Hearing management

Updated 09 April 2019


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

Minette Lister graduated with a Bachelor of Communication Pathology (Audiology) from the University of KwaZulu-Natal, Westville in 2015. Thereafter, she completed her compulsory year of community service at Phoenix Assessment and Therapy Centre in Durban. In 2017, Minette started working for Thompson and Hoffman Audiology Inc. She is passionate about working with children and adults to diagnose and manage hearing loss using state of the art technology. Minette offers hearing screening programmes for newborn and high-risk babies, as well as school-aged children, in order to decrease the incidence of late or unidentified hearing loss.

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