Most Common Type of Hearing Loss in Older Adults
Sensorineural hearing loss (SNHL), specifically age-related hearing loss (presbycusis), is the most common type of hearing loss in the older adult population. 1
Defining Characteristics
Age-related sensorineural hearing loss refers to progressive bilateral sensorineural hearing loss associated with aging in persons ≥50 years old. 1 This condition affects:
- 1 in 3 adults between ages 65-74 1
- Nearly 50% of those 75 years or older 1
- More than 60% of individuals by age 70 1
- 80% of individuals older than 85 years 1
Pathophysiological Mechanism
The primary mechanism of presbycusis is degeneration of hair cells, particularly starting at the basal turn of the cochlea. 1, 2 While earlier theories suggested strial atrophy was the primary driver, more recent evidence confirms hair cell loss as the predominant cause. 1
The condition presents with:
- Initial high-frequency hearing loss that progressively affects mid-range and lower frequencies 1
- Bilateral, symmetric pattern (audiometric results within 15 dB pure tone average between ears, with word recognition score differences ≤15%) 1
- Gradual progression, as opposed to sudden-onset forms 1
Clinical Distinction from Other Types
While conductive hearing loss (from cerumen impaction, middle ear effusion, or ossicular pathology) can occur in older adults and may be present in up to 30% of elderly patients with hearing loss, presbycusis remains the predominant type. 1, 3 The American Academy of Otolaryngology-Head and Neck Surgery emphasizes that conductive causes are generally correctable, whereas sensorineural hearing loss is permanent and progressive, requiring amplification and rehabilitation. 4
Important Clinical Caveat
Clinicians must evaluate and refer patients with asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing, as these patterns may indicate serious underlying pathology such as vestibular schwannoma. 1, 4 This distinguishes pathological conditions from typical age-related presbycusis.
Screening Recommendation
The American Academy of Otolaryngology-Head and Neck Surgery recommends screening all patients aged 50 years and older for hearing loss at the time of health care encounters. 1 If screening suggests hearing loss, otoscopic examination should be performed to rule out treatable conductive causes like cerumen impaction before attributing symptoms to presbycusis. 1