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