Age-related hearing loss (presbycusis)

Age-related hearing loss is accelerated when other factors such as cardiovascular and metabolic diseases, hereditary predisposition, or nicotine consumption are added. This is due to wear and tear on the inner ear, auditory nerve, and auditory centre, as well as noise pollution.

Age-related hearing loss is insidious, beginning with hearing loss at high frequencies and a decrease in understanding speech in noisy surroundings. It is often accompanied by tinnitus, a constant noise in the ears.

Untreated presbycusis can lead to mental deterioration and dementia, social withdrawal, and insecurity, and age-related hearing loss does not lead to deafness. Early diagnosis and treatment by an ENT doctor are recommended.

Hearing loss: definition and frequency

Hearing impairment (hypacusis) is a limitation of the ability to hear, ranging from a minor impairment to complete hearing loss, and can be temporary or permanent.

Hearing is a complex process that involves the perception and processing of acoustic signals and the translation of information in the brain. There are many causes of hearing loss, including noise pollution and hypacusis.

Hearing loss is a common disease that affects over 450 million people worldwide. It is caused by auditory pathway degeneration, which makes it difficult to distinguish between affected sounds. If this degeneration is counteracted at an early stage by a hearing aid, the broad spectrum of hearing can be retained.

Early detection is essential for successful therapy, especially for children, as general mental and language development require normal hearing. The early childhood hearing campaign of Deutsche Kinderhilfe assumes that there are two to three children with hearing impairments per 1,000 births, and the rate is higher for premature births.

Hearing loss: causes and risk factors

Sound waves travel through the external auditory canal to the eardrum, where they are processed into electrical impulses in the hair cells. These impulses reach the auditory center of the brain via the nerve tracts of the auditory nerve. Hearing loss occurs when there is a disorder or disease on the path between the ear canal and the brain. Causes of hypacusis can occur in both acute and chronic forms.

Hearing loss: symptoms and early signs

Hearing loss is characterised by the reduced or complete inability to hear certain frequencies and sound volumes. The underlying cause and severity of the disease have a significant impact on the accompanying symptoms. For instance, since the balance organ is also located in the inner ear, pathological changes there frequently cause tinnitus, vertigo, and balance issues all at once.

People who are hard of hearing are more quickly exhausted because the hearing process requires more effort and concentration. 

The first signs of hearing problems can manifest themselves in the following ways:

  • Overhearing natural sounds such as the rustling of leaves, the sea or birdsong
  • Overhearing household noises i.e. refrigerator whirring, alarm clock ticking, etc.
  • Ignoring the phone or the bell
  • Increased feeling that the interlocutor is mumbling and making inquiries necessary
  • Poor understanding of speech in background noise (e.g. during conversations in a group or during conversations in a restaurant with other conversations and music in the background)
  • Family members or neighbors complain that the TV or radio is too loud

At the first signs, those affected should have their hearing checked by an ENT doctor.

stages of deafness

The two most important units for assessing hearing ability are pitch and volume. Pitch is measured in Hertz (Hz) and the threshold at which a person with normal hearing feels uncomfortable is 80-85 dB. Volume is measured in decibels (dB). The hearing threshold is the limit of perception of an auditory impression, which is frequency dependent and divided into five stages.

  • Normal hearing: A deviation in hearing ability from the defined hearing threshold of up to 20 dB is in the range of normal hearing.
  • Slight hearing loss is present with a deviation of more than 20 dB, ie the ticking of a wristwatch or the rustling of leaves can no longer be heard acoustically. The affected person can only hear tones with a sound intensity of 25 to 40 dB.
  • Moderate hearing loss starts at a hearing loss of 40 dB, which is about the same as background noise in a residential area. The affected person can only hear tones with a sound intensity of 40 to 60 dB.
  • Severe hearing loss occurs at at least 60 dB, at which point a conversation partner can no longer be heard at a normal speaking volume.
  • Hearing loss bordering on deafness begins with a hearing loss of more than 80 dB. In these cases, you don’t hear loud music or the sounds of a freeway. If you hear practically nothing, you are deaf or deaf.


4th Professional Medical Student. Karachi Medical and Dental College.

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