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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