PRESBYCUSIS: Exploring the Causes, Symptoms, and Treatment of OLD AGE HEARING LOSS



Presbycusis refers to bilateral age-related hearing loss.

In literal terms, presbycusis means “old hearing” or “elder hearing.” It becomes noticeable around age 60 and progresses slowly.

Presbycusis is a gradual decline in hearing ability and can have a significant impact on an individual’s quality of life. 

In this blog, we will explore the causes, symptoms, and the various treatment options available to help individuals manage their hearing loss and improve their overall quality of life.

What Is Presbycusis?

Hearing loss related to normal aging is known as presbycusis. It is defined as the loss of hearing in old age.

In most cases of presbycusis, hearing loss is symmetrical or in both ears. 

Presbycusis, or age-related hearing loss, is a common cause of hearing loss in adults worldwide.

Presbycusis is a complex and multifactorial disorder characterized by symmetrical progressive hearing loss over many years. It usually affects high hearing frequencies, although its presentation and clinical course can be variable.

What Causes Presbycusis or Age-Related Hearing Loss?

The following are some of the common causes of presbycusis:

  • Natural changes or reduction in sensitivity or performance of our inner ear.
  • Age-related degeneration of nerves from the ear to the brain.
  • Hereditary factors

Other factors that can speed up the onset of presbycusis are:

  • Continuous exposure to loud sounds (music or noise pollution)
  • Health conditions like diabetes mellitus, high blood pressure, and heart disease.
  • Ototoxicity or side effects of certain medicines.

Risk factors —

Multiple factors can influence the onset and severity of presbycusis. These factors include:

  • White race
  • Low socioeconomic status
  • Loud noise exposure
  • Exposure to ototoxins (eg, aminoglycosides, chemotherapeutic agents, heavy metals)
  • Otologic infections
  • Smoking
  • Hypertension
  • Diabetes
  • Vascular disease
  • Immunologic disorders, and
  • Hormonal factors (eg, aldosterone, thyroid hormones, estrogen).
  • Loud noise exposure during youth can hasten the progression of age-related hearing loss despite the cessation of noise exposure.
  • A genetic component also predisposes individuals to age-related hearing loss.
  • Dietary factors (eg, a high-fat diet) may also be associated with an increased risk of developing presbycusis.

At What Age Does Hearing Loss Begin?

Presbycusis is a common age-related hearing loss.

1 in 4 people experience hearing loss from the age of 45 years onwards, and the possibility of presbycusis increases with age.

The table below shows the age and the percentage of people suffering from hearing loss.

45 – 5425%
55 – 6450%
65 – above75%

What Are Some of The Common Symptoms of Presbycusis?

Some of the common presbycusis symptoms are:

  • Speech of others sounds mumbled or slurred
  • High-pitched sounds, such as “s” or “th” are hard to distinguish
  • Men’s voices are easier to hear than women’s
  • Some sounds seem overly loud and annoying
  • Tinnitus, ringing, buzzing, hissing or other sounds in the ear when no external sound is present
  • Need for increased volume on television, radio, music, and other audio sources
  • Difficulty using the telephone
  • Loss of directionality of sound
  • Difficulty understanding speech, especially women and children
  • Difficulty in speech discrimination against background noise (cocktail party effect)
  • Gradually withdrawing themselves from family discussions and social events as a conversation with acquaintances is embarrassing.

Is Presbycusis Conductive or Sensorineural Hearing Loss?

Presbycusis is a sensorineural hearing loss since it affects the cochlea, the hair cells, and to some extent, the neural pathways. Age-related hearing loss is mostly due to the inner ear and not due to the outer ear or the middle ear. Hearing loss caused by problems in the outer ear and the middle ear is classified as conductive hearing loss.

What Are the Types of Presbycusis?

There are 4 main types of presbycusis:

1. Sensory Presbycusis

Involving damage to sensory hair cells and supporting cells.

2. Neural Presbycusis

Caused by the damage to nerve cells in the cochlea and auditory pathways to the brain.

3. Metabolic Presbycusis

Due to the damage to the stria vascularis. The stria vascularis regulates the chemical and bioelectrical balance and metabolic health of the cochlea.

4. Mechanical Presbycusis

Caused by degenerative thickening and stiffening of the basilar membrane of the cochlea.

How Is Presbycusis Diagnosed?

Presbycusis diagnosis starts with the patient’s medical history, followed by the physical examination of the ear. The ENT doctor will look into the ear with the help of an otoscope to check for infection, inflammation, earwax accumulation, or any sign of physical damage.

Routine physical exam maneuvers alone are not sufficient for diagnosing presbycusis. An in-office screening AUDIOMETRY TEST (PURE TONE AUDIOMETRY and TYMPANOMETRY) administered by trained personnel should be considered by providers such as GERIATRIC OTOLARYNGOLOGISTS who have a large population of older adults at high risk of presbycusis.

[Note: GERIATRIC OTOLARYNGOLOGISTS are ENT doctors who specialize in dealing with ear, nose, throat, head, and neck complaints of elderly people]

IMAGING is usually not performed except in cases in which there is a discrepancy between presentation and auditory testing or there are associated neurological changes.

In general, an audiometry exam tests the ability to hear sounds at varying intensities (loudness) and frequencies (tone).

Commonly, Pure Tone Audiometry (PTA) testing (also known as an Audiogram) is performed in patients with suspected age-related hearing loss. Pure tones are delivered through the use of headphones to one ear at a time. Patients are asked to respond if they hear a sound.

In presbycusis, the highest-frequency sounds are typically affected first, followed by lower and lower-frequency sounds as the condition progresses. Presbycusis is characterized by bilateral hearing loss above 2000 Hertz. On a standard audiogram, presbycusis is an overall down-sloping line representing impaired hearing at higher frequency sounds.

The presbycusis tests are:

• Hearing Screening
• Pure-Tone Audiometry
• Speech Audiometry Test
• Hearing In Noise Test (HINT)

Laboratory testing for Presbycusis

Mainly for diseases commonly associated with hearing loss, such as —

  • Dyslipidemia,
  • Diabetes, and
  • Renal dysfunction may be indicated.


Management of patients suffering from presbycusis is teamwork; following specialties can help in the management of these patients to improve outcomes.


Referral for formal audiometry testing, hearing aid fitting, and education

Urgent ENT specialist consultation

If the hearing impairment is sudden in onset, asymmetric, or concern for different auditory pathology


For further investigation into other causes of hearing impairment, especially if there are cooccurring neurologic signs and symptoms (headache, loss of balance, vertigo, facial numbness/weakness, visual changes)


if there are concerns for concurrent cognitive impairment or dementia


if there are concerns for ototoxicity related to specific cancer treatment regimens


for negative effects on mood, anxiety, and depression

How To Treat Presbycusis?

Despite the high prevalence and impact of presbycusis, a directed treatment to prevent or reverse its effects is not available. However, multiple options can compensate for hearing loss and improve daily function and well-being.

Your healthcare provider will figure out the best treatment based on the following:

  • How old are you
  • Your overall health and medical history
  • How sick you are
  • How well can you handle specific medications, procedures, or therapies?
  • How long is the condition expected to last
  • Your opinion or preference

Treatment options for age-related hearing loss may include the following:

  • Hearing aid(s)
  • Assistive devices, such as telephone amplifiers or technology that converts speech to text
  • Cochlear implants
  • Training in speech-reading (to use visual cues to determine what is being said)
  • Techniques for preventing excess wax in the outer ear
  • Lip-reading

How To Prevent Hearing Loss in Old Age?

Hearing loss in old age cannot be prevented as it is age-related. Like the other parts and organs of the body, natural aging or wear and tear of the organs takes place. But precautions can be taken to delay the onset or progression of hearing loss.

Some of the ways to prevent age-related hearing loss are:

  • Protect your ears from loud music and noise. Use earplugs if you are working in a factory or a construction site. Read our article for tips on protecting your hearing.
  • Avoid self-medication, and do not consume medicines without consulting the doctor. Some medicines cause ototoxicity that permanently damages the delicate hair cells in the inner ear.
  • Take care of your health; diseases like diabetes, high blood pressure, and heart problems are causes of hearing loss. Read our article on diseases that cause hearing loss.
  • Treat ear infections. Though mild cases of infection heal independently, consult a doctor if the infection persists.
  • Avoid smoking and drinking in excess. Many everyday habits can cause hearing loss. read our article on habits that can cause hearing loss.



This blog, including information, content, references, and opinions, is for informational purposes only.

The Author does not provide any medical advice on this platform.

Viewing, accessing, or reading this blog does not establish any doctor-patient relationship.

The information provided in this blog does not replace the services and opinions of a qualified medical professional who examines you and then prescribes medicines.

And if you have any questions of medical nature, please refer to your doctor or qualified medical personnel for evaluation and management at a clinic/hospital near you.

The content provided in this blog represents the Author’s own interpretation of research articles.

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