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Diseases & Conditions

Presbycusis (Age-Related Hearing Loss)

Hearing loss related to aging, known as presbycusis, affects one in three adults over 65 years of age. In fact, presbycusis is the third most common chronic healthcare condition among older adults. The others are arthritis and hypertension (high blood pressure).

What are the early warning signs of presbycusis?

There are many warning signs and changes in behavior that may be related to age-related hearing loss. For example, people with hearing loss may:

  • Say that people are mumbling
  • Often ask people to repeat what they have said
  • Avoid noisy rooms, social events, or family gatherings
  • Keep the television or radio louder than other people prefer
  • Have a hard time understanding people when they cannot see the faces of the people who are talking
  • Have trouble hearing at the movies, theater, house of worship, or other public places
  • Have a hard time understanding conversations in a group
  • Become more impatient, irritable, frustrated, or withdrawn

Why do older adults with hearing loss often say that they can hear but not understand what is being said?

It is harder for these people to hear high-pitched consonant sounds (such as d, t, sh, s, f, th) than low-pitched vowel sounds (such as o, a, ah, i, e). The high-pitched sounds carry the meaning of words, so they help us understand speech. In normal conversation, high-pitched sounds are softer than low-pitched vowel sounds. As a result, speech may sound loud but not clear. For example, "Do you have the time?" may sound like "Do you have a dime?" Such problems in understanding may cause confusion and embarrassment. Also, older adults often need more time to process what is being said, especially when there is background noise.

Is there a simply way to screen for hearing loss?

The Hearing Handicap for the Elderly-Screening version (HHIE-S) 1, 2 is a quick and efficient way to see if hearing loss may be affecting an older person’s everyday life. Here is the 10-item HHIE-S, the scoring method and suggestions after the questions are completed.

Instructions: The purpose of the following questionnaire is to identify the problems your hearing loss may be causing you. Answer YES, SOMETIMES, or NO for each question. Do not skip a question if you avoid a situation because of a hearing problem.

If you use a hearing aid, please answer according to the way you hear with the aid. To obtain a total score, add up the YES (4 points), SOMETIMES (2 points), and NO (0 points) responses.


Yes (4)

Sometimes (2)

No (0)

1. Does a hearing problem cause you to feel embarrassed when you meet new people?

2. Does a hearing problem cause you to feel frustrated when talking to members of your family?


3. Do you have difficulty when someone speaks in a whisper?


4. Do you feel handicapped by a hearing problem?


5. Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?


6. Does a hearing problem cause you to attend religious services less often than you would like?


7. Does a hearing problem cause you to have arguments with family members?


8. Does a hearing problem cause you difficulty when listening to TV or radio?


9. Do you feel that any difficulty with your hearing limits or hampers your personal or social life?


10. Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?


Total HHIE-S Score: _____

Recommendation: If your score is 10 points or greater, then you should seek evaluation by an audiologist for a comprehensive hearing examination.

What is included in a hearing test?

Audiologists are health care professionals who conduct the comprehensive hearing evaluation. The testing will tell the degree and type of hearing loss. The test will also show the impact on the person’s ability to communicate in everyday life. Audiologists use special equipment to get accurate hearing test results. The test is usually done in a sound-treated room. The complete test usually takes about 30 minutes and is painless. Medical diagnosis of ear disease is performed by ear, nose, and throat physicians. These doctors are known as otolaryngologists or ENTs.

How often should I have a hearing test?

In general, a hearing test should be done every 2 years after you reach the age of 50. However, a hearing test should be done immediately if you have symptoms such as a sudden change in hearing, increase in tinnitus (ringing in the ears), or dizziness.

What is the treatment for sensorineural hearing loss related to presbycusis?

Hearing aids are the main treatment for hearing loss related to inner ear and/or nerve damage. Hearing aids have been shown to improve the quality of life of people who use them. The performance of hearing aids has improved due to advances in digital signal processing technology.

The audiologist will discuss various styles of hearing devices, the latest advances in technology, and realistic expectations for hearing aid use. Together, the patient and audiologist will decide which device is best suited to lifestyle and communication needs. Other types of hearing-assistive technology may be recommended. These devices are used with hearing aids and include:

  • FM (frequency modulation) devices
  • telephone amplifiers
  • TV listening devices

Do hearing aids really help?

The National Council on Aging has shown that hearing aids do help. People who use them report:

  • improved personal relationships
  • ease in communication
  • improved mental health
  • better sense of control over life events3

A Task Force of the American Academy of Audiology conducted a study evaluating the benefits of amplification in adults.4 This study found that hearing aid use improves adults' quality of life by reducing the psychological, social, and emotional effects of hearing loss for which no medical treatments are available. Hearing loss may affect the ability to interact effectively with healthcare workers. So hearing aid use helps older adults to better understand the instructions from their healthcare provider.


1. Ventry IM, Weinstein BE. Identification of elderly people with hearing problems. ASHA 1983;25(7):37-42.

2. Lichtenstein MJ, Bess FH, Logan SA. Validation of screening tools for identifying hearing-impaired elderly in primary care. JAMA 1988;259:2875-2878.

3. National Council on the Aging. The consequences of untreated hearing loss in older persons. A study conducted by the Seniors Research Group, an alliance between The National Council on the Aging and Market Strategies, Inc. Washington, DC:1999.

4. Chisolm TH, Johnson CE, Danhauer JL, Portz, LJ, Abrams HB, Lesner S, et al. A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults. J Am Acad Audiol 2007;18:151-183.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/22/2011…#14793