What Is Presbycusis and What Causes It?

Reviewed on 7/27/2022
Gray-haired elderly man getting his ears checked by a doctor
Presbycusis is age-related hearing loss that is caused by changes in the inner ear as people age, changes in the middle ear, and complex changes along the nerve pathways leading to the brain.

Presbycusis is hearing loss that gradually occurs in most people as they age. It is estimated that 30 to 35 percent of adults age 65 and older experience hearing loss and up to 50 percent of people 75 and older have hearing loss.

Hearing loss usually occurs more often with high-pitched sounds than with low-pitched sounds. For example, a person with presbycusis may have difficulty hearing a bird chirping nearby but may have no problem hearing the low rumble of a thunderstorm. 

Causes of presbycusis include: 

  • Changes in the inner ear as people age (most common cause)
    • Cumulative effects of repeated exposure to noise such as daily traffic sounds, construction work, noisy offices, noisy equipment, and loud music 
    • Loss of sensory receptors in the inner ear, which may occur as a result of hereditary factors along with aging, some health conditions, and side effects of certain medications such as aspirin and some antibiotics
    • Changes in blood supply to the ear due to heart disease, high blood pressure, vascular conditions caused by diabetes, or other circulatory problems
  • Changes in the middle ear 
    • Abnormalities of the outer ear and/or middle ear may include reduced function of the eardrum or reduced function of the three tiny bones in the middle ear that carry sound waves from the tympanic membrane to the inner ear
  • Complex changes along the nerve pathways leading to the brain

What Are Symptoms of Presbycusis?

Presbycusis usually affects both ears equally and because the hearing loss occurs gradually, people may not realize their hearing is diminishing. 

Symptoms of presbycusis include: 

  • Sounds may seem less clear and lower in volume
  • Difficulty hearing and understanding speech
    • Other people sound as if they are mumbling or slurring words when speaking
    • High-pitched sounds such as “s” and “th” are difficult to hear and distinguish
    • Conversations are hard to understand, especially when background noise is present
  • Lower-pitched voices, such as adult male voices, are usually easier to hear than higher-pitched voices of females or children
  • Some sounds can seem annoying or overly loud
  • Ringing, roaring, or hissing sound in one or both ears (tinnitus

How Is Presbycusis Diagnosed?

Presbycusis is diagnosed with a patient history and physical examination of the ear with an otoscope, a lighted scope that allows a doctor to visualize the outer ear canal and the ear drum. They will check for damage to the ear drum, blockage of the ear canal from foreign objects or impacted ear wax, inflammation, or infection.

A hearing specialist (audiologist) may perform an audiogram, which is a test in which sounds are played through headphones to one ear at a time and patients indicate when they hear a sound. The results of this test can suggest whether some hearing loss is present. 

What Is the Treatment for Presbycusis?

Treatment for presbycusis may include: 

  • Hearing aids 
  • Assistive listening devices 
  • Built-in telephone amplifier
  • FM systems to help make sounds clearer by delivering sound waves like a radio
  • Training in speechreading to help people better understand what is being said in conversations 

How Do You Prevent Presbycusis?

Hearing loss that is caused by noise exposure can often be prevented. 

  • When possible, avoid loud noises and reduce the amount of time spent exposed to the loud sounds
  • When loud noises are present and cannot be avoided, use: 
    • Ear plugs
    • Special fluid-filled ear muffs


What is hearing loss? See Answer

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Reviewed on 7/27/2022

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