Presbycusis Jagad

PRESBYCUSIS
Genggam Jagad Agami
1
ANATOMY AND
PHYSIOLOGY
INTRODUCTION
The normal process of aging affects all parts

of the ear
The greatest clinical impact is on cochlear

and vestibular function
Flint PW, Haughey BH, Robbins KT, Thomas JR, Niparko JK, Lund VJ, et al. Cummings otolaryngology-
head and neck surgery e-book: Elsevier Health Sciences; 2014.
Wang jin,Luc jean. Presbycusis: An Update on Cochlear Mechanisms
and Therapies. J. Clin. Med. 2020, 9, 218; doi:10.3390/jcm9010218 2
Introduction
Aging is a progressive decline or loss of tissue and organ function
The aging process has three distinct components:biological

degeneration, extrinsic damage, and intrinsic damage
Accelerated aging resulting from the genetic

background interacting throughout life with environmental and lifestyle
factors
and Therapies. J. Clin. Med. 2020, 9, 218; doi:10.3390/jcm9010218
AGING PROCESS
4
PATHOPHYSIOLOGY OF AGE
RELATED HEARING LOSS
CONDUCTIVE
MECHANISM OF EAR
Transduction mechanism
of the ear
The central auditory

system
Howarth A, Shone GR. Ageing and the auditory system. Postgrad Med J. 2006;82(965):166-71. 5
OTHER CAUSES HEARING LOSS IN
•
ELDERLY
While the ageing process itself is
associated with degeneration of the
auditory system, other insults to the
cochlea from noise or ototoxic drugs
can accumulate over a lifetime and
contribute to the decline in hearing
experienced by older people
• Ototoxicity as a cause of hearing loss

may often be unrecognised—it has
been estimated that up to 30% of
elderly patients presenting with
hearing impairment are taking
potentially ototoxic drugs
Howarth A, Shone GR. Ageing and the auditory system. Postgrad Med J. 2006;82(965):166-71. 16
INTRODUCTION
• Presbycusis refers to sensorineural hearing impairment in elderly

• Most common otolaryngologic problem of elderly
• Involves bilateral high – frequency hearing loss associated with difficulty in
speech discrimination and central auditory processing of information
• Association between advanced age and high tone deafness was first described by
Zwaardemaker in 1891
Flint PW, Haughey BH, Robbins KT, Thomas JR, Niparko JK, Lund VJ, et al. Cummings otolaryngology-head and neck surgery e-book: Elsevier Health Sciences; 2014. 3
DEFINITION
Presbycusis or age-related hearing loss is

the cumulative effect of aging on hearing.
It is a progressive and irreversible

bilateral symmetrical age-related
sensorineural hearing loss resulting from
degeneration of the cochlea or associated
structures of the inner ear or auditory
nerves.
EPIDEMIOLOGY
 Based on data from the National Health and Nutritional

Examination Survey (NHANES), 26.7 million U.S. adults
aged 50 years and older have clinically significant hearing
loss
 Hearing-loss prevalence doubles in each decade of life from
the second to seventh decade and is present in nearly two
thirds of U.S. adults 70 years and older
EPIDEMIOLOGY
This decrease in social

engagement can have
↓ Quality of profound consequences, and
Presbycusis
Life loneliness is a known
determinant of morbidity
and mortality in the elderly.
Epigenetic Factors
Increasing Age Environmental Factors
RISK FACTORS
Genetic Predisposition Health comorbidities
Flint PW, Haughey BH, Robbins KT, Thomas JR, Niparko JK, Lund VJ, et al. Cummings
otolaryngology-head and neck surgery e-book: Elsevier Health Sciences; 2014.
and Therapies. J. Clin. Med. 2020, 9, 218; doi:10.3390/jcm9010218 23
Molecular Mechanisms of Presbycusis
Sensory Neural
Presbycusis Presbycusis
HISTOPATHOLOGIC
TYPES OF
PRESBYCUSIS
Inner Ear
Conductive Strial
Presbycusis Presbycusis
Subtypes Pathology
Sensory • Pathologic lesions are limited to the first few millimeters of the basal turn of the cochlea.
• A flattening and atrophy of the organ of Corti is due to the loss of hair cells and
supporting cells.
Neural • The organ of Corti is largely intact

• Atrophy of the spiral ganglion and nerves of the osseous spiral lamina occur mainly in the
basal turn of the cochlea.
Metabolic • Atrophy of the stria vascularis

(Strial presbycusis) • The organ of Corti and spiral ganglion cells are usually unaffected.
Inner Ear Conductive Presbycusis • The histopathologic pattern of atrophy of the spiral ligament includes different degrees of
pathologic changes that are progressive through the patient’s life
• Cystic degeneration may cause detachment of the organ of Corti from the lateral cochlear
wall, thereby resulting in hearing loss.
SENSORY PRESBYCUSIS
Audiometric findings : an abrupt, steep, and high

frequency sensorineural hearing loss with slow,
symmetric bilateral progression, usually beginning
during middle age.
NEURAL PRESBYCUSIS
Audiometric findings : gradual hearing loss with a
moderate slope toward the high frequencies; however,
the decrease in speech discrimination is
disproportionately severe
STRIAL PRESBYCUSIS (METABOLIC)
● Flat sensory loss beginning during the third through
sixth decades and progressing slowly.
● Speech discrimination is generally good, and no

recruitment is present.
● This condition is often familial, and patients do well with

amplification.
INNER EAR CONDUCTIVE PRESBYCUSIS
● Both inner ear conductive presbycusis and atrophy of the

spiral ligament cause bilateral symmetric sensorineural
hearing loss with an upward slope toward the high frequency
and preserved speech discrimination
● No anatomic correlates with conductive sensorineural

hearing loss are known, but it is hypothesized that the
functional loss is due to stiffness of the basilar membrane,
which correlates with its anatomic shape.
Schuknecth’s Classification
MIXED PRESBYCUSIS
● Site of lesion - any combination

● Hearing loss - any combination
● Speech discrimination - mild loss
Schuknecth’s Classification
INTERMEDIATE PRESBYCUSIS
● No distinct lesions
● Flat or abrupt high frequency hearing loss Probable etiologies
• Impaired cellular
 similar to strial or sensory presbycusis metabolism
 withouth histopathology correlate • Diminished synaptic
function
• Chemical alterations of
● Speech - mild loss
endolymph
• Dysfunction in central
auditory pathway
CLINICAL MANIFESTATION
• The speech of others seems mumbled or slurred.
• High-pitched sounds such as “s” and “th” are difficult to hear and tell apart.
• Conversations are difficult to understand, especially when there is background noise.
• A man’s voice is easier to hear than the higher pitches of a woman’s voice.
• Certain sounds seem annoying or overly loud.
• Tinnitus (a ringing, roaring, or hissing sound in one or both ears) may also occur.
DIAGNOSIS
Detailed history
to rule out any specific etiology :
• noise exposure / trauma / ear infections
• ototoxicity
• vit-D deficiency
• Neurologic disorders - multiple sclerosis
• Advanced vascular disease - TIA,related brain stem ischemia
• Genetic
PTA, tympanometry
If asymmetric → ABR, MRI

PREVENTION
● Counseling - important for young patients with genetic or familial pattern
● Periodic otologic examination
● Annual audiograms in high risk patients
● Career or life-style change
Pharmacotherapies
● Antioxidants, Free Radical Scavengers, and Anti-
Inflammatories
● Regulators of Mitochondrial Function and Metabolism
● Caspase Inhibitors
● Neurotrophins
No effective medical or surgical treatment
TREATMENT
● Amplification
Amplification remains the mainstay of

treatment for age-related hearing loss;
however, the current use of hearing aids in
the United States remains low.
Only 3.8 million people, or 14.2% of

individuals over age 50 in the NHANES
cohort, wear hearing aids
TYPES OF HEARING AID
45
TREATMENT
● Correction of health factors
Correction of health factors such as smoking, hypertension, and cholesterol level should be
considered.
● Cochlear implantation
Cochlear implantation may play a role in treating older adults with severe to profound
sensorineural deafness. Such a degree of hearing loss is most often due to an underlying
pathologic process such as Meniere disease or otosclerosis in combination with presbycusis; the
latter does not product this degree of hearing impairment on its own
TREATMENT
Overall, the goal of treatment for presbycusis is to enable effective communication in all
settings. Although addressing peripheral functioning deficits through hearing aids and
cochlear implant is essential, the growing body of evidence suggesting a link between
hearing loss and cognitive decline suggests that a more comprehensive management
strategy is necessary.
Expansion of diagnostic testing to include speech in

noise and cognitive evaluation (or appropriate
referrals for such evaluation), as well as incorporation
of rehabilitation and counseling, will contribute to
comprehensive approach
PROGNOSIS
MAJORITY → Slow deterioration
NEURAL PRESBYCUSIS → worsen more rapidly
THANK YOU
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PRESBYCUSIS

Genggam Jagad Agami

The normal process of aging affects all parts

The greatest clinical impact is on cochlear

The aging process has three distinct components:biological

Accelerated aging resulting from the genetic

The central auditory

• Ototoxicity as a cause of hearing loss

• Presbycusis refers to sensorineural hearing impairment in elderly

Presbycusis or age-related hearing loss is

It is a progressive and irreversible

 Based on data from the National Health and Nutritional

This decrease in social

Increasing Age Environmental Factors

Genetic Predisposition Health comorbidities

Neural • The organ of Corti is largely intact

Metabolic • Atrophy of the stria vascularis

Audiometric findings : an abrupt, steep, and high

● Speech discrimination is generally good, and no

● This condition is often familial, and patients do well with

● Both inner ear conductive presbycusis and atrophy of the

● No anatomic correlates with conductive sensorineural

● Site of lesion - any combination

If asymmetric → ABR, MRI

● Periodic otologic examination

● Annual audiograms in high risk patients

● Career or life-style change

Amplification remains the mainstay of

Only 3.8 million people, or 14.2% of

Expansion of diagnostic testing to include speech in

NEURAL PRESBYCUSIS → worsen more rapidly

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