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presbycusis

High-frequency (3000-8000 Hz) sensorineural hearing loss associated with aging. Etiology: 1) controversial 2) accumulated effect of life-long exposure to noise 3) possible genetic predisposition 4) systolic hypertension may be risk factor [5] Epidemiology: 1) the most common cause of hearing loss 2) 40-50% of elderly (>= 75 years of age) Pathology: - pathologic changes in temporal bone [5] - atrophy of hair cells in the organ of Corti - loss of neurons in the basal part of the spiral ganglion - patchy atrophy of the stria vascularis over middle & apical regions of the cochlea, restricting blood supply to neurosensory receptors - degeneration of the stria vascularis at the base & apex of the cochlea is the most prominent manifestation - changes in motion mechanics of the cochlear duct [5] - degenerative changes in the brainstem & auditory cortex of temporal lobe - hearing loss is associated with saccular dysfunction* * hearing loss is not associated with utricle dysfunction Clinical manifestations: 1) bilateral symmetrical hearing loss 2) tends to be gradual in onset & mild-moderate in severity 3) irreversible 4) tinnitus 5) unable to hear high frequency sounds a) great difficulty hearing a whisper b) unable to hear consonant (non-vowel) sounds 6) may hear people speak, but not be able to make out words 7) may complain that other people mumble 8) Weber test: response is midline 9) Rinne test: air conduction better than bone conduction Special laboratory: a) hand-held audioscope b) audiometer - sensorineural hearing loss more pronounced at higher frequencies [9] Differential diagnosis: - vestibular dysfunction Management: - amplification (digital hearing aid) - only 14% of patients with hearing loss use hearing aids [5,6,7,8] - use increases with age (from 4.3% among adults 50-59 years, 22% among adults >= 80 years) [5] - cochlear implant if not responsive to hearing aid [5]

General

sensorineural hearing loss

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 43
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 392, 407
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. Mangione C. in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  5. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Chien W, Lin FR. Prevalence of hearing aid use among older adults in the United States. Arch Intern Med. 2012 Feb 13;172(3):292-3. PMID: 22332170 Free PMC Article
  7. Gopinath B, Schneider J, Hartley D et al Incidence and predictors of hearing aid use and ownership among older adults with hearing loss. Ann Epidemiol. 2011 Jul;21(7):497-506. PMID: 21514179
  8. Mizutari K, Michikawa T, Saito H et al Age-related hearing loss and the factors determining continued usage of hearing aids among elderly community- dwelling residents. PLoS One. 2013 Sep 23;8(9):e73622. PMID: 24086287 Free PMC Article
  9. NEJM Knowledge+ Otolaryngology
  10. Presbycusis ( Age-Related Hearing Loss) http://www.nidcd.nih.gov/health/hearing/presbycusis.asp