Presbycusis

What it is

Presbycusis, or age-related hearing loss, is the sensorineural hearing loss associated with the physiological aging process in the ear. It usually manifests at 50-60s; a second page dates it as starting in the 5th and 6th decades and puts 65 years against it. It is the hearing loss of the elderly.

Causes and risk

Three changes in the ear are named as the etiology:

• Hair cell and basilar membrane degeneration
• Cochlear neuron damage
• Ischemia of the inner ear

How it presents

The hearing loss is progressive and bilateral, initially at high frequencies, then middle. Discrimination of speech is lost, and it is lost with background noise, so that patients describe people as mumbling. Two further features belong to the same picture:

• The recruitment phenomenon: inability to tolerate loud sounds
• Tinnitus, which is why presbycusis heads a table of the causes of tinnitus

Two cases carry the presentation. A 58-year-old woman is referred to the hearing clinic by her GP, complaining of difficulty following conversations and finding herself asking people to speak louder; she has no history of vertigo or nausea, and otoscopy shows minimal wax in the external auditory canal, no erythema and an intact tympanic membrane. A 78-year-old man complains of difficulty following conversations and his wife says he has the TV turned up too loud.