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Presbycusis - Causes, Symptoms, Diagnosis, and Management

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Presbycusis - Causes, Symptoms, Diagnosis, and Management

5 min read


Hearing loss that occurs slowly as age increases is called presbycusis or age-related hearing loss. For more details, read this article.

Written by

Dr. Ruchika Raj

Medically reviewed by

Dr. Mohammed Osama Aboborda

Published At August 10, 2022
Reviewed AtMay 31, 2024


Hearing loss related to age or presbycusis can occur in one or both ears. Hearing loss occurs so slowly that it is difficult to realize that the efficiency of hearing is reduced. Hearing is an event that occurs when sound waves are converted into electrical signals, and these signals are transferred by the auditory nerve to the brain in various steps:


What Is the Prevalence of Age-Related Hearing Loss?

It mostly affects people in the age group of approximately 60 to 75 with hearing loss and difficulty hearing in the age group above 70.

What Are the Causes of Age-Related Hearing Loss?

  • Abnormal changes in the:

    • Inner ear.

    • Middle ear.

    • Hearing pathway.

  • Continuous exposure to loud noise.

  • Genetics.

  • Damage or loss of hair cells.

  • With increasing age.

  • Smoking.

  • Excessive use of earphones or other ear devices.

  • Medicinal side effects like cancer medications or drugs that are toxic to the ears.

  • Systemic diseases like diabetes and heart diseases.

What Are the Causes of Presbycusis?

Presbycusis is a condition that is caused by any alteration in the inner ear that occurs as a person ages. It usually affects both ears and occurs gradually. Many people are affected by age-related hearing loss and noise-induced hearing impairment. In the long run, loud noises tend to damage the sensory hair cells, which is the segment of the ear that allows hearing. Some common causes of age-related hearing loss are,

  • Diabetes.

  • Increased blood pressure.

  • Family history of hearing impairment.

  • Continuous exposure to high noise.

  • Aging.

  • Destruction of hair cells.

  • Side effects of certain medications such as Aspirin.

This condition can also be caused due to alterations in certain regions, such as

  • Alteration in the inner ear.

  • Changed within the inner ear.

  • Alteration along the nerve path.

What Are the Signs and Symptoms of Presbycusis?

  • Hearing slurred speech when other people talk.

  • Ringing sound in the ears.

  • Difficulty in listening to high-pitched sounds.

  • Men's voices are much easier to understand.

What Are the Types of Presbycusis?

The types are

  • Sensory presbycusis:

This type is caused when the person loses outer hair cells in the corti at the base of the cochlea.

  • Neural presbycusis:

The hearing depends on nerve cells in the cochlea and the auditory path to the brain. These nerve cells are destroyed as a person ages.

How Can Age-Related Hearing Loss Be Diagnosed?

  • Physical Examination: An otoscope (small instrument with light) is used by the doctor to check the outer ear canal, eardrum, ear canal blockage with ear wax or other external objects, and ear infections.

  • An Audiogram: This is performed to check whether each sound can be heard or not to identify the severity of the hearing loss.

  • Pure Tone Test: This test is done for patients who are in rehabilitation, including patients who are using a hearing aid.

  • Hearing in Noise Test (HINT): This test is done to evaluate a person's ability to hear in both loud and quiet environments.

  • Central Auditory Processing Disorder (CAPD): It is common in patients with presbycusis, where a person has normal hearing, but the sound is disturbed by background noise. In this test, the speech-hearing test is done in a noisy place where the results are compared to the pure-tone test.

How to Prevent Age-Related Hearing Loss?

It can be prevented by,

  • Avoid using earphones or hearing aids for a longer duration.

  • Fix the volume for earphones at a safety level.

  • Avoid smoking.

  • In case of any ear infections, get it checked by the doctor immediately.

  • Keep the ears clean and dry.

  • Avoid cleaning the ear with external objects to prevent trauma to the ears.

  • Avoid places with loud noise as much as possible.

Age-related hearing loss is not a reversible condition, so prevention is very important.

What Are the Possible Treatments for Age-Related Hearing Loss?

  • Hearing Aids: These are small electronic instruments that are worn in or behind the ear to hear the sound loud and clear.

  • Cochlear Implants: These are electronic devices that are implanted surgically into the inner ears of a person having severe hearing loss or who are almost deaf.

  • Bone Anchored Hearing System: It is designed to transfer sound through bone conduction.

  • Assistive Listening Devices (ALDS): Various types of assistive listening devices are available for hearing loss, like hearing loop systems, infrared systems, and personal amplifiers. These devices help people to hear clear sounds even with a lot of background disturbance.

  • Alerting Devices: Sound, light, or vibration devices are kept in the house to alert for any particular event occurring.

  • Augmentative and Assistive Communication Devices (AACD): These devices help people with communication disorders by using simple picture boards or any computer program that can convert text to speech format.

How to Select the Most Suitable Hearing Aid?

  • Visit an ENT (ear, nose and throat) specialist to make the correct diagnosis of the problem after a physical examination.

  • The type and degree of hearing loss are identified by the specialist after performing a test.

  • A test or trial is conducted to find an appropriate hearing aid by the specialist and then advised to the patient.

How to Communicate With a Person Who Has Age-Related Hearing Loss?

  • Use shorter phrases to speak.

  • Avoid any background noise during the conversation.

  • Face the person having hearing loss while talking.

  • Speak slowly and clearly.

  • Speak louder than normal.

What Is Further Research Conducted for People With Age-Related Hearing Loss?

Much research is conducted on assisted technology for people with age-related hearing loss:

  • Brain-Computer Interface Research: Research is making a prosthetic device that can convert a person's thoughts into speech and sentences. These devices will be small electrodes that will be implanted into the mortar cortex of the brain.

  • Improved Devices for People With Hearing Loss: Ongoing research is being done on forming new portable devices so that multiple users can message each other and display them in real-time.

  • Improved Devices for People With Speaking Problems: Research is going on to form text-to-speech converting devices for persons who are at risk of losing their speaking ability.

What Are the Complications of Presbycusis?

  • Difficulty in conversation with family and friends.

  • A feeling of depression and loneliness.

  • Difficult to understand important instructions like health, financial, and legal information.

  • Loss of self-confidence to join a conversation.

What Can a Person Expect if They Have Presbycusis?

This condition gets worse over time. But this condition can be managed using hearing aids. Those people who experience hearing loss due to aging can be managed.

How to Take Care?

Some ways how a person can take care when affected by this condition is

  • Share the Situation:

The person should tell their friends, family, and colleagues.

  • Protect the Hearing:

Loud noises can make the condition even worse. So the person should wear ear protection when they are around any loud noises.

  • Wearing of Hearing Aids:

Hearing aids help to magnify the sound and make it easier for the person to hear and comprehen speech.


Age-related hearing loss is a very slow and progressive process affecting mainly people above 65 years of age. Hearing loss is a slow process, so realizing any change or loss of hearing abilities is even more difficult. As it is an irreversible condition, prevention is very important. Timely care of all health problems on a priority basis at older age helps to prevent age-related diseases such as presbycusis.

Frequently Asked Questions


What Are the Classic Symptoms of Presbycusis?

The main three symptoms of presbyacusis are:
- Difficulty in distinguishing high-pitched sounds.
- Trouble in hearing voices, especially when there is background noise.
- Male voices seem to be more audible than females.
Ringing sound.


What Causes Presbyacusis?

Presbyacusis is caused by multiple factors, but mostly due to age-related changes in the nerve pathways or inner and middle ear. Other factors include:
- Exposure to loud noise.
- Genetic and hormonal changes.
- Systemic disorders.


How Does the Doctor Diagnose Presbycusis?

When the patient complains of hearing loss, the doctor may use an otoscope to check
the eardrum, canal, etc. The other test used in the evaluation of presbyacusis is:
- Audiometry exam test.
- Pure tone test.
- Hearing in noise test (HINT).


How Is Presbycusis Treated?

As presbycusis is not entirely curable, the doctor may suggest the following measure to improve the hearing:
- Hearing aids amplify the sound.
- Alerting devices.
- Surgically placed cochlear implants.
- Bone anchored hearing system.
- Other sound amplifiers.


Does Presbycusis Worsen?

Presbyacusis may progress over age, but it may not cause complete hearing loss. In addition, the affected individual may have ill mental and physical health. Therefore, they require supportive care to cope with it. The doctor also may suggest hearing aids and other amplifiers to improve hearing. It is also essential to stay away from loud noises and avoid using earphones for a long time.


What Is It Like Living With Presbycusis?

Presbyacusis may mostly occur as a consequence of aging. But, it may cause difficulty in hearing voices in the presence of background noise, trouble in distinguishing certain sounds (“s” and “th”), etc. It may even be worse with increasing age. However, it is manageable with hearing aids. Therefore, visiting an otorhinolaryngologist and audiologist is essential to managing hearing loss.


At Which Age Does Presbycusis Begin?

Age-related hearing loss is more common in people between 60 to 75 years of age. However, it may begin at 30 to 40 years, and it most commonly affects both ears. It causes the inability to hear voices with background noise, trouble in understanding few sounds, and also affects mental health due to disturbance in communication. The hearing loss also worsens with increasing age.


Which Is the Common Form of Presbycusis?

The primary forms of presbyacusis include:
- Sensory.
- Neural.
- Metabolic.
- Cochlear conductive.
However, reports show that the metabolic type is more common, and the affected individual may have high-frequency hearing loss.


Can Presbycusis Be Inherited?

Various factors cause presbyacusis or age-related hearing loss. While some may acquire it genetically, and it affects the inner, middle ear, or the nerves responsible for transmitting sound signals. In addition, studies show hearing loss occurs due to changes in mitochondrial DNA. These factors may lead to the occurrence of hearing loss at an early age. However, it is irreversible and requires hearing aids and cochlear implants.


How Can I Improve Presbycusis?

Here are a few measures that you can follow to prevent complete hearing loss and protect the amount of hearing ability with presbyacusis:
- First, stay away from loud noises.
- Use ear plugs to protect your ears.
- Do not hear loud noises for a prolonged time.
- Consult audiologist and otolaryngologist periodically.
- Finally, wear hearing devices as suggested by the specialist.


Does Presbycusis Have a Good Prognosis?

Presbyacusis is not entirely treatable, and it is not possible to regain the natural hearing ability. In addition, such hearing loss also worsens or progresses with age. However, following specific measures might prevent its progression but not cure it. But, their symptoms are managed with hearing aids, cochlear implants, and amplifiers.


Is Presbycusis Reversible?

Age-related hearing loss is not reversible, and the chances of its progression are high. It may also affect mental health, causing depression, lack of self-confidence, etc. Therefore, it is vital to prevent such conditions by:
- Protecting the ears with ear plugs.
- Stay away from loud noises.
- Treating systemic conditions.
Source Article IclonSourcesSource Article Arrow
Dr. Mohammed Osama Aboborda
Dr. Mohammed Osama Aboborda

Otolaryngology (E.N.T)


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