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Hearing Deficits in Older People

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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  1. Hearing Deficits inOlder People Prodip K. Das Sam Blakemore Brighton & Sussex University Hospitals, Brighton, UK University of Toronto, Canada 27th January 2011

  2. 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

  3. Anatomy of the ear

  4. Organ of Corti

  5. Anatomy of the Cochlear

  6. Human Hearing Frequencies Normal: 20Hz-20,000Hz (20kHz) • 8kHz • 10kHz • 12kHz • 15kHz • 16kHz • 18kHz • 20kHz

  7. 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

  8. Age related Hearing Loss • Risks: • Aging • Noise damage • Genetic susceptibility • Otological disorders • Ototoxic agents

  9. Clinical Pathophysiology • Starts as High Tone Loss • multifactorial: • Loss of basal hair cells • Declining metabolic function of striavascularis • Easter island study

  10. Clinical Findings • Initial: Background Noise • Later: Any situation (2-4kHz)

  11. Presbyacusis is bilateral • Any unilateral hearing loss/tinnitus should be referred to ENT

  12. Examination

  13. Screening? • “do you have a hearing problem?” • PTA

  14. Treatment • H/L affects not only communication but QoL • No treatment available to restore lost hearing…yet!

  15. 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)

  16. Prevention

  17. Prevention

  18. Management of Age Related Hearing Loss • Improve Communication Strategies • Assistive listening devices • FM Transmitters • Telephone couplers • Teletext • Flashing/vibrating alarms • Amplification

  19. Hearing Aids • >40dB at 4Khz • Analogue Vs Digital • Directional microphones • Noise suppression technology • Telephone coils • Multiple programmes

  20. Hearing Aids • Drawbacks: • Do not restore normal hearing • Need long learning adjustment (Central adaption) • Uncomfortable, unsightly • Education on expectation and perseverence

  21. 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

  22. Results • Untreated suffer negative symptoms: • Sadness & Depression • Worry & Anxiety • Paranoia • Less social activity • Emotional turmoil and insecurity

  23. Results • If treated: • Better relationships with families • Better feelings about themselves • Improved mental health • Greater independence and security • Role of Central Processing Disorders

  24. Results • Most non users: • Think they do not need an aid • Believe aids don’t work • Lack of confidence in professionals • Stigma of aids

  25. 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

  26. Differential Diagnoses • Early symptoms: • Anxiety • Disorientation • Reduced language comprehension • Inappropriate responses

  27. 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

  28. 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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