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Hearing Deficits
in
Older People
Prodip K. Das
Sam Blakemore
Brighton & Sussex University Hospitals, Brighton, UK
University of Toronto, Canada
27th January 2011
Aims
► Give
an overview of common age related
hearing problems.
 Pathophysiology
 Identifying patients
 When to refer
► Present
the treatment of these conditions.
► Discuss sequelae if left untreated
Anatomy of the ear
Organ of Corti
Anatomy of the Cochlear
Human Hearing Frequencies
Normal: 20Hz-20,000Hz (20kHz)
8kHz
► 10kHz
► 12kHz
► 15kHz
► 16kHz
► 18kHz
► 20kHz
►
Age Related Hearing Loss
► Presbyacusis
 Greek:
Prevalence
Overall:
>65yrs:
>75yrs:
Presby="he that goes first”
Acusis=hearing
of hearing loss:
10% population
40% population
70% population
2025: WHO predicts 1.2 billion people >60yrs
Age related Hearing Loss
► Risks:





Aging
Noise damage
Genetic susceptibility
Otological disorders
Ototoxic agents
Clinical Pathophysiology
► Starts
as High Tone Loss
 multifactorial:
►Loss
of basal hair cells
►Declining metabolic function
of stria vascularis
► Easter
island study
Clinical Findings
► Initial:
► Later:
Background Noise
Any situation (2-4kHz)
Presbyacusis is bilateral
► Any
unilateral hearing loss/tinnitus should
be referred to ENT
Examination
Screening?
► “do
you have a hearing problem?”
 PTA
Treatment
► H/L
affects not only communication but QoL
 No treatment available to restore lost
hearing…yet!
Prevention
 Noise at work regulations 2005:
►85dB
(peak 135dB) – request protection
►87dB (peak 137dB) – mandatory protection
►Must not exceed 90dB (peak 140dB)
 Noise protection (insert ear plugs attenuate
approx 20dB)
Prevention
Activity dB(A)
Quiet office
40-50
Normal conversation
50-60
Loud radio
65-70
Tractor cab
75-85
Busy street
78-85
Underground Carriage
90-100
Power drill
90-100
Heavy lorry (7m away)
95-100
Bar of a night club
95-105
Road drill
100-110
Chain saw
115-120
Jet aircraft taking off (25m away
140
Prevention
Management of Age Related
Hearing Loss
► Improve
Communication Strategies
► Assistive listening devices




FM Transmitters
Telephone couplers
Teletext
Flashing/vibrating alarms
► Amplification
Hearing Aids
► >40dB
at 4Khz
► Analogue Vs Digital
► Directional microphones
► Noise suppression technology
► Telephone coils
► Multiple programmes
Hearing Aids
► Drawbacks:
 Do not restore normal hearing
 Need long learning adjustment (Central
adaption)
 Uncomfortable, unsightly
► Education
on expectation and perseverence
Consequences of Untreating
Older Persons
► National
Council on the Aging, Washington,
DC (1999)
 2304 hearing impaired people
 2090 family members about the person
Aims:
►Measure
effect of not treating HL on QoL
►Compare perceptions among family members
►Identify reasons for not seeking treatment
►Assess impact of using HA on QoL
Results
► Untreated





suffer negative symptoms:
Sadness & Depression
Worry & Anxiety
Paranoia
Less social activity
Emotional turmoil and insecurity
Results
► If




treated:
Better relationships with families
Better feelings about themselves
Improved mental health
Greater independence and security
► Role
of Central Processing Disorders
Results
► Most




non users:
Think they do not need an aid
Believe aids don’t work
Lack of confidence in professionals
Stigma of aids
Implications
► Potential
negative consequences of not
treating
► Health professionals of older people should:
 Play a role in identifying and encourage
treatment
 Be aware that many older people are in denial
 5 minute Questionnaire
Differential Diagnoses
► Early




symptoms:
Anxiety
Disorientation
Reduced language comprehension
Inappropriate responses
Dementia
► National
Dementia Strategy (2009)
 Awareness of similarities
 Audiological studies:
►Contributes
to cognitive dysfunction in older adults
 Not a cause, but can exacerbate dementia
►Dementia
assessment-verbal ?skew results
►?role for audiological review as part of Strategy
Conclusion
► Age
related hearing loss is a common
disorder:





With no cure
Prevention
Identify early
Motivate patients
Treat early and presevere