An elderly patient presents with gradual, symmetric high-frequency sensorineural hearing loss that is worse in noisy environments. Audiometry shows downward-sloping hearing loss from 2 kHz onwards. The most likely type of presbycusis is:

• A Neural (Schuknecht type)
• B Metabolic (strial)
• C Sensory (Schuknecht type) ✓
• D Mechanical (cochlear conductive)

Explanation

Sensory presbycusis (Schuknecht's classification) is caused by loss of cochlear hair cells, predominantly at the basal turn, resulting in a steeply sloping high-frequency sensorineural loss. It begins in mid-life and progresses slowly. Neural presbycusis involves loss of spiral ganglion cells and causes difficulty with speech discrimination disproportionate to threshold loss. Strial (metabolic) presbycusis shows a flat audiogram.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.