Presbycusis (hearing loss)

man has a hearing loss so he's holding to his ear

Dr. Arnaud Tripet

ENT Brain and Facial Surgery, Chemin de Beau-Soleil, Geneva

February 19, 2021

Presbycusis is an age-related hearing loss. It’s a gradual loss of hearing which means that some people won’t even recognize it at the start. The causes are mostly genetic or environmental. This can be caused by prolonged listening to loud sounds, loss of hair cells, aging, side effects of medications, inherited factors, etc. There are treatments of course, but they vary depending on your age, overall severity, medication preference, overall health and medical history, and more. More often than not, hearing aids are required in order to help lessen hearing loss. Thankfully, with technology and medicine constantly progressing, this is becoming an easier burden to bear.

Want to learn more? Keep reading the article by Dr. Arnaud Tripet.

From the Greek “presbus” meaning old and “acoustics” meaning hearing, presbycusis is a physiological phenomenon that is part of a much more global process of normal aging of the individual. It is indeed a progressive loss of hearing that affects the entire population, even if we are not all equal when faced with this handicap. There is indeed a great deal of individual variability in terms of the date of onset, progression, and impact on everyday life. Nevertheless, at least 30% of the population over 60 and more than 50% of those over 80 show symptoms. Men seem to be more affected than women. Presbycusis is rarer in people under 50, but the statistics change depending on hearing habits, such as noise exposure.

Manifestations

The hearing impairment of presbycusis is slow and insidious and manifests itself as a progressive loss in the high frequencies that has little or no clinical impact until a certain threshold is reached. Sometimes it is only the tinnitus (whistling) that brings the person to the clinic. The discovery of presbycusis is then fortuitous.

The social repercussions are apparent as soon as the thresholds are 30 dB higher than normal, at a frequency of 2000 Hz. Most of the time, people with presbycusis complain that they can no longer hear conversations in noisy environments and that they cannot understand high-pitched female voices. People who work do not hesitate to seek help, as hearing quality can be an important issue in their work. Unfortunately, many people delay seeing a specialist and the hearing loss slowly progresses to a more advanced stage, with a real impact on communication and often isolation of the person from those around them.

As communication becomes too difficult, but also because noise is experienced as aggression, public places, theatres, and cinemas are avoided. Even telephoning becomes a problem, and it is not uncommon to see the onset of a depressive syndrome.

Presbycusis is a disorder of the inner ear, but not only. The cochlea, which is an incredible organ (if you can call it that), is lined with hair cells (neurosensory cells) arranged in a palisade, and unfolded could be compared to a piano keyboard. The cells responsible for coding the high frequencies are located in the basal spiral and seem to be more fragile with age, which explains a loss of high frequencies with relative conservation of thresholds up to 1000 Hz. Nerve damage is also possible, in the “electrical wiring” between the inner ear and the brain, which, after a certain degree of deterioration, is responsible not only for the loss of high frequencies but also for a reduction in discrimination, corresponding to the ability to select the frequencies of the speaker, for example.

Other types of damage are also possible (vascular striae, basilar membrane, spiral ligament, degeneration of the auditory pathways of the brainstem) and may be associated with problems with memory, attention, or coordination of movements.

Causes

The causes are mainly environmental and genetic.

Exposure to high-intensity noise, or lower intensity noise of long duration, causes damage in the high frequencies while preserving the low frequencies. Each individual would have variable sensitivity to these exposures.

Correlations with vascular pathologies have been demonstrated, such as coronary artery disease, transient or permanent vascular accidents, arteriopathy of the lower limbs, etc.

The toxic effect of certain drugs on the auditory organ is known.

Hypothyroidism, diabetes, alcohol, tobacco, and various middle ear pathologies have been shown to have a correlation with presbycusis.

Finally, we have been able to demonstrate that genetic factors have an influence on presbycusis, either directly or by promoting a greater sensitivity to environmental factors.

Screening

Screening is mainly based on the search for impaired comprehension in noise, (in shops or restaurants for example), as well as intolerance to exposure to loud sounds. Tinnitus, which is a whistling sound that is especially annoying in quiet, can be a reason for consultation and can sometimes reveal incipient or sub-clinical presbycusis. That said, presbycusis can be advanced without necessarily being accompanied by tinnitus. Without realizing it, some people with hearing loss develop lip-reading skills. Not everyone has the same facility to adapt.

The Tonal Audiogram tests the limits of hearing for frequencies between 250 and 8000 Hz, corresponding to a part of the hearing spectrum used daily. The speech audiogram is based on the comprehension of simple words given at different power levels and is used to determine the ability to understand. These tests are performed by the ear, nose, and throat specialist, but screening can be performed by the hearing care professional.

Treatment

Most often, a hearing aid is required. Technologies have progressed a great deal in this field, and hearing aids have become very efficient, miniaturized, and increasingly discreet. The choice of a hearing aid is essential and must take into account the user’s needs. The most expensive hearing aid is not necessarily the most suitable, and the role of the hearing aid specialist is essential in this phase, particularly to ensure the fineness of the adjustments and the follow-up.

Depending on the extent of the hearing loss, the AI or AVS insurance covers part of the expenses. An assessment must be made by a certified ENT specialist who will help you formulate the request.

Sometimes a profound hearing loss on both sides of the ear cannot be fitted with a hearing aid. Depending on the situation, a cochlear implant can be considered.

Presbycusis is part of a much more global approach to aging, which must be screened for, but also take into account the various conditions that can directly or indirectly influence hearing loss. Noise exposure, high blood pressure, metabolic disorders, alteration of higher functions, visual disorders, balance, walking, for example, should not be ignored.

Nowadays, daily discomfort, isolation, or depression due to hearing loss is no longer necessarily a fatality. Professionals are there to listen to you, to answer your questions, and of course to guide you towards appropriate solutions.

You May Also Like…

Memory problems in mid-life

Memory problems in mid-life

Memory problems can occur at any time, even in our mid-life. The issues can be small or big, depending on the severity...

Sleep apnea syndrome

Sleep apnea syndrome

Sleep apnea could potentially be a serious sleep disorder. There are several different sleep apneas and they cause...