Aging of the auditory system

Presbycusis or age-related hearing loss (ARHL) affects most elderly people. It is characterized by reduced hearing thresholds and speech understanding with the well-known negative consequences for communication and quality of social life. The hearing loss is connected to age-related histologic changes, as described and classified by Schuknecht. Aging itself is a multifactorial, genetically driven process that is influenced by oxidative stress that gradually leads to reduced endocochlear potential and cell loss of key players in sound transmission and supporting structures. Oxidative stress is caused by damaging factors like noise, infection, and other systemic factors. All reparative mechanisms in acute and chronic cochlear damage attempt to reduce oxidative stress and to balance inner-ear homeostasis. Accurate clinical assessment of ARHL starts with the differentiation between peripheral and central components. Treatment of the peripheral hearing loss often involves hearing aids, whereas auditory and psychologic training seems to be important in central auditory disturbance