• Presbycusis

    (Presbyacusis; Age-Related Hearing Loss; Presbyacusia)

    Definition

    Presbycusis is gradual hearing loss in both ears that commonly occurs as people age. Nearly half of all people 75 years and older have this form of gradual hearing loss which can be mild, moderate, or severe. Presbycusis usually involves permanent hearing loss sometimes referred to as nerve deafness. Certain medical problems can also lead to hearing loss. If you suspect you have presbycusis, contact your doctor.
    The Ear
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    Causes

    There are several causes of presbycusis including:
    • Gradual degeneration of the eardrum or delicate structures within the inner ear (hair cells) due to age
    • Changes in the hearing nerve pathways in the ear leading to the brain
    • Repeated exposure to loud sounds, music, or equipment which can damage the fragile hair cells within the inner ear involved in hearing
    • Hereditary or genetic influences

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition.
    The following factors increase your chances of developing presbycusis:
    • Family history of gradual hearing loss with advancing age
    • Use of certain medications, including aspirin, some antibiotics, and cancer medications
    • Certain health conditions, including cardiovascular disease, high blood pressure , diabetes , and other circulatory problems

    Symptoms

    If you experience any of these symptoms do not assume it is due to presbycusis. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
    • Noticeable loss of hearing of higher-pitched sounds, such as female voices, telephone ringing, or bird calls
    • Sounds appear less clear and sharp
    • Difficulty understanding conversations, particularly in noisy places or while speaking on the telephone
    • Ringing in one or both ears, a condition called tinnitus
    • Background sounds appear overly loud or bothersome
    • Ear fullness with or without dizziness
    With presbycusis, hearing loss is usually very gradual, affecting both ears equally.

    Diagnosis

    Your doctor will ask about your symptoms and medical history, and perform a physical exam of your ear canal and eardrum with a lighted instrument called an otoscope. You will probably need to see a specialist, including an otolaryngologist, a doctor specially trained in disorders of the ear, nose, and throat. You may also see an audiologist who can do a complete hearing evaluation to determine the extent of hearing loss. Your primary care doctor can help refer you to an otolaryngologist, who often works in association with an audiologist.
    Tests may include the following:
    • Rinne test—involves a vibrating tuning fork placed on the bone behind your ear to test for hearing loss
    • Weber test—a tuning fork is placed on the forehead to determine one-sided hearing loss
    • Audiometry —wearing headphones and listening for different tones, which vary in pitch and loudness

    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Hearing Aids and Assistive Listening Devices

    If it is determined that a hearing aid may be useful, the audiologist will conduct several tests to determine the type of hearing aid that will best improve hearing of speech. The extent of benefit varies according to the cause and degree of hearing loss. Sometimes hearing aids will need to be replaced with other models if hearing loss progresses. Some people with presbycusis may benefit from telephone amplifiers that help hear speech on the telephone.

    Cochlear Implants

    For certain people with very severe hearing loss that is not improved by a simple hearing aid, a cochlear implant device may improve sound generation to the brain. It may provide partial hearing to the profoundly deaf.

    Prevention

    To help reduce your chances of developing presbycusis, take the following steps:
    • Avoid repeated exposure to loud noises and sounds of any type, including those at work, home, and during recreation.
    • When working with loud machinery or in loud environments, wear protective ear plugs or ear muffs.

    RESOURCES

    American Academy of Audiology http://www.audiology.org

    American Academy of Otolaryngology, Head and Neck Surgery http://www.entnet.org

    Hearing Loss Association of America http://www.hearingloss.org

    National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov

    CANADIAN RESOURCES

    Canadian Hearing Society http://www.chs.ca

    Canadian Society of Otolaryngology http://www.csohns.com

    References

    Gates GA, Mills JH. Presbycusis. Lancet . 2005;366:1111-1120.

    Hearing loss and deafness. Merck Manual of Medical Information . 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.

    Revision Information

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