Hearing loss is not a normal part of aging
In the third of a series of medical guest posts on hearing health, Daniel Fink MD explains why hearing loss is not a normal part of aging.
See first post on why loud restaurants are bad for your hearing health and second post on non-auditory health effects of noise.
Daniel Fink MD
Why don’t people do more to prevent hearing loss? One reason may be that they think hearing loss is an inevitable part of aging, just like gray hair, weight gain, difficulty walking, and wrinkled skin. Doctors and audiologists think this, too, using the terms age-related hearing loss or presbycusis to describe hearing loss with age. If something is inevitable, why worry too much about it.
But hearing loss with age isn’t part of normal aging. It overwhelmingly is noise-induced hearing loss. I presented my analysis of this topic at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich in 2017. 
The basic biological processes of aging are still not yet completely understood but the results of the passage of time are visible in all living things. In humans, much of what is considered normal aging may be normal in terms of being common, but not normal in terms of physiology. Abnormal or pathological aging is caused by bad diet, disuse atrophy, or exposures.
Graying of the hair may be normal, but weight gain with age, with associated hypertension and diabetes, is caused by poor diet and insufficient exercise. [2,3] Difficulty walking is caused by muscle weakness from inactivity.  Wrinkled skin is caused by sun exposure, not by age alone.  And similarly, significant hearing loss with age is largely caused by noise exposure. A series of studies done in the 1960s [6,7,8,9], in isolated populations in Africa not exposed to loud noise, found that older people heard almost as well as younger people. There was less than a 10 decibel decrement in hearing in older adults compared to younger ones.
Other reasons people don’t do much to prevent hearing loss include a misunderstanding of what the safe noise exposure level is ; the fact that hearing loss isn’t usually a problem until after age 65 , when most people are out of the workforce; the fact that older people tend to be isolated, so their problems are less noticeable; and the fact that hearing as a sense is perceived as less important than vision. If people were going blind from noise exposure, noise would get a lot more attention.
Noise-induced hearing loss starts early in life. A recent report from the Netherlands found that children age 9-11 who used headphones to listen to music were more likely to have hearing problems than those who didn’t.  With ubiquitous personal music players use worldwide, an epidemic of early-onset noise-induced hearing loss is probably occurring. In the next two decades, I expect that hearing loss will become a problem for people in mid-life, in the peak of their earning and family years. But it will be too late for them to do anything except to purchase costly hearing aids or less expensive personal sound amplification devices. Neither is an adequate replacement for preserved normal hearing.
It makes much more sense to protect hearing now. If it sounds too loud, it is too loud. People should avoid loud noise and if they can’t avoid it, should use hearing protection. The stark choice is clear: earplug use now or hearing aid use later.
- Fink DJ, Hearing loss with age is probably not part of normal aging. Presented at the 12th Congress of the International Commission on the Biological Effects of Noise, June 20, 2017, Zurich, Switzerland. Available at https://pdfs.semanticscholar.org/fc97/2b7e9f3cb847ef9266d48c31438bf1ac9349.pdf
- Bowman K, Delgado J, Henley WE, Masoli JA, Kos K, Brayne C, Thokala P, Lafortune L, Kuchel GA, Ble A, Melzer D, Obesity in older people with and without conditions associated with weight loss: follow-up of 955,000 primary care patients, J Gerontol A Biolo Sci Med Sci, 2017; 72(2):203-209 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5233914/
- Rahmouni K, Correia MLG, Haynes WG, Mark AL, Obesity-associated hypertension: new insights into mechanisms, Hypertension 2005;45:9-14 https://www.ncbi.nlm.nih.gov/pubmed/15583075
- Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, Physical activity and public health in older adults: recommendations from the American College of Sports Medicine and the American Heart Association, Circulation 2007;116(9):1094-1105 Available at https://scholarcommons.sc.edu/cgi/viewcontent.cgi?article=1361&context=sph_epidemiology_biostatistics_facpub
- Flament F, Bazin R, Laquieze S, Rubert V, Siimonpietri E, Piot B, Effect of the sun on visible clinical signs of aging in Caucasian skin, Clinical Cosmetic and Investigational Dermatology 2013;6:221-232 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790843/
- Rosen S, Bergman M, Plester D, El-Mofty A, Satti, MH Presbycusis study of a relatively noise-free population in the Sudan, Ann Otol 1962;71:727-742
- Dickson RC, The normal hearing of Bantu and Bushmen: a pilot study, J Laryng Otol 1968;82(6):505-522
- Jarvis JF, van Heerden HG, The acuity of hearing in the Kalahari Bushmen, J Laryng Otol 1967;81(1):63-68
- van der Sandt W, Glorig A, Dickson R, A survey of the acuity of hearing in the Kalahari Bushmen, Int J Audiology 1969;8(2-3):290-298
- Fink, DJ What is a safe noise level for the public? Am J Publ Health 2017;107:44-45 Available at https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2016.303527
- Lin FR, Niparko JK, Ferrucci L, Hearing loss prevalence in the United States. Arch Int Med 2011;171;151-1852 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564588/
- Le Clerq CMP, Goedegebure A, Jaddoe VWV et al. Association between poertable music player use and hearing loss among children of school age in the Netherlands. JAMA Otolaryngol Head Neck Surg 2018;144:66-675. Available at https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2684510
Note: The articles from the 1960s, References 6-9, are not available online.