hearing deficits in older people
DESCRIPTION
Hearing Deficits in Older People. Prodip K. Das Sam Blakemore Brighton & Sussex University Hospitals, Brighton, UK University of Toronto, Canada 27 th January 2011. Aims. Give an overview of common age related hearing problems. Pathophysiology Identifying patients When to refer - PowerPoint PPT PresentationTRANSCRIPT
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Hearing Deficits Hearing Deficits inin
Older PeopleOlder PeopleProdip K. DasProdip K. Das
Sam BlakemoreSam Blakemore
Brighton & Sussex University Hospitals, Brighton & Sussex University Hospitals, Brighton, UKBrighton, UK
University of Toronto, CanadaUniversity of Toronto, Canada2727thth January 2011 January 2011
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AimsAims►Give an overview of common age related Give an overview of common age related
hearing problems.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
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Anatomy of the earAnatomy of the ear
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Organ of CortiOrgan of Corti
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Anatomy of the CochlearAnatomy of the Cochlear
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Human Hearing FrequenciesHuman Hearing FrequenciesNormal: 20Hz-20,000Hz (20kHz)Normal: 20Hz-20,000Hz (20kHz)
► 8kHz8kHz► 10kHz10kHz► 12kHz12kHz► 15kHz15kHz► 16kHz16kHz► 18kHz18kHz► 20kHz20kHz
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Age Related Hearing LossAge Related Hearing Loss►PresbyacusisPresbyacusis
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
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Age related Hearing LossAge related Hearing Loss►Risks:Risks:
AgingAging Noise damageNoise damage Genetic susceptibilityGenetic susceptibility Otological disordersOtological disorders Ototoxic agentsOtotoxic agents
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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
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Clinical FindingsClinical Findings► Initial:Initial: Background NoiseBackground Noise►Later: Later: Any situation (2-4kHz)Any situation (2-4kHz)
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Presbyacusis is bilateralPresbyacusis is bilateral►Any unilateral hearing loss/tinnitus Any unilateral hearing loss/tinnitus
should be referred to ENTshould be referred to ENT
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ExaminationExamination
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Screening?Screening?►““do you have a hearing problem?”do you have a hearing problem?”
PTAPTA
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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!
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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)
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PreventionPreventionActivity dB(A)Quiet office 40-50Normal conversation 50-60Loud radio 65-70Tractor cab 75-85Busy street 78-85Underground Carriage 90-100Power drill 90-100Heavy lorry (7m away) 95-100Bar of a night club 95-105Road drill 100-110Chain saw 115-120Jet aircraft taking off (25m away 140
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PreventionPrevention
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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
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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
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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
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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 personAims: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
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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
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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
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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
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ImplicationsImplications►Potential negative consequences of not Potential negative consequences of not
treatingtreating►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
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Differential DiagnosesDifferential Diagnoses►Early symptoms:Early symptoms:
AnxietyAnxiety DisorientationDisorientation Reduced language comprehensionReduced language comprehension Inappropriate responsesInappropriate responses
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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
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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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