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Presbycusis

Presbycuses

Presbycusis (presbyacusis) is a progressive, bilateral sensorineural hearing loss associated with aging.


Presentation

The hallmark of presbycusis is the progressive, symmetric loss of high frequency hearing over many years [1]. Patients present with difficulty in hearing and understanding low pitched sounds, and complain of having to ask other people to repeat what they are saying in order to hear them.

Turkish
  • CONCLUSION: Results of this study suggest that, in Turkish population, while sensory presbycusis is more common in males, strial presbycusis is more common in females.[ncbi.nlm.nih.gov]
Weight Gain
  • Body weights of controls did not change over 6 months (approximately 32 g), but there was a significant (approximately 5 g) decline in the T1DM, while T2DM exhibited approximately 10 g weight gain.[ncbi.nlm.nih.gov]
Normal Hair
  • Quantitative analysis of five "normal" ears, aged 54-89 yrs, without any history of otologic disease, suggests that cochlear synaptopathy and the degeneration of cochlear nerve peripheral axons, despite a near-normal hair cell population, may be an important[ncbi.nlm.nih.gov]
Tinnitus
  • MATERIAL AND METHODS: The subjects were divided into 2 groups, presbycusis with tinnitus (tinnitus) group and presbycusis without tinnitus (control) group, with each group comprising 8 temporal bones from 8 subjects.[ncbi.nlm.nih.gov]
  • Presbycusis affects men more than women, and tinnitus accompanies it in many cases. In fact, hearing loss is the leading cause of tinnitus.[tinnitusformula.com]
Hearing Impairment
  • Moreover, the study investigated the effect of speechreading on word intelligibility depending on hearing impairment severity.[ncbi.nlm.nih.gov]
Hearing Problem
  • They had all come to the clinic because of hearing problems. The subjects were selected for this study because no cause of their hearing loss could be found other than presbycusis.[ncbi.nlm.nih.gov]
  • How can I tell if I have a hearing problem? Ask yourself the following questions. If you answer “yes” to three or more of these questions, you could have a hearing problem and may need to have your hearing checked.[my.clevelandclinic.org]
  • Hearing problems can be serious, and it’s vital to identify the problem and evaluate your treatment options early.[newsoundhearing.com]
  • This is a health care professional who specializes in testing hearing problems and managing hearing problems. Key points Age-related hearing loss is a gradual hearing loss in both ears. It is a common problem associated with aging.[hopkinsmedicine.org]
  • Special training, hearing aids, certain medicines, and surgery are some of the choices that could help people with hearing problems.[irishhealth.com]
Speech Deterioration
  • Speech audiometry in the elderly revealed serious difficulties in understanding speech. Deteriorated temporal resolution, as demonstrated by increased gap detection thresholds, correlated significantly with increased speech recognition thresholds.[ncbi.nlm.nih.gov]
  • Clinical psychoacoustics in Alzheimer's disease central auditory processing disorders and speech deterioration. Ann. Gen. Hosp. Psychiatry 2:12. doi: 10.1186/1475-2832-2-12 PubMed Abstract CrossRef Full Text Google Scholar Jayakody, D. M.[doi.org]
Possibly Dementia
  • Left untreated, presbycusis of a moderate or greater degree affects communication and can contribute to isolation, depression, and, possibly, dementia. These psychological effects are largely reversible with rehabilitative treatment.[ncbi.nlm.nih.gov]

Workup

  • Rinne's test to examine if the hearing loss is nerve related.
  • Weber's test if the hearing loss is bilateral or just one-sided.
  • Audiometry to check the extent of hearing loss.
  • CT scan to rule out structural abnormality.
  • Blood tests to rule out any autoimmune disorder.

Screening tests

The Hearing Handicap for the Elderly-Screening version (HHIE-S) [2] is an efficient way of screening elderly people of hearing loss as well as to check, to some extent, the degree of severity of the loss. It also helps in discovering how much the hearing loss is affecting the daily life of the patient.

Test results

If a patient's score of the HIEE-S test is 10 points or greater, then he should seek evaluation by an audiologist for a more comprehensive examination [2] [3].

Treatment

Amplification devices

These devices, simply known as hearing aids, are the most preferred method of managing presbycusis. A task force of the American Academy of Audiology conducted a study evaluating the benefits of amplification in adults [4]. They concluded that these devices are highly effective.

Cochlear implants

Good outcomes have been reported for cochlear implants in patients with presbycusis [6]. In patients with presbycusis due to cochlear damage, like in mechanical presbycusis, this treatment is highly effective.

Active middle ear implant

Active middle-ear implant [5] is a prosthesis which mechanically vibrates the middle ear structures, and is useful for mild to moderate sensorineural hearing loss.

Prognosis

Since this condition develops due to old age, it will keep on getting worse as the age advances. However, if there is an underlying conditioning such as diabetes, hypertension or otosclerosis, it should be treated to stop the condition from progressing.

Complications

Untreated presbycusis leads to social isolation, and depression, and may cause or worsen cognitive impairment and dementia [7]. There are no serious medical complications of presbycusis. The life style of the patient however, is mostly affected.

Etiology

Presbycusis is a multifactorial process driven by environmental factors and exacerbated by concurrent disease [8]. There is no certain causative factor known of this condition. So it is assumed that a combination of factors contribute in the development of this condition. These factors may include preexisting disease like diabetes, hypertension and arteriosclerosis. Other factors are continuous and unprotected exposure to damaging sounds, such as to people working in airports and factories, use of ototoxic drugs, exposure to environmental chemicals, etc. Genetics plays an important role in the development of presbycusis. So a combination of one, or more often, more than one factors makes a person vulnerable to sensorineural hearing loss.

Epidemiology

Incidence

Around 25-30% people between the 6th and 7th decade of life are estimated to have presbycusis. WHO estimates that by 2025, there will be 1.2 billion people over 60 years of age worldwide, with more than 500 million individuals who will suffer significant impairment from presbycusis [5].

Age

Prevalence of hearing loss increases with age, with up to 80% of functionally significant hearing loss occurring in older adults [8].

Sex

Although there is no specific cause known, some studies reveal that presbycusis is found to occur more in males than in females. However, no definite predominance is established as yet.

Sex distribution
Age distribution

Pathophysiology

No single histopathological finding can reliably account for the clinical variability seen in presbycusis [9]. However, as age advances, changes in the histologic make up of the inner ear and the nerves gradually occur. It is the accumulation of these progressive changes that ultimately result in hearing loss. According to the main histologic finding, presbycusis can be divided into 4 types.

Sensory presbycusis

In this type, damage occurs in the organ of Corti and the sensory hair cells. Damage could be in the form of atrophy, impairment of function and/or accumulation of lipofuscin granules.

Neural presbycusis

In this type, the major histopathologic finding is in the nerve cells. Cells of the organ of Corti to those of the Vestibularcochlear nerve (8th cranial nerve) may suffer atrophy. The basilar portion of the cochlea is more vulnerable to damage, however, the entire organ may become involved.

Mechanical presbycusis

Due to advancing age, there may be thickening of the basilar membrane of the cochlea. This thickening may be due to a number of factors such as sloughing off of old cells, lipofuscin deposition, high exposure to loud sounds, etc and occurs particularly at the basal turn of the cochlea because here the basilar membrane is the narrowest. Whatever the reason of thickening maybe, the stiff basilar membrane is now ineffective in transmitting sound waves and hearing loss ensues. This is called mechanical or conductive presbycusis.

Metabolic presbycusis

In this type of old-age hearing loss, the stria vascularis suffers damage or atrophy. Note that the stria vascularis's function is to maintain the biochemical state of balance of the cochlea. Damage to the stria results in impaired functioning of the cochlea and hence, hearing loss.

Prevention

Presbycusis may be prevented by regular and proper cleaning of the ear to prevent accumulation of cerumen (ear wax), avoiding exposure to high and loud sounds, wearing protective ear muffs if working in noisy areas, etc.

Summary

Presbycusis, or age-related hearing loss is a common cause of hearing loss in adults worldwide [10]. It may be defined as sensorineural hearing impairment due to old age. Presbycusis most commonly occurs in both ears but the onset and rate of severity of the condition may differ. It is such a prevalent condition that some elderly people go about living with it without taking any serious medical treatment or aid.

Patient Information

Presbycusis is a condition of old age in which gradual hearing loss occurs. With the help of hearing aids and implants, this condition can easily be managed.

References

Article

  1. Gates GA, Mills JH. Presbycusis. Lancet 2005; 366: 1111
  2. Ventry IM, Weinstein BE. Identification of elderly people with hearing problems. ASHA 1983, 25 (7): 37-42
  3. Lichtenstein MJ, Bess FH, Logan SA. Validation of screening tools for Identifying hearing-impaired elderly in primary care. JAMA 1988, 259: 2875-78
  4. Chisolm TH, Johnson CE, Danhauer L, Portz LJ, Abrams HB, Lesner S, et al. A systematic review of health related quality of life and hearing aids: final report of the American Academy if Audiology Task Force on the health related quality of life benefits of amplification in adults. J Am Acad Audiol 2007; 18: 151-183
  5. Guy's and St Thomas' NHS Trust; Auditory Implant Program: The Middle Ear Implant (MEI) - Information for referers.
  6. Sprinzl GM, Riechelmann H. Current trends in Treating hearing loss in elderly people: a review of the gerontology. 2010; 56 (3): 351-8. ePub. 2012
  7. Dalton DS, Cruickshanks KJ, Klein BE, et al. The impact of hearing loss on quality of life in older adults. Gerontologist. 2003, Oct, 43 (5): 661-8
  8. Davis AC. Epidemiological profile of hearing impairments: the scale and nature of the problem with special reference to the elderly. Acta Otolaryngol Suppl, 1990, 476: 23
  9. Suga F, Lindsay JR. Histopathological observations of presbycusis. Ann Otol Rhinol Laryngol.1976; 85: 169
  10. Nelson EG, Hinojosa R. Presbycusis: a human temporal bone study of worth individuals with downward sloping audiometric patterns of hearing loss and review of the literature. Laryngoscope 2006; 116: 1

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Last updated: 2019-07-11 22:28