Age-related hearing loss is exactly what it says i.e. as we get older we do slowly and progressively lose our hearing. The term medical people use is presbycusis. Robert Mair explores the causes, symptoms, treatment and diagnosis.

What is presbyacusis?

Presbyacusis is the name for age-related hearing loss and affects about half of all people over the age of 75. More men are affected than women and it occurs over a long period of time – meaning people often have no idea their hearing has deteriorated.

Tiny hairs inside our ears help us hear by picking up sound waves and changing them into never signals that the brain interprets. Presbyacusis is usually caused by the loss of or damage to these tiny hairs and unfortunately when the hair cells do not regrow, hearing loss is permanent. In some cases the condition may also be the result of the deterioration of nerves in the ear.

The hearing loss can start in early adulthood and gradually worsen over a number of years. As hearing worsens, it can become difficult to hear lower pitched sounds.

What causes presbyacusis?

There is no single cause for the condition, but there is evidence that the following factors can contribute to its progression:

  • Genetic factors (presbyacusis tends to run in families)
  • Exposure to loud noises in life
  • Smoking or a poor diet
  • Some medical conditions and medications

These are covered in more detail in the ‘risk factors’ section.


The most common symptom of presbyacusis is the failure to hear high-frequency sounds such as conversation – people’s speech can sound mumbled or slurred. It usually affects both ears simultaneously.

Other signs of presbyacusis include:

  • ‘s’ and ‘th’ sounds become difficult to hear or distinguish from each other because of the pitch
  • A woman’s voice becomes harder to understand compared to a man’s voice
  • Background noise, such as a TV or radio, makes conversations hard to understand
  • Certain sounds may seem overly loud
  • A constant ringing sensation (tinnitus) might occur

In some cases the change in hearing is sudden or comes with other symptoms such as a headache, vision changes or dizziness.

Risk factors

There are a number of risk factors associated with presbyacusis, including:

  • Constant exposure to loud noises, such as music (using headphones or attending loud concerts), machinery or traffic without ear protection
  • The premature ageing of the cochlea (a bone in the middle ear). Often there is a predisposed genetic reason for this
  • Furring of the arteries to the inner ear, reducing oxygen supply to the cochlea. This can be exacerbated by a lifetime of smoking or a poor diet
  • Hypertension, which can cause a reduction in blood supply to the cochlea
  • Drugs that damage the inner ear, such as aspirin and some types of chemotherapy. They are also known as ototoxic drugs

In many cases, the damage is caused at a young age – through working in a noisy environment or listening to loud music – and cannot be reversed in later life.

Diagnosis and treatment

The first stop should be your GP, especially if the change in hearing came on suddenly. They or another medical professional will conduct a physical examination to rule out other medical conditions which can cause temporary or permanent hearing loss. Many times a build-up of wax can block ear canals and cause hearing loss until it’s cleared.

Once common causes are ruled out, you may be referred to a specialist ear, nose and throat (ENT) consultant or hearing specialist. They will conduct further tests to determine the extent and cause of the hearing loss.

Although presbyacusis can’t be cured, a number of lifestyle changes ensure the condition can be lived with and therefore treatment tends to focus on improving your everyday quality of life.

A hearing aid is the most common solution to the problem and these can be prescribed following a consultation with an ENT specialist. Modern digital hearing aids are much smaller and less intrusive than the traditional analog ones and are increasingly available on the NHS.

A fitting is required and at first it may seem uncomfortable to wear. Due to years of dulled or muffled sounds, hearing will be amplified noticeably – possibly to uncomfortable levels for a short period of time afterwards.

But even with an aid fitted, hearing will not return to its previous best.

Other lifestyle changes include:

  • Telephone amplifiers or other assistive technology devices such as specially designed doorbells or smoke alarms which have a visual element as well as sound
  • Speech or lip-reading techniques
  • Sign language

For those with very severe hearing loss, a cochlear implant via a surgical process do make sounds seem louder but it doesn’t restore full hearing.