Table of contents


What's new

Added 2024 AAO-HNSF, 2024 AAFP, 2023 SFORL/SFA, and 2021 USPSTF guidelines for the diagnosis and management of presbycusis.



Presbycusis, also known as age-related hearing loss, is a multifactorial process characterized by a gradual, progressive, and symmetrical loss of hearing ability that occurs as part of the natural aging process.
The pathophysiology of presbycusis involves degenerative processes associated with aging, such as the loss of hair cells in the cochlea and the degeneration of auditory nerve fibers. These changes can lead to impairments in both peripheral hearing and central auditory processing, contributing to the overall hearing loss.
The prevalence of presbycusis in the US is estimated at 29.3%, 55.1%, and 79.1% at 60-69 years, 70-79 years, and ≥ 80 years, respectively.
Disease course
The clinical course of presbycusis typically begins with difficulty in hearing high-frequency sounds, which gradually progresses to a generalized hearing loss over time. This process is often gradual, so the individual may not notice the hearing loss until it becomes severe.
Prognosis and risk of recurrence
The hearing loss in presbyscusis is irreversible, with significant impacts on the QoL, including effects on communication, social isolation, depression, and potentially dementia.


Key sources

The following summarized guidelines for the evaluation and management of presbycusis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2019), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2024), the French Society of Audiology (SFA/SFGG/SFORL 2023), and the U.S. Preventive Services Task Force (USPSTF 2021)....
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Screening and diagnosis

Indications for screening: as per AAO-HNSF 2024 guidelines, Screen patients aged ≥ 50 years for hearing loss at the time of a healthcare encounter.
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Diagnostic investigations

Physical examination: as per AAO-HNSF 2024 guidelines, Perform otoscopy to examine the ear canal and tympanic membrane for cerumen impaction, infection, or other abnormalities in patients with screening results suggesting hearing loss.

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  • Audiometry (indications)

  • Audiometry (technical considerations)

  • Diagnostic imaging

  • Psychosocial assessment

  • Evaluation for other causes

Nonpharmacologic interventions

Hearing aids: as per AAO-HNSF 2024 guidelines, Offer appropriately fit amplification in patients with presbycusis.

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  • Cognitive training

Therapeutic procedures

Cochlear implant: as per AAFP 2024 guidelines, Refer patients with hearing loss refractory to hearing aids for cochlear implant evaluation.

Patient education

General counseling
As per AAO-HNSF 2024 guidelines:
Educate and counsel patients with hearing loss and their family/care partners on the effects of hearing loss on their communication, safety, function, cognition, and QoL.
Counsel patients with hearing loss about communication strategies and assistive listening devices.

Follow-up and surveillance

Serial clinical assessment
As per AAO-HNSF 2024 guidelines:
Obtain assessment to determine if communication goals have been achieved and if there has been an improvement in hearing-related QoL at a subsequent healthcare encounter or within 1 year in patients with hearing loss.
Consider assessing hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.