Presbycusis (Age-Related Hearing Loss)

📌 Definition: Sensorineural hearing loss associated with the physiological aging process of the ear.

Onset & Aetiology

• Typical Age: Manifests at 65 years.
• Early Onset Factors:
  • Hereditary predisposition.
  • Chronic noise exposure.
  • Generalized vascular disease.

Pathological Types

There are four identified types based on the site of degeneration (Table):

Type	Pathology	Clinical Features
1. Sensory	Degeneration of Organ of Corti. (Starts basal coil → Apex).	High freq affected. Good Speech Discrimination.
2. Neural	Degeneration of Spiral Ganglion cells. (Starts basal coil → Apex).	High tone loss. Speech Discrimination is POOR (out of proportion to tone loss).
3. Strial (Metabolic)	Atrophy of Stria Vascularis. (Energy production affected). *Runs in families.	Audiogram: Flat. Good Speech Discrimination.
4. Cochlear Conductive	Stiffening of the Basilar Membrane affecting movement.	Audiogram: Sloping type.

Clinical Features

The Classic Complaints:

• "Cocktail Party Effect": Difficulty hearing in the presence of background noise (though they hear well in quiet).
• Phonemic Regression: "I can hear you speaking, but I cannot understand the words."
• Recruitment Positive: Sounds suddenly become intolerable when volume is raised.
• Tinnitus: A bothersome problem; sometimes the only complaint.

Management

1. Amplification

• Hearing Aids: The primary mode of rehabilitation.

2. Rehabilitation

• Speech Reading: Lessons in using visual cues (lip reading) to supplement hearing.

3. Lifestyle Modifications

To help decrease Tinnitus:

• Curtailment of Smoking.
• Avoid stimulants like Tea and Coffee.