FFinalistSouthampton · 2027
ENT
AKT · ENT/Ear & hearinglow yield

Presbycusis

Age-related sensorineural hearing loss (cochlear hair-cell loss)

Overview

Age-related, bilateral, symmetrical SENSORINEURAL hearing loss from progressive loss of cochlear hair cells (high frequencies first). The commonest cause of hearing loss in older adults, managed with hearing aids.

Recognise

  • Gradual, bilateral, symmetrical high-frequency sensorineural loss — difficulty with consonants and in background noise
  • "I can hear but not understand"; often with tinnitus
  • Normal otoscopy

Red flags

  • ASYMMETRIC sensorineural loss or unilateral tinnitus → exclude a vestibular schwannoma (MRI) — see neurology; sudden SNHL is an emergency

Differentials & how to tell them apart

Noise-induced hearing lossoccupational/noise history, a notch at 4 kHz
Otosclerosisconductive loss in a younger adult
Vestibular schwannomaASYMMETRIC sensorineural loss/tinnitus → MRI (neurology)
Ototoxicityaminoglycosides, cisplatin, loop diuretics — drug history

Investigations

Pure-tone audiometry (bilateral symmetrical high-frequency sensorineural loss); Rinne positive both sides, Weber central. MRI if asymmetric.

Management

Hearing aids + communication support

  1. 1Audiometry to confirm; refer for hearing aids and aural rehabilitation.Gate: Presbycusis is SYMMETRICAL — an ASYMMETRIC sensorineural loss or unilateral tinnitus must be imaged (MRI) to exclude a vestibular schwannoma rather than assumed to be ageing
  2. 2Severe/profound loss unaided → cochlear implant assessment; address modifiable factors and isolation.
Hearing aids — the mainstay; addressing hearing loss also reduces social isolation and dementia risk
Assistive listening + communication strategies — adjuncts
Cochlear implant — severe-to-profound loss not helped by aids

Key points

Bilateral symmetrical high-frequency SNHL in an older adult = presbycusis → hearing aid. Asymmetry is the red flag that mandates MRI. Untreated hearing loss is a modifiable dementia risk factor.

Monitor & prognosis

Audiometry; hearing-aid benefit; cognitive/social impact.

Progressive but well supported by aids.

Source: NICE NG98 (hearing loss in adults); ENT UK