1. Hearing Deficits in Older People Prodip K. Das Sam Blakemore Brighton & Sussex University Hospitals, Brighton, UK University of Toronto, Canada 27 th 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 8kHz ► 10kHz 10kHz ► 12kHz 12kHz ► 15kHz 15kHz ► 16kHz 16kHz ► 18kHz 18kHz ► 20kHz 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 stria vascularis ► 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

14. Screening? ► “do you have a hearing problem?”  PTA

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

16. 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)

17. Prevention Activity dB(A) Quiet office40-50 Normal conversation50-60 Loud radio65-70 Tractor cab75-85 Busy street78-85 Underground Carriage90-100 Power drill90-100 Heavy lorry (7m away)95-100 Bar of a night club95-105 Road drill100-110 Chain saw115-120 Jet aircraft taking off (25m away140

18. Prevention

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

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

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

22. 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

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

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

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

26. 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 5 minute Questionnaire 5 minute Questionnaire

27. Differential Diagnoses ► Early symptoms:  Anxiety  Disorientation  Reduced language comprehension  Inappropriate responses

28. 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

29. Conclusion ► Age related hearing loss is a common disorder:  With no cure  Prevention  Identify early  Motivate patients  Treat early and presevere