Presbycusis Clinical Presentation

  • Author: Peter S Roland, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: May 24, 2012
 

History

The clinical presentation of presbycusis varies from patient to patient and is a result of the various combinations of cochlear and neural changes that have occurred. Patients typically may have more difficulty understanding rapidly spoken language, vocabulary that is less familiar or more complex, and speech within a noisy, distracting environment. In addition, localizing sound is increasingly difficult as the disease progresses.

For example, an elderly patient may be healthy and mentally alert. The patient’s only report may be a gradually progressive hearing loss with particular difficulty understanding words and conversation when a high level of ambient background noise is present. This may interfere with his effectiveness at meetings. He may have a history of noise exposure (eg, armed services, hunting, use of power tools, industrial occupation). A high-frequency sloping sensorineural hearing loss may be found. His speech discrimination score may be normal unless tested in the presence of background noise. Hearing aids with more gain in the higher frequencies to match his hearing loss may provide substantial benefit, depending on his needs and motivation. He may also be counseled to avoid excessive noise exposure.

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Physical

In patients with presbycusis, no abnormalities are found on physical examination.

  • Presbycusis is a diagnosis of exclusion that should not be made until all other possible etiologies of hearing loss in elderly individuals have been evaluated and excluded.
  • Etiologies as simple as cerumen impaction and as complex as otosclerosis or cholesteatoma must not be overlooked in the elderly patient with hearing loss because these are amenable to treatment.
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Causes

Although the precise etiology of presbycusis is currently not known, the cause of presbycusis is generally agreed to be multifactorial. Proposed causes include the following:

  • Arteriosclerosis: Arteriosclerosis may cause diminished perfusion and oxygenation of the cochlea. Hypoperfusion leads to the formation of reactive oxygen metabolites and free radicals, which may damage inner ear structures directly as well as damage mitochondrial DNA of the inner ear. This damage may contribute to the development of presbycusis.
  • Diet and metabolism
    • Diabetes accelerates the process of atherosclerosis, which may interfere with perfusion and oxygenation of the cochlea.
    • Diabetes causes diffuse proliferation and hypertrophy of the vascular intimal endothelium, which may also interfere with perfusion of the cochlea.
    • In 2009, Kovacií et al studied auditory brainstem function in elderly diabetic patients with presbycusis. Their data supported a hypothesis that brainstem neuropathy in diabetes mellitus can be assessed with auditory brainstem response, even in elderly patients with sensorineural hearing loss.[14]
    • Le and Keithley have demonstrated diets high in antioxidants such as vitamins C and E reduce the progression of presbycusis in a mouse model.
  • Accumulated exposure to noise
  • Drug and environmental chemical exposure
  • Stress
  • Genetics
    • Genetic programming for early aging of parts of the auditory system may influence the development of presbycusis. Often, concomitant impairment of hearing, balance, sense of smell, taste, and visual acuity is associated with the aging process.
    • Likewise, genetically programmed susceptibility to environmental factors (eg, noise, ototoxic drugs and chemicals, stress) may be involved.
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Contributor Information and Disclosures
Author

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon Labs Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear Corp Honoraria Board membership; Med El Corp travel grants Consulting; Foresight Consulting fee Consulting

Coauthor(s)

Joe Walter Kutz Jr, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center

Joe Walter Kutz Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Michelle C Marcincuk, MD  Clinical Assistant Professor of Otolaryngology, University of Texas Southwestern Medical Center; Consulting Staff, Department of Surgery, Division of Otolaryngology, Texas Health Care, PLLC

Michelle C Marcincuk, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Texas Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jack A Shohet, MD  President, Shohet Ear Associates Medical Group, Inc; Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, School of Medicine

Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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