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Current Trends in Treating Hearing Loss in Elderly People: a Review of the Technology and Treatment Options – a Mini-Review

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Current Trends in Treating Hearing Loss in Elderly People: a Review of the Technology and Treatment Options – a Mini-Review Regenerative and Technological Section Gerontology 2010;56:351–358 Received: March 30, 2009 DOI: 10.1159/000275062 Accepted: November 30, 2009 Published online: January 12, 2010 Current Trends in Treating Hearing Loss in Elderly People: A Review of the Technology and Treatment Options – A Mini-Review G.M. Sprinzl H. Riechelmann Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Innsbruck , Austria Key Words implants (CIs) are the most commonly used devices for treat- -Presbycusis ؒ Hearing loss in the elderly ؒ Adults with ing mild-severe presbycusis. Reported outcomes with hear hearing loss ؒ Sensorineural hearing loss ؒ Cochlear ing aids indicate they are an effective method for treating -implants ؒ Hearing aids ؒ Amplification mild-moderate HL in cases where the patient is appropri ately fitted and is willing, motivated, and able to use the de- vice. Depending on the type and severity of the HL and the Abstract specific needs of the patient, electric-acoustic stimulation Background: According to the World Health Organization and active middle ear implants may also be appropriate so- (WHO), by 2025 there will be approximately 1.2 billion peo- lutions for treating presbycusis. Finally, very positive QoL ple in the world over the age of 60, which marks a shift in and speech perception outcomes have been documented in world population to a greater proportion of older people. An treating severe-profound presbycusis with CIs. In some stud- estimated 70–80% of adults between 65 and 75 years of age ies, QoL outcomes have even exceeded expectations of el- suffer from presbycusis, or age-related, bilateral sensorineu- derly patients. Copyright © 2010 S. Karger AG, Basel ral hearing loss (HL) in the high frequencies. Presbycusis is correlated with decreased quality of life (QoL) and depres- sion and according to WHO, is a leading cause of years lived with disability in the adult years. Objective: The purpose of Introduction the current study was to review the body of literature on treatment options and considerations for the elderly popu- According to the World Health Organization (WHO) lation, as there is a variety of audio-technology available [1] , by 2025 there will be approximately 1.2 billion people today to treat presbycusis. Methods: A PubMed literature in the world over the age of 60. This marks a shift in pop- search was conducted using the keywords ‘presbycusis/ ulation demographics, from a greater proportion of presbyacusis/geriatric AND hearing aids/cochlear implants/ young people to a more balanced proportion of young electric acoustic stimulation/middle ear implants’ and ‘el- and old. This aging of the world’s population has been derly AND cochlear implants’. References were also mined attributed to a decrease in fertility and an increase in life from papers found. Results: 431 articles were considered in expectancy in many countries [1] . An estimated 25% of this review of treatment options for elderly patients suffer- people aged 65–75 years and 70–80% of people over age ing from presbycusis. Conclusion: Hearing aids and cochlear 75 suffer from sensorineural hearing impairment associ- © 2010 S. Karger AG, Basel Prof. Dr. Georg M. Sprinzl 0304–324X/10/0563–0351$26.00/0 Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde Fax +41 61 306 12 34 Medizinische Universität Innsbruck, Anichstrasse 35 E-Mail [email protected] Accessible online at: AT–6020 Innsbruck (Austria) www.karger.com www.karger.com/ger Tel. +43 512 504 25204, Fax +43 512 504 23144, E-Mail georg.sprinzl @ i-med.ac.at ated with aging (known as presbycusis) [2]. According to years lived with disability (YLDs) in adults [10] . In the the Royal National Institute for Deaf People (RNID), case of HL, many of these YLDs presumably occur during there are already over 300 million people in the world the elderly years. with presbycusis and by 2050, it is projected that there HL in people over 60 years of age is treatable in most will be 900 million [3] . cases. Treatment options, depending on the type and se- Presbycusis is most often characterized by a bilateral, verity of HL, may include assistive devices, adaptation of symmetrical hearing loss (HL) which begins in the high the environment, training of communication partners, frequencies. Many speech sounds are high frequency amplification with hearing aids (HAs), middle ear im- sounds, which means that even a mild loss in these fre- plantation, electric acoustic stimulation (EAS), or direct quencies can greatly impair speech understanding. For stimulation of the cochlea via a cochlear implant (CI). these reasons, an elderly patient with presbycusis will The purpose of this paper is to present and discuss pos- typically complain first that he cannot understand peo- sible solutions for treating HL in patients over 60 years of ple’s speech, not necessarily that he cannot hear [4] . age. Causes of presbycusis are assumed to be the slow aging of the system, including: loss of or damage to hair cells from everyday noise exposure over time, loss of blood supply M e t h o d s to the cochlea referred to as ‘metabolic’ presbycusis by Schuknecht [5] , and loss of nerve fibers and neural ele- 431 articles were considered in this review of treatment op- tions for elderly patients suffering from HL: 419 identified through ments. While all of these factors may contribute to pres- PubMed search using the keywords ‘presbycusis/presbyacusis/ge- bycusis, metabolic changes appear to be the most pre- riatric AND hearing aids/cochlear implants/electric acoustic dominant factor. While there is some evidence that age- stimulation/middle ear implants’ and ‘elderly AND cochlear im- related pathology also occurs in the central auditory plants’; 5 identified through a general internet search; and 7 from system, more research is needed to explore this. Depend- reference mining. ing on the patient, other factors may contribute to these aging processes, such as acquired auditory stresses, trau- ma, or otological diseases [4] . Though the layperson com- Review of Hearing Technology monly associates advanced age with HL, the impact of presbycusis on everyday functional communication and Hearing Aids emotional well-being is often underestimated. HAs can be effective in treating presbycusis, depend- Noise-induced HL (NIHL) is the second leading cause ing on the type and severity of the HL. The audiologist is of adult-onset HL after presbycusis. In the current elder- key in HA selection, as some HA models and features are ly population, suspecting that an individual’s HL derives more appropriate for certain types of HL than others, and from both NIHL and presbycusis is not uncommon, es- some models with smaller controls may not be appropri- pecially among veterans of war and retired industrial ate for older adults with poor fine motor skills. Nowa- workers. Some estimate that prevalence of NIHL will days, HAs come in a variety of shapes and sizes, including continue to rise as the current generation ages, partly be- traditional behind the ear, in the canal, completely in the cause of the popularity of personal stereo systems capable canal, and open fit models. Multidirectional microphones of producing sound above 85 dB and also because of ex- are also an option. Two types of electronics are used in posure to loud music in clubs, or ‘recreational noise’. HAs today: analog and digital. NIHL resulting from recreational noise and occupation- Analog HAs pick up sound waves through a micro- al hazards can add to presbycusis, producing a more se- phone, convert them into electrical signals, amplify them, vere HL in old age. and send them through the ear canal to the tympanic Regardless of etiology, HL in people over 60 years of membrane. They can be programmed to have different age can have devastating effects on quality of life (QoL) settings for different listening situations. As a rule, ana- [6–8] and overall functioning [8] . In fact, a strong corre- log HAs are less expensive than digital HAs and work on lation between HL and depression has been found in old- a more linear model of amplification across frequencies. er patients [9] . Left untreated, these effects become an Digital hearing aids allow the implementation of many ongoing contributor to the decline of health with age. Us- additional features not possible with analog hearing aids. ing WHO terminology, HL ranks third after depression Fully digital hearing aids can be programmed with mul- and other unintentional injuries as a leading cause of tiple programs that can be selected by the user, or that 352 Gerontology 2010;56:351–358 Sprinzl/Riechelmann operate automatically and adaptively. These programs re- Hearing-Assistive Technologies duce acoustic feedback, reduce background noise, detect A variety of devices which support listeners with hear- and automatically accommodate different listening envi- ing impaired are currently available on the market. Some ronments, control additional components such as multi- are listening aids, while some alert or signal the user via ple microphones to improve spatial hearing, transpose auditory, visual, or tactile modalities. Some may be used frequencies (shift high frequencies that a wearer may not in combination with other hearing instruments, e.g. tele- hear to lower frequency regions where hearing may be coils which attach to HAs or CIs. Some are available to better), and implement many other features. Fully digital hearing impaired listeners attending events in public circuitry also allows control over wireless transmission venues. capability for both the audio and the control circuitry. Harkins and Tucker [18] recently surveyed a group of 423 adults with HL, 48% of which were 61 and older and Outcomes with HAs all of which were either using HAs (78%) or CIs (22%). Several studies have shown that HAs provide im- 84% of respondents in the survey indicated using assis- proved hearing for older patients [11] .
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