Presbyacusis

• = Age-Related Hearing Loss
• hallmark of presbycusis is the progressive, symmetric loss of high-frequency hearing
• occurs when the outer hair cells within the cochlea gradually deteriorate with age and causes a symmetrical SNHL that is apparent at the high frequencies. 
• Onset in middle age, and slowly progressive
• Most notable over age 65 years
• Most common cause of Sensorineural Hearing Loss

Symptoms

• Slowly progressive high frequency Hearing Loss
  • Decreased speech discrimination
• Poor understanding of speech even when loud enough
• Described as “cocktail party effect,” which emphasizes the difficulty that patients experience with communication in social settings
• Recruitment
  • With increasing deafness, hair cells may be recruited to hear a particular frequency.
  • Patients show a reduced dynamic range of hearing. 
  • They remain unable to hear quieter sounds
    • e.g. may not begin to hear until 40 dB 
    • but find that hearing is rapidly overloaded
    • e.g. sounds are too loud by 80 dB.
  • The classic scenario is of an individual saying in one breath “Speak up, I can’t hear”, and in the next: “There’s no need to shout, I’m not deaf”.
  • This occurs in presbyacusis and Meniere’s disease.

Risk Factors

• Older Age
• Chronic loud noise exposure
• Tobacco Abuse 
• Heavy Alcohol use
• Ototoxin exposure

Diagnosis

• Pure Tone audiometry
• MRI & CT
  • not indicated for the diagnosis of presbycusis
  • MRI may be indicated to exclude neural or central pathology in cases where there is significant asymmetry of hearing loss or other indications of possible tumor, such as vestibular schwannoma or other skull base lesions 
  • should be particularly considered if there is associated unilateral or pulsatile tinnitus, vertigo, or other cranial nerve deficits

Treatment 

• Reassurance that the patient will not go completely deaf is helpful
• explaining the problem to family and friends and encouraging them to be tolerant.
• The main difficulty in treating these patients is to selectively amplify their response to the different frequencies in everyday sounds
• Options of treatment include:
  • Hearing aid(s)
  • Assistive devices, such as telephone amplifiers or technology that converts speech to text
  • Techniques for preventing excess wax in the outer ear
  • Auditory rehabilitation
    • active listening training
    • speech reading(to use visual cues to determine what is being said)
    • communication enhancemet