Makindo Medical Notes

Presbycusis 👂: The most common cause of sensorineural hearing loss in the elderly. It has a tremendous impact on quality of life, contributing to social isolation, depression, and even cognitive decline.

About

• Sensorineural, age-related hearing loss.
• Gradual, progressive, bilateral.
• Typically affects those >65 years old.

Aetiology

• Sensory: Hair cell degeneration in the cochlea.
• Neural: Loss of auditory neurons.
• Strial: Atrophy of the stria vascularis affecting endolymph production.
• Cochlear conductive: Stiffening of basilar membrane.
• May also be noise-induced or hereditary.
• Ageing affects the entire hearing pathway: cochlea, hair cells, ossicles, auditory nerve, and temporal lobe processing.

Clinical Features

• Progressive deafness (usually bilateral).
• Tinnitus may accompany hearing loss.
• Difficulty hearing high-frequency sounds first → male voices easier to hear than female or children’s voices.
• Often struggles in noisy environments (loss of speech discrimination).

Differential Diagnoses

• Noise-induced hearing loss (history of chronic exposure).
• Ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics).
• Other sensorineural hearing loss causes (vestibular schwannoma, Ménière’s disease).

Investigations

• Audiometry: Bilateral symmetrical high-frequency loss, gradually worsening with age.
• Speech audiometry: Impaired speech discrimination scores.
• MRI internal auditory meatus: May be needed to exclude vestibular schwannoma or other pathology if asymmetrical loss.

Management

• Hearing aids: Amplify sound; worn in or behind the ear.
• Cochlear implants: Considered in severe or profound cases with poor hearing aid response.
• Communication strategies: Ask speakers to talk clearly (not shout), face the patient, reduce background noise.
• Psychosocial support: Address risk of isolation, depression, delirium due to sensory deprivation.
• Regular audiology follow-up and hearing aid maintenance essential.

References

• British Society of Audiology Guidelines on Adult Hearing Loss.
• Rosen S. “Presbycusis study.” Ann Otol Rhinol Laryngol, 1962.

Revisions

• Last updated: 30/07/2017

💡 Clinical Pearls

• Presbycusis = high-frequency bilateral sensorineural hearing loss in elderly → male voices often clearer than female voices.
• Always exclude asymmetrical loss with MRI to rule out vestibular schwannoma.
• Untreated hearing loss increases risk of cognitive decline and dementia.