Presbycusis: age-related hearing loss, symptoms and what helps in the UK

Presbycusis is the medical term for hearing loss that develops with age. It is the commonest cause of gradual hearing loss in older people. NHS inform explains the mechanism: hearing loss is the result of sound signals not reaching the brain, and in sensorineural hearing loss this is due to damage to the sensitive hair cells inside the inner ear or to the auditory nerve, which can happen naturally with age or as a result of injury.

NHS inform says some people are born with hearing loss, but most cases develop as you get older. The NHS table of causes gives gradual hearing loss in both ears, from ageing or damage from loud noise over many years, as the typical pattern.

The NHS lists difficulty hearing other people clearly and misunderstanding what they say, especially in noisy places; needing to ask people to repeat themselves; listening to music or watching TV with the volume higher than other people need; difficulty hearing on the phone; finding it hard to keep up with a conversation; and feeling tired or stressed from having to concentrate while listening.

NHS inform adds difficulty hearing the doorbell and difficulty telling which direction a noise is coming from. It notes that a ringing, buzzing or hissing sound in the ears could be tinnitus, which is often associated with hearing loss.

• Misunderstanding speech, especially in groups or noisy places.

• Asking people to repeat themselves.

• Turning the television or music up louder than others need.

• Difficulty hearing on the phone or the doorbell.

• Tiredness from the effort of listening.

• Ringing or buzzing in the ears (tinnitus).

The NHS says to see a GP if you have problems with your hearing, because it could be caused by something that can be easily treated, such as earwax. It advises seeing a GP if you think your hearing is getting gradually worse or if you have had treatment for an ear infection or earwax but your hearing has not come back. It adds that you can sometimes get a free hearing test at some pharmacies and opticians.

The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if you have sudden hearing loss in one or both ears, your hearing has been getting worse over the last few days or weeks, or you have hearing loss along with other symptoms such as earache or discharge from the ear, because it may need to be treated quickly. These do not fit the usual slow pattern of presbycusis and should not be put down to age.

The NHS lists conditions that can cause or add to hearing loss, which a GP looks for before concluding that it is age-related: ear infection, earwax build-up, a perforated eardrum, and labyrinthitis or Meniere's disease where hearing loss comes with dizziness, vertigo or tinnitus. NHS inform adds conductive causes such as glue ear, fluid after infection and disorders of the hearing bones.

Noise exposure over many years is the other major contributor. NHS inform describes noise-induced hearing loss as hearing loss from loud noise and says that it is possible to reduce the risk by using headphones that block out outside noise, wearing ear protection in noisy work or at loud events, and not having television, radio or music on too loud.

NHS inform says a GP can check for problems and may refer you to an audiologist (hearing specialist) or an ear, nose and throat (ENT) specialist for further tests. Hearing tests are also available on the high street, but you may have to pay for these. The NHS points to the RNID's free online hearing test as a first check.

The NHS says that if hearing loss is not caused by something a GP can treat, you may be referred to a hearing specialist for further tests and treatment. The diagnosis of age-related loss is therefore one reached after treatable causes such as wax and infection have been considered.

There is no cure for age-related sensorineural loss, but there are several ways to make hearing and communication easier. NHS inform lists digital hearing aids, available through the NHS; bone-anchored implants for people who cannot use hearing aids; middle ear implants for some people who cannot use hearing aids; cochlear implants for people who find hearing aids are not powerful enough; and lip reading or sign language such as British Sign Language.

The NHS says hearing aids will not make hearing perfect but make sounds louder and clearer, and some people may need a hearing implant. If hearing loss is caused by something the GP can treat, such as an infection or earwax, treatment is with antibiotics, ear drops or removal.

Hearing loss can be tiring and isolating, and the NHS notes feeling tired or stressed from the effort of listening. NHS inform lists organisations such as RNID, the British Deaf Association and Hearing Link for information and support.

NHS inform advises not inserting objects such as fingers, cotton buds, cotton wool or tissue into the ears, and says to speak to your GP practice if you or your child have signs of an ear infection such as severe earache, discharge or hearing loss.

On the NHS, a GP refers to audiology, where hearing aids are provided free. NHS inform notes that digital hearing aids are available through the NHS.

NHS inform notes that hearing tests are also available on the high street, but you may have to pay for these. Whichever route you take, a check for treatable causes and a clear plan for ongoing support are sensible starting points.