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Learning Objectives

  • Learn the epidemiology, pathophysiology, diagnosis, clinical features, risk factors, and treatment of hearing impairments in older adults.

  • Understand the interplay between common medical comorbidities, medications, genetics, and hearing disorders in older patients.

  • Gain a clear understanding of tests used to distinguish various kinds of hearing impairments.

  • Learn about recent technological advances involving hearing aids and cochlear implants, as well as emerging therapies targeting hair cell regeneration.

Key Clinical Points

  1. Age-related hearing loss (ARHL) is the most common sensory impairment in older adults, and its prevalence increases steadily with age.

  2. Men develop ARHL earlier than women. Family history and specific genes increase risk for presbycusis. Over 55% of ARHL in older patients can be attributed to heritability.

  3. Diabetes mellitus and cardiovascular disease, two of the most common comorbidities seen in older adults, promote hearing loss and cochlear pathology.

  4. Pure tone audiometry, tympanometry, acoustic reflex measurements, and word recognition scores are the most common methods for hearing assessment.

  5. Older patients often present with difficulties in speech recognition rather than inability to hear sound.


The sense of hearing is unequalled by our other sensory modalities in terms of its sensitivity, dynamic range, and discrimination of the finest nuances in stimuli. It does serve us well through a part of our lifetime, but beginning in our 40s (slightly earlier for men and later for women) our inner ears suffer the influence of aging in a very subtle yet progressive manner. Age-related hearing loss (ARHL) affects most people aged 65 and older and represents the predominant neurodegenerative disease of aging.

(The terms “age-related hearing impairment” and “age-related hearing loss” are interchangeably used in the literature whereby “loss” does not imply a complete loss of hearing but may signify any degree of auditory dysfunction. Individuals with hearing loss are generally referred to as “hard-of-hearing.”)

Hippocrates had already noted deafness to be more prevalent among his older patients and in The Comedy of Errors, Shakespeare’s older merchant, Aegeon, complains of his own “dull deaf ears.” Thus, ARHL or presbycusis is not a disease of modern societies but has been accepted for centuries as one of Lord Byron’s inevitable “woes that wait on age” that it still appears to be today. It was the New York otologist St. John Roosa who first drew the attention of his colleagues to hearing loss of older adults as a medical condition. In 1885 he proposed the name presbycusis that he had coined from the Greek πρέσβυς, old man, and ακούειν, to hear. Systematic studies of the anatomical pathology began in the late nineteenth century, leading by the 1930s to the realization that the decreased auditory acuity could be attributed to deterioration of the auditory sensory cells and the auditory nerve. These changes frequently affect the perception of the upper frequencies first, resulting in high-frequency (high “pitch”) hearing loss ...

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