Age-Related Hearing Loss

Definition and Prevalence

• The American Academy of Otolaryngology-Head and Neck Surgery defines age-related sensorineural hearing loss as progressive bilateral sensorineural hearing loss associated with aging in persons ≥50 years old, affecting 1 in 3 adults between ages 65-74, nearly 50% of those 75 years or older, more than 60% of individuals by age 70, and 80% of individuals older than 85 years 1, 4, 6, 7

Pathophysiology

• The primary mechanism of presbycusis is degeneration of hair cells, particularly starting at the basal turn of the cochlea, with initial high-frequency hearing loss that progressively affects mid-range and lower frequencies 1, 7, 8

Clinical Presentation

• Age-related hearing loss typically presents with a bilateral, symmetric pattern, gradual progression, and poor word recognition on diagnostic testing 1, 4, 7

Screening and Diagnosis

• The American Academy of Otolaryngology-Head and Neck Surgery recommends screening all patients aged 50 years and older for hearing loss at the time of health care encounters, and if screening suggests hearing loss, otoscopic examination should be performed to rule out treatable conductive causes like cerumen impaction before attributing symptoms to presbycusis 1, 4

Clinical Distinction

• The American Academy of Otolaryngology-Head and Neck Surgery emphasizes that conductive causes are generally correctable, whereas sensorineural hearing loss is permanent and progressive, requiring amplification and rehabilitation 2, 3

Important Clinical Caveat

• Clinicians must evaluate and refer patients with asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing, as these patterns may indicate serious underlying pathology such as vestibular schwannoma 1, 4, 5