The patient in this vignette most likely has presbycusis, as evidenced by his bilateral sensorineural hearing loss with predominant of high frequency hearing loss on audiogram.
Presbycusis is a common cause of hearing loss in the older individual (presby = old). The This is classic reason why older males often struggle to hear female voices as they age, as women speak with a higher voice frequency. On exam, a Weber test is non-localizing, as the problem is most often bilateral. Because this condition is a form of sensorineural hearing loss, the Rinne reveals better air conduction compared to bone (the inner ear has impaired ability to transmit auditory signals so both air and bone conduction reduced equally, maintaining the normal balance of air conduction over bone conduction).
Isaacson and Vora discuss the diagnosis of hearing loss, which can be subdivided into conductive, sensorineural, or both. The leading causes of conductive hearing loss include cerumen impaction, otitis media, and otosclerosis, while the most common causes of sensorineural hearing loss include inherited disorders, noise exposure, and presbycusis.
Pacacla and Yueh discuss hearing loss in older adults. They report that age-related hearing loss (presbycusis) is the most common type of hearing loss in older adults,. This multifactorial sensorineural loss frequently includes a component of impaired speech discrimination. The mainstay of treatment is amplification with hearing aids.
Figure A demonstrates a classic audiogram of presbycusis, in which there is a decrease in high frequency hearing.
Answer 1: Otosclerosis is a conductive hearing loss problem, with low-frequency hearing loss first, followed later by high frequency hearing loss.
Answer 2: Statins are not a common cause of drug-induced ototoxicity and would be a less likely cause of this patient's hearing loss.
Answer 3: Acoustic neuromas would need to be bilateral be a potential cause, as this patient has a symmetric exam. Neurofibromatosis type II, which typically presents before age 20, classically has bilateral acoustic neuromas and is unlikely in this gentleman.
Answer 4: Meniere's disease is associated with a sensation of aural fullness and episodic vertigo, which is not present in the patient.
Isaacson JE, Vora NM. Differential diagnosis and treatment of hearing loss. Am Fam Physician. 2003 Sep 15;68(6):1125-32.
PMID:14524400 (Link to Abstract)
Pacala JT, Yueh B. Hearing deficits in the older patient: "I didn't notice anything". JAMA. 2012 Mar 21;307(11):1185-94. doi: 10.1001/jama.2012.305.
PMID:22436959 (Link to Abstract)