How is it Diagnosed?
Presbycusis, or age-related hearing loss, is a gradual, bilateral sensorineural hearing
impairment predominantly affecting older adults. Diagnosis relies on clinical evaluation,
audiometric testing, and exclusion of other causes.
The clinical history includes gradual onset of hearing difficulty, especially for highfrequency sounds, and trouble understanding speech in noisy environments. Patients
may also report tinnitus.
Otoscopy is performed to rule out external or middle ear pathology such as cerumen
impaction or tympanic membrane abnormalities. Tuning fork tests, including Rinne and
Weber, help differentiate conductive from sensorineural hearing loss.
The gold standard diagnostic tool is pure tone audiometry. It typically reveals a
symmetrical high-frequency sensorineural hearing loss pattern. Speech audiometry
assesses the patient’s ability to recognize and understand spoken words, often
impaired in presbycusis.
Tympanometry and acoustic reflex testing are performed to evaluate middle ear
function and auditory pathway integrity.
If audiometric findings are atypical or asymmetric, further evaluation with imaging such
as MRI may be indicated to exclude retrocochlear pathologies like vestibular
schwannoma.
Additional assessments may include questionnaires (e.g., Hearing Handicap Inventory
for the Elderly) to gauge the functional impact of hearing loss on daily life.
Presbycusis is a diagnosis of exclusion made after ruling out other reversible or
pathological causes of hearing loss. Early identification and audiological rehabilitation,
including hearing aids and assistive listening devices, can significantly improve
communication and quality of life.