Presbycusis

What is Presbycusis?

Presbycusis is a term that refers to age-related hearing loss in both ears. Literally, it means “old hearing.” Usually, people start noticing this around the age of 60 and it worsens slowly. However, certain stressful conditions can speed up the rate of hearing deterioration. This condition can be diagnosed through a hearing test known as audiometry. The key symptom of presbycusis is trouble understanding high-pitch parts of speech, like the ‘p,’ ‘k,’ ‘f,’ ‘s,’ and ‘ch’ sounds. Unfortunately, there’s no cure, but hearing aids that increase sound volume can help manage the symptoms.

Presbycusis affects different parts of the hearing system in the body. It’s mainly caused by changes in specific parts of the ear related to aging, such as hair cells, the stria vascularis (a part of the inner ear), and spiral ganglion neurons (nerve cells that send sound signals to the brain).

Here’s how normal hearing works: The outer ear, shaped like a funnel, captures sound, which is simply air vibrations. These vibrations hit a part of the ear called the tympanic membrane, causing it to vibrate at a specific frequency and loudness. The vibrations are then boosted by three small bones in the middle ear: the malleus, incus, and stapes. These vibrations go through fluid in the inner ear and reach a part called the cochlea. Hair cells in the cochlea convert these vibrations into nerve signals, which are sent to the part of the brain that processes sound, the auditory cortex, through the cochlear nerve.

What Causes Presbycusis?

Presbycusis, or age-related hearing loss, has many contributing factors. These include natural aging which results in physical changes, inherited genetic traits, hormone changes, exposure to loud sounds or ear-damaging substances, previous ear infections, and the presence of certain diseases.

It’s essential to note that presbycusis can be categorized by which parts and functions of the ear are mainly affected. There is some debate whether it’s useful breaking presbycusis into subtypes since it doesn’t significantly change the treatment approach, and often there is combination of causes. Currently, there are six categories identified:

1. Sensory presbycusis: loss of receptor hair cells at the base of the cochlea, resulting in a loss of high-pitched sounds.
2. Neural presbycusis: loss of nerve fibers in the cochlea and the spiral ganglion neurons.
3. Strial presbycusis: degeneration of essential cells in the stria vascularis (a part of the cochlea) that helps maintain the balance of ions in the cochlea fluid for proper signal transmission. This is also known as metabolic presbycusis.
4. Mechanical presbycusis: the physical changes of the cochlea duct, which can be identified through an ear examination.
5. Mixed presbycusis: changes in more than one of the above structures.
6. Indeterminate presbycusis: Changes that aren’t significant to the structures described above.

Genetics can play a role in presbycusis, particularly variations in genes affecting mitochondrial DNA and oxidative stress.

Some medications, as well as workplace and environmental exposure to specific chemicals like toluene, styrene, lead, carbon monoxide, and mercury, can damage the ears and contribute to age-related hearing loss. Avoiding exposure to these substances can help prevent hearing loss.

Long-term studies have suggested that those who have experienced noise-induced ear damage in their younger years may develop more severe presbycusis later in life. Chronic noise exposure can lead to damage and loss of spiral ganglion neurons, an important part of the hearing process.

Hormones like glucocorticoids and sex hormones, along with glutamate signaling, are believed to play a role in presbycusis. Conditions that result in prolonged corticosterone levels, loss of nuclear factor kappa B, or use of progestin and hormone replacement therapy in postmenopausal women, have been linked with increased hearing loss.

Risk Factors and Frequency for Presbycusis

Presbycusis, or age-related hearing loss, is a key health concern around the world, especially for those above 70. About two-thirds of Americans in this age group are estimated to have some level of hearing loss. However, it’s hard to come up with exact figures because different researchers have different ways of defining what counts as hearing loss.

There have been several attempts to study just how many people have hearing loss. These studies include large groups of people and use data from surveys like the national health and nutrition examination survey (NHANES), as well as the health, aging, and body composition (ABC) study.

Data from NHANES has shown that the likelihood of hearing loss doubles for every additional decade of life from the age of 12 up to 79. The ABC study, on the other hand, found that hearing loss is most common in white men, followed by white women, black men, and black women.

• Presbycusis, or age-related hearing loss, is seen in about two-thirds of Americans aged 70 and above.
• Exact numbers are hard to define because of different criteria for what counts as hearing loss.
• Data from NHANES shows that the likelihood of hearing loss doubles with each passing decade from 12 to 79 years of age.
• According to the ABC study, hearing loss is most common in white men, followed by white women, black men, and black women.

Age-related hearing loss is also a major concern globally. Over half of adults aged 75 and almost all adults aged 90 are affected. The World Health Organization anticipates that by 2025, more than 500 million people aged 60 and above will have significant age-related hearing loss.

Signs and Symptoms of Presbycusis

Presbycusis is an age-related hearing loss that usually starts off subtly and can be hard to detect in its early stages. It’s crucial for healthcare providers, particularly those working with older adults, to regularly check their patients for any signs of hearing difficulty. Often, the individuals who notice the hearing loss first are not the patients themselves, but their family members and friends. A common early sign of presbycusis is having trouble understanding speech in noisy environments.

Some people might also experience tinnitus, a ringing sound in their ears, but this symptom can be associated with other hearing issues, not just presbycusis. A comprehensive questionnaire like the “hearing handicap inventory for the elderly-screening (HHIE-S)” exists for assessing hearing impairment, but sometimes, asking the simple question, “Do you have a hearing problem now?” can be an effective screening method too.

• Problems with picking up speech in noisy settings
• Tinnitus (ringing in the ears)

In addition to these signs, a thorough patient history, including any personal or occupational exposure to loud noises, usage of ototoxic medications, and family history of age-related hearing loss, can be helpful. If the hearing impairment is sudden, one-sided, or comes with neurological symptoms like facial numbness, balance issues, or dizziness, a referral to an ear, nose, and throat specialist (otolaryngologist) may be necessary.

Typically, physical check-ups of patients with presbycusis do not reveal any significant findings. Older adults may show harmless age-related changes like a clouding of the eardrum or buildup of earwax. If there’s a lot of earwax, it should be removed to rule out any blockages as a potential cause of hearing loss.

Simple tools like tuning forks can be employed to distinguish between conductive hearing loss (caused by problems in the outer or middle ear) and sensorineural hearing loss (caused by issues in the inner ear or auditory nerve). The Weber and Rinne tests done using a tuning fork can help in figuring out the type of hearing loss, but they should not replace comprehensive audiometry tests. In presbycusis, which is a sensorineural hearing loss, the Rinne test would typically show that sound travels longer through air than through bone in both ears. Similarly, Weber’s test would suggest that the sound is louder in the ear with better hearing due to nerve-related hearing loss in the other ear.

Testing for Presbycusis

A physical examination on its own is often not enough to diagnose age-related hearing loss, also known as presbycusis. If you’re an older adult who might be at risk for this condition, your doctor may perform a hearing test, called an audiometry test, in their office. You might be referred for more in-depth hearing tests if your doctor thinks you have presbycusis. Usually, doctors don’t order imaging tests like CT scans or MRIs, unless there’s a big difference between what you’re experiencing and your hearing test results, or if other neurologic changes are happening.

There are many different kinds of hearing tests, but in general, an audiometry test checks how well you can hear sounds of different volumes and pitches. One common test is something called pure tone testing. During this test, you wear headphones and listen to sounds one ear at a time, and you respond whenever you hear a sound. The results of this test are drawn on a graph called an audiogram. With age-related hearing loss, typically, you lose the ability to hear high-pitch sounds first, and then over time, it becomes more difficult to hear sounds at lower pitches.

Presbycusis is defined by hearing loss above 2000 Hertz (a measurement of sound frequency) in both ears. On the audiogram, this shows up as a downward slanting line that represents higher frequency hearing impairments.

Your doctor might also recommend blood tests for conditions like high cholesterol, diabetes, and kidney disease, which are common in people with hearing loss. However, these tests aren’t necessary to diagnose presbycusis.

Treatment Options for Presbycusis

There’s no known cure for presbycusis, a condition that leads to hearing loss as you age. While effective in many cases, the solution of using hearing aids is not perfect. Hearing aids can’t restore normal hearing. Instead, they amplify noises so they’re easier to hear. That being said, they are usually quite expensive and often not covered by insurance. Smaller hearing aids might be more comfortable and less noticeable, but they might also be more difficult for an older person to handle. Using a hearing aid is a journey – it takes time to adjust to wearing them physically and to get used to how they work. Because of this, it’s recommended that a team made up of your main doctor and a professional specialized in hearing (audiologist) help you manage your hearing aids.

Patients often need encouragement when it comes to using hearing aids, as they might find them uncomfortable, not visually appealing or embarrassing. Hearing aids are usually recommended when hearing loss reaches failure to hear specific sound frequencies. For serious hearing loss conditions that can’t be managed with hearing aids, cochlear implants might be an option. To qualify for these implants, you need to meet specific criteria, usually based on how severe your hearing loss is.

On top of using hearing aids or implants, there are some other things you can do to manage presbycusis. Make sure to use earplugs or earmuffs if you’re going to be around loud noises, as these can make hearing loss progress more quickly. A diet low in saturated fat might help slow down your hearing loss. Regular exercise and a healthy lifestyle can also be beneficial, as hearing loss has been linked with conditions such as stroke, heart disease, high blood pressure, high levels of fats in your blood and diabetes. It’s also a good idea to quit smoking, as this has been shown to delay hearing loss related to age.

There’s still a lot we don’t know about hearing loss as an age-related issue. Some researchers are studying whether taking antioxidants can slow hearing loss – these are substances that could potentially protect your cells from damage. While early research in rats suggested that a substance called alpha-lipoic acid might prevent hearing loss, further studies in humans showed that a diet full of antioxidants didn’t slow down the hearing loss progression. Other substances, such as coenzyme Q-10 and ginkgo biloba, are controversial and have been studied, but there’s not enough proof to recommend their use. These substances have been associated with higher risk of death when used for a long time. Research into gene and hormone therapies for hearing loss are ongoing.

What else can Presbycusis be?

Presbycusis, or age-related hearing loss, is usually identified by ruling out other potential causes first. If a person’s hearing loss is of the sensorineural type (where there is a problem with the nerves in the ear), they should get a detailed hearing test called an audiometry test. Other conditions that might cause this type of hearing loss include :

• Blasting loud sounds
• Infections
• Ménière’s disease (a disorder of the inner ear)
• Injury to the ear
• Autoimmune diseases
• Perilymph fistula (a tiny tear or defect in the inner ear)
• Hearing loss that runs in the family
• Otosclerosis (a bone growth problem in the ear)
• Tumors
• Exposure to medicines that can harm the ear
• Problems with how the body processes energy

In addition to hearing tests, other examinations such as imaging or metabolic tests may be done. Also, other conditions linked to presbycusis like diabetes, high blood pressure, kidney issues, and high cholesterol should be evaluated.

If the hearing loss is conductive (where sound is not efficiently conducted through the outer ear canal to the eardrum and tiny bones of the middle ear), then other reasons beyond presbycusis should be explored. They include:

• Earwax blockage
• Foreign body in the ear
• Tumor obstruction
• Infections
• Perforation (hole in the eardrum)
• Otosclerosis
• Cholesteatoma (skin growth in the middle ear behind the eardrum)

Presbycusis should be considered in older adults who show changes in mood and thinking abilities as these might be due to underlying hearing problems.

What to expect with Presbycusis

As we age, changes in our hearing abilities are a normal part of growing older. Presbycusis, a condition associated with age-related hearing loss, usually doesn’t lead to complete deafness. However, if presbycusis is ignored or not treated, it can negatively impact mental, cognitive, and physical health.

Even though there isn’t a cure for presbycusis, hearing aids can help control the symptoms and prevent or slow down some of the effects of hearing loss. To make the most of hearing aids, it’s important to wear them regularly and join in auditory rehabilitation, which can help people learn to adjust their minds and behaviors to their changing hearing abilities.

It’s important to remember that hearing aids can’t stop age-related changes, and these changes will keep happening even with treatment. If hearing aids aren’t helping, there are surgical options that may help improve your hearing.

Possible Complications When Diagnosed with Presbycusis

Hearing loss in older adults has been found to have a link with decreased mental capabilities.[44] Research indicates that if an older adult has difficulties with their hearing, the risk for dementia significantly increases.[45][46][47] Many studies have looked at the link between how severe hearing loss is to cognitive impairment. The exact relationship however, is still not completely understood. It is thought that when there’s significant hearing impairment, the brain needs to work a lot harder and tap into its resources to account for the lack of auditory perception or hearing in simple terms. Because our brains have a limited amount of these resources, this extra work infringes on other cognitive functions such as memory.[48][49].

id=”link_2087959″>[50]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193888/#R44Our hearing plays a big role in our everyday life, it helps us communicate, be aware of our safety, and socialize. It is believed that older adults who are hard of hearing tend to be more socially isolated and have less independence[41]. It also negatively impacts their mood leading to increased anxiety, depression, and tiredness.[42][51]. Aids like hearing devices can greatly improve their quality of life[3][30].

Future concerns that are also problematic with impaired hearing, particularly in high frequencies, is that it becomes difficult for older adults to hear certain warnings or signals such as doorbells, phone rings, smoke alarms and turn signals. It is also thought that there might be a connection between hearing loss and the body’s stability in older adults[43][52]. This connection primarily relates to how we perceive our body’s movement and placement in space. Knowing more about this connection could potentially lead to a reduction in falls among older adults, which is a leading cause of severe injury and death.

PROPOSED LIST:

• Hearing loss linked to cognitive dysfunction in older adults.
• Increased risk of dementia with age-related hearing loss.
• Severe hearing impairment could limit cognitive functions like memory.
• Hearing loss can result in social isolation and decreased independence.
• Negative mood effects such as anxiety, depression, and lethargy.
• Treatment with hearing aids improves quality of life.
• Difficulty hearing warnings and signals.
• Possible connection between hearing loss and body stability.
• Increased understanding could reduce frequency of falls in older adults.

Preventing Presbycusis

Presbycusis, a fancy term for age-related hearing loss, is a common health issue experienced by many people as they get older. It’s crucial for patients, caregivers, and even their friends to understand that age-related hearing loss is often prevalent and can have several impacts on the individual’s life. Good news is that there are effective solutions available. Identifying the issue early and treating it can help slow down the progression of hearing loss and enhance your quality of life. As a general rule, all adults aged 60 and above should regularly check for hearing problems. This can be as simple as asking oneself or being asked, “Do you have trouble hearing?”.

Interestingly, a poor hearing condition can be linked with factors that pose a risk to heart health. Adopting a healthy lifestyle, avoiding smoking, and staying physically and mentally active may all contribute to delaying the start and slowing the progression of hearing loss. These steps have other health benefits beyond hearing health, so they are worth pursuing even if you’re simply at risk – it doesn’t necessarily mean you’ll lose your hearing. It’s also essential for our senior folks to be mindful of the effects their surroundings have on their ability to comprehend sounds, especially in environments with a lot of background noise.

Furthermore, keeping your ears clean by removing earwax in a safe manner and avoiding loud noises without using ear protection can help prevent some other types of hearing loss that might worsen the symptoms of presbycusis.