Hearing deficits in older people
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Hearing Deficits in Older People. Prodip K. Das Sam Blakemore Brighton & Sussex University Hospitals, Brighton, UK University of Toronto, Canada 27 th January 2011. Aims. Give an overview of common age related hearing problems. Pathophysiology Identifying patients When to refer

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Hearing Deficits in Older People

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Hearing deficits in older people

Hearing Deficits inOlder People

Prodip K. Das

Sam Blakemore

Brighton & Sussex University Hospitals, Brighton, UK

University of Toronto, Canada

27th January 2011


Hearing deficits in older people

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

Anatomy of the ear


Organ of corti

Organ of Corti


Anatomy of the cochlear

Anatomy of the Cochlear


Human hearing frequencies

Human Hearing Frequencies

Normal: 20Hz-20,000Hz (20kHz)

  • 8kHz

  • 10kHz

  • 12kHz

  • 15kHz

  • 16kHz

  • 18kHz

  • 20kHz


Age related hearing loss

Age Related Hearing Loss

  • Presbyacusis

    • Greek: Presby="he that goes first”

      Acusis=hearing

      Prevalence of hearing loss:

      Overall:10% population

      >65yrs:40% population

      >75yrs:70% population

      2025: WHO predicts 1.2 billion people >60yrs


Age related hearing loss1

Age related Hearing Loss

  • Risks:

    • Aging

    • Noise damage

    • Genetic susceptibility

    • Otological disorders

    • Ototoxic agents


Clinical pathophysiology

Clinical Pathophysiology

  • Starts as High Tone Loss

    • multifactorial:

      • Loss of basal hair cells

      • Declining metabolic function

        of striavascularis

  • Easter island study


Clinical findings

Clinical Findings

  • Initial:Background Noise

  • Later: Any situation (2-4kHz)


Presbyacusis is bilateral

Presbyacusis is bilateral

  • Any unilateral hearing loss/tinnitus should be referred to ENT


Examination

Examination


Screening

Screening?

  • “do you have a hearing problem?”

    • PTA


Treatment

Treatment

  • H/L affects not only communication but QoL

    • No treatment available to restore lost hearing…yet!


Prevention

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)


Prevention1

Prevention


Prevention2

Prevention


Management of age related hearing loss

Management of Age Related Hearing Loss

  • Improve Communication Strategies

  • Assistive listening devices

    • FM Transmitters

    • Telephone couplers

    • Teletext

    • Flashing/vibrating alarms

  • Amplification


Hearing aids

Hearing Aids

  • >40dB at 4Khz

  • Analogue Vs Digital

  • Directional microphones

  • Noise suppression technology

  • Telephone coils

  • Multiple programmes


Hearing aids1

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

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

Results

  • Untreated suffer negative symptoms:

    • Sadness & Depression

    • Worry & Anxiety

    • Paranoia

    • Less social activity

    • Emotional turmoil and insecurity


Results1

Results

  • If treated:

    • Better relationships with families

    • Better feelings about themselves

    • Improved mental health

    • Greater independence and security

  • Role of Central Processing Disorders


Results2

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

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

Differential Diagnoses

  • Early symptoms:

    • Anxiety

    • Disorientation

    • Reduced language comprehension

    • Inappropriate responses


Dementia

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

Conclusion

  • Age related hearing loss is a common disorder:

    • With no cure

    • Prevention

    • Identify early

    • Motivate patients

    • Treat early and presevere


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