Article by Dr Manasa S, B.A.M.S
AIAPGET Points
– Presbycusis is age related hearing loss. It is one of the most common sensory changes associated with aging.
– The other names of Presbycusis are – ‘old hearing’ & ‘elderly hearing’.
– Presbycusis is a sensorineural hearing loss. It arises from age-related damage within the inner ear or auditory pathways.
– Epidemiological data – One in three adults aged 65-74 years experience some degree of hearing loss. Nearly half of individuals over age 75 years have measurable hearing difficulty.
– People suffering from presbycusis find it difficult to understand conversations, especially in noisy environments. They are found to frequently increase the volume of televisions, mobile phones or other devices.
– Common types of Presbycusis – Sensory and Neural Presbycusis.
– Sensory Presbycusis – occurs due to loss of outer hair cells in the organ of Corti within the cochlea. The person faces reduced hearing sensitivity, especially for higher-pitched sounds.
– Neural Presbycusis – results from gradual loss of nerve cells in the cochlea or along the pathways that carry sound signals to the brain. This affects speech understanding. The person finds it difficult to follow conversations in spite of the sounds being loud enough.
– Age related changes in the ear which causes presbycusis – structural changes in the ear, reduced blood flow to cochlea, degeneration of auditory nerves, altered processing of sound by the brain and damage or loss of hair cells within the cochlea.
– Common symptoms of presbycusis – difficulty hearing high-pitched sounds, trouble understanding speech especially in noisy and crowded places, difficulty distinguishing similar consonants and voices sounding muffled or unclear. Some sounds seem unusually loud or sharp or tinnitus. These people frequently increase the volume on television, radio, computer or phone. They need people to repeat themselves. They feel fatigued or strained trying to catch up with conversations / listening efforts.
– Complications of presbycusis include social isolation, anxiety and stress, depression.
– Treatment of presbycusis focuses on improving communication and reducing the impact of hearing loss. Use of hearing aids, using assistive listening devices (telephone amplifiers, TV listening systems, personal sound amplifiers), communication supports (lip or speech reading training, learning basic-sign language) and using cochlear implants. Regular follow up sessions with specialist doctors is essential.
Article
Presbycusis, or age-related hearing loss, is one of the most common sensory changes associated with aging. In literal terms, presbycusis means “old hearing” or “elderly hearing.” Although it is not life-threatening, untreated presbycusis can significantly impact communication, social interaction, and overall quality of life.
As people age, various physiological changes occur throughout the body, and hearing decline is among the most prevalent. Presbycusis typically develops gradually over time and is classified as a sensorineural hearing loss, arising from age-related damage within the inner ear or auditory pathways.
Epidemiological data highlight its widespread occurrence: approximately one in three adults aged 65 to 74 experience some degree of hearing loss, and nearly half of individuals over age 75 have measurable hearing difficulty.
Common symptoms include difficulty understanding conversations, especially in noisy environments, and frequently increasing the volume on televisions, mobile phones, or other devices. While there is no definitive cure for presbycusis, timely evaluation and the appropriate use of hearing aids and assistive technologies can greatly improve auditory function and daily communication.
Related Reading – Global characteristics and trends of presbycusis research from 2002 to 2021: a bibliometric study
Ayurveda Understanding of Presbycusis
In old age, there is predominance of Vata, as a rule. In old age there will also be dhatu kshaya i.e. progressive tissue depletion. This is also responsible for vata increase. Vata increase further causes dhatu kshaya. Presbycosis is a disease of old age and is hence predominantly caused by increased vata and also due to the effect of dhatu kshaya. Shravanendriya i.e. sense organ of hearing is one of the important seats of Vata. Even this way, Presbycusis occurs in and afflicts the seat of vata.
BADHIRYA – Badhirya means deafness. This is an umbrella term which includes all kinds of deafness explained in modern medicine.
The pathogenesis follows damage to the channels of hearing (shabdavaha srotas) and shravanendriya (sense organ of hearing) by aggravated vata or vata clouded by kapha.
Indriya Pradoshaja Vikara – Presbycusis can be classified under Indriya Pradoshaja Vikara. In these conditions, the sense organs and their functions will be affected by aggravated doshas, the sense organ of hearing in this context.
Treatment prevention – The main principles of treatment of presbycusis include avoiding the causative factors (nidana parivarjana), implementation of vata balancing measures (foods, lifestyle changes and therapies and medicines), karnapurana, nasya, rasayana, yoga and meditation and treatment principles of badhirya.
Related Reading – ‘Presbycusis – Ayurveda Understanding’
Types of Presbycusis
The type of presbycusis a person develops depends on the specific age-related changes occurring in the inner ear. The commonly described types include:
Sensory Presbycusis
This type occurs due to the loss of outer hair cells in the organ of Corti within the cochlea. These hair cells help amplify sound, so their loss leads to reduced hearing sensitivity, especially for higher-pitched sounds.
Neural Presbycusis
Neural presbycusis results from the gradual loss of nerve cells in the cochlea or along the pathways that carry sound signals to the brain. This type particularly affects speech understanding, making it difficult to follow conversations even when sounds seem loud enough.
Related Reading – Presbycusis
Causes of Age-Related Hearing Loss
Age-related hearing loss develops gradually and results from a combination of physiological changes within the auditory system as well as external or systemic influences. Key contributors include:
Age-Related Changes Within the Ear
Structural changes in the inner ear that reduce its ability to conduct sound effectively.
Reduced blood flow to the cochlea, limiting oxygen and nutrient supply needed for hearing.
Degeneration of auditory nerves, which carry sound signals from the ear to the brain.
Altered processing of sound by the brain, affecting how speech and environmental noises are interpreted.
Damage or loss of hair cells within the cochlea—tiny sensory receptors essential for converting sound vibrations into nerve signals.
Other Contributing Factors
In addition to natural aging, several health and lifestyle factors may accelerate or worsen presbycusis:
– Diabetes and other metabolic disorders.
– Poor circulation, which can impair cochlear function.
– Chronic exposure to loud noise (occupational or recreational).
– Use of ototoxic medications, which may damage inner ear structures.
– Family history of age-related hearing loss.
– Smoking, which reduces blood flow and contributes to cochlear damage.
Related Reading –
Novel insights into mechanisms and therapeutics for presbycusis
Presbycusis and balance disorders in the elderly
Symptoms of Presbycusis
Symptoms of presbycusis develop gradually, often beginning with difficulty hearing high-pitched sounds. Many people first notice problems understanding the voices of women or children or following conversations in noisy environments. Over time, overall hearing clarity may decline.
Common symptoms include:
Early and Progressive Symptoms
– Difficulty hearing high-pitched sounds such as birds chirping, alarms, or doorbells.
– Trouble understanding speech, especially in noisy places like crowded rooms or restaurants.
– Difficulty distinguishing similar consonants, such as “s,” “f,” or “th.”
– Voices sounding muffled or unclear.
Changes in Sound Perception
– Certain sounds seem unusually loud or sharp.
– Tinnitus (ringing, buzzing, or hissing in the ears).
Behavioural Indicators
– Frequently increasing the volume on the television, radio, computer, or phone.
– Needing people to repeat themselves, especially over the telephone.
– Feeling fatigued or strained after trying to follow conversations due to listening effort.
Related Reading – Presbycusis: Pathology, Signal Pathways, and Therapeutic Strategy
Complications of Presbycusis
Presbycusis affects more than just the ability to hear. As hearing declines, individuals may begin to feel anxious or self-conscious during conversations, especially when they struggle to follow speech or frequently need clarification. Over time, this can lead to withdrawal from social interactions and a tendency to avoid gatherings or conversations.
Research indicates that untreated age-related hearing loss is associated with an increased risk of several emotional and cognitive complications, including:
– Social isolation, due to difficulty participating in conversations.
– Anxiety, arising from the stress of trying to interpret unclear sounds or speech.
– Depression, resulting from reduced social engagement and communication challenges.
Related Reading – Central Presbycusis: A Review and Evaluation of the Evidence
When to Consult a Health Professional
You should seek medical evaluation if you notice gradual difficulty hearing, trouble understanding speech, or the need to increase volume on electronic devices. Your primary care provider may then refer you to an audiologist for specialized hearing assessment.
After a diagnosis of presbycusis, regular follow-up appointments—usually once a year—are recommended. These visits allow your audiologist to monitor changes in your hearing and adjust your treatment plan or hearing aids as needed.
You should contact your audiologist sooner if:
– You experience worsening hearing despite using hearing aids.
– Your hearing aids are no longer providing the clarity or amplification they once did.
– You develop new symptoms such as tinnitus, dizziness, or sudden changes in hearing.
Early consultation and ongoing monitoring help ensure optimal hearing support and maintain quality of life.
Treatment and Management
There is no cure for presbycusis, but many options can help you hear better and make daily life easier. Treatment focuses on improving communication and reducing the impact of hearing loss.
- Hearing Aids
– Hearing aids are the most common treatment.
– They make sounds louder and clearer, helping you follow conversations more comfortably.
– Modern hearing aids are small, adjustable, and can be customized to your needs.
- Assistive Listening Devices
These devices support hearing in specific situations. Examples include:
– Telephone amplifiers
– TV listening systems
– Personal sound amplifiers
They are helpful if you struggle in busy or noisy places.
- Communication Support
For moderate to severe hearing loss, you may benefit from:
– Lip-reading or speech-reading training
– Learning basic sign language (if hearing loss is advanced)
These techniques make daily communication smoother.
- Cochlear Implants
– If hearing aids no longer help, your doctor may recommend a cochlear implant.
– This is a small electronic device placed in the inner ear through surgery.
– It does not restore natural hearing, but it can make sounds much clearer than hearing aids for people with severe hearing loss.
- Regular Follow-Up
– Hearing changes over time.
– Your audiologist will check your hearing every year and adjust your hearing aids or treatment plan as needed.
Coping and Self-Care: What You Can Do to Feel Better
Living with presbycusis can be challenging, even when using hearing aids. The following strategies can help you manage symptoms and maintain communication and confidence:
Share Your Hearing Needs
Inform family, friends, and colleagues about your hearing loss. They can support you by speaking clearly, facing you during conversations, and reducing background noise when possible.
Protect Your Ears
Continued exposure to loud sounds can worsen presbycusis. Use ear protection—such as earplugs or noise-reducing earmuffs—when around loud machinery, concerts, or traffic.
Wear Your Hearing Aids Consistently
Regular use of hearing aids improves speech understanding and reduces listening fatigue. If your devices feel uncomfortable or painful, consult your audiologist for adjustments.
Preventing Progression of Age-Related Hearing Loss
While presbycusis cannot be completely prevented, several measures can help slow its progression or reduce the severity of hearing loss:
Avoid Loud Sounds
Limit repetitive or prolonged exposure to loud noise. If avoidance is not possible, always use appropriate hearing protection.
Manage Chronic Conditions
Control blood sugar levels if you have diabetes, and manage cardiovascular or circulatory disorders—these conditions can accelerate hearing decline.
Seek Early Evaluation and Treatment
Prompt assessment and timely use of hearing aids help preserve your ability to understand speech. Early intervention reduces the risk of auditory deprivation, where the brain’s ability to process sound declines over time.
Related Reading – Presbycusis: An Update on Cochlear Mechanisms and Therapies
How to Lower Your Overall Risk
You cannot eliminate the possibility of age-related hearing loss, but you can adopt habits that support long-term ear health:
– Use earplugs or protective devices in noisy environments such as concerts, industrial areas, or traffic-heavy settings.
– Increase your distance from loud sound sources, such as speakers at events, if you do not have ear protection.
– Reduce the volume of televisions, music systems, and headphones—especially when using earbuds.
– Quit smoking, as nicotine reduces blood flow to the inner ear and increases the risk of earlier or more severe hearing loss.
– Maintain overall health, including regular exercise, a balanced diet, and control of blood pressure, cholesterol, and diabetes.
Related Reading – Research trends and hotspot analysis of age-related hearing loss: A bibliometric analysis from 2019 to 2023
For Further Reading:
Advances in understanding of presbycusis
Novel insights into mechanisms and therapeutics for presbycusis
Presbycusis: An Update on Cochlear Mechanisms and Therapies
Molecular genetic epidemiology of age-related hearing impairment
Progress on mechanisms of age-related hearing loss
