Key Takeaways

• Presbycusis is a type of hearing loss that gradually occurs as we age.
• One in three people ages 65–74 have hearing loss, and almost half aged 75 and older have hearing loss. ^[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
• While no single known cause of age-related hearing loss exists, it’s believed to be caused by changes in the inner ear that occur as people age, genetics, and lifetime exposure to loud noises.
• The most common symptoms of age-related hearing loss are perceiving sound as muffled, a persistent ringing sound, and difficulty hearing high-pitched sounds.

Imagine familiar voices and everyday sounds gradually 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 team set to find out. For more information on how our team researches hearing aids, see our hearing aid review methodology.

Presbycusis definition

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.

Presbycusis generally begins in your 50s or 60s. It might be difficult to notice the extent of hearing loss with presbycusis because it’s often 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.

Symptoms and causes of age-related hearing loss

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 talk 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 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 others find comfortable. Talking on the phone may also become increasingly difficult. These hearing loss symptoms can lead to feeling isolated and left out.

Presbycusis symptoms

Common symptoms of presbycusis include:

• Difficulty hearing high-pitched sounds
• Ringing or buzzing in the ears (tinnitus)
• 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

Common responses to these symptoms include asking people to repeat what they say and listening to the radio or television loudly enough that it’s annoying to others.

Presbycusis causes

No single cause of age-related hearing loss is known. Age-Related Hearing Loss. Medline Plus. NIH. Found on the internet at https://medlineplus.gov/ency/article/001045.htmMost commonly, it’s caused by changes in the inner ear. ^[2]Age-Related Hearing Loss. Medline Plus. NIH. Found on the internet at https://medlineplus.gov/ency/article/001045.htm 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.

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, which can lead to lung disease] 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.”

How is presbycusis diagnosed?

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. Using 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 use 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.

How is age-related hearing loss treated?

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 are 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, 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 at several studies on the topic 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 with 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 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 people 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.

How is age-related hearing loss prevented?

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 (medications that can damage the ear), whenever possible. Earplugs or protective earmuffs should be used when you might be exposed to loud noises.

Bottom line

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 someone’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 people with presbycusis by allowing them to continue to enjoy their daily activities and social interactions.

Frequently asked questions

At what age does hearing start to decline?

Hearing can start to decline as early as our 30s or 40s, but it’s typically around the 50s to early 60s when many people begin to notice changes in their hearing. ^[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. This varies greatly from person to person and is influenced by factors such as genetics, exposure to loud noises, overall health, and lifestyle.

Can hearing loss cause dementia?

Research has shown a link between untreated hearing loss and an increased risk of cognitive decline and dementia. ^[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. The exact reasons for this link are still being researched, but some theories suggest hearing loss could lead to increased cognitive load, social isolation, and changes in brain structure over time.

Do I need a hearing aid for mild hearing loss?

Whether you need a hearing aid for mild hearing loss depends on the impact the hearing loss is having on your daily life. If you’re finding it hard to follow conversations, especially in noisy environments, or if you’re having to frequently ask others to repeat themselves, it might be beneficial to consider a hearing aid.

What type of hearing aid is best for presbycusis?

The best type of hearing aid for presbycusis depends on several factors, including the severity of the hearing loss, your lifestyle, your manual dexterity, and your personal preferences. An audiologist or hearing care professional can guide you to the hearing aid best suited to your needs.

Can presbycusis be treated with hearing aids?

Yes, hearing aids are one of the main treatments for presbycusis. They help by amplifying sounds, making it easier for people to hear and understand speech. While they do not cure the condition, they significantly improve the quality of life for those living with presbycusis.

Do I need to see an ENT or audiologist for presbycusis?

Yes, it’s recommended to see a hearing specialist if you’re experiencing signs of hearing loss. An ear, nose, and throat (ENT) doctor can rule out any medical issues that could be causing your hearing loss, such as infections or earwax buildup. An audiologist specializes in diagnosing and managing hearing loss and can guide you through the process of getting and adjusting to hearing aids if they’re needed.

How common is presbycusis among older adults?

Presbycusis is common among older adults. It’s estimated one in three people in the United States between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing, with presbycusis being the most common cause. ^[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.

Can you prevent presbycusis?

While age-related hearing loss is largely unavoidable due to the natural aging process, certain strategies might help delay its onset, like avoiding exposure to loud noises, maintaining good cardiovascular health, and avoiding ototoxic drugs (medications that can damage hearing), if possible.

Does Medicare or Medicaid cover hearing aids for presbycusis?

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. Always check your specific plan to know what coverage is available.

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

Sources

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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
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14. ENT Education Swansea. Hearing Loss. Found on the internet at https://www.enteducationswansea.org/hearing-loss
15. National Institute on Deafness and Other Communication Disorders. Cochlear Implants. 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. U.S. Food and Drug Administration. How to Get Hearing Aids. 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