Understanding Presbycusis (Age-related Hearing Loss): Causes, Symptoms, Treatment and Prevention

Presbycusis, or age-related hearing loss, is one of the most common chronic conditions affecting older adults. It typically develops gradually and affects both ears equally, often going unnoticed until it interferes with daily life.

Recognising and managing presbycusis is crucial for maintaining quality of life and social engagement. In this article, we’ll explain presbycusis, its causes, its signs and symptoms, how it is diagnosed, and available management options.

• What is Presbycusis?
• What Causes Presbycusis?
• What are the Common Signs and Symptoms of Presbycusis?
• How is Presbycusis Diagnosed
• What are the Treatment Options for Presbycusis?
• FAQs about Presbycusis

Presbycusis is the gradual loss of hearing that occurs as people age. It primarily affects the ability to hear high-pitched sounds and can make it difficult to understand speech, especially in noisy environments. While it’s a natural part of ageing, presbycusis can significantly impact communication, independence, and relationships if left unmanaged.

Presbycusis is most commonly associated with degenerative changes in the inner ear, where sound waves are converted into nerve impulses that are sent to the brain. 

As we age, the sensory hair cells in the cochlea can deteriorate or die. This degeneration often leads to reduced sound clarity.

However, presbycusis can also involve degeneration of the auditory nerve and the neural pathways that carry sound information to the brain. In some cases, age-related changes in the eardrum or the small bones of the middle ear may also contribute to hearing loss, though these are less common. 

In most cases, hearing loss results from a combination of age-related changes and long-term exposure to environmental and lifestyle factors, such as:

• Long-term noise exposure
• Loss of sensory hair cells in the inner ear
• Genetics
• Ototoxic medications (e.g. chemotherapy medicines, and certain antibiotics)
• Medical conditions (e.g. diabetes, cardiovascular disease, infections)
• Smoking

Presbycusis tends to progress slowly, so it may go unnoticed until hearing loss becomes more apparent. Symptoms may also differ among people. Common signs and symptoms include:

• Difficulty hearing conversations, especially in noisy settings
• Frequently asking people to repeat themselves
• Trouble hearing high-pitched sounds (e.g. birds chirping, reverse alert tones in car)
• Increasing the volume of the television or radio
• Tinnitus (ringing in the ears)
• Muffled hearing

Diagnosing presbycusis requires a thorough evaluation by an Ear, Nose and Throat (ENT) specialist or audiologist.

The clinician will ask about the onset and progression of your hearing loss. They’ll also consider contributing factors such as prolonged noise exposure, history of ear infections, head trauma, certain medical conditions (e.g. diabetes or cardiovascular disease), and use of medications known to affect hearing (ototoxic drugs).

A visual examination of your ears will be performed to check for issues such as earwax impaction, signs of infection, inflammation or structural abnormalities. This is typically done using an otoscope, a handheld instrument with a light and magnifying lens, that allows the clinician to view the ear canal and eardrum clearly.

A series of audiological tests will help assess the type and degree of hearing loss:

• Pure Tone Audiometry: This test measures the quietest sounds you can hear at various pitches. You’ll wear headphones or ear inserts and respond to a series of tones played at different frequencies and volumes.
• Speech Audiometry: This test commonly includes a speech discrimination test, which evaluates how well you can recognise and repeat spoken words at various volume levels. It helps determine how clearly you can understand speech, providing additional information beyond what pure tone testing alone can offer.

Together, these assessments help confirm a diagnosis of presbycusis and guide further management or hearing rehabilitation strategies.

An audiogram showing symmetrical, sensorineural hearing loss in both ears

Presbycusis is typically characterised by bilateral, symmetrical sensorineural hearing loss that predominantly affects sounds above 2000 Hz. On a standard audiogram, this appears as a gradual down-sloping curve from left to right, indicating worsening hearing thresholds at higher frequencies.

While presbycusis cannot be reversed, various management options can improve hearing and communication in daily life.

Hearing aids are the most common and effective solution for presbycusis. Although they do not cure hearing loss or restore normal hearing, they amplify sound and help individuals maintain social connections, independence, and overall quality of life.

Modern hearing aids are discreet, comfortable, and feature advanced technology such as noise reduction, directional microphones, and Bluetooth connectivity. Some premium models, like those from Oticon, come with groundbreaking technology that offers greater personalisation and reduced listening effort.

For example, the Oticon Intent includes 4D sensors that adapt to your listening needs in real time, along with BrainHearing™ technology, which supports how the brain naturally makes sense of sound. Moreover, audiologists can fine-tune hearing aids to match your unique pattern of hearing loss for optimal performance.

ALDs are tools that enhance sound clarity in specific settings or situations. These include:

• Telephone and mobile phone amplifiers to improve clarity during calls
• Smartphone apps that stream sound directly to hearing aids or function as personal amplifiers
• Hearing loop systems or FM systems used in public venues like theatres, lecture halls, or places of worship, which transmit sound directly to compatible hearing aids or receivers

These devices can be particularly helpful in noisy environments or when hearing aids alone are insufficient.