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The affected cochlear structures include the stria vascularis and its vasculature, spiral ligament, sensory hair cells and auditory neurons. Dysfunction of the stria vascularis results in a reduced endocochlear potential. Without this potential, the cochlear amplification provided by the electro\u2010motility of the outer hair cells is insufficient, and a high\u2010frequency hearing\u2010loss results. Degeneration of the sensory cells, especially the outer hair cells also leads to hearing loss due to lack of amplification. Neuronal degeneration, another hallmark of ARHL, most likely underlies difficulties with speech discrimination, especially in noisy environments. Noise exposure is a major cause of ARHL. It is well\u2010known to cause sensory cell degeneration, especially the outer hair cells at the high frequency end of the cochlea. Even loud, but not uncomfortable, sound levels can lead to synaptopathy and ultimately neuronal degeneration. Even in the absence of a noisy environment, aged cells degenerate. This pathology most likely results from damage to mitochondria and contributes to degenerative changes in the stria vascularis, hair cells, and neurons. The genetic underpinnings of ARHL are still unknown and most likely involve various combinations of genes. At present, the only effective strategy for reducing ARHL is prevention of noise exposure. If future strategies can improve mitochondrial activity and reduce oxidative damage in old age, these should also bring relief.<\/jats:p>","DOI":"10.1002\/jnr.24439","type":"journal-article","created":{"date-parts":[[2019,5,8]],"date-time":"2019-05-08T01:14:38Z","timestamp":1557278078000},"page":"1674-1684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":229,"title":["Pathology and mechanisms of cochlear aging"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7710-5052","authenticated-orcid":false,"given":"Elizabeth M.","family":"Keithley","sequence":"first","affiliation":[{"name":"Division of Otolaryngology \u2010 Head and Neck Surgery University of California San Diego 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