Hearing management

Updated 07 December 2017


Presbycusis is the loss of hearing due to ageing.



  • Presbycusis is the loss of hearing due to ageing.
  • Most older people experience this common disorder to some degree.
  • It often affects the perception of speech and soft, high-pitched sounds.
  • It is mostly caused by accumulative damage to the inner ear, due to repeated exposure to noise.
  • While hearing loss is usually permanent, hearing aids and coping skills can improve quality of life.
  • Hearing loss can be minimized by protecting ears against exposure to loud sounds.

Alternative names

What is Presbycusis?
Presbycusis is the hearing loss that occurs due to ageing. It is a very common disorder, which most people experience to some degree.

A person with hearing loss is not deaf and can still hear a range of sounds. It often particularly affects the perception of soft, high-pitched sounds and of speech. Because hearing loss is gradual, many people may not realize that it is happening.

What causes Presbycusis?
With age, the inner ear becomes damaged through simple wear and tear. Repeated exposure to noise, such as loud machinery, traffic or music, results in damage to the tiny hairs in the cochlea (part of the inner ear), or to the auditory nerve. Electrical signals are not transmitted properly and hearing loss occurs. This is called sensorineural hearing loss and is the most common type of presbycusis.

Hearing loss can also occur as a result of:

  • Various health conditions which can reduce blood supply to the cochlea
  • Infections or abnormal growths in the ear
  • Illnesses that result in high fever, which can damage the cochlea
  • Head or ear trauma
  • Side effects of medicines, such as aspirin and some antibiotics, in certain people
  • Wax build-up
  • Hereditary susceptibility

What are the symptoms of Presbycusis?
If you have Presbycusis, you may experience:

  • Problems hearing soft or high-pitched sounds
  • Difficulty understanding words, especially with background noise. Other people seem to mumble or slur.
  • A need to turn up the volume of the television or radio (or people frequently asking you to turn it down)
  • Earache, dizziness or tinnitus (buzzing or ringing in the ears)
  • Difficulty hearing the doorbell or telephone
  • Problems knowing the direction where sounds are coming from
  • Discomfort with certain sounds that seem annoying or very loud

These problems usually occur equally in both ears.

How is a diagnosis made?
A doctor may do a general hearing examination, before referring the patient to an ear, nose and throat specialist, or to an audiologist. The audiologist inspects the ear canal and ear drum and does a thorough hearing evaluation. If a hearing aid would be useful, the audiologist will fit one.

How is it treated?
Unfortunately, except in the case of an easily removed earwax blockage, hearing loss is usually irreversible. However, most people will be helped to some degree by a hearing aid, which makes sounds stronger and easier to hear. There are several types:

  • Analogue hearing aids pick up sound signals with a microphone, amplify them and convert them into electrical signals, which are transmitted into the ear.
  • Digital hearing aids convert sound into digital form and manipulate it. These hearing aids can be sensitively programmed and are very small. However, they are more expensive.
  • Hearing aids often sit behind the ear, although there are models that are positioned in the ear, or almost invisibly in the ear canal. The type required depends on the specific type of hearing loss.

Other medical procedures and electronic aids may make hearing loss easier to manage:

  • Assistive listening devices, like telephone amplifiers, can be helpful.
  • If there is more severe damage to the inner ear, an electronic device called a cochlear implant might be required.

If you have hearing loss, these tips can improve social interactions:

  • Face the person you're speaking to.
  • Turn off background noise and avoid noisy, crowded settings.
  • Ask others to speak clearly.
  • Try to learn some basic speechreading (lipreading) skills.

When speaking to someone with hearing loss, try to:

  • Catch the person's attention before you begin, look directly at them and maintain eye contact.
  • Make sure your face is well-lit and visible.
  • Don't cover your mouth, chew or smoke - but also don't exaggerate lip movements.
  • Speak at a normal rate, in your normal tone, just slightly louder. Don't shout.
  • Accompany your words with body language, gestures and facial expressions.
  • Rephrase your words if not understood the first time.
  • In a group, keep the person with hearing loss filled in on the conversation.

What is the prognosis?
While most hearing loss is unfortunately irreversible and to some degree inevitable, there are medical procedures, devices and coping skills that can improve one's quality of life and slow, or prevent further damage.

Without proper care and assistance, people with presbycusis can feel cut off, lonely and misunderstood. They may withdraw from social situations. Others may also treat them without understanding or respect.

When to call your doctor
Talk to your doctor if you have difficulty hearing, or if you notice any of the symptoms listed above.

How can it be prevented?
Certain precautions can minimise noise-induced hearing loss, or avoid further deterioration:

  • Protect your ears in noisy recreational or work environments with earmuffs or earplugs. Avoid loud noises and reduce the amount of time you are exposed to them.
  • Have your hearing tested, especially if you are regularly exposed to high volumes. Early detection might help you to prevent further hearing loss.
  • When listening to music, keep the volume at a lower level.


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Ask the Expert

Hearing Expert

Dr Kara Hoffman graduated from UCT in 2004, thereafter she completed her year of community service in Durban. In 2010 she completed her Masters Degree in Paediatric Aural Rehabilitation from UKZN. In 2016, she became a Doctor of Audiology through the University of Arizona (ATSU). Dr Hoffman and her partner Lauren Thompson opened a fully diagnostic audiology practice called Thompson & Hoffman Audiology Inc. In 2011 with world-class technology and equipment to be able to offer the broad public all hearing-related services including hearing testing for adults and babies, vestibular (balance) assessments and rehabilitation, industrial audiology, hearing devices, central auditory processing assessments for school-aged children, school screening, neonatal hearing screening programmes at Alberlito and Parklands Hospital, cochlear implants and other implantable devices, medicolegal assessments and advanced electroacoustic assessments of hearing. Thompson and Hoffman Audiology Inc. are based at Alberlito Hospital in Ballito, St Augustines Hospital in Durban and at 345 Essenwood Road, Musgrave. The practices are all wheelchair friendly. There are three audiologists that practice from Thompson & Hoffman – including Dr Kara Hoffman, Lauren Thompson & Minette Lister. The practice boasts professional, highly qualified, and extensive diagnostic services where all your hearing healthcare needs can be met. The additional licensing in vestibular assessment and rehabilitation, paediatric rehabilitation and cochlear implantation places this practice in one of the top specialist audiological positions in South Africa, with a wealth of experience in all clinical areas of audiology and is a very well respected and sought-after practice.

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