**4. Conclusion**

*Geriatric Medicine and Gerontology*

on ARHL-related genetic factors.

*2.3.1 Consequences of suffering ARHL*

overcome obstacles caused by hearing loss.

**3. Hearing loss treatments**

aging or is not amenable to treatment.

caused by the atrophy of the stria vascularis resulting in a decrease in endolymphatic potential [74]. Also, there is a mixed type where the progressive degeneration of sensory cells is observed along loss of cochlear neurons [75–77]. Moreover, still controversial if the loss of neurons is a secondary consequence or a primary cause. The task to distinct between genetic and environmental factors in acquired hearing loss is very challenging. In this regard, to progress the understanding of the mechanisms that lead to the damage, physiopathology of age-related hearing loss had been assessed by *in vitro* (cell lines) and *in vivo* (rodents and zebrafish) models [70]. The studies provided evidences of specific inner damage such as inflammation, oxidative stress, reduced cochlear blood flow, disrupted ion hemostasis and death of sensory and neuronal cells [78]. **Table 3** summarizes all current knowledge

Age-related hearing loss affects communication and information reception reducing the quality of live and psychosocial well-being (e.g., anxiety or depression) of elder population. Limitation in communication has an impact on social and personal relationships triggering to loss of autonomy and dependency [122, 123]. Even though the World Health Organization estimates that by 2025 approximately 500 million will suffer from age-related hearing loss; there is a lack of awareness by health care professionals as well as no educational programs on how patients could

Few studies have investigated the psychological factor and how individuals develop their lives in the presence of hearing loss. The studies reveal that maladaptive behavior (e.g., escape, avoiding social interaction and/or pretending to understand) has a negative effect on well-being of elder patients comparing to adaptive strategies (e.g., training verbal skills or self-awareness) [124, 125]. Additionally, there is a significant increase of hearing aids use by cases who attend audiology clinic with a relative than others attending alone [126]. Therefore, elder population with acquired hearing loss requires social support from family and health care professionals. Educational programs on how to use hearing aids and communication strategies as well as counseling for follow-up and feedback are needed in order

Hearing loss is not a curable disease however science made some considerable progress. Current therapies based on cochlear implants (a device that provides direct electrical stimulation to the auditory nerve in the inner ear) and hearing aids (are non-surgically placed in the ear canal) which help patients to recover partly hearing. Hearing aids could be a stigma in the society as are negatively perceived as well as expensive making that only one out of five people who could benefit from a hearing aid actually wears it (WHO, [128]). Therefore, the major barriers to improve hearing in elder population include perception that hearing loss is a normal part of

Based on the animal research studies, several clinical trials are working to investigate the effects of a variety of drugs to prevent hearing loss including antioxidants, ROS scavengers, alpha lipoic acid, N-acetylcysteine or anti-inflammatory

New generation treatments based on microRNA, short interfering RNA as well as tissue regeneration using stem cells are promising tools [135, 136]. Due to

to increase adherence to treatment and improve life quality [127].

**124**

agents [129–134].

Of the senses that humans use to interact with their environment, hearing is considered as one of the dominant after vision. The loss of hearing can occur through genetic mutations, through environmental factors or through a combination of both. ARHL is an increasingly important public health problem which reduces life's quality, isolation, dependence and frustration. Besides basic research and more effective therapies for the optimal treatment, management of the condition is still a pending task. Social support by the family and health care professionals is critical to the life quality of the older adults with hearing loss. The quality of care and well-being could be improved by active education and counseling to provide appropriate support to facilitate everyday communication.
