AUDIOLOGICAL STUDY OF AGE RELATED HEARING LOSS

*Jameel K.M.,** M. Ravi Kumar Raju,***M.A.N. Murthy,****Beena. V

ABSTRACT
The physiologic loss of hearing acuity brings with it a number of problems. Among these are the difficulties in
distinguishing age related hearing loss from hearing loss associated with long exposure to intense industrial noise
and the psychological disturbances often associated with it. We present a retrospective audiological study using
pure tone average for both ears in a period of 1year conducted in ENT OPD, KIMS, Amalapuram.
Keywords: Deafness, Pure tone average, Pure tone audiometry, Presbyacusis, Hearing loss.

Vol.-9, Issue-II, July-Dec. - 2015

INTRODUCTION
Age-related hearing loss, known as presbycusis,
affects most older adults to some degree. The most
frequent cause of age-related hearing loss is the natural
breakdown of nerve cells in the inner ear. Age-related
hearing loss can also be caused by age-related changes
that may affect the eardrum or the bones of the middle
ear, which affects how well sound can move into the
inner ear. Long-term medical conditions, such as high
blood pressure, heart disease, and diabetes, or other
problems with blood movement (circulation), may also
contribute to age-related hearing loss. The physiologic
loss of hearing acuity bring with it a number of
problems. Among these are the difficulties in
distinguishing age related hearing loss from hearing loss
associated with long exposure to intense industrial noise
and the psychological disturbances often associated with
it. Speech sounds mumbled, and conversations are hard
to understand, especially when there is background
noise. Ability to hear and distinguish high-pitched
sounds is reduced, a mans lower-pitched voice.11
Tinnitus may increase as hearing loss gets worse11.
AIM :
To find age related involvement of patients with
hearing loss.
To find sex predilection in hearing loss.
To find percentage of hearing loss in different age
groups in both male & female to compare both ears.
MATERIALS and METHODS :
Inclusion criteria : All patients who underwent

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PTA in ENT OPD KIMS & RF, Amalapuram, in last

1 year and who have sensorineural deafness.
Exclusion criteria : All patients less than 10years
of age to eliminate congenital loss, Patients with only
conductive hearing loss
Pure tone audiogram was done in standard two
cubical sound proof audiology lab in our hospital.
Percentage of hearing loss calculated for both ears
separately with formula PTA 25 1.5, where PTA is
pure tone average taken as average of Air conduction in
500, 1000, 2000 Hz and Binaural percentage of hearing
disability is calculated using formula described by AMA
(1979) American Medical Associatiion (1979) as
[1.5(PTA25)](better ear)

+1.5 (PTA-25)(poorer ear) ]

RESULTS :
Our study revealed a majority of 55 male patients
and 29 female patients of the total 84 patients included
in the study. Maximum number of patients are between
Affiliations:
*PG Resident,**Assoc. Prof,***Prof & HOD,****P.G Resident
KIMS & RF (KONASEEMA INSTITUTE OF MEDICAL SCIENCES AND
RESEARCH FOUNDATION
Address of Correspondence:
Dr. M. Ravi Kumar Raju,M.S(ENT), MRCS
(GLASG), DOHNS(LON)
Assoc. Prof. ENT
KIMS & RF (KONASEEMA INSTITUTE OF
MEDICAL SCIENCES AND RESEARCH FOUNDATION
Amalapuram-533201
E.G.DT, A.P STATE
mob : 9908547999
e-mail : rajumrk@yahoo.com

51-60 yrs. Youngest in our study recorded is 14yrs and

oldest is 78yrs. Of the total 84 patients, 82 of them
have bilateral ear involvement with two patients having
unilateral ears of which one of them has right ear
involved and the other left ear. Making it total of 166
ears. Maximum hearing loss is seen Severe category with
71-90db loss and in 51-60 age group.
DISCUSSION :
Age related hearing loss is characterized by
degenerative changes in the hair cells of cochlea and
central auditory connections and functionally by
sensorineural hearing loss.1 The onset of auditory
system degeneration starts before the beginning of
elderly age. It is characterized by audiometric threshold
shift, deterioration in speech understanding, and speech
perception difficulties in noisy environment.2
Age related hearing loss most often occurs in both
ears affecting then equally. Risk factors such as systemic
diseases & poor habits add to the age related hearing
loss.
It is well established that there are both genetic
and environmental factors that contribute to age related
hearing loss.3 Risk factors are male gender, smoking,
noise exposure, stress, metabolic & vascular conditions
(diabetes, dyslipidaemia, systemic arterial hypertension,
atherosclerosis) and hereditary. The association between
this age related hearing loss & the risk factors. However,
it remains controversial & has not been well
documented.
These were 84 patients in our study comprising
of 55 males & 29 females. The ages ranged from 10 - 80
years excluding age group less than 10 years to minimize
congenital causes of deafness.

According to our study age related hearing

difficulties were significantly more common in men
compared to women. Our findings are in consistent
with study Rosenhall U et. al who have reported that
hearing difficulties were more prevalent in men. 4
Differential Oestrogen exposures have been suggested
as a cause for the higher prevalence of hearing difficulties
in men.5
From our study it appears that hearing loss tended
to be start manifesting in the middle ages peaked at
about fifth decade and progressed gradually over the
years. The incidence of hearing loss in people aged about
50-59 years increased 150%.6
Fransen et.al stated that age related hearing loss
occurs in elderly people in their 60s and 50% of people
in the over 70 age group.7 One third patients in our
study were within the fifth decade of life. The youngest
being 14 years and oldest being 78 year. In Great Britain
MRC study on hearing loss, median hearing threshold
levels in adults suggested that age related high frequency
hearing decline commences after 30years in men but
doesnt become apparent in women until after 50years
of age8. Average peak loss in men & women is in fifth
decade in our study. Hearing acuties also reduced with
increasing age after eighth decade may be due to fewer
number of patients above this age. In our study of 84
subjects, 82 subjects reported B/L hearing loss & 2
subjects reported U/L hearing loss each one affected
with a different ear. Hinchcliffe (1959)9 has also recorded
audiogram loss in the left ear due to rifle fire, whereas
Jacobs et. al have shown that there is no such
preponderance of left sided hearing defect in male
children. Our study didnt show any significance

Vol.-9, Issue-II, July-Dec. - 2015

Table 1 Age and sex wise distribution.

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regarding hearing loss between the ears.

both male and female.

When overall percentage loss calculated, more loss

seen in males and significant loss seen between 51-80 %.

When overall percentage loss calculated, more loss

seen in males and significant loss seen between 51-80 %.

Age related changes in hearing predominantly seen

in male population compared to female population.
Peak age group affected in our study is fifth decade in

Youngest patient affected with sensorineural

hearing loss in our study is 14 years old and oldest is 78
years.

Table 2 Hearing loss(PTA) in various age groups in both sexes to compare both ears.

Vol.-9, Issue-II, July-Dec. - 2015

Table 3 Percentage of hearing loss in Right and left ears.

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No significant variation in hearing loss between

right and left ears in both sexes of all age groups.

4.

Hasson D, Theorell T, Westerlund H, Canlon B:

Prevalance and characterstics of hearing problems
in a working and non working Swedish
population. J Epidemiol community health 2010,
64:453-460.

5.

Adams PF, Marano MA. Current estimates from

the national health interview survey,1994. Vital
and Health Statstics Series 10, Data from the
national survey. 1995:1.

6.

Fransen E, Lemkens N, Van Laer L, Van Camp

G. Age related hearing impairment (ARHL):
environmental risk factors and genetic prospects.
Exp Gerentol 2003;38:353-9.

7.

Davis A. Hearing in adults. Whurr publishers Ltd.

London. 1995. First ed London.

8.

Hinchcliffe, R. Acta Otolaryngologica, 1959; 50,

411.

9.

Gates GA, Mills JH. Presbyacusis. Lancet

2005;366:1111-20.

CONCLUSION :
Sensorineural hearing loss though thought to be
seen in old age, can occur in any age group due to
various factors. There is no clinical method to predict
the age related hearing loss in advance. There is neither
medical prevention nor treatment that can restore
hearing loss at this time.10 Open mind in recognizing
the problems in any age group with sound knowledge
to diagnose them at the earliest needed to minimize
morbidity.
DISCLOSURES
(a)

Competing interests/Interests of Conflict- None

(b) Sponsorships - None

(c)

Funding - None

(d) No financial disclosures.

REFERENCES:
1.

Rosenhall U. presbyacusis-hearing loss in old age.

Lakartidningen.2001;98(23):2802-2806.

2.

Liu XZ, Yan D. Ageing and hearing loss . J Pathol

2007;211:188-97.

3.

Fetoni AR, Picciotti PM, Paludeti G. Troiani D.

Pathogenesis of presbyacusis in animal models: A
review. Experimental gerontology, 2011
jun.46:413-423.
[PubMed:21211561] Rosenhall U. jonsson R,
Soderlind O: self assessed hearing problems in
Sweden: a demographic study. Audiology 1999,
38:328-334.

10. Primary Medical Reviewer William H. Blahd, Jr.,

MD, FACEP-: Brian D. OBrien, MD AgeRelated Hearing : - Emergency Medicine ; Internal
Medicine Specialist Medical Reviewer Charles M.
Myer, III, MD, Otolaryngology; http://
www.healthlinkbc.ca/healthtopics/content.asp?
hwid=tf4270#tf4270-Credits.
11. Dobie RA: The AMA method of Estimation of
hearing disability; a validation study: Ear Hear2011-Nov-Dec, 32(6): 732-40.doi.10. 1097 AUD.
obo13e31822228be.

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Table 4 % of Binaural hearing loss in both sexes.