Presbyakusis

Presbyakusis, also known as presbycusis or age-related hearing loss, is a progressive, bilateral sensorineural hearing loss that arises as part of the aging process. It typically affects the cochlea and central auditory pathways and results from long-term degenerative changes in the auditory system.

Pathophysiology is multifactorial. Age-related changes include loss of hair cells, atrophy of the stria vascularis, degeneration of spiral ganglion neurons, and connective tissue alterations within the cochlea. These changes can be categorized into several overlapping patterns, such as sensory (hair cell loss), neural (loss of nerve fibers), strial/metabolic (reduced endocochlear potential), and sometimes cochlear conductive components. Cumulative lifetime noise exposure, vascular factors, ototoxic medications, smoking, and metabolic diseases like diabetes can contribute or accelerate the condition.

Clinical features are typically gradual and symmetric, often beginning with high-frequency hearing loss. Individuals may notice difficulty understanding speech, especially in background noise, and may require higher volume levels for media and conversations. Tinnitus is commonly associated, while vertigo is uncommon. The condition progresses slowly and varies in severity among individuals.

Diagnosis is made through audiometric testing, usually showing bilateral, sensorineural hearing loss with greater loss at higher frequencies and reduced word recognition. Differential diagnosis includes other sensorineural or conductive disorders; a clinical history and, when needed, imaging or additional tests help exclude non-age-related causes.

Management focuses on improving communication and quality of life. Options include hearing aids with appropriate programming, other amplification devices, assistive listening devices, and, in selected cases, cochlear implants. Preventive strategies emphasize noise protection, cardiovascular risk management, and regular hearing evaluations to monitor progression.