Presbycusis: Why Your Hearing Declines With Age and What You Can Do About It
Key takeaways:
Presbycusis is age-related hearing loss. Most people over the age of 65 have hearing loss in both ears.
There’s no way to completely prevent age-related hearing loss. But there are a number of effective treatments available, including hearing aids and hearing alert devices.
If left untreated, presbycusis can be a safety concern. It can also increase the risk of isolation, depression, and dementia.
If you’ve found it harder to hear well the older you get, you’re not alone. As many as 1 in 3 people over age 65 experience significant hearing loss. Presbycusis (age-related hearing loss) is one of the most common conditions affecting older adults.
Presbycusis is an important condition to recognize. That’s because hearing loss can lead to confusion, risk of harm, and isolation.
What causes presbycusis?
Presbycusis is caused by age-related changes to the hearing pathway. There are two main parts of this pathway: the sensory part (cochlea) and the neural part (nerves and ganglia).
Prescription Savings Are Just the Beginning
See what other savings you qualify for—from hearing aids to product samples.
The cochlea is part of the inner ear where vibrations are sensed and turned into electrical signals. The auditory nerves and spiral ganglia carry the electrical signals to the brain to be interpreted. Damage to any of these parts can lead to presbycusis.
Almost all age-related hearing loss occurs in the sensory or nerve structures of the inner ear. Presbycusis can happen because of damage to the cochlea, its lining, or the fluid it contains. It can also happen because of damage to the nerve fibers. In rare cases, presbycusis can happen because of damage to the outer or middle ear structures.
What are the symptoms of age-related hearing loss?
Age-related hearing loss is usually gradual and can be subtle. Some of the signs of presbycusis to look for are:
Having to ask people to repeat what they just said
Feeling like others aren’t speaking clearly or are mumbling
Needing to turn up the TV or radio louder than normal
Not understanding what others are saying, especially in a noisy area
Not hearing words or syllables when talking on the phone
How do you diagnose age-related hearing loss?
An audiogram (pure-tone hearing test) helps to make the diagnosis of age-related hearing loss. It measures your ability to hear the intensity of sound (loudness) and its frequency (tone).
During an audiogram, sounds are delivered through headphones to one ear at a time. You press a button when you hear a sound. Then a computer makes a graph (audiogram) for each ear, showing both the frequency and intensity of the sounds you heard.
You’re likely to get a diagnosis of presbycusis if you can’t hear sounds above 2,000 Hz.
Read more like this
Explore these related articles, suggested for readers like you.
How do you treat age-related hearing loss?
Treatment for presbycusis is limited — there are no medications. But there are devices that can help improve the symptoms. Approved interventions for age-related hearing loss are:
Hearing alert devices: These technologies alert you of noises. They may include light signals to indicate activity from a doorbell, phone, or alarm.
Direct-to-consumer hearing aids: Some hearing aids don’t need a hearing evaluation or prescription. These are only for mild hearing loss.
Conventional hearing aids: These are for mild, moderate, or severe hearing loss. They require a prescription. You can adjust the volume and sensitivity based on your needs.
Cochlear implant: This device is useful if you have severe sensorineural hearing loss. It helps with hearing by bypassing the damaged portion of the auditory pathway.
Can you prevent or reverse presbycusis?
Hearing experts aren’t sure if age-related hearing loss can be delayed or prevented. But research shows that people who live in preindustrial societies enjoy excellent hearing late into life. This may be due to a lack of exposure to loud noise and toxic chemicals.
When people from these societies move to industrialized nations, they develop presbycusis. In the end, more research is needed. Studying the habits of those with minimal age-related hearing loss may give clues about prevention.
Unfortunately, once age-related hearing loss starts, it doesn’t seem possible to reverse it. The best course of action is to minimize the factors that make age-related hearing loss worse.
Factors that make age-related hearing loss better or worse
Not everyone ends up with presbycusis, but most people experience it to some degree. Factors that may increase your risk of presbycusis include:
Exposure to loud noise (especially when young)
Family history
Chemical exposure (such as mercury and carbon monoxide)
Smoking
Alcohol use
Long-term steroid use (like prednisone)
Hormone replacement after menopause
Chronic ear infections
Certain medications (like chemotherapy and diuretics)
While you can’t control your genetics or age, there are some things you can do to reduce your risk. It’s important to stay away from loud noises and wear ear protection when possible. If you have a family history of age-related hearing loss, talk to your healthcare provider. They can help with additional ways to decrease your risk.
When does presbycusis usually begin?
Presbycusis happens earlier in men as compared to women. And it starts with higher-pitched sounds. Men start to see a decline in hearing around age 30. Women can begin to notice hearing loss between 40 to 50 years old.
In older adults, the rate of hearing loss is greatest in men. And the lower-pitched sounds are affected the older you get.
How is presbycusis different from other types of hearing loss?
Anytime you notice hearing loss, you should see your healthcare provider to figure out the cause. A full history, physical exam, hearing test, and lab tests can help find the cause of new hearing loss. There are many reasons for hearing loss, and they have different patterns.
Age-related hearing loss affects both ears, gets worse as you age, and affects higher-pitched sounds first. This helps to separate age-related hearing loss from other types of hearing loss. Other possible causes of hearing loss include:
Autoimmune disease
Head trauma
Tumors
Otosclerosis (bone growth in the middle ear)
The bottom line
Presbycusis is a common age-related condition. In fact, most people over the age of 65 have some degree of hearing loss. Although you can’t completely prevent it, limiting your exposure to loud noise and certain toxins can decrease the severity of hearing loss. Left untreated, presbycusis can lead to a diminished quality of life. Talk to your provider about treatments that may help to improve your hearing loss symptoms.
Why trust our experts?
References
American Academy of Audiology. (n.d.). Seniors and hearing loss.
American Speech-Language-Hearing Association. (n.d.). Causes of hearing loss in adults.
Cheslock, M., et al. (2022). Presbycusis. StatPearls.
Michels, T. C., et al. (2019). Hearing loss in adults: Differential diagnosis and treatment. American Family Physician.
National Institute on Deafness and Other Communication Disorders. (2022). Age-related hearing loss.
Sharashenidze, N., et al. (2007). Age-related hearing loss: Gender differences. Georgian Med News.
U.S. Food and Drug Association. (2022). Cochlear implants.
Wang, J., et al. (2020). Presbycusis: An update on cochlear mechanisms and therapies. Journal of Clinical Medicine.
