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Presbyacusis

Presbyacusis. Dr. Vishal Sharma. Synonyms. Age-related sensori-neural hearing loss Age-associated hearing loss (AAHL) Presbycusis (in USA) No official agreed age above which a person suffers from presbyacusis & below which he/she does not. Arbitrary agreed age is 50 years. Definitions.

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Presbyacusis

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  1. Presbyacusis Dr. Vishal Sharma

  2. Synonyms • Age-related sensori-neural hearing loss • Age-associated hearing loss (AAHL) • Presbycusis (in USA) • No official agreed age above which a person suffers from presbyacusis & below which he/she does not. Arbitrary agreed age is 50 years.

  3. Definitions • Presbyacusis: B/L symmetric, progressive SNHL due to aging, in absence of other etiologies • Socioacusis:B/L symmetric SNHL due to non- occupational noise, fatty diet & lack of exercise • Nosoacusis: B/L symmetric SNHL due to diseases with ototoxic effects • SNHL after 50 yrs age = presbyacusis + nosoacusis + socioacusis + occupational NIHL

  4. Diagnosis of exclusion Exclude other causes of hearing loss in elderly: • Noise induced hearing loss • Atherosclerosis (hyperlipidemia), diabetes, hypertension, myxoedema, Paget’s bone disease • CSOM, Meniere’s disease, acoustic neuroma, cochlear otosclerosis, ear trauma & ototoxic drug

  5. History • Toynbee (1849) first wrote about age-related hearing loss & prescribed a treatment (application of silver nitrate solution to external auditory canal) • Zwaardemaker (1891) gave first accurate description of presbyacusis. He detected high frequency involvement & origin in cochlea.

  6. Mechanism of Presbyacusis Age-related arteriosclerosis  hypo-perfusion &  oxygenation of cochlea  formation of reactive oxygen metabolites & free radicals  damage inner ear structures & mitochondrial DNA of inner ear  Presbycusis

  7. Genetic Predisposition • Genetic programming for early aging of parts of auditory system  early development of presbycusis • Genetically programmed susceptibility to environmental factors (noise, ototoxic drugs, stress) may be involved

  8. Types of Presbyacusis(Gacek & Schuknecht, 1993) • Sensory • Neural • Metabolic or strial or vascular • Mechanical or cochlear conductive • Mixed • Indeterminate or intermediate

  9. Sensory Presbyacusis • Loss of sensory hair cells in organ of Corti due to accumulation of lipofuscin pigment granules • Process originates in basal turn (for a length > 10 mm) & slowly progresses toward apex • Audiogram: abrupt, steep, high-frequency SNHL • Speech discrimination score: good

  10. Sensory Presbyacusis

  11. Neural Presbyacusis • Atrophy of spiral ganglion & cochlear neurons (> 50%) mainly in basal turn of cochlea • Slowly progressive HL (Pure Tone Average not affected until 90% neurons are destroyed) • Audiogram: ski-slope toward high frequencies • Speech discrimination score: poor (disproportionate)

  12. Neural Presbyacusis

  13. Metabolic Presbyacusis • Atrophy of stria vascularis (> 30% destroyed) • Stria vascularis maintains chemical + bioelectric balance & metabolic health of cochlea • Results in slowly progressive deafness • Audiogram: Flat (as entire cochlea is affected) • Speech discrimination score: good

  14. Metabolic Presbyacusis

  15. Mechanical Presbyacusis • Slowly progressive SNHL due to thickening & stiffening of basilar membrane of cochlea • More severe in basal turn of cochlea where basilar membrane is narrow • Audiogram: ski-slope toward high frequencies • Speech discrimination score: slightly impaired

  16. Mechanical Presbyacusis

  17. Other Types Mixed Presbyacusis: • Many ears have a combination of 4 pathologies Indeterminate or Intermediate Presbyacusis: • SNHL which progresses with age, without light microscopic evidence of cochlear pathology • Pathology: altered cellular metabolism / ed synapse numbers / change in endolymph composition / central auditory pathway changes

  18. Other age-related changes • Outer ear:ed cerumen formation, ed epithelial migration, ed hair growth, collapse of EAC • Middle ear:stiffening of TM, Arthritis + ossicular joints ossification, degeneration of middle ear muscles They do not make marked contribution in deafness

  19. Clinical Features • Gradually progressive hearing loss • Difficulty in understanding conversation around high level of ambient background noise • Recruitment: abnormal growth in perception of loudness (at high intensity) in pt with hearing loss • Tinnitus (30-50%):indicate worsening of deafness • Social isolation & depression

  20. Investigations • Pure Tone Audiometry • Speech Audiometry: diminished scores • MRI: to rule out vestibular schwannoma Indications of MRI in presbyacusis pt: • Asymmetry > 10 dB of PTA between both ears • Asymmetry > 20 dB of any single frequency • Unilateral tinnitus

  21. Audiogram

  22. Treatment • Medical: no medical cure • Diet modification & supplementation • Psychological counseling • Amplification devices or hearing aids • Lip reading & assisted listening devices • Cochlear Implantation • Tinnitus retraining therapy • Avoidance of aggravating factors

  23. Dietary advice • 30% caloric dietary restriction • Use of antioxidant dietary supplements (vitamins A, C, E; selenium) reduce production of reactive oxygen metabolites that harm inner ear & lead to age-related hearing loss • Neuro-vitamins & Gingko biloba have no role

  24. Hearing Aids Binaural hearing aids give more benefit Candidacy for hearing aids: • speech reception threshold > 30 dB in better ear • hearing level > 40 dB at 3 & 4 kHz in better ear Pt with poor speech discrimination score are poor candidates for hearing aids

  25. Body worn

  26. Spectacle

  27. Spectacle

  28. Completely in canal

  29. Completely in canal

  30. Completely in canal

  31. Behind the ear

  32. In the ear

  33. In the canal

  34. Completely in canal

  35. Lip reading or speech reading Skill of understanding spoken message by looking at speaker's lips, jaws, tongue, teeth, facial expressions, gestures & body language Lip reading is helpful in patients with diminished speech discrimination & hearing aid users who have hearing difficulty in noisy environments

  36. Assisted Listening Devices • They are NOT hearing aids • They are NOT used instead of hearing aids • Help pt with hearing loss to function better in communication situations to overcome distance, background noise, or poor room acoustics • Can be used with or without hearing aids

  37. Vibrating wrist watch & alarm clock

  38. CO2 & smoke alarm with strobe light

  39. Amplified & captioned telephone

  40. T.V. & F.M. amplifiers

  41. Personal & multi-user amplifier

  42. Alerting Devices

  43. Amplified Stethoscope

  44. Cochlear Implantation • Patients with cochlear damage & relatively intact spiral ganglia + central pathways are best candidates • Cochlear implantation have been performed on patients up to 85 years old, with good results

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