Presbycusis

BASICS

Definition: Age-related hearing loss (HL); gradual, progressive, bilateral, often high-frequency sensorineural HL with tinnitus.
Presentation: Difficulty hearing in noisy environments; reduced clarity, especially for speech; “clarity” of sounds affected.
Types:
Central: CNS degeneration affecting perception/speech.
Peripheral: Bilateral sensorineural HL (SNHL), symmetric.
No cure; management is risk factor mitigation and auditory amplification (hearing aids).

Cochlear hair cells—critical for hearing—are lost due to noise, disease, ototoxins, and aging.
Causes: Accumulated noise exposure, systemic disease, ototoxic drugs, genetics, oxidative damage.
Genetic Links: GSTM1, GSTT1, NAT2*6A, GRM7, GRHL2, DFNA5, MYO6, KCNQ4; mitochondrial mutations.
Mechanism: Hair cells don’t regenerate—damage = permanent HL.

Avoid hazardous noise exposure; use hearing protection.
Screening: No USPSTF recommendation for routine adult screening. Tools: Hearing Handicap Inventory for the Elderly.
RCT evidence: Screening + intervention increases hearing aid use vs. controls.

Whispered voice test
Otoscopy: rule out infection, tumor, cerumen impaction, TM perforation
Rinne/Weber: help distinguish SNHL vs. conductive HL (not for general screening)

Cerumen impaction, foreign body, chronic otitis, cholesteatoma, otosclerosis, perilymph fistula, Ménière disease, acoustic neuroma (unilateral), autoimmune HL, trauma, vascular anomaly

Audiometry: Symmetric high-frequency SNHL; descending slope; >2kHz affected first
Imaging: Only if asymmetric HL (MRI for acoustic neuroma)
Labs/other: Not routinely needed

Mainstay: OTC options for mild/moderate HL.
Types: Analog (basic amplification), digital (programmable, background noise reduction, better adaptation).
Average gain: ~16 dB.
Loudness recruitment: Hypersensitivity to loud sounds

Alone or with HAs
FM/infrared systems, induction loops, TDD, TV/telephone amplifiers, alerting devices

Indication: Poor aided hearing (≤50% keyword recognition in worst ear, ≤60% better ear)
Bypasses cochlea, direct nerve stimulation
Most common: Unilateral CI (sometimes bilateral or bimodal [CI+HA])
Best results if implanted younger

Monitor: Annual audiograms; check device fit/compliance
Education: Face-to-face communication, confirm message understood, consider speechreading classes
Support: Address device-related issues; encourage ongoing use

Hearing loss can impact mood, cognition, and social function—treatment improves quality of life.
Early intervention = better cognitive, emotional, and social outcomes.

Age-related, symmetric, high-frequency SNHL; often with tinnitus
Difficulty hearing in noisy conditions is classic
Associated with depression, social isolation, and dementia risk
Hearing aids, cochlear and middle ear implants can improve cognition and quality of life
Refer early to audiology for any suspected HL