rechargeable hearing aids to enhance her quality of life. By 2024, Mrs. Hines experienced further hearing decline, leading to adjustments in her Starkey hearing aids, which restored her satisfaction. This case highlights the importance of regular hearing evaluations, timely intervention, and patient-centered care in managing age-related hearing loss.

Introduction

Definition of Presbycusis (Age-Related Hearing Loss):

Presbycusis, also known as age-related hearing loss, is the gradual loss of hearing that occurs as people age. It is one of the most common hearing problems among older adults. This condition usually affects both ears equally, meaning that hearing loss is bilateral and typically symmetrical. Presbycusis impacts various sounds from low to high pitches; however, it can primarily impact high-pitched sounds. High-pitched or high-frequency sounds include the voices of women and children or certain consonants like “s” and “t.” As a result, individuals with presbycusis often struggle to understand speech, especially in noisy environments where background sounds make it harder to pick out critical words. This type of hearing loss can make everyday activities, like following conversations or enjoying social events, more challenging.

Incidence and Prevalence of Presbycusis

Presbycusis is a widespread condition affecting a significant portion of the older population. Approximately one in three individuals aged 65 to 74 experiences some degree of age-related hearing loss. The prevalence increases with age, impacting nearly half of those over 75 years old. This high prevalence highlights the importance of addressing hearing loss in the elderly population (Quaranta et al., 2015).

In the United States, around 30 million adults could benefit from hearing aids to help with their hearing loss. However, only about 20% of these people actually use hearing aids (Krist et al., 2021). This suggests that there may be obstacles preventing people from getting the help they need, such as cost, lack of information, or stigma (concerns about how hearing aids look).

Mrs. Hines’ Case History

In 2005, Ms. Hines, an 85-year-old woman, requested an audiological evaluation due to a noticeable decline in her hearing. The audiogram (Decibel Chart) indicated a normal to downsloping severe sensorineural hearing loss (SNHL) in both ears. After a thorough evaluation, she was diagnosed with presbycusis by her ENT physician. Although she was a suitable candidate for hearing aids, Ms. Hines felt that she could manage without them and was not ready to try hearing aids at that time. Despite being medically cleared for hearing aids, she chose not to pursue them.    

                                        Mrs. Hines 2005 Decibel Chart

In 2013, Ms. Hines returned to the clinic due to increased difficulty understanding speech, particularly in noisy environments, and mentioned that the TV volume was no longer sufficient. She also expressed noticeable decreased hearing in her right ear. The audiogram showed mild to downsloping severe sensorineural hearing loss in her right ear and mild to severe sloping sensorineural hearing loss in her left ear. It was unclear why her right hearing sensitivity decreased from 250-1000 Hz; however, her ENT physician reported that the cause is age-related in nature.

                                   Mrs. Hines/ 2013 Decibel Chart

Given these findings, Ms. Hines chose to try hearing aids and was fitted with Resound Alera AL 730-D ITC hearing aids in both ears. She preferred in-the-canal (ITC) aids due to the combination of advanced technology with user-friendly design and to accommodate her glasses.  She reported being satisfied with the improvement in her hearing after her fitting appointment.

            Mrs. Hines’ Resound Alera AL 730-D In-The-Canal Hearing aid

Continued Challenges and Progress

In 2018, Ms. Hines came in for her overdue routine hearing evaluation. The audiogram (Decibel Chart) results showed that her hearing remained stable compared to her 2013 test results. As her hearing had not significantly changed, no adjustments were needed for her hearing aids. Ms. Hines continued to be satisfied with her devices and did not require any changes.

                                     Mrs. Hines’ 2018 Decibel Chart

In 2021, Ms. Hines visited the clinic because her current hearing aids were no longer meeting her needs, as the devices were more than 8 years old and were worn down. She expressed that she wanted an upgrade to a new set of hearing aids. She reported experiencing difficulty with the dexterity of her hands and fingers and expressed that changing batteries became too cumbersome for her. She indicated she would like a set of custom hearing aids with rechargeable batteries and Bluetooth capabilities so that she can adjust her hearing aids when needed based on her everyday listening situation. Her updated hearing test was completed and showed that her hearing had remained stable since 2018.

                                   Mrs. Hines’  2021 Decibel Chart

To address her concerns, she was fitted with Starkey Livio AI 1600 ITC rechargeable hearing aids, which removed the need for battery management. Ms. Hines reported being satisfied with her new hearing aids and the improvements they provided.

Starkey Livio AI 1600 In-The-Canal Hearing Aids and Travel Charger

In 2024, Ms. Hines returned to the clinic because she noticed a significant decrease in her hearing sensitivity. The audiogram (Decibel Chart) revealed a slight worsening of her hearing, showing moderate to severe sensorineural hearing loss in both ears. To address these changes, her hearing aids were adjusted accordingly. Ms. Hines was pleased with the adjustments and felt they improved her hearing.

                                   Mrs. Hines’ 2024 Decibel Chart

Positive Impact with New Hearing Aid Technology

The introduction of Starkey Livio AI 1600 ITC hearing aids significantly enhanced Mrs. Hines' auditory experience. The advanced features of these devices improved her ability to understand speech, even in complex listening environments. Mrs. Hines' feedback highlights the crucial role of ongoing technological advancements in hearing aid design and their substantial effect on improving her quality of life.

Despite these technological improvements, Mrs. Hines continues to experience challenges in some noisy settings. She recognizes that while hearing aids provide considerable benefits, they cannot fully restore hearing to normal levels.

Mrs. Hines also kept up with her regular medical and hearing care and check-ups. She sees her audiologist and other physicians when needed to ensure any changes in her hearing are quickly handled. This hearing health team effort is important for managing her age-related hearing loss and getting the most out of her hearing aids.

Conclusion

Mrs. Hines' case underscores the importance of ongoing monitoring and advancements in technology for managing age-related hearing loss. The switch to Starkey Livio AI 1600 ITC hearing aids greatly improved her hearing experience, showing how new hearing aid technologies can make a difference. Regular check-ups and a team approach are crucial for addressing both her hearing needs and overall care. While hearing aids have their limits, the improvements in sound quality and speech clarity offer hope for others dealing with similar issues.

Audiologist's Takeaway

Ms. Hines’ case illustrates a typical progression of presbycusis, where gradual hearing loss can significantly affect communication over time. It was somewhat challenging that Ms. Hines chose not to address her hearing loss immediately after her diagnosis in 2005. However, it is understandable that individuals may take time to come to terms with their hearing challenges. Her decision to seek intervention nearly eight years later reflects a significant step toward managing her hearing health more proactively.

The transition from Resound Alera ITC hearing aids to Starkey Livio AI 1600 ITC models demonstrated Ms. Hines’ commitment to enhancing her hearing experience. This upgrade, combined with regular follow-ups, played a vital role in adapting her hearing aids to her changing needs. These adjustments ensured her continued satisfaction and ability to fully engage in daily activities. Ms. Hines' experience highlights the value of early and ongoing care, showing how timely interventions and advanced technology can make a meaningful difference in managing age-related hearing loss.

2025/01/05 Update

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References:

1. National Institute on Deafness and Other Communication Disorders. (n.d.). *Age-related hearing loss*. Retrieved from https://www.nidcd.nih.gov/health/age-related-hearing-loss

1. World Health Organization. (n.d.). Deafness and hearing loss. Retrieved from https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

1. Lin, F. R., Niparko, J. K., & Ferrucci, L. (2011). Hearing loss prevalence in the United States. Archives of Internal Medicine, 171(20), 1851–1852. https://doi.org/10.1001/archinternmed.2011.506

1. Starkey Hearing Technologies. (2023). Livio AI user guide. https://www.starkey.com/hearing-aids/technologies/livio-ai

1. Gifford, R. H., & Dorman, M. F. (2021). Artificial intelligence in hearing aids: A review of Starkey's Livio AI. Journal of the American Academy of Audiology, 32(3), 210-220. https://doi.org/10.3766/jaaa.19095

1. Abrams, H. B., & Kihm, J. (2013). Hearing aid outcomes with ReSound Alera: A review of real-world performance. Hearing Review, 20(8), 38-42.

1. Quaranta, N., Coppola, F., Casulli, M., Barulli, M. R., Panza, F., Tortelli, R., Solfrizzi, V., Sabba, C., & Logroscino, G. (2015). Epidemiology of age related hearing loss: a review. Hearing, Balance and Communication, 13(2), 77-81.

1. Krist, A. H., Davidson, K. W., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., et al. (2021). Screening for hearing loss in older adults: US Preventive Services Task Force recommendation statement. JAMA, 325*(12), 1196-1201. https://doi.org/10.1001/jama.2021.1712

***Please Note: To safeguard the individual's privacy, the name has been changed in this article.

***Disclaimer: The content presented here serves general informational purposes and is not intended as professional advice or a replacement for medical consultation. It is essential to seek personalized guidance and assistance from a qualified physician or hearing healthcare provider for any specific questions, concerns, or individual health conditions related to hearing. A professional in the field can offer a comprehensive evaluation and suitable recommendations based on your unique circumstances. Ignoring or postponing seeking medical or professional help may have negative impacts on your health. Always consult with a healthcare professional for precise diagnosis, appropriate treatment, and personalized advice concerning your hearing health.***

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