What is the ear like and how do we hear?

The ear is divided into three parts - outer, middle, and inner ear. Sound waves come into the outer (external) ear and hit the eardrum causing it to vibrate.

Behind the eardrum, in the middle ear, are three tiny bones (ossicles) - the malleus, incus, and stapes. The vibrations pass from the eardrum to these middle ear bones. The bones then transmit the vibrations to the cochlea in the inner ear. The cochlea converts the vibrations to sound signals which are sent down the the ear nerve to the brain which we 'hear'.

What is presbyacusis?

Presbyacusis is the medical term for the hearing loss of older people. It is the commonest cause for hearing loss in people over 55. (Less common causes of hearing loss in older people include infections and injury to the inner ear.)

The hearing loss comes on gradually, often over several years. You may not be aware of it at first. You may only realise that your hearing is becoming poor when you have difficulty using the telephone or following a conversation in a group. Friends or family may comment about the television being loud or having to repeat themselves more often to people with hearing loss.

Why does it happen?

Most people will tend to lose some of their hearing to a greater or lesser extent as they become older. The inner ear (cochlea) contains nerve cells that convert sound into nervous impulses which are sent to the brain. As you become older, these nerve cells don`t work as well and they begin to degenerate. It is part of the ageing process. When a sufficient number have degenerated this is when you notice hearing loss. Most people do not go completely deaf. The severity of the hearing loss varies from person to person of the same age.

Can it be prevented?

There is little that can be done to prevent this age-related process. It is possible that being exposed to a lot of loud noise over long periods may make hearing loss worse when older. For example, if you work in a noisy factory you should wear ear protection.

Plugs of ear wax may make any hearing loss worse. Therefore, from time to time it may be worthwhile having your ears checked for wax. Wax can usually be cleared out to allow the hearing to be as good as possible. See separate leaflet called 'Ear Wax' for details.

Hearing assessment

When there is a mild degree of hearing loss, most people manage well in normal situations of everyday life. Asking people to speak more clearly may be all that is required. Eventually you may need a hearing aid. Hearing aids are provided by the NHS after referral to an audiology clinic or Ear, Nose and Throat unit for assessment. A hearing test is performed to confirm the diagnosis and assess the level of deafness. A mould of the outer ear is made if a hearing aid is prescribed. Generally it is worn behind the ear and is not very noticeable.

Will my hearing go back to normal with a hearing aid?

Although modern hearing aids are excellent, they cannot make hearing fully normal. Modern hearing aids are a lot better in quality and also a lot smaller than they used to be. It must be stressed that it does take time to get used to wearing a hearing aid. After several years of dulled hearing it may take a while to become used to the amplified sound. In time, most people get used to them and find them of great benefit. It is important that hearing aid users are fully instructed on how to use and look after their aid.

In addition, there are a variety of other devices which can help if you have hearing loss (whether you use a hearing aid or not). These include:

  • Telephone amplifiers for ordinary telephones.
  • Specially designed telephones for people with hearing loss.
  • Devices to let you know when your telephone or doorbell are ringing.
  • Lights and devices to let you know when smoke detectors, alarm clocks, etc, are activated.
  • Equipment to help you listen to the TV, radio, stereo, etc.

Further information

RNID Information Line
19-23 Featherstone Street, London EC1Y 8SL
Telephone: 0808 808 0123
Textphone: 0808 808 9000
Fax: 020 7296 8199
Royal National Institute for Deaf People (RNID) is the largest charity representing deaf and hard of hearing people in the UK. They can give you information about hearing aids and equipment.

RNID Sound Advantage
1 Haddonbrook Business Centre, Orton Southgate, Peterborough PE2 6YX
Telephone: 01733 232607
Textphone: 01733 238020
Fax: 01733 361161
Sell a range of equipment for deaf and hard of hearing people.

British Society of Hearing Aid Audiologists (BSHAA)
The professional body which represents the interests of the private hearing aid profession within the UK. Their website includes information aimed at the general public about hearing aids, the different types, how they work, etc. Their website also includes a directory of BSHAA members who are available to offer you advice on hearing loss and ways of overcoming it.