definitions (1)

Presbycusis is a high-frequency sensorineural hearing loss, commonly occurs from age 65, is symmetrical
on the left and right ear. Can be started at a frequency of 1000 Hz or more. Progressive hearing loss is
influenced by age and sex, in men faster than women.

Etiology and Risk Factors

Presbycusis is the result of a process of degeneration. Presbiukusis incident allegedly has links with
hereditary factors, diet, metabolism, arteriosclerosis, infections, noisy, lifestyle or are multifactorial.
Hearing gradually decreasing function is a cumulative effect of the influence of these factors.

pathogenesis

The process of degeneration cause structural changes in the cochlea and nerve VIII. Cochlear significant
change is atrophy and degeneration of hair cells in the organ corti support. The process of atrophy is
accompanied by vascular changes also occur in stria vaskularis. In addition there is also a change in the
form of a reduced number and size of the ganglion cells and nerve. The same thing happens also in
myelin nerve axons.

Classification

Based on the pathological changes that occur. Schuknecht et al classify presbycusis into 4 types:

1. Sensory (11.9%)
Lesions limited to the cochlea. Corti organ atrophy, the number of hair cells and supporting cells
is reduced.
2. Neural (30.7%)
Neurons in the cochlea and auditory pathways is reduced
3. Metabolic / strial presbycusis (34.6%)
Vaskularis stria atrophy, decreased mikrofonik potential. Cell function and balance biochemistry
/ bioelectrical cochlear reduced.
4. Mechanical / cochlear presbycusis (22.8%)
There were changes in the mechanical movement cochlear duct. Atrophy of the spiral ligament.
Basilar membrane more rigid.

Clinical symptoms

The main complaint in the form of hearing loss is presbycusis slowly progressive, symmetrical on both
ears. When was the hearing loss is not known. Another complaint is ringing in the ears (tinnitus high
tone). Patients can hear the speech, but it is difficult to understand, especially when pronounced quickly
in place with a noisy background (cocktail party deafness). When the sound intensity will arise elevated
pain in the ear, this is caused by nervous exhaustion factor (recruitment).
diagnosis

With otoscopic examination, the tympanic membrane looks bleak, reduced mobility. In tests peala
obtained sensorineural deafness. Pure tone audiometric examination showed a high note nerve
deafness, bilateral and symmetrical.

In the early stages there is a sharp reduction (sloping) after 2000 Hz. These figures are typical of the type
of sensory and neural presbycusis.

The threshold of hearing on audiogram type of metabolic and mechanical more horizontal, then on the
next stage of gradual decline. In all types of presbycusis advanced stage also decreased at a lower
frequency.

Said audiometric examination showed impaired speech discrimination (speech discrimination). This
situation is clearly seen in presbycusis types of neural and cochlear.

Management

Rehabilitation as an effort to restore auditory function is performed by the installation of a hearing aid
(hearing aid). Sometimes the installation of hearing aids need to be combined with exercise to read the
speech (speech reading), and exercise hearing (auditory training), the training procedure conducted with
speech therapists (speech therapist).

complications Presbikusis (2)

Hearing loss can have a big impact on the quality of life of people with presbycusis, especially the
elderly. Hearing loss causes the conversation difficult, so they tend to become reclusive and depressed.

In addition, hearing loss also led to a decrease in cognitive abilities such as the ability to understand and
remember things, and solve problems.

Prognosis (3)

Patients with presbycusis can not be cured, the longer it will decrease the function of hearing. A
decrease in auditory function occurs slowly, so that patients can still use the existing auditory function.

prevention Presbikusis (2)

The decline in hearing ability with age is difficult to avoid. However, there are several ways you can do
to prevent this condition occur early and develop faster, namely:
 1. Using hearing protection, such as foam earplugs, if you work in a noisy work environment.
2. Avoid activities that risk damaging the hearing, such as listening to music at high volume.
3. Do not insert any object or liquid into the ear without the permission of the doctor.
4. Eating a nutritious diet and regular exercise to prevent diseases that interfere with the function
of auditory risk, such as diabetes.
5. Quit smoking.
6. To examine the function of hearing regularly to the doctor.

Ref :

(1).Buku Ajar Ilmu Kesehatan Telinga Hidung Tenggorok Kepala & Leher.Edisi ke 7. Fakultas Kedokteran
Universitas Indonesia

(2). Lee, KY. (2013). Pathophysiology of Age-Related Hearing Loss (Peripheral and Central). Korean
Journal of Audiology

(3). Dina L.2013. Prevalensi Presbikusis dan Faktor Resiko yang Mempengaruhi Lanjut Usia di Balai
Perlindungan Sosial Banten. Fakultas Kedokteran. Universitas Islam Negeri Syarif Hidayatullah. Jakarta.