Presbycusis

Definition/diagnostic criteria Presbycusis, commonly known as age-related hearing loss, is a progressive and bilateral sensorineural hearing loss occurring in individuals as they age. This condition typically affects high frequencies initially, progressing to involve lower frequencies as it advances. Diagnostic criteria are based on patient history, audiometric testing and ruling out other causes of hearing loss.

Epidemiology Presbycusis is the most common cause of hearing loss in the elderly population. Action on Hearing Loss UK says it affects over 40% of people over 50 years and up to 71% of people over the age of 70 in the UK. The condition is slightly more prevalent in men than in women.

Diagnosis
Clinical features: Patients often report difficulty in hearing high-pitched sounds, understanding speech in noisy environments, and may have a history of gradually progressive bilateral hearing loss. Tinnitus is also a common associated symptom. During the examination, the Weber test typically lateralises to the better-hearing ear, and the Rinne test shows air conduction to be better than bone conduction, indicating sensorineural hearing loss.

Investigations: Audiometric testing is the cornerstone of diagnosis. It typically shows a bilateral symmetrical sensorineural hearing loss, with a greater loss at higher frequencies. The speech reception threshold and speech discrimination scores may also be affected. Pure-tone audiometry is the primary tool used. Additional tests, such as otoacoustic emissions and auditory brainstem responses, can help in differentiating presbycusis from other causes of hearing loss.

Treatment Management of presbycusis is focused on improving the patient’s quality of life and communication abilities.

Treatment options include:

• Hearing aids: these are the mainstay of treatment. Proper fitting and adjustment are essential.
• Assistive listening devices: devices like amplified telephones and TV listening systems can be helpful.
• Aural rehabilitation: this includes speech reading, auditory training and counselling to cope with hearing loss.
• Regular monitoring: continued assessment and monitoring of hearing levels and device functionality.

Pharmacological interventions are currently limited and not routinely recommended for presbycusis.

Prognosis While presbycusis is a progressive condition, the rate of progression varies among individuals. With appropriate intervention, most patients can maintain a good quality of life. Early detection and management are crucial in reducing the associated social, psychological, and cognitive impacts.