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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 inOlder 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: 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 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 striavascularis

  • Easter island study


Clinical Findings

  • Initial:Background Noise

  • Later: 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


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


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