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Audiological Study of an Elderly Brazilian Population

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Audiological Study of an Elderly Brazilian Population Rev Bras Otorrinolaringol 2008;74(3):342-9. ARTIGO ORIGINAL ORIGINAL ARTICLE Estudo audiológico de uma Audiological study of an elderly população idosa brasileira brazilian population Luís Cláudio do Carmo1, José Alexandre Médicis da Silveira2, Sílvio Antônio Monteiro Marone3, Palavras-chave: audiometria tonal, idoso, presbiacusia. Fabiana Gonçalez D’Ottaviano4, Ludmila Lima Keywords: tonal audiometry, elderly, presbycusis. Zagati5, Eliane Maria Dias von Söhsten Lins6 Resumo / Summary A população idosa brasileira cresce e representa 8,6% do The Brazilian elderly population is growing, and already total populacional. Fatores ambientais, hábitos de vida, sexo represents 8,6% of our total population. Environmental e fatores genéticos interferem na evolução da presbiacusia factors, lifestyle, gender and genetics impact the development que reduz a qualidade de vida. Objetivo: Investigar queixas of presbycusis, which reduces quality of life. Aim: investigate audiológicas e vestibulares em idosos, executar audiometria audiologic and vestibular complaints in the elderly; perform tonal, verificar se há diferenças entre os sexos. Forma de tonal audiometry and check to see if there are differences Estudo: Clínico prospectivo de corte transversal. Material e between genders. Study: Cross-sectional clinical prospective Método: 320 pacientes idosos (160 homens e 160 mulheres) study. Materials and Methods: 320 elderly patients (160 foram submetidos a anamnese audiológica e audiometria men and 160 women) were submitted to audiologic interview tonal. Análise estatística dos resultados pelos testes ANOVA, and tonal audiometry. The results were statistically analyzed Mann-Whitney e Qui-Quadrado. Resultado: As queixas au- by the following methods: ANOVA, Mann-Whitney and diológicas e vestibulares (perda auditiva, tinnitus, plenitude Chi-Squared. Results: audiologic and vestibular complaints auricular, tontura) foram similares entre os sexos (exceção, (hearing loss, tinnitus, ear fullness, dizziness) were similar a tontura: p<0,05); audiometria tonal apresentou diferença between the genders (except for dizziness: p<0,05); tonal significante, com perda auditiva nas altas freqüências entre os audiometry showed a significant difference, with hearing homens, e entre as mulheres, curvas descendentes e planas. loss in the high frequencies among men; and among women Esses resultados foram estaticamente significantes (p<0,001). the curves were descending and flat. These results were Conclusão: Os resultados permitem concluir que, quando statistically significant (P<0,001). Conclusion: our results comparados os sexos, a perda auditiva no idoso possui sinto- lead us to conclude that, when the genders are compared, matologia semelhante, mas apresenta diferenças significativas hearing loss in the elderly has similar symptoms; however, na audiometria tonal. there are significant differences in tonal audiometry. 1 Doutor em ORL pela FMUSP, Chefe da Residência em ORL do Hospital Santa Marcelina e Clínica Otorhinus. 2 Doutor em ORL pela FMUSP, Chefe da Residência em ORL do Hospital Santa Marcelina e Clínica Otorhinus. 3 Doutor em ORL pela FMUSP, Professor Titular da Disciplina de ORL da PUC-Campinas e HCFMUSP. 4 Mestranda em ORL pela FCMSCSP, Preceptora da Residência em ORL do Hospital Santa Marcelina e Clínica Otorhinus. 5 Médica, Residente em ORL do Hospital Santa Marcelina. 6 Médica, Residente em ORL do Hospital Santa Marcelina. Centro de Referência do Idoso (SES-SP). Endereço para correspondência: Luís Cláudio do Carmo - Rua Ivaí 318 apto. 102 A Tatuapé São Paulo SP 03080-010. Este artigo foi submetido no SGP (Sistema de Gestão de Publicações) da RBORL em 14 de janeiro de 2007. Cod. 3601. Artigo aceito em 28 de março de 2007. REVISTA BR ASILEI R A DE OT orr IN O LA R ING O L O GIA 74 (3) MAI O /JUNH O 2008 http://www.rborl.org.br / e-mail: [email protected] 342 INTRODUÇÃO sociar patologias de orelha interna com a perda auditiva para as altas freqüências. Descreveram duas mudanças No Brasil, a situação do idoso passou a despertar patológicas: uma, envolvendo o órgão de Corti e outra, o interesse de diferentes áreas da sociedade após 1976, envolvendo os neurônios do gânglio espiral. A perda audi- quando foram realizados os primeiros seminários sobre a tiva indicada pelo audiograma foi atribuída tanto à atrofia problemática das pessoas idosas em nosso meio. Consul- do órgão de Corti, quanto à atrofia do nervo coclear, na 1 tando-se os dados do IBGE , pode-se constatar que nas porção basal da cóclea. últimas décadas têm sido, de fato, acelerado o processo Schuknecht12 classificou a presbiacusia em quatro de crescimento da população brasileira considerada idosa categorias: sensorial, neural, metabólica e mecânica. Jo- (indivíduos com 60 anos ou mais de idade). hnson & Hawkins13 criaram mais duas categorias de pres- O Censo Nacional de 1960 revelava que a popula- biacusia: vascular e central. Por fim, Corso8 enfatizou que ção brasileira era constituída por 4,7% de idosos, subindo uma vez que esses seis tipos de presbiacusia tenham sido vagarosamente para 5,1% nos anos 70 e alcançando 6.1% identificados, raramente, ocorreriam separadamente. de idosos no início da década de 801. Kirikae et al.14 encontraram mudanças degenerativas No Censo Nacional de 2000, descobriu-se que os nos núcleos da via auditiva e concluíram que “mudanças idosos no Brasil representam 8,6% da população, o que senis das células nervosas devem ser consideradas como equivale a um contingente de 14,5 milhões de pessoas. Em um importante fator na origem da presbiacusia”. relação a 1991, houve um crescimento de 35,5% na quan- Hansen & Reeske-Nilsen15 realizaram uma pesquisa tidade total de pessoas idosas. Naquele ano, a proporção nos núcleos cocleares em 12 cérebros de pessoas idosas desse segmento na população total era igual a 7,3% ou e concluíram que deve haver uma redução nas células do 1 10,7 milhões de idosos . núcleo coclear comparadas a cérebros normais. O aumento da população de idosos poderia sugerir Suga & Linsay16 observaram que a mudança histo- sua associação com o aumento da esperança média de patológica mais proeminente na orelha interna era uma vida da população brasileira, indicador social da melhoria diminuição na população de células do gânglio espiral. da qualidade de vida e bem-estar social. Entretanto, ainda Schuknecht17 afirmou que com o aumento da idade, que se tenha elevado a esperança média de vida, isso não há diminuição da capacidade de mitose de certas células, significa que tenham melhorado as condições objetivas diminuição de proteína nuclear, acúmulo de pigmentos 2 de vida para o idoso . Sem dúvida alguma, a privação e outros compostos insolúveis no citoplasma e alterações sensorial proveniente do declínio da acuidade auditiva químicas no fluido intercelular. representa uma das mais terríveis causas de isolamento Em relação aos fatores predisponentes para perda 3 social para o idoso . auditiva no idoso, Glorig & Nixon18 criaram o termo “so- 4 Berkowitz afirmou que aproximadamente 55% cioacusia”, isto é, o efeito global inevitável da exposição dos adultos americanos com perda auditiva significativa diária não-ocupacional ao ruído, infecções, drogas e trau- suficiente para interferir com a recepção de fala estão com ma acústico. A perda auditiva no envelhecimento seria, mais de 65 anos. Estatísticas mais recentes revelaram que para aqueles autores, o efeito combinado da presbiacusia, a presbiacusia afeta aproximadamente 25% da população socioacusia e ruído ocupacional. americana entre 65 e 74 anos e 38% da população acima Rosen et al.19 realizaram uma avaliação audiomé- 5 dessa idade . trica em homens pertencentes a uma tribo no Sudão, os 6 Zwaardemaker foi o primeiro pesquisador a descre- Mabaans, grupo este não afetado por ruído, arteriosclero- ver a perda auditiva para freqüências altas e, mais tarde, a se, fumo e drogas. Os resultados deste estudo revelaram utilizar o termo presbiacusia, o qual, literalmente, significa um declínio mínimo da audição à medida que a idade 7 “perda auditiva no velho”, ou, segundo Davis , o decrés- aumentou, assim, com poucos indícios de perda auditiva cimo fisiológico da audição com a idade. Estritamente, a relacionada à idade ou ao sexo. presbiacusia poderia ser caracterizada como “uma perda Outros dados importantes foram obtidos através da auditiva bilateral para tons de alta freqüência, devida a comparação entre o modo de vida dos habitantes rurais e mudanças degenerativas e fisiológicas no sistema auditivo urbanos feita por Weston20. Os resultados demonstraram 8 com o aumento da idade” . que a sensibilidade auditiva dos habitantes rurais era, sig- 9 Bunch demonstrou as mudanças audiométricas nificativamente, superior a dos moradores urbanos. para as altas freqüências, documentando o declínio da Hinchcliffe21 examinou uma população semelhan- função auditiva nas freqüências acima de 500Hz, à medida te na Jamaica, obtendo resultados que mostraram muito que a idade avançava. Ainda observou que a presbiacusia pouca diferença nas perdas auditivas relacionadas à idade atinge a população na seguinte ordem: homens brancos > entre os idosos jamaicanos e escoceses. mulheres brancas > homens negros > mulheres negras. Para Gilad & Glorig22, a perda auditiva devida ao 10 11 Crowe et al. e Saxén foram os primeiros a as- envelhecimento seria o resultado do efeito cumulativo REVISTA BR ASILEI R A DE OT orr IN O LA R ING O L O GIA 74 (3) MAI O /JUNH O 2008 http://www.rborl.org.br / e-mail: [email protected] 343 de vários fatores
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