Definition: Presbycusis is a condition in which hearing gradually deteriorates with age and is common among older adults. Approximately 1/3 of people aged 75 and older experience hearing loss.
Causes·pathophysiology: The main causes are age-related changes in the inner ear (cochlea) and auditory nerve. A combination of damage to the outer and inner hair cells, changes in ions and blood flow, and reduced central auditory processing ability contributes to the condition.
Main symptoms: In the early stages, the ability to identify speech declines due to reduced hearing of high-frequency sounds (e.g., consonants such as /s/, /ʃ/, /t͡s/, /f/, and /h/). Conversation becomes difficult in noisy environments, and as the condition progresses, hearing loss may also occur in the low-frequency range. Tinnitus, stress and fatigue related to hearing loss, and social withdrawal may also occur.

Hearing aids: The primary treatment for moderate or greater sensorineural hearing loss. Adaptation education (auditory rehabilitation) and regular hearing-aid adjustments are necessary.
Cochlear implant: Considered when hearing aids are ineffective or in cases of severe or profound hearing loss. Evaluation before and after surgery and a rehabilitation process are necessary.
Auditory rehabilitation: Hearing-aid adaptation training, auditory training (speech-recognition training), and environmental adjustments (reducing noise, changing seating positions, etc.).
Medication: Drug treatment that fundamentally restores presbycusis is not currently recommended as a standard treatment. Symptomatic treatment for accompanying conditions (such as tinnitus and dizziness) may be provided when necessary.
Lifestyle management·prevention: Avoiding noise exposure, taking care with ear hygiene (avoiding excessive use of cotton swabs on your own), managing cardiovascular risk factors (high blood pressure, diabetes, and hyperlipidemia), quitting smoking, and maintaining appropriate exercise and nutrition.
Precautions: Learn how to wear and maintain hearing aids, undergo regular hearing tests (to monitor changes), and consult a specialist if hearing aids cause discomfort or skin problems or if tinnitus worsens.
Risk of complications: Social isolation, depression, reduced cognitive function (an association with an increased risk of dementia has been reported), and a possible increased risk of falls.

Items to bring (recommended)
- A list of medications currently being taken (including prescription drugs, over-the-counter medications, and supplements)
- Previous otolaryngology examination results or hearing test results (if available)
- When the symptoms began and how they have progressed (including aggravating factors), along with specific examples of situations in which hearing is difficult (e.g., restaurants and telephone conversations)
- A record of whether tinnitus, dizziness, or ear pain is present
- Family history (hearing loss or ear disease) and occupational history (long-term noise exposure)
Examples of information and questions that are useful to provide in advance at the outpatient visit (writing them down and bringing them can be helpful)
- When and how did the symptoms begin?
- Is hearing more difficult with certain sounds (high or low frequencies)?
- Is it difficult to understand speech in noisy environments?
- Have you used hearing aids before, or do you have results from a previous hearing test?

What is the cause of this condition, and what is the relevant pathophysiology in my case?
What treatment options do you recommend (hearing aids vs. surgery, etc.), and what are the expected effects of each?
How long is the adaptation period when using hearing aids, and how should they be maintained?
What side effects or precautions are associated with this medication (or assistive device)?
How often should follow-up examinations be performed, and which tests are needed?
What impact does hearing loss have on daily life, driving, and work?

How should I interpret the results of my hearing tests (pure-tone audiometry and speech audiometry)? (e.g., the degree and type of hearing loss and the expected effects in daily life)
Which type of hearing aid is most suitable for me (behind-the-ear, in-the-ear, rechargeable, etc.), and what are the costs and support services (subsidies and adaptation programs)?

Age-related hearing loss

Doctors who treat Age-related hearing loss