Presbycusis: Age-Related Hearing Loss Facts

Imagine living in a world that gradually grows silent, with familiar voices and everyday sounds becoming muffled or indistinguishable. For millions of older adults, this isn’t just a hypothetical scenario—it’s a reality. This phenomenon, known as presbycusis, is one of the most common types of age-related hearing loss.

But what is presbycusis? What are its signs, and how is it diagnosed? Can it be treated, and if so, how? Could a device as common as a hearing aid make a significant difference? Our Reviews Team set to find out. For more information on how our Reviews Team researches hearing aids, see our hearing aid review methodology.

Presbycusis, pronounced prez-buh-KYOO-sis, is a type of sensorineural ⓘSensorineural hearing loss is one of the most prevalent types of hearing loss. It’s caused by damage to the auditory nerve or sensory cells in the inner ear. hearing loss that occurs gradually as we age. It’s one of the most common conditions accompanying aging, affecting about one in three people ages 65–74 and nearly half of those 75 and older in the United States. ^[1] Age-Related Hearing Loss (Presbycusis). NIDCD. NIH. Update March 17, 2023. Found on the internet at https://www.nidcd.nih.gov/health/age-related-hearing-loss Essentially, presbycusis is a slow decline of high-pitched hearing in both ears.

How to pronounce presbycusis:

People with presbycusis often perceive sounds as muffled or less clear—imagine trying to listen to a radio station with poor reception. ^[2] Age-Related Hearing Loss. Medline Plus. Found on the internet at https://medlineplus.gov/ency/article/001045.htm. Higher-pitched sounds (like voices, especially children’s and women’s) are usually the hardest to understand. Conversations become challenging to follow, especially in noisy environments or when multiple people are talking simultaneously. It may seem like people are mumbling, and you may have to ask people to repeat themselves. This can be frustrating in social settings, which may lead you to avoid these types of situations. Some people describe a persistent ringing or buzzing noise, known as tinnitus ⓘA condition that is often linked to hearing loss and causes constant or periodic ringing or buzzing in the ear. You may notice you can’t hear the TV at volumes comfortable for others. Talking on the phone may also become increasingly difficult. This can all lead to feeling isolated and left out.

Normal hearing sounds like this: Play on SoundCloud

Presbycusis sounds like this: Play on SoundCloud

Common symptoms of presbycusis include:

• Difficulty hearing high-pitched sounds
• Ringing or buzzing in the ears (tinnitus)
• Asking people to repeat what they say
• Feeling like people are mumbling or unclear when they speak
• Struggling to hear or understand people in loud spaces
• Unable to hear full conversations on the phone
• Listening to the radio or television loudly enough that it’s annoying to others

Presbycusis affects both ears and generally begins in your 50s or 60s. It might be difficult to notice the extent of hearing loss with presbycusis because it’s so slow and gradual. ^[3] Arvin B, et al. High Frequency Presbycusis-Is There an Earlier Onset? Indian J Otolaryngol Head Neck Surg. Nov. 30, 2011. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889367/#:~:text=Discussion-,Presbycusis.

Presbycusis can have many negative impacts on health, including cognitive health, mental health, and safety.

Hearing loss and cognitive health

Cognitive decline (including memory and concentration) is more common in older adults with untreated hearing loss. ^[4] Uchida, Yasue, et al. Age-Related Hearing Loss and Cognitive Decline — The Potential Mechanisms Linking the Two, Auris Nasus Larynx, February 2019. Found on the internet at https://www.sciencedirect.com/science/article/pii/S0385814618304589 Studies have shown older adults with hearing loss have a greater risk of developing dementia than those with normal hearing. The prevalence of dementia among study participants with moderate to severe hearing loss was 61% higher than among participants with normal hearing. ^[5] Huang AR, et al. Hearing Loss and Dementia Prevalence in Older Adults in the US. JAMA. Jan. 10, 2023. Found on the internet at https://jamanetwork.com/journals/jama/fullarticle/2800197

Hearing loss and safety

Hearing loss is linked to an increased risk of dizziness, vertigo, and falls. ^[6] Blevins, Nikolas, M.D. Presbycusis. Up to Date. Reviewed June 2023. Found on the internet at https://www.uptodate.com/contents/presbycusis Even mild hearing loss triples the risk of an accidental fall. ^[7] Lin, Frank R. and Ferrucci, Luigi. Hearing Loss and Falls Among Older Adults in the United States. Arch Intern Med. Feb. 27, 2012. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518403/ It makes it difficult to understand advice from doctors, respond to warnings, and hear headphones, doorbells, and smoke alarms. It can also affect public safety, like while driving, because horns and sirens are harder to hear.

Presbycusis and mental health

Presbycusis can significantly impact your mental health, both directly and indirectly. As hearing loss progresses, it can create a barrier to communication. Older people who can’t hear well may become depressed or withdrawn due to embarrassment or frustration in social settings. ^[8] Hearing Loss: A Common Problem for Older Adults. NIA. NIH. Reviewed Jan. 19, 2023. Found on the internet at https://www.nia.nih.gov/health/hearing-loss-common-problem-older-adults They may appear confused, unresponsive, or uncooperative. These circumstances can lead to social isolation and loneliness.

In addition, the constant strain of trying to comprehend speech and sounds can lead to fatigue and increased stress. ^[9] Fatigue. American Academy of Audiology. Found on the internet at https://www.audiology.org/consumers-and-patients/hearing-and-balance/fatigue/#:~:text=When%20hearing%20loss%20is%20present,the%20brain%20and%20finally%20fatigue. Older adults with presbycusis are more likely to experience anxiety, especially about their ability to hear important sounds, like alarms or announcements. ^[10] Ma, Wen, et al. High-Frequency Hearing Loss is Associated With Anxiety and Brain Structural Plasticity in Older Adults. Sec. Neurocognitive Aging and Behavior. March 10, 2022. Found on the internet at https://www.frontiersin.org/articles/10.3389/fnagi.2022.821537/full

No single cause of age-related hearing loss is known. ^[2] Age-Related Hearing Loss. Medline Plus. NIH. Found on the internet at https://medlineplus.gov/ency/article/001045.htm Most commonly, it’s caused by changes in the inner ear, which occur as you grow older. Your genetics and lifetime exposure to loud noise (for example from loud concerts, headphones, and military or industrial occupations) are thought to play a role.

About 25–40 out of 100 over 65 are affected. Half of all people older than 75, and 80% of 80-year-olds, have difficulty hearing. ^[11] Hearing Loss and Deafness: Normal Hearing and Impaired Hearing. Informed Health. Updated Nov. 30, 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/books/NBK390300.

Age-related hearing loss is primarily caused by damage to the tiny hair cells in the inner ear that transmit sound waves into nerve signals to your brain. These cells can’t regrow, so hearing loss caused by hair cell damage is permanent.

The following factors contribute to age-related hearing loss: ^[2] Age-Related Hearing Loss. Medline Plus. Found on the internet at https://medlineplus.gov/ency/article/001045.htm.

• Family history
• Repeated exposure to loud noises
• Smoking
• Certain medicines, such as chemotherapy drugs for cancer
• Viral or bacterial ear infections
• Wax buildup
• Stroke
• Chronic diseases, such as diabetes, heart disease, kidney disease, high cholesterol, high blood pressure, thyroid disease

On the final bullet point in the above list, Rachel Magann Faivre, AuD, owner of Ash Audiology in Oklahoma City, said, “These combined with dementia and depression [and smoking] are nine of the 10 most common chronic diseases for people over 65. Untreated hearing loss is associated with other health conditions, but the ones mentioned above are the primary ones affecting older adults.”

Prevention of presbycusis

While age-related hearing loss is largely unavoidable, especially if there is a strong family history (genetic component), certain strategies might help delay its onset. ^[1] Age-Related Hearing Loss (Presbycusis). National Institute on Deafness and Other Communication Disorders. Updated March 17, 2023. Found on the internet at https://www.nidcd.nih.gov/health/age-related-hearing-loss. These include avoiding exposure to loud noises (like at concerts or from headphones, construction equipment, fireworks, guns, lawn equipment, motorcycles, and airplanes), maintaining good cardiovascular health, not smoking, and avoiding ototoxic drugs, whenever possible. Earplugs or protective earmuffs should be used when exposure to loud noises is possible.

Hearing loss is usually categorized into four stages: mild, moderate, severe, and profound. Each stage is defined by the range of decibels (dB) a person can hear. ^[12] Degrees of Hearing Loss. Happy Ears Hearing Center. Found on the internet at https://www.happyearshearing.com/hearing-loss/degrees-of-hearing-loss.

A person with normal hearing can hear decibels as low as -10 decibels, mild hearing loss occurs between 20–40 decibels, moderate hearing loss occurs between 40–70 decibels, severe hearing loss occurs between 70–90 decibels, while profound hearing loss cannot hear 90–120 decibels

Source: Degrees of Hearing Loss. Happy Ears Hearing Center. Found on the internet at https://www.happyearshearing.com/hearing-loss/degrees-of-hearing-loss.

To diagnose presbycusis, your audiologist or otolaryngologist will start by examining your ear. ^[13] Age-Related Hearing Loss (Presbycusis). Cleveland Clinic. Reviewed June 7, 2021. Found on the internet at https://my.clevelandclinic.org/health/articles/5840-age-related-hearing-loss. Utilizing an instrument known as an otoscope—a small, light-equipped magnifying device—they inspect your eardrum and outer ear canal for potential issues, such as damage to the eardrum, inflammation, or signs of infection.

You will then undergo testing, which starts with wearing headphones and responding to a series of beeping sounds. Words spoken at different volumes will be played, and you’ll be asked to repeat them. This helps the audiologist to chart your hearing sensitivity on an audiogram, a graph that aids in discerning the type, severity, and potential cause of your hearing loss. A typical audiogram for a person with presbycusis will show a bilateral (both ears) decline in hearing abilities in the upper frequencies, like here: ^[14] Hearing Loss. ENT Education Swansea. Found on the internet at https://www.enteducationswansea.org/hearing-loss

A typical audiogram with presbycusis shows a bilateral decrease in hearing as frequencies rise.

Source: Hearing Loss. ENT Education Swansea. Found on the internet at https://www.enteducationswansea.org/hearing-loss.

Online hearing tests

While visiting a hearing doctor is necessary for diagnosing and treating presbycusis, you may want to first utilize an online hearing test to screen yourself at home.

When to see a doctor

You should consider seeing a doctor for a hearing evaluation if you:

• Notice a sudden or rapid loss of hearing
• Experience tinnitus (ringing, buzzing, or other noises in the ear)
• Find you’re frequently asking people to repeat themselves
• Have difficulty following conversations when two or more people are speaking
• Struggle to hear in noisy environments or over the phone
• Often turn up the volume on the TV or radio to levels others find too loud
• Feel a sense of exhaustion or stress from trying to concentrate on hearing
• Experience dizziness or problems with balance
• Notice certain sounds seem overly loud or bothersome
• Hear better in one ear
• Experience ear drainage or pain

Remember, regular hearing check-ups are also a good idea as we age, even if you don’t notice any immediate problems. Like many health issues, early detection and intervention can make a significant difference in managing presbycusis.

Currently, there is no known cure for presbycusis. Fortunately, its impact can be minimized through assistive listening devices, such as hearing aids and cochlear implants. Cochlear implants are designed to treat profound deafness and less commonly, used in treating presbycusis. ^[15] Cochlear Implants. National Institute on Deafness and Other Communication Disorders. Update March 24, 2021. Found on the internet at https://www.nidcd.nih.gov/health/cochlear-implants. Therapeutic interventions, like counseling and online therapy, can improve quality of life, enhance social interactions, and boost overall mental health. Intervention is important, not only for current quality-of-life improvements but also to negate the impact untreated hearing loss can have on your health. A recent meta-analysis found people who used hearing restorative devices had a lower risk of long-term cognitive decline than those with uncorrected hearing loss. ^[16] Yeo, Brian SY, et al. Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-analysis. JAMA Neurology. Feb. 1, 2023. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/36469314.

Can hearing aids help age-related hearing loss?

The most common tool in the management of presbycusis is hearing aids. They can significantly help manage presbycusis by amplifying sounds, making it easier for individuals to hear and comprehend speech. They work by collecting sounds from the environment, amplifying them, and delivering these amplified sounds into the ears.

Modern hearing aids are also capable of suppressing background noise, making it easier to follow conversations in noisy environments, a common challenge for those with presbycusis.

Although over-the-counter hearing aids are available, it’s crucial to consult with a hearing doctor (audiologist or otolaryngologist) before beginning any form of treatment. ^[17] How to Get Hearing Aids. FDA. Update Nov. 18, 2022. Found on the internet at https://www.fda.gov/medical-devices/hearing-aids/how-get-hearing-aids

Can hearing aids make hearing loss worse?

Improper use or incorrectly fitted hearing aids could potentially cause problems. For instance, if the volume is consistently set too loud, it might lead to further damage to the auditory system due to loud noise exposure. ^[18] Can Hearing Aids Damage Hearing? Quality Hearing Aid Center. April 17, 2020. Found on the internet at https://hearingaidsforyou.com/can-hearing-aids-damage-hearing. Relying on only one hearing aid when bilateral hearing aids are recommended might lead to auditory deprivation in the non-amplified ear, where the brain loses some of its ability to interpret sounds due to lack of stimulation. ^[19] Victory, Joy. Why Two Hearing Aids are Better Than One. Health Hearing. Update June 12, 2023. Found on the internet at https://www.healthyhearing.com/report/51388-Hearing-aids-two-are-better-than-one Regular follow-ups with your hearing professional will ensure your hearing aids are properly fitted, the settings are optimal, and they are used correctly. This is the best way to make sure they are benefitting your hearing without causing additional issues.

Considerations in hearing aids for presbycusis

Choosing the right hearing aid for presbycusis involves several factors: ^[17] How to Get Hearing Aids. FDA. Update Nov. 18, 2022. Found on the internet at https://www.fda.gov/medical-devices/hearing-aids/how-get-hearing-aids

• Type/style: Hearing aids come in four main types: Behind-the-ear (BTE), in-the-ear (ITE), in-the-canal (ITC), and completely-in-canal (CIC). Some people prefer more discreet hearing aids, while others might not have a preference. The style best suited for you may be determined by other factors.
• Type of hearing loss: The kind and severity of your hearing loss will dictate the most suitable type of hearing aid. For instance, for those with profound hearing loss, a more powerful behind-the-ear model might be recommended.
• Lifestyle needs: Your daily activities and lifestyle can influence the type of hearing aid best for you. If you frequently find yourself in noisy environments, a hearing aid with good noise reduction capabilities may be beneficial. Those who swim regularly will want a waterproof design.
• Manual dexterity: Some hearing aids are extra small and may be difficult to handle for individuals with issues related to fine motor skills, arthritis, or visual impairment. In such cases, a larger model might be more suitable.
• Budget: Hearing aids vary in price, and your budget will play a role in your choice. It’s important to balance cost considerations with the quality and suitability of the device.
• Additional features: Some hearing aids come with added features, such as connectivity to smartphones or televisions, rechargeable batteries, or tinnitus-masking sounds. You’ll want to consider how important these features are to you.

Hearing aids come in many models to choose from, and your doctor will help guide your selection, but we will briefly highlight and compare three popular models that work well for treating presbycusis.

Jabra Enhance Select 200

The newest and most advanced hearing aid from Jabra Enhance is the Select 200. At $1,795–$1,995 per pair, this OTC, receiver-in-canal-style device is chock full of features, including Bluetooth streaming, hands-free phone calls, adjustments through a mobile app, advanced speech clarity, and background noise reduction.

Eargo 7

If you prefer a nearly invisible, completely-in-the-canal style hearing aid, look at the Eargo 7. This OTC hearing aid costs $2,650 per pair and connects to the Eargo app through Bluetooth. It also offers automatic sound profile adjustments and advanced background noise reduction, and it’s sweat and water-resistant enough to withstand workouts, rain, and showering.

Phonak Audeo Lumity

This receiver-in-canal-style, waterproof hearing aid has Bluetooth connectivity and a rechargeable battery. Unlike many over-the-counter options, which are only suitable for mild to moderate hearing loss, this prescription device can accommodate a wide range of hearing impairments from mild to profound. One of its key features is AutoSense technology, which adjusts to your surrounding noise levels automatically, without the need for manual intervention. The price for the Audeo Lumity aids ranges from $2,600–$6,500 per pair.

When it comes to insurance, coverage for hearing aids varies widely. Unfortunately, traditional Medicare does not cover hearing aids, though some Medicare Advantage plans may offer hearing aid benefits. Medicaid coverage for hearing aids varies from state to state and by plan within each state. Some private insurance plans do cover hearing aids, so it’s always worth checking your specific plan.

You may qualify for certain local programs that help pay for hearing aids. To check what’s available in your area, visit our Benefits CheckUp page.

Presbycusis, or age-related hearing loss, is a prevalent issue that affects many older adults and gradually impairs their ability to perceive sounds. It can significantly impact an individual’s quality of life and mental health. The causes are usually a combination of age and environmental factors, but prevention strategies can slow progression. The diagnosis involves working with an audiologist or otolaryngologist.

The good news is there are effective treatment options, generally involving hearing aids. These devices have evolved to offer sophisticated features, like automatic adjustments to changing environments, Bluetooth connectivity to mobile apps, and advanced background noise reduction. Hearing aids are designed to not only enhance hearing but also enrich the overall quality of life for individuals with presbycusis by allowing older adults to continue to enjoy their daily activities and social interactions.

Have questions about this article? Email us at reviewsteam@ncoa.org.

1. Age-Related Hearing Loss (Presbycusis). National Institute on Deafness and Other Communication Disorders. Updated March 17, 2023. Found on the internet at https://www.nidcd.nih.gov/health/age-related-hearing-loss.
2. Age-Related Hearing Loss. Medline Plus. Found on the internet at https://medlineplus.gov/ency/article/001045.htm.
3. Arvin B, et al. High-Frequency Presbycusis—Is There an Earlier Onset? Indian Journal of Otolaryngology and Head & Neck Surgery. Nov. 30, 2011. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889367.
4. Uchida, Yasue, et al. Age-Related Hearing Loss and Cognitive Decline — The Potential Mechanisms Linking the Two. Auris Nasus Larynx. February 2019. Found on the internet at https://www.sciencedirect.com/science/article/pii/S0385814618304589.
5. Huang AR, et al. Hearing Loss and Dementia Prevalence in Older Adults in the U.S. JAMA Network. Jan. 10, 2023. Found on the internet at https://jamanetwork.com/journals/jama/fullarticle/2800197.
6. Blevins, Nikolas. Presbycusis. UpToDate. Reviewed June 2023. Found on the internet at https://www.uptodate.com/contents/presbycusis.
7. Lin, Frank R. and Ferrucci, Luigi. Hearing Loss and Falls Among Older Adults in the United States. JAMA Internal Medicine. Feb. 27, 2012. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518403.
8. Hearing Loss: A Common Problem for Older Adults. National Institue on Aging. Reviewed Jan. 19, 2023. Found on the internet at https://www.nia.nih.gov/health/hearing-loss-common-problem-older-adults.
9. Fatigue. American Academy of Audiology. Found on the internet at https://www.audiology.org/consumers-and-patients/hearing-and-balance/fatigue.
10. Ma, Wen, et al. High-Frequency Hearing Loss is Associated With Anxiety and Brain Structural Plasticity in Older Adults. Frontiers in Aging Neuroscience. March 10, 2022. Found on the internet at https://www.frontiersin.org/articles/10.3389/fnagi.2022.821537/full
11. Hearing Loss and Deafness: Normal Hearing and Impaired Hearing. Informed Health. Updated Nov. 30, 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/books/NBK390300.
12. Degrees of Hearing Loss. Happy Ears Hearing Center. Found on the internet at https://www.happyearshearing.com/hearing-loss/degrees-of-hearing-loss.
13. Age-Related Hearing Loss (Presbycusis). Cleveland Clinic. Reviewed June 7, 2021. Found on the internet at https://my.clevelandclinic.org/health/articles/5840-age-related-hearing-loss.
14. Hearing Loss. ENT Education Swansea. Found on the internet at https://www.enteducationswansea.org/hearing-loss.
15. Cochlear Implants. National Institute on Deafness and Other Communication Disorders. Update March 24, 2021. Found on the internet at https://www.nidcd.nih.gov/health/cochlear-implants.
16. Yeo, Brian SY, et al. Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-analysis. JAMA Neurology. Feb. 1, 2023. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/36469314.
17. How to Get Hearing Aids. FDA. Update Nov. 18, 2022. Found on the internet at https://www.fda.gov/medical-devices/hearing-aids/how-get-hearing-aids.
18. Breaker, Doug. Can Hearing Aids Cause Hearing Loss? MDHearing. Oct. 15, 2016. Found on the internet at https://www.mdhearingaid.com/blog/can-hearing-aids-cause-hearing-loss.
19. Victory, Joy. Why Two Hearing Aids are Better Than One. Healthy Hearing. Update June 12, 2023. Found on the internet at https://www.healthyhearing.com/report/51388-Hearing-aids-two-are-better-than-one.