Hearing Deficits Hearing Deficits inin
Older PeopleOlder People
Prodip K. DasProdip K. DasSam BlakemoreSam Blakemore
Brighton & Sussex University Hospitals, Brighton & Sussex University Hospitals, Brighton, UKBrighton, UK
University of Toronto, CanadaUniversity of Toronto, Canada2727thth January 2011 January 2011
AimsAims
►Give an overview of common age Give an overview of common age related hearing problems.related hearing problems. PathophysiologyPathophysiology Identifying patientsIdentifying patients When to referWhen to refer
►Present the treatment of these Present the treatment of these conditions.conditions.
►Discuss sequelae if left untreatedDiscuss sequelae if left untreated
Anatomy of the earAnatomy of the ear
Organ of CortiOrgan of Corti
Anatomy of the CochlearAnatomy of the Cochlear
Human Hearing FrequenciesHuman Hearing Frequencies
Normal: 20Hz-20,000Hz (20kHz)Normal: 20Hz-20,000Hz (20kHz)
► 8kHz8kHz► 10kHz10kHz► 12kHz12kHz► 15kHz15kHz► 16kHz16kHz► 18kHz18kHz► 20kHz20kHz
Age Related Hearing LossAge Related Hearing Loss
►PresbyacusisPresbyacusis Greek: Presby="he that goes first”
Acusis=hearingPrevalence of hearing loss:
Overall: 10% population>65yrs: 40% population>75yrs: 70% population
2025: WHO predicts 1.2 billion people >60yrs
Age related Hearing LossAge related Hearing Loss
►Risks:Risks: AgingAging Noise damageNoise damage Genetic susceptibilityGenetic susceptibility Otological disordersOtological disorders Ototoxic agentsOtotoxic agents
Clinical PathophysiologyClinical Pathophysiology
►Starts as High Tone LossStarts as High Tone Loss multifactorial:multifactorial:
►Loss of basal hair cellsLoss of basal hair cells►Declining metabolic functionDeclining metabolic function
of stria vascularisof stria vascularis
►Easter island studyEaster island study
Clinical FindingsClinical Findings
► Initial:Initial: Background NoiseBackground Noise►Later: Later: Any situation (2-4kHz)Any situation (2-4kHz)
Presbyacusis is bilateralPresbyacusis is bilateral
►Any unilateral hearing loss/tinnitus Any unilateral hearing loss/tinnitus should be referred to ENTshould be referred to ENT
ExaminationExamination
Screening?Screening?
►““do you have a hearing problem?”do you have a hearing problem?” PTAPTA
TreatmentTreatment
►H/L affects not only communication H/L affects not only communication but QoLbut QoL No treatment available to restore lost No treatment available to restore lost
hearing…yet!hearing…yet!
PreventionPrevention
Noise at work regulations 2005:Noise at work regulations 2005:►85dB (peak 135dB) – request protection85dB (peak 135dB) – request protection►87dB (peak 137dB) – mandatory protection87dB (peak 137dB) – mandatory protection►Must not exceed 90dB (peak 140dB)Must not exceed 90dB (peak 140dB)
Noise protection (insert ear plugs Noise protection (insert ear plugs attenuate approx 20dB)attenuate approx 20dB)
PreventionPrevention
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
PreventionPrevention
Management of Age Related Management of Age Related Hearing LossHearing Loss
► Improve Communication StrategiesImprove Communication Strategies►Assistive listening devicesAssistive listening devices
FM TransmittersFM Transmitters Telephone couplersTelephone couplers TeletextTeletext Flashing/vibrating alarmsFlashing/vibrating alarms
►AmplificationAmplification
Hearing AidsHearing Aids
►>40dB at 4Khz>40dB at 4Khz►Analogue Vs DigitalAnalogue Vs Digital►Directional microphonesDirectional microphones►Noise suppression technologyNoise suppression technology►Telephone coilsTelephone coils►Multiple programmesMultiple programmes
Hearing AidsHearing Aids
►Drawbacks:Drawbacks: Do not restore normal hearingDo not restore normal hearing Need long learning adjustment (Central Need long learning adjustment (Central
adaption)adaption) Uncomfortable, unsightlyUncomfortable, unsightly
►Education on expectation and Education on expectation and perseverenceperseverence
Consequences of Untreating Consequences of Untreating Older PersonsOlder Persons
►National Council on the Aging, National Council on the Aging, Washington, DC (1999)Washington, DC (1999) 2304 hearing impaired people2304 hearing impaired people 2090 family members about the person2090 family members about the person
Aims:Aims:►Measure effect of not treating HL on QoLMeasure effect of not treating HL on QoL►Compare perceptions among family membersCompare perceptions among family members►Identify reasons for not seeking treatmentIdentify reasons for not seeking treatment►Assess impact of using HA on QoLAssess impact of using HA on QoL
ResultsResults
►Untreated suffer negative symptoms:Untreated suffer negative symptoms:
Sadness & DepressionSadness & Depression Worry & AnxietyWorry & Anxiety ParanoiaParanoia Less social activityLess social activity Emotional turmoil and insecurityEmotional turmoil and insecurity
ResultsResults
► If treated:If treated: Better relationships with familiesBetter relationships with families Better feelings about themselvesBetter feelings about themselves Improved mental healthImproved mental health Greater independence and securityGreater independence and security
►Role of Central Processing DisordersRole of Central Processing Disorders
ResultsResults
►Most non users:Most non users: Think they do not need an aidThink they do not need an aid Believe aids don’t workBelieve aids don’t work Lack of confidence in professionalsLack of confidence in professionals Stigma of aidsStigma of aids
ImplicationsImplications
►Potential negative consequences of Potential negative consequences of not treatingnot treating
►Health professionals of older people Health professionals of older people should:should: Play a role in identifying and encourage Play a role in identifying and encourage
treatmenttreatment Be aware that many older people are in Be aware that many older people are in
denialdenial 5 minute Questionnaire5 minute Questionnaire
Differential DiagnosesDifferential Diagnoses
►Early symptoms:Early symptoms: AnxietyAnxiety DisorientationDisorientation Reduced language comprehensionReduced language comprehension Inappropriate responsesInappropriate responses
DementiaDementia
►National Dementia Strategy (2009)National Dementia Strategy (2009) Awareness of similaritiesAwareness of similarities Audiological studies:Audiological studies:
►Contributes to cognitive dysfunction in older Contributes to cognitive dysfunction in older adultsadults
Not a cause, but can exacerbate dementiaNot a cause, but can exacerbate dementia
►Dementia assessment-verbal ?skew resultsDementia assessment-verbal ?skew results►?role for audiological review as part of Strategy?role for audiological review as part of Strategy
ConclusionConclusion
►Age related hearing loss is a common Age related hearing loss is a common disorder:disorder: With no cureWith no cure PreventionPrevention Identify earlyIdentify early Motivate patientsMotivate patients Treat early and presevereTreat early and presevere
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