Appendix
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Otolaryngology

Hearing Loss in the Elderly

Hearing loss in the elderly is an increasingly common condition, affecting millions worldwide. This condition has far-ranging impacts on individual health and wellbeing. The etiology of hearing loss in the elderly is broad and proper diagnosis is key in preventing morbidity. To properly diagnose and manage this condition, providers must understand the common causes of hearing loss in the elderly (including sensorineural, conductive, and mixed losses) and the appropriate workup for each. Adequate

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Perhaps most important is the possibility of a missed or delayed diagnosis.
  • Hearing loss in the elderly has a significant prognostic impact on patients, and without proper identification and management, the risk of adverse outcomes such as social withdrawal increases.
  • The prevalence alone indicates that hearing loss should be a key concern for healthcare providers caring for older adults.
  • The audiogram is the cornerstone of the diagnostic evaluation in hearing loss.
  • Therefore, referral for audiologic assessment is a crucial component of care for any patient with suspected hearing loss.
  • The audiometric workup typically involves pure-tone audiometry to assess both bone and air conduction across frequencies from low to high and to determine hearing thresholds.
  • In addition to audiology, if specific underlying causes of hearing loss are of concern, such as schwannoma or cholesteatoma, imaging with computed tomography or magnetic resonance imaging is often required for diagnosis.
  • A thorough head and neck physical exam should always be performed in patients with hearing loss, including visualization of the tympanic membrane and in-office hearing tests, including tuning-fork exams (Weber and Rinne) and gross hearing exam (finger rub test).
  • The workup also commonly includes sound perception, speech recognition, tympanometry, and the acoustic reflex.
  • Generally, the conductive causes of hearing loss are diagnosis-specific; for example, otosclerosis is managed with stapedectomy, whereas cerumen impaction is managed with cerumen removal.
  • Conversely, sensorineural hearing loss is typically managed with amplification, which requires specific fitting, planning, and follow-up with an audiologist.
  • Proper ear protection and ear health should be advised for all patients, including avoidance of excessive noise or ototoxic exposure, which may further worsen hearing loss.
  • Hearing aid choice and type is based on multiple patient factors, including the cause and degree of hearing loss and functional and physical factors.
  • There are numerous hearing aids and amplification devices, including external amplification devices (such as FM systems), behind-the-ear, in-the-canal, and implantable.
  • Key complications of hearing loss in the elderly relate to the proper identification and workup of the underlying etiology.
  • Due to the gradual and sometimes difficult-to-diagnose nature of hearing loss, many elderly patients go untreated or undiagnosed.
  • Additionally, misdiagnosis may lead to inappropriate treatment or unnecessary workup, which can prolong the effects of hearing loss or cause harm from additional testing.
  • Ensuring that patients have adequate follow-up with audiology and understanding their hearing aids or amplification devices is vital to the proper and beneficial use of hearing aids.
  • review
    Hearing Loss in the Elderly. StatPearls [Internet] — Dylan Z. Erwin, Philip Chen — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov