Presbyacusis

Presbycusis
ALSO KNOWN AS
• Age-Related Sensori-Neural Hearing Loss
• Age Associated Hearing Loss (AAHL)
• Presbyacusis (in USA)
Definition
• Its defined as bilateral symmetric, progressive sensory neural hearing
loss due to physiological aging process in the absence of other
etiologies
Etiology
• Mainly manifest by 65yrs of age but can occur earlier if the person is
associated with these factors
a. Hereditary Predisposition
b. Chronic nose exposure
c. Generalised vascular disease
• Pathogenesis of presbycusis-I
Age related arteriosclerosis
Hypo-perfusion and decrease oxygenation of cochlea
Formation of reactive oxygen metabolites and free radicals
Damage inner ear structures and mitochondrial DNA of inner ear
Presbycusis
• Pathogenesis- II
Genetic predisposition Genetically programmed susceptibility to enviro-
ntal factor (nose, ototoxic, drug, stress)
Genetic programming for early aging of parts of auditory system

Early development of presbycusis
Type
1. Sensory
2. Neural
3. Metabolic
4. Mechanical/Cochlear Conductive
5. Mixed
6. Indeterminate/Intermediate
1. Sensory Presbycusis
Its characterized by:
i. Degeneration/loss of sensory hair cells in
organ of corti due to accumulation of
lipofuscin pigment granules.
ii. The process originates in basal turn (for a
length 10 mm) and slow progress toward
apex.
iii. Audiometric factors
• Abrupt sleep
• High frequency SNHL are affected
iv. Speech discrimination score: Good

2. Neural Presbycusis
Its characterized by
i. Degeneration of cells in spiral ganglion
and cochlear neurons (>50%) mainly in
basal turn of cochlea.
ii. Slowly progressive hearing loss (Pure
Tone Average not affected until 90%
neurons are destroyed)
iii. Audiometric features: Ski-slope toward
high frequencies.
iv. Speech discrimination score is poor and
out of proportion to the pure tone loss.
3. Metabolic/Strial Presbycusis
• Its characterized by
i. Atrophy is stria vascularis (<30% destroyed) in
all turns of cochlea
ii. Physical and chemical process of energy
production, bioelectric balance and metabolic
health of cochlea are affected.
iii. Runs in families
iv. Results in slowly progressive deafness.
v. Audiometric features- Flat (as entire cochlea is
affected)
vi. Speech discrimination score: Good
Cochlear Conductive
Its characterized by
i. Thickening and stiffening of basilar
membrane of cochlea
ii. More severe in basal turn of cochlea
where basilar membrane is narrow
iii. Result in slowly progressive SNHL
iv. Audiometric features
Ski-slope towards high frequencies
v. Speech discrimination score: Slightly
impaired
Mixed Presbycusis
• Site of lesion-Any combination
• Hearing loss-Any combination
• Speech discrimination-Mild loss
Indeterminate/Intermediate presbycusis
• It is type presbycusis on which there is SNHL which
progresses with age without light microscopic evidence
of cochlear pathology
Pathology
• Altered cellular metabolism/ decreased synapse numbers/ change in
endolymph composition/central audiotory pathway changes.
Other age related changes:
i) Outer ear
• Increased cerumen formation
• Increased hair growth
• Collapse EAC
• Decreased epithelial migration
ii) Middle ear

• Stiffening of TM
• Arthritis and ossicular joints classification
• Degeneration of middle ear muscles
Clinical Features
i. Gradually progressive hearing loss
ii. Difficulty in understanding conversion around high level of ambient background noise
iii. Recruitment: Abnormal growth of sound in perception of loudness (at high intensity)
in pt. with hearing loss
iv. Tinnitus (30-50%): Indicates worsening of deafness
v. Social isolation and depression
INVESTIGATION
1. Pure tone audiometry
2. Speech audiometry: diminished scores
3. MRI: To rule out vestibular schwannoma
Treatment
1. Medical: No medical care
2. Diet modification
3. Psychological counselling
4. Amplification devices or hearing aids.
5. Lip reading and assisted listening devices
6. Cochlear implantation
7. Tinnitus retaining therapy
8. Avoidance of aggrevating factors
Dietary Advice
• 30% caloric dietary restriction
• Use of antioxidant dietary supplements (Vitamins A,C,E selenium) reduce
production of reactive oxygen metabolites that harm inner ear and lead to age-
related hearing loss.
• Neuro-vitamins and Gingko biloba have no rule.
Avoidance of following factors
• Noise exposure
• Ototoxic drug
• Uncontrolled DM
• Hyperlipidemia
• Curtailment of smoking and stimulant (tea, coffee) help to decrease tinnitus
• SUBSCRIBE

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Presbycusis

Hypo-perfusion and decrease oxygenation of cochlea

Formation of reactive oxygen metabolites and free radicals

Damage inner ear structures and mitochondrial DNA of inner ear

Genetic programming for early aging of parts of auditory system

iv. Speech discrimination score: Good

ii) Middle ear

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