A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says "I can't always tell where the sound is coming from" and that the words often sound "mixed up." What might the nurse suspect as the cause for this change?

A) Atrophy of the apocrine glands
B) Cilia becoming coarse and stiff
C) Nerve degeneration in the inner ear
D) Scar tissue in the tympanic membrane

Presbycusis is a type of hearing loss that occurs in 60% of those older than 65 years of age, even in those living in a quiet environment. This sensorineural loss is gradual and caused by nerve degeneration in the inner ear. Words sound garbled, and the ability to localize sound is also impaired. This communication dysfunction is accentuated when background noise is present. Atrophy of the apocrine glands causes cerumen to be more dry and cilia becoming coarse and stiff may cause cerumen to accumulate and oxidize and reduce hearing but they do cause this patient's symptoms of not being able to locate the source of sounds or sounds being mixed up. Scarring of the tympanic eardrum are sequelae of repeated ear infections but do not necessarily affect hearing.