Alexandru Ionuț HRISTIAN , Manuela PĂDURARIU
ABSTRACT :
Introduction: Hearing loss in middle and older adulthood is dominated by cumulative sensorineural mechanisms rather than the infection-driven conductive pathology typical of early life. Understanding this shift is essential for guiding occupational health policy, prevention, and auditory rehabilitation strategies in ageing populations. Materials and methods: This paper presents the three oldest age categories from a retrospective review of 1,275 audiological screenings and evaluations in which 648 patients received a confirmed diagnosis of hearing loss. The present cohort comprises 307 diagnosed patients aged 36-97 years, stratified into three categories: 36-49 years (n=116), 50-65 years (n=121), and 66-97 years (n=70). For each category, the distribution of conductive hearing loss (CHL) versus sensorineural hearing loss (SNHL), device-fitting status, and underlying aetiology was analysed; full-cohort data on hearing-aid severity distribution and longitudinal threshold outcomes — which are concentrated in this age range — are also presented. Results and discussion: Sensorineural hearing loss predominated across all three categories, affecting 69% of cases in the 36-49 age group, 90.1% in the 50-65 age group, and 92.9% in the 66-97 age group — an aggregate of 254 of 307 patients (82.7%). Ototoxic medication exposure and occupational or recreational noise exposure emerged as dominant etiological drivers throughout this age range, with presbycusis and acoustic trauma appearing as major contributors from the sixth decade. Device-fitting rates rose markedly with age, from 11 of 80 SNHL patients aided (13.8%) in the youngest category of this cohort to 79 of 109 (72.5%) and 48 of 65 (73.8%) aided in the two oldest categories. Among the 155 hearing-aid recipients across the full parent cohort, severity was distributed as mild (21), moderate (70), severe (53), profound (9), and cochlear-implant-dependent (2). Aided patients demonstrated a mean threshold gain of 1-7 dB over 6-12 months, whereas unaided SNHL patients experienced a threshold decline of 4-16 dB over the same interval. Conclusions: Hearing loss in middle and older adulthood is overwhelmingly sensorineural, driven by occupational and recreational noise exposure, ototoxic medication use, and presbycusis. Timely device fitting is associated with threshold stabilisation, underscoring the clinical value of early identification and consistent auditory rehabilitation in this population.