The Aging Ear

Dear Colleagues,

Aging is a progressive, multifactorial biological process characterized by a gradual decline in physiological and cognitive functions, beginning in early adulthood and continuing throughout the lifespan. It results from the cumulative effects of molecular and cellular damage, impaired tissue homeostasis, and reduced regenerative capacity. Genetic predisposition, environmental exposures, and lifestyle factors modulate the trajectory of aging, while the progressive failure of repair and maintenance mechanisms increases vulnerability to disease. Aging is the predominant risk factor for a broad spectrum of chronic conditions, including cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative disorders. Beyond systemic disease, it contributes to progressive impairments in motor control, memory, and other cognitive domains, as well as profound social and emotional transitions such as retirement, relocation, and bereavement.

One of the most prevalent sensory consequences of aging is age-related hearing loss, which affects a substantial proportion of older adults. Presbycusis is primarily caused by structural and functional degeneration within the auditory system, from the external ear to cortical areas, including loss of cochlear hair cells, degeneration of spiral ganglion neurons, strial atrophy, and alterations in central auditory pathways. These changes reduce auditory sensitivity, particularly to high frequencies, and impair temporal and spatial sound processing, which severely limits speech perception in noisy environments. Concomitant vascular insufficiency and metabolic decline further exacerbate cochlear vulnerability.

In parallel, age-related deterioration of the vestibular apparatus—including loss of vestibular hair cells, degeneration of the vestibular nerve, and reduced efficacy of central vestibular integration—leads to impaired balance control. This contributes to postural instability, dizziness, and an increased risk of falls, which represent a major cause of morbidity and mortality in the elderly population.

Early identification of presbycusis and vestibular dysfunction, through audiological and vestibular testing, is essential for timely intervention. Evidence-based strategies such as amplification devices (e.g., hearing aids, cochlear implants), auditory rehabilitation, and vestibular rehabilitation programs can significantly mitigate functional decline, enhance communication, reduce fall risk, and improve overall quality of life in older adults.

Prof. Dr. Alessandro Martini
Prof. Dr. Stefania Maggi
Guest Editors

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• genetics and epigenetics of aging
• external and middle ear aging
• presbycusis
• presbyastasia
• cognitive decline
• aural rehabilitation