Presbycusis
Presbycusis is age-related, bilateral, symmetric, high-frequency-predominant sensorineural hearing loss from cochlear hair cell loss, diagnosed by pattern recognition and audiometry after excluding other causes, and treated primarily with amplification.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Age-related sensorineural hearing loss: presbycusis is a gradual, bilateral, symmetric sensorineural hearing loss that occurs in elderly patients and is typically noticed by around 60 years of age.
- Epidemiology
Very common with advancing age: an estimated 50% of adults aged 60 to 69 years in the United States have hearing loss that affects daily communication, and presbycusis is the leading cause of this age-related sensorineural loss.
- Risk factors
Advancing age: the dominant risk factor; prevalence rises steeply through the 60s and beyond.
- Pathophysiology
Destruction of cochlear hair cells at the base: age-related, progressive sensorineural hearing loss results from destruction of hair cells at the cochlear base, which encodes high-frequency sound.
- Clinical features
Gradual, bilateral, symmetric hearing loss: the hallmark is a slowly progressive, symmetric decline affecting both ears, noticed by around age 60, without the acute or unilateral onset that should prompt a search for another cause.
- Differential diagnosis
Sudden sensorineural hearing loss: often idiopathic, more often unilateral, onset within 72 hours; sudden or unilateral onset is a red flag against presbycusis and requires urgent audiology referral and MRI.
- Diagnosis
A clinical diagnosis of exclusion confirmed by audiometry: presbycusis is diagnosed from the characteristic pattern (bilateral, symmetric, high-frequency, gradual, age-appropriate onset) once other…
- Management
First, confirm the diagnosis and route to audiology: refer for formal audiometry once presbycusis is suspected, since routine audiologist referral is indicated whenever hearing loss is identified.
- Complications
Social isolation and reduced quality of life: untreated hearing loss impairs day-to-day communication and negatively affects relationships.
- Prognosis
Progressive but slow: presbycusis continues to progress gradually over years and is not a static or reversible process, though the pace varies between patients.
- Prevention
Screen with a simple question rather than skipping screening entirely: ask "Do you feel you have hearing loss?" at routine visits in adults 50 and older, since the U.S.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Hearing loss
Hearing loss is evaluated with the Weber and Rinne tuning fork tests to sort conductive from sensorineural loss at the bedside, then confirmed with audiometry; treatment ranges from cerumen removal or hearing aids to urgent oral prednisone and otolaryngology referral for sudden sensorineural loss.
- Noise-induced hearing loss
Noise-induced hearing loss is a preventable sensorineural hearing loss from cochlear hair-cell injury, either sudden after a single very loud blast (acute acoustic trauma) or gradual from cumulative occupational or recreational exposure (chronic noise-induced hearing loss), with high-frequency loss first and no restorative drug therapy once established.
- Sudden sensorineural hearing loss
Sudden sensorineural hearing loss is unilateral hearing loss occurring within 72 hours, most often idiopathic, that is an otologic emergency because delayed treatment worsens recovery.
- Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma is a benign Schwann-cell tumor of CN VIII in the internal auditory canal/cerebellopontine angle that presents with slowly progressive unilateral sensorineural hearing loss and disequilibrium rather than true vertigo. Diagnosis rests on asymmetric audiometry followed by contrast-enhanced MRI, and management is a size- and growth-driven choice among observation, stereotactic radiosurgery, and microsurgical resection.
- Otosclerosis
Otosclerosis is a bony overgrowth of the stapes footplate that fixes the ossicular chain and produces slowly progressive, often bilateral conductive hearing loss in young adults, confirmed by a conductive Weber/Rinne pattern and treated with hearing aids or stapes surgery.
- Cerumen impaction
Cerumen impaction is accumulated earwax that occludes the external auditory canal, causing conductive hearing loss, fullness, or itching; management ranges from observation to cerumenolytics, irrigation, or manual/instrument removal, chosen by canal findings and tympanic membrane integrity.
- Tinnitus
Tinnitus is the conscious perception of sound without an external source, most often subjective (heard only by the patient) and linked to hearing loss, noise exposure, or an ototoxic drug. Management treats any identified cause first (stop the ototoxic agent, treat hearing loss), since no drug cures tinnitus itself, then adds sound therapy, hearing aids, or cognitive behavioral treatment for persistent symptoms.