Overview

Presbycusis (‘presby’ – old, ‘cusis’ – hearing) describes bilateral high-frequency sensorineural hearing loss with an associated difficulty in speech discrimination. It is progressive and seen in older people as they age. 

It is due to a combination of factors such as the loss of auditory neurones and cochlear outer hair cells, inflammation, noise, and comorbidities such as diabetes mellitus and hypertension. 

Epidemiology

  • Prevalence increases with age
  • More common in men than in women
  • 70% of people >70 years of age have some level of hearing loss

Risk Factors

  • Excessive noise exposure e.g. occupational nose and insufficient ear protection
  • Smoking
  • Ototoxic drugs:
    • Aminoglycosides
    • Loop diuretics
    • NSAIDs, particularly aspirin
  • Family history
  • Obesity
  • Hypertension
  • Diabetes mellitus
  • Cardiovascular disease

Presentation

Patients often first notice the problem in noisy environments. They often find they have trouble understanding speech due to progressive bilateral sensorineural hearing loss. Some features may be:

  • Difficulty understanding speech – often seen earliest
    • Patients struggle to understand consonants such as ch, f, k, p, and s, and this makes understanding speech difficult
  • Increasing the volume on televisions/radio/phones etc.
  • Symptoms are worse in noisy environments
  • Symptoms may be confused for cognitive impairments/depression in the elderly
  • Examination is usually normal, however, Weber’s test may lateralise to the least affected side

Differential Diagnoses

Noise-related hearing loss

  • There may be a history of previous exposure to high levels of noise e.g. machinery or loud music
  • There may be associated tinnitus
  • Examination is usually normal

Vestibular schwannoma (acoustic neuroma)

Investigations

  • Otoscopy:
    • To rule out external ear causes e.g. impacted wax/foreign body/cholesteatoma etc.
  • Pure tone audiometry:
    • Confirms the diagnosis and shows bilateral high-frequency sensorineural hearing loss

Management

  • 1st-line: lifestyle modifications and environmental noise reduction + reassurance
  • Hearing aids, assistive listening devices, and cochlear implants may be considered 

Patient Advice

  • Patients should reduce noisiness in their environment and maintain a healthy lifestyle through exercise and a balanced diet. They should be offered help with these.

Complications

  • Communication difficulties
  • Employment difficulties
  • Increased risk of dementia

Prognosis

  • Presbycusis is progressive and permanent, however early intervention and management can improve the patient’s quality of life, although it cannot restore normal hearing.

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