Older people whose hearing loss symptoms are not reflected in pure-tone or speech audiometry results may be
experiencing increased difficulties stemming from central presbycusis. Counseling and management should take into account treatment options beyond providing audibility. We need to remember, when assessing and counseling older adults who report hearing difficulties, that we hear with our brains, not just our ears, and to consider the ramifications of central presbycusis on auditory function in real-world environments.