Presbycusis is described as age-related hearing loss. It is a type of sensorineural hearing loss that occurs as people get older. It tends to affect high-pitched sounds first and more notably than lower-pitched sounds. The hearing loss occurs gradually and symmetrically. 

The causes of reduced hearing in presbycusis are complex. There are several different mechanisms, including loss of the hair cells in the cochlea, loss of neurones in the cochlea, atrophy of the stria vascularis and reduced endolymphatic potential. 


Risk Factors

  • Age
  • Male gender
  • Family history
  • Loud noise exposure
  • Diabetes
  • Hypertension
  • Ototoxic medications
  • Smoking


Exposure to loud noise over time is a key risk factor that can be addressed to potentially prevent or reduce the extent of presbycusis. Hearing protection should be worn in environments where there is exposure to loud noises for prolonged periods to reduce the risk of presbycusis, for example, in occupations such as woodworking or construction. 



Hearing loss in presbycusis is gradual and insidious. The gradual onset may mean patients do not notice the change in their hearing. The loss of high-pitched sounds can make speech difficult to hear and understand, particularly in loud environments. Male voices may be easier to hear than female voices (due to the generally lower pitch). Patients may present after others have noticed they are not paying attention or missing details of conversations. Sometimes patients can present with concerns about dementia, when in fact, the issue is hearing loss.

There may be associated tinnitus (ringing in the ears).

It is worth noting patients with hearing loss are more likely to develop dementia, and treating the hearing loss (e.g., a hearing aid) may reduce the risk.



Audiometry is the investigation of choice for establishing the diagnosis and extent of hearing loss. Presbycusis will give a sensorineural hearing loss pattern, with normal or near-normal hearing at lower frequencies and worsening hearing loss at higher frequencies.



The effects of presbycusis cannot be reversed. 

Management involves supporting the person to maintain normal functioning:

  • Optimising the environment, for example, reducing the ambient noise during conversations
  • Hearing aids
  • Cochlear implants (in patients where hearing aids are not sufficient)


Last updated July 2021