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Presbycusis

Definition

With age, physiological changes occur at different locations in the organism. The auditory system is not excluded from this, it also undergoes alteration over the years. Presbycusis is defined as a hearing impairment due to aging. 

Most age-related changes are located in the inner ear and the central auditory system (the brain). The inner ear, which includes the cochlea, contains thousands of cells that transform sounds into electrical signals. Those electrical signals are then transmitted to the brain by other nerve cells to be analyzed. With age, damages accumulate in these cells and in the anatomical structures that surround them. These damages cause a hearing loss, making it harder for sounds to be well detected and decoded. In other words, the volume of sounds needs to be louder to be heard and complex sounds, like speech, lose some of their clarity. 

Manifestations

Presbycusis causes a symmetrical hearing loss in both ears, more pronounced in the high pitch sounds (high frequencies). Hearing impairment sets in very slowly over time, which means it can go unnoticed for many years. Because of its insidious onset, the person’s family and friends often notice signs of hearing loss before the person is aware of it. 

At first, presbycusis is mild and can lead to difficulty hearing bird song or certain tones (eg microwave beeping), difficulty understanding speech in noise, on the cellphone, etc. Always very gradually, the hearing loss degree increase and sounds become more difficult to perceive. Speech clarity deteriorates, which can give the impression that others do not articulate well. Other signs include television and radio volume needing to be increased, difficulty understanding someone who speaks quickly, from the back or from a distance (eg from another room in the house), etc. Over time, all of these difficulties can lead to activity restriction and social withdrawal. In addition, the person’s safety may be compromised if it is difficult to hear alarms (eg smoke detector alarm), cars on the street, etc.

Moreover, it should be noted that tinnitus, loud sounds intolerance and loss of balance may be associated with presbycusis. 

Audiologist’s Role

First of all, the audiologist does a hearing evaluation to determine the presence of a hearing loss, its degree and its origin. The audiologist can make a hypothesis of a presbyacusis. The person’s needs in different situations (eg at home, at the restaurant, at work, etc.) are also evaluated to then make the appropriate recommendations. These may include hearing aids, assistive listening devices (eg amplified phone or headphones to watch television), counseling about communication strategies to the person’s family and friends, lip reading classes, etc. The options vary according to the needs of the person and his entourage. 

Ressources

ASHA

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