Presbycusis, or age-related hearing loss, is a common, progressive, unpreventable, and irreversible form of sensorineural hearing loss that mainly affects people aged 65 years and over and causes damage to the auditory nerve and/or sensory cells in the inner ear of both ears.
Are you ‘all ears’ and have your interest piqued?! Wonderful! Read on to learn more about presbycusis, its main signs and symptoms, causes, risk factors (with intriguing novel genetic studies to look forward to!), diagnostic tests, management and treatment options, and more!
According to the National Institute on Deafness and Other Communication Disorders,1 age-related hearing loss, or presbycusis (pronounced ‘’prez-buh-kyoo-sis’’), as it is widely known, is defined as gradual hearing loss that typically occurs with old age.
Presbycusis affects both ears and is considered one of the ’’one of the most common’’ conditions1 in older people.
Causes of presbycusis
Presbycusis has many causes1 including:
- Long-term exposure to loud noise and/or high background noise, e.g. loud music
- Health conditions, e.g. diabetes, heart disease, and/or hypertension (high blood pressure)
- Medications, e.g. chemotherapy and ototoxic drugs, can cause permanent damage to the sensory cells (tiny hair cells that turn sound waves into electrical signals that the brain interprets as sound) within the inner ear.
Examples of chemotherapy drugs2 include:
The main ototoxic drugs2 that may cause permanent and/or severe hearing loss include:
- Aminoglycosides e.g. streptomycin and vancomycin
- Ethacrynic acid
Presbycusis can occur owing to abnormalities of the middle ear (less common), e.g. otosclerosis, which is a condition that occurs when bone grows abnormally in the middle ear, thus preventing sound from travelling from the middle ear to the inner ear, leading to hearing loss.
However, according to recent research studies, the most common cause of presbycusis in older people involves changes to the sensory cells and/or auditory nerve fibres (nerves responsible for hearing) in the inner ear (termed ‘’sensorineural hearing loss’’).3
Signs and symptoms of presbycusis
Presbycusis can cause ANY or ALL of the following signs and symptoms:4
- Difficulty hearing high-pitched sounds, e.g. children’s voices, phones, doorbells, smoke alarms etc.
- Reading lips when being spoken to
- Turning the volume on high when listening to the radio and/or watching TV
- Difficulty understanding and following conversations in places with high background noise, e.g. restaurants
- Tinnitus in one or both ears: a ringing, buzzing, ‘’cricket’’-like sensation in the ear/s
Management and treatment for presbycusis
Management and treatment for presbycusis depends on the severity of the age-related hearing loss.1 Depending on the signs and symptoms, your doctor, general practitioner (GP) or healthcare provider might recommend the following treatment options or devices:1
- Hearing aids (main treatment): these are electronic instruments that are worn either in or behind the ears. They make noises louder and are recommended for people with mild to moderate hearing loss. They may be purchased over the counter (OTC) without the need for a prescription from a doctor or a hearing test. Some people are eligible to receive hearing aids through the NHS.
- Cochlear implants: these are small electronic devices that are surgically inserted (implanted) inside the inner ear. They stimulate the auditory nerve, thus enabling those who are deaf, have any form of hearing impairment, or have severe hearing loss to hear sounds.
- Assistive listening devices: these include telephone amplifying devices, smartphone/tablet apps, and closed-circuit systems (‘’hearing loop systems’’) in theatres, auditoriums or places of worship
Diagnosis of presbycusis
A GP, doctor or healthcare provider will provide a diagnosis for presbycusis by performing a series of tests in the following order:4
- Medical History: The healthcare provider will thoroughly investigate the patient’s medical and family history in order to determine whether other health conditions have contributed to the hearing loss
- Physical Examination: The healthcare provider will use a small magnifying instrument with a light called an otoscope to look inside parts of the outer ear, including the ear canal and eardrums. By doing so, the healthcare provider will be able to assess the patient’s hearing health and determine whether there is any eardrum damage, inflammation, and/or infection in the ears.
Depending on the results, the healthcare provider might refer the patient to a hearing specialist (audiologist), and/or an ear, nose, and throat specialist (otolaryngologist).
Typically, the audiologist will perform an audiogram, which is a test that involves the patient listening to sounds at varying volumes through a pair of headphones and is asked to respond if any sound is heard. The results are recorded in a graph and help the audiologist determine the type, degree and cause of the patient’s hearing loss.
Can presbycusis be prevented?
No,4 unfortunately not, at least not to date. However, scientists and experts believe that older people could decrease their risk of developing presbycusis and protect their hearing health by adhering to the following tips:4
- Reducing noise exposure
- Avoiding noisy environments with loud sounds and high background noise, e.g. concerts or sports stadiums
- Managing health conditions, e.g. diabetes, heart disease, hypertension, etc., by maintaining a healthy, well-balanced and active lifestyle
- Wearing earplugs or earmuffs to prevent further hearing problems and ear damage
- Watching TV and/or listening to the radio at a moderate and reasonable volume (not too high or too low)
How common is presbycusis?
Very common. In fact, it’s been suggested1 that 1 in 3 American adults, aged between 65 and 74 years, have presbycusis. After the age of 75 years, almost half (50%) of older people experience age-related hearing loss and hearing problems.
Who is at risk of presbycusis?
The risk of presbycusis is high in:1,4
- People aged 65 years old and over
- People with long-term loud noise exposure: noise-induced hearing loss is believed to trigger, worsen, and accelerate age-related hearing loss
- People with health conditions, e.g. diabetes, heart disease and/or hypertension
- People with a family history of hearing problems: age-related hearing loss tends to have a strong familial link, according to recent research.3
- People who take chemotherapy and/or ototoxic drugs
- People who smoke regularly.3
- People who drink excessively (alcohol abuse)3
Although much remains undetermined and elusive in this area, new research conducted in 20203 suggests that genetics also play an important role in presbycusis predisposition and development, with the two following groups appearing to have the highest risk:
- People with certain ‘’candidate’’ genes, e.g. glutathione S-transferase (GSTM1) and N-acetyltransferase 2 (NAT2*6A), grainy head-like 2 genes (GRHL2), nonsyndromic sensorineural deafness type 5 (DFNA5), and potassium voltage-gated channel subfamily q Member 4 (KCNQ4)
- People who have the 4977th base pair (bp) of their mitochondrial DNA (mtDNA) ‘deleted’ or removed: This results in a ‘mutation’ or change in the mtDNA structure that is thought to increase the risk of presbycusis
When should I see a doctor?
See a doctor if you:1
- Have a hearing problem
- Have sudden hearing loss and/or untreated hearing loss
- Have presbycusis, and your symptoms worsen
- Have a family history of hearing loss
- Have diabetes, heart disease, and/or hypertension
Presbycusis, or age-related hearing loss, is a normal, common, progressive and irreversible form of sensorineural hearing loss that typically occurs in people aged 65 years and over.
Presbycusis is mainly caused by changes to the sensory cells and/or auditory nerve fibres in the inner ear of both ears.
Presbycusis is often diagnosed via an otoscopy through a physical examination and an audiogram performed by an audiologist (hearing specialist).
Although presbycusis cannot be prevented (at least not to date), people can reduce their risk of developing presbycusis by protecting their hearing health via the following:
- Limiting and/or avoiding exposure to harmful environmental factors, including:
- High-pitched sounds and loud background noise (biggest risk factor)
- Ototoxic drugs
- Alcohol abuse
- Wearing earplugs
- Effectively managing blood sugar and blood pressure levels, as well as heart health through healthy eating and regular exercise
The main current management and treatment options for presbycusis include:
- Hearing aids
- Cochlear implants
- Assistive listening devices
See a doctor mainly if you:
- Suspect you have presbycusis due to family history and/or showing some signs and symptoms
- Have presbycusis, and your symptoms worsen.
- Have sudden hearing loss
- Have diabetes, heart disease, and/or hypertension and want to determine your risk of developing presbycusis.
- National Institute on Deafness and Other Communication Disorders. Age-Related Hearing Loss (Presbycusis) [Internet]. Available from: https://www.nidcd.nih.gov/health/age-related-hearing-loss [cited 2023 May 22].
- MSD Manual Professional Version. Drug-Induced Ototoxicity [Internet]. Available from: https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/inner-ear-disorders/drug-induced-ototoxicity [cited 2023 May 22].
- Wang J, Puel JL. Presbycusis: An Update on Cochlear Mechanisms and Therapies. J Clin Med. 2020 Jan 14;9(1):218. doi: https://doi.org/10.3390/jcm9010218
- Cleveland Clinic. Age-Related Hearing Loss (Presbycusis) [Internet]. Available from: https://my.clevelandclinic.org/health/articles/5840-age-related-hearing-loss [cited 2023 May 22].