Hearing Loss

  • What Is Presbycusis?

    Presbycusis—the gradual loss of hearing that accompanies aging—is a type of sensorineural or perceptive hearing loss that is brought on by degeneration of specialized receptor cells (nerve endings or hair cells) of the inner ear. This is in contrast to typically more treatable conductive hearing losses, which occur when earwax, fluid, a tumor, or a tear in the eardrum physically interferes with the transmission of sound through the middle ear.

    Like many types of sensorineural hearing loss, presbycusis is characterized by difficulty understanding speech, especially in the presence of background noise (common in restaurants, for example). Presbycusis is not necessarily an inevitable part of aging; many people in their 80s hear perfectly well. Individual risk factors determine the degree of hearing loss that a person will experience with age. A decline in auditory sensitivity may begin as early as age 40, although presbycusis rarely becomes noticeable before the age of 55. By age 65, one in every three people has some degree of hearing loss.

     

    Who Gets Presbycusis?

    The incidence of presbycusis increases with age. About one third of Americans between ages 65 and 74 have some degree of hearing loss. Nearly half of those age 75 and older have hearing loss.

     

    Symptoms

    • Progressive hearing loss.
    • Inability to discern high-frequency sounds.
    • Difficulty understanding speech, especially in noisy or crowded environments and large rooms in which sounds reverberate.
    • Tinnitus, or noises in the ear.

     

    Causes/Risk Factors

    • Presbycusis is caused by age-related degeneration of sensory cells of the inner ear.
    • Cumulative lifetime exposure to excessive noise can hasten hearing loss.
    • Atherosclerosis (the buildup of cholesterol-based plaques in the arteries) may deprive structures in the ear of sufficient blood supply.
    • Certain drugs, such as aminoglycoside antibiotics and some chemotherapy agents, may be toxic to tissues in the inner ear.
    • A hereditary predisposition appears to be involved.

     

    Diagnosis

    • Patient history and hearing tests (audiometry) are necessary. Examination is usually conducted by an audiologist (hearing specialist).
    • Other procedures, including blood tests, x-rays, and CT (computed tomography) scans or MRI (magnetic resonance imaging), may be ordered to rule out other possible causes of hearing problems.

     

    Treatment

    • Generally, the only remedy available for presbycusis is a hearing aid. Resist the temptation to go directly to a hearing-aid supplier or to order from companies that advertise on television or in print. They typically cannot provide the flexibility or quality of technology that enables comfortable, effective listening. Go instead to a certified audiologist, preferably one recommended by your primary-care physician or otolaryngologist (ear, nose, and throat specialist). Advances in technology have made hearing aids more effective and better suited to individual needs than ever before.
    • An audiologist may provide counseling and nonmedical rehabilitation techniques, such as lip-reading.

     

    Prevention

    • Avoid loud sounds and noisy places as much as possible. Use earplugs whenever you are likely to be exposed to machine-generated noise or weapon fire.

     

    Diagnosis

    • Patient history and hearing tests (audiometry) are necessary. Examination should be performed by a physician in conjunction with a hearing test conducted by an audiologist (hearing specialist).
    • Other procedures, including blood tests, x-rays, and CT (computed tomography) scans or MRI (magnetic resonance imaging), may be ordered to rule out other possible causes of hearing problems.

     

    When To Call Your Doctor

    • Consult your doctor if you experience any degree of hearing difficulty. You will likely be referred to an audiologist or an otolaryngologist for testing and diagnosis.

     

    Reviewed by Alan Lipkin, M.D., Otolaryngologist, Private Practice, Denver, Colorado. Review provided by VeriMed Healthcare Network.