Age-related hearing loss (ARHL), also known as presbycusis, is a common condition affecting older adults in the United States (US). About one-third of adults between the ages of 65 and 74 years have hearing loss, and prevalence increases to about half of adults over the age of 75 years.¹ In general, ARHL occurs in both ears and develops gradually, so some adults might not notice their hearing loss until later stages;^1,2 in some cases, family members or friends might notice hearing loss in a loved one before the individual notices it themselves.³

Multiple factors can contribute to the development of ARHL. Age-related factors include changes to the inner and middle ears and along the neural pathways to the brain.^1,3 Use of certain medications (e.g., salicylates, loop diuretics, aminoglycoside) or exposure to toxins, such as lead, carbon monoxide, styrene, mercury, and toluene, can contribute to ARHL as well. Genetics, long-term exposure to noise, and hormonal factors are also associated with ARHL.³ Diseases associated with hearing loss include Type 2 diabetes, stroke, cardiovascular disease, and hyperlipidemia. Smoking has been associated with ARHL as well.^3,4 Other risk factors include male sex, being of non-Hispanic White descent, and lower education level.^4,5

Adults with hearing loss experience difficulty understanding speech, which, along with other changes associated with ARHL, is thought to be due to age-related alterations in the peripheral and central auditory pathways and cognitive functions.^4,6 Research has shown that older age is correlated with poorer recognition of time-compressed (rapid) speech, compared to younger adults,⁶ as well as difficulty understanding speech in the presence of other noise or reverberation.^4,6 

Multiple studies have shown an association between ARHL and cognitive decline and dementia, but the exact mechanisms behind this link is unknown.^3–7 Cognitive processes involved in speech comprehension that can become impaired with age include working memory, processing speed, selective attention, and divided attention.^4,6 Several hypotheses have been posited to explain the association between ARHL and cognitive decline. The common cause hypothesis proposes that there is a common neurodegenerative mechanism responsible for both ARHL and cognitive decline.^4,7 The information degradation hypothesis suggests that impaired hearing causes an increased demand for resources required for cognitive processing, which therefore results in taking resources that were to be used for other cognitive functions, such as memory, and reallocating them toward auditory perception.^3,4,7 The sensory deprivation hypothesis postulates that long-term reallocation of cognitive resources toward auditory perception due to the sensory deprivation caused by ARHL is responsible for cognitive decline, emphasizing the role of cortical reorganization.^4,7 Furthermore, the decreased social interaction and increased depression associated with ARHL could contribute to cognitive decline.^4,6,7

If you suspect you might have hearing loss, consult with a primary care physician, otolaryngologist, or audiologist. Work to prevent hearing loss by limiting your time around loud noises, wearing earplugs or protective earmuffs when exposed to high levels of environmental noise, and monitoring your risk factors.^1,3 While ARHL cannot be cured, it can be managed. Hearing aids can be utilized to amplify sounds and have been associated with improved communication and quality of life³ and decreased risk of cognitive decline.² Hearing aids can be prescribed, and over-the-counter hearing aids have recently become available for those with mild-to-moderate hearing loss.^1,2 It is important to note that adjusting to a hearing aid can take time and effort, and some may find them uncomfortable to wear.³ Cochlear implants are a surgical option to treat severe hearing loss.^1,2 Numerous assistive devices, such as those that amplify sounds or send visual signals or vibrations, can help as well.²

SOURCES

1. National Institute on Deafness and Other Communication Disorders. Age-related hearing loss (presbycusis).Updated 17 Mar 2023. https://www.nidcd.nih.gov/health/age-related-hearing-loss. Accessed 3 May 2023.
2. National Institute on Aging. Hearing loss: a common problem in older adults. Reviewed 19 Jan 2023. https://www.nia.nih.gov/health/hearing-loss-common-problem-older-adults. Accessed 3 May 2023. 
3. Cheslock M, De Jesus O. Presbycusis. Updated 12 Feb 2023. In: StatPearls [Internet]. StatPearls Publishing.
4. Jayakody DMP, Friedland PL, Martins RN, Sohrabi HR. Impact of aging on the auditory system and related cognitive functions: a narrative review. Front Neurosci. 2018;12:125. 
5. Sheffield AM, Smith RJH. The epidemiology of deafness. Cold Spring Harb Perspect Med. 2019;9(9):a033258. 
6. Li-Korotky HS. Age-related hearing loss: quality of care for quality of life. Gerontologist. 2012;52(2):265–271. 
7. Slade K, Plack CJ, Nuttall HE. The effects of age-related hearing loss on the brain and cognitive function. Trends Neurosci. 2020;43(10):810–821.