presbycusis

Presbycusis, or age-related hearing loss, is a common form of bilateral, symmetrical sensorineural hearing loss that gradually develops with aging. It typically affects high-frequency sounds first and progresses over years, leading to difficulties understanding speech, especially in noisy environments. The condition reflects degenerative changes in the inner ear and central auditory pathways, including hair cell loss in the cochlea, atrophy of the stria vascularis, and loss of auditory nerve fibers. It is multifactorial, with genetic predisposition and lifelong exposure to noise, vascular factors, smoking, and ototoxic medications contributing to progression.

Risk factors include advancing age, cumulative noise exposure, cardiovascular disease, diabetes, smoking, and certain medications. Clinically, patients report trouble hearing consonants, background noise, and needing higher volumes. The onset is gradual, and the condition is typically bilateral and progressive rather than sudden.

Diagnosis relies on audiometric testing showing symmetric, bilaterally sloping sensorineural loss, usually more pronounced at frequencies above 2 kHz, with normal tympanometry and middle-ear function. Speech discrimination is often disproportionately affected, and evaluation may exclude other causes of hearing loss or retrocochlear pathology if findings are atypical.

Management has no cure to reverse presbycusis, but interventions can improve communication and quality of life. Options include hearing aids, cochlear implants for severe cases, and assistive listening devices. Rehabilitation and communication strategies, along with addressing cardiovascular risk factors, avoiding ototoxic drugs, and protecting against further noise exposure, can help slow progression and reduce social and functional impact.