The hallmark of presbycusis is the progressive, symmetric loss of high frequency hearing over many years [1]. Patients present with difficulty in hearing and understanding low pitched sounds, and complain of having to ask other people to repeat what they are saying in order to hear them.

• Normal Hair

  Quantitative analysis of five "normal" ears, aged 54-89 yrs, without any history of otologic disease, suggests that cochlear synaptopathy and the degeneration of cochlear nerve peripheral axons, despite a near-normal hair cell population, may be an important [ncbi.nlm.nih.gov]

• Tinnitus

  Presbycusis affects men more than women, and tinnitus accompanies it in many cases. In fact, hearing loss is the leading cause of tinnitus. [tinnitusformula.com]

  MATERIAL AND METHODS: The subjects were divided into 2 groups, presbycusis with tinnitus (tinnitus) group and presbycusis without tinnitus (control) group, with each group comprising 8 temporal bones from 8 subjects. [ncbi.nlm.nih.gov]

  The gender difference in tinnitus Elderly Women suffered a lower prevalence of hearing loss and tinnitus loudness than men did, but tinnitus annoyance was stronger in older women than men [21]. [intechopen.com]

  The severity of tinnitus was evaluated using the Tinnitus Handicap Inventory (THI; Newman et al., 1996). [frontiersin.org]

• Hearing Impairment

  Moreover, the study investigated the effect of speechreading on word intelligibility depending on hearing impairment severity. [ncbi.nlm.nih.gov]

  Over one quarter of people age 65 years and older have hearing impairment. By age 75, one third of people have signs of hearing impairment. Hearing impairment can alter a person's ability to understand speech. [merckmanuals.com]

• Hearing Problem

  How can I tell if I have a hearing problem? Ask yourself the following questions. If you answer "yes" to three or more of these questions, you could have a hearing problem and may need to have your hearing checked. [nidcd.nih.gov]

  problem ( C0260662 ), Degenerative AND/OR vascular disorder of ear ( C0155528 ), Ear structure ( C0013443 ), Diagnosis/Diseases Component ( C0497531 ), Sensorineural Hearing Loss ( C0018784 ), Diseases of inner ear ( C0494559 ) Sources AOD, COSTAR, CSP [66.199.228.237]

• Benign Paroxysmal Positional Vertigo

  paroxysmal positional vertigo - Vestibular neuronitis - Vertigo - Labyrinthitis - Perilymph fistula Hearing impairment Conductive hearing loss - Sensorineural hearing loss - Presbycusis Other Tinnitus - Hyperacusis See also congenital [bionity.com]

• Speech Deterioration

  Speech audiometry in the elderly revealed serious difficulties in understanding speech. Deteriorated temporal resolution, as demonstrated by increased gap detection thresholds, correlated significantly with increased speech recognition thresholds. [ncbi.nlm.nih.gov]

  Clinical psychoacoustics in Alzheimer's disease central auditory processing disorders and speech deterioration. Ann. Gen. Hosp. Psychiatry 2:12. doi: 10.1186/1475-2832-2-12 PubMed Abstract | CrossRef Full Text | Google Scholar Jayakody, D. M. [doi.org]

• Rinne's test to examine if the hearing loss is nerve related.
• Weber's test if the hearing loss is bilateral or just one-sided.
• Audiometry to check the extent of hearing loss.
• CT scan to rule out structural abnormality.
• Blood tests to rule out any autoimmune disorder.

Screening tests

The Hearing Handicap for the Elderly-Screening version (HHIE-S) [2] is an efficient way of screening elderly people of hearing loss as well as to check, to some extent, the degree of severity of the loss. It also helps in discovering how much the hearing loss is affecting the daily life of the patient.

Test results

If a patient's score of the HIEE-S test is 10 points or greater, then he should seek evaluation by an audiologist for a more comprehensive examination [2] [3].

Amplification devices

These devices, simply known as hearing aids, are the most preferred method of managing presbycusis. A task force of the American Academy of Audiology conducted a study evaluating the benefits of amplification in adults [4]. They concluded that these devices are highly effective.

Cochlear implants

Good outcomes have been reported for cochlear implants in patients with presbycusis [6]. In patients with presbycusis due to cochlear damage, like in mechanical presbycusis, this treatment is highly effective.

Active middle ear implant

Active middle-ear implant [5] is a prosthesis which mechanically vibrates the middle ear structures, and is useful for mild to moderate sensorineural hearing loss.

Since this condition develops due to old age, it will keep on getting worse as the age advances. However, if there is an underlying conditioning such as diabetes, hypertension or otosclerosis, it should be treated to stop the condition from progressing.

Complications

Untreated presbycusis leads to social isolation, and depression, and may cause or worsen cognitive impairment and dementia [7]. There are no serious medical complications of presbycusis. The life style of the patient however, is mostly affected.

Presbycusis is a multifactorial process driven by environmental factors and exacerbated by concurrent disease [8]. There is no certain causative factor known of this condition. So it is assumed that a combination of factors contribute in the development of this condition. These factors may include preexisting disease like diabetes, hypertension and arteriosclerosis. Other factors are continuous and unprotected exposure to damaging sounds, such as to people working in airports and factories, use of ototoxic drugs, exposure to environmental chemicals, etc. Genetics plays an important role in the development of presbycusis. So a combination of one, or more often, more than one factors makes a person vulnerable to sensorineural hearing loss.

Incidence

Around 25-30% people between the 6th and 7th decade of life are estimated to have presbycusis. WHO estimates that by 2025, there will be 1.2 billion people over 60 years of age worldwide, with more than 500 million individuals who will suffer significant impairment from presbycusis [5].

Age

Prevalence of hearing loss increases with age, with up to 80% of functionally significant hearing loss occurring in older adults [8].

Sex

Although there is no specific cause known, some studies reveal that presbycusis is found to occur more in males than in females. However, no definite predominance is established as yet.

No single histopathological finding can reliably account for the clinical variability seen in presbycusis [9]. However, as age advances, changes in the histologic make up of the inner ear and the nerves gradually occur. It is the accumulation of these progressive changes that ultimately result in hearing loss. According to the main histologic finding, presbycusis can be divided into 4 types.

Sensory presbycusis

In this type, damage occurs in the organ of Corti and the sensory hair cells. Damage could be in the form of atrophy, impairment of function and/or accumulation of lipofuscin granules.

Neural presbycusis

In this type, the major histopathologic finding is in the nerve cells. Cells of the organ of Corti to those of the Vestibularcochlear nerve (8th cranial nerve) may suffer atrophy. The basilar portion of the cochlea is more vulnerable to damage, however, the entire organ may become involved.

Mechanical presbycusis

Due to advancing age, there may be thickening of the basilar membrane of the cochlea. This thickening may be due to a number of factors such as sloughing off of old cells, lipofuscin deposition, high exposure to loud sounds, etc and occurs particularly at the basal turn of the cochlea because here the basilar membrane is the narrowest. Whatever the reason of thickening maybe, the stiff basilar membrane is now ineffective in transmitting sound waves and hearing loss ensues. This is called mechanical or conductive presbycusis.

Metabolic presbycusis

In this type of old-age hearing loss, the stria vascularis suffers damage or atrophy. Note that the stria vascularis's function is to maintain the biochemical state of balance of the cochlea. Damage to the stria results in impaired functioning of the cochlea and hence, hearing loss.

Presbycusis may be prevented by regular and proper cleaning of the ear to prevent accumulation of cerumen (ear wax), avoiding exposure to high and loud sounds, wearing protective ear muffs if working in noisy areas, etc.

Presbycusis, or age-related hearing loss is a common cause of hearing loss in adults worldwide [10]. It may be defined as sensorineural hearing impairment due to old age. Presbycusis most commonly occurs in both ears but the onset and rate of severity of the condition may differ. It is such a prevalent condition that some elderly people go about living with it without taking any serious medical treatment or aid.

Presbycusis is a condition of old age in which gradual hearing loss occurs. With the help of hearing aids and implants, this condition can easily be managed.

1. Gates GA, Mills JH. Presbycusis. Lancet 2005; 366: 1111
2. Ventry IM, Weinstein BE. Identification of elderly people with hearing problems. ASHA 1983, 25 (7): 37-42
3. Lichtenstein MJ, Bess FH, Logan SA. Validation of screening tools for Identifying hearing-impaired elderly in primary care. JAMA 1988, 259: 2875-78
4. Chisolm TH, Johnson CE, Danhauer L, Portz LJ, Abrams HB, Lesner S, et al. A systematic review of health related quality of life and hearing aids: final report of the American Academy if Audiology Task Force on the health related quality of life benefits of amplification in adults. J Am Acad Audiol 2007; 18: 151-183
5. Guy's and St Thomas' NHS Trust; Auditory Implant Program: The Middle Ear Implant (MEI) - Information for referers.
6. Sprinzl GM, Riechelmann H. Current trends in Treating hearing loss in elderly people: a review of the gerontology. 2010; 56 (3): 351-8. ePub. 2012
7. Dalton DS, Cruickshanks KJ, Klein BE, et al. The impact of hearing loss on quality of life in older adults. Gerontologist. 2003, Oct, 43 (5): 661-8
8. Davis AC. Epidemiological profile of hearing impairments: the scale and nature of the problem with special reference to the elderly. Acta Otolaryngol Suppl, 1990, 476: 23
9. Suga F, Lindsay JR. Histopathological observations of presbycusis. Ann Otol Rhinol Laryngol.1976; 85: 169
10. Nelson EG, Hinojosa R. Presbycusis: a human temporal bone study of worth individuals with downward sloping audiometric patterns of hearing loss and review of the literature. Laryngoscope 2006; 116: 1