• Hearing loss begins around the

third decade of life and its

incidence increases sharply with

age.

• Forty percent of those over age

sixty-five have measureable

hearing loss.

• Ninety percent of those ninety

years and older have hearing

loss.

HEARING & THE

EFFECTS OF AGING

Hearing impairment in the elderly

has been associated with

psychological features such as:

• Depression

• Confusion

• Increased tension

• Negativism

• Inattentiveness

HEARING & THE

EFFECTS OF AGING

Hearing impairment in the elderly

has also been associated with

functional problems such as:

• Poor general health

• Reduced mobility

• Reduced interpersonal

communications

HEARING & THE

EFFECTS OF AGING

There are various forms of

Presbycusis (old-age hearing). We

need to keep in mind, that during

our lifetimes, we encounter a

variety of insults to our auditory

system such as: 1) noise exposure,

2) vascular disease, 3) concussive

damage, 4) pollutants, 5) ototoxic

drugs, 6) poor nutrition, 7) tobacco

HEARING & THE

EFFECTS OF AGING

Aging effects of the outer and

middle ear structures occur.

However, studies do not support

significant conductive hearing loss

associated with these outer and

middle ear changes.

HEARING & THE

EFFECTS OF AGING

Studies of the inner ear suggest

four specific types of presbycusis

may present. They are:

1. Sensory presbycusis

2. Neural presbycusis

3. Metabolic presbycusis

4. Mechanical or cochlear

conductive presbycusis

HEARING & THE

EFFECTS OF AGING

Sensory Presbycusis

It is characterized by the

degeneration of hair cells and

supporting hair cells at the base of

the cochlea and subsequent

cochlear fiber degeneration.

HEARING & THE

EFFECTS OF AGING

Neural Presbycusis

It is characterized by the loss of

cochlear neurons resulting in

problems with transmission of

information coding.

HEARING & THE

EFFECTS OF AGING

Metabolic Presbycusis

Also known as strial presbycusis, it

is a result of the degeneration of

the Stria Vascularis which causes

disruptions in the nutrient supply

of the inner ear resulting in

modified cochlear electrical

potentials.

HEARING & THE

EFFECTS OF AGING

Mechanical Presbycusis

It is characterized by alterations to

the cochlear mechanics produced

by mass/stiffness changes or spiral

ligament atrophy

HEARING & THE

EFFECTS OF AGING

Audiograms may reflect a

summation of various

physiologic effects of aging of

the inner ear.

HEARING & THE

EFFECTS OF AGING

Let’s review some signature

audiograms for the various

forms of presbycusis on page

#200 of Northern.

HEARING & THE

EFFECTS OF AGING

Males and females over the age of

sixty exhibit hearing loss—

especially in the high frequency

regions.

HEARING & THE

EFFECTS OF AGING

It has long been reported that

older persons experience greater

difficulty understanding

comfortably loud speech within the

presence of competing background

noise.

HEARING & THE

EFFECTS OF AGING

Aging & Speech Recognition

When speech recognition scores

are assessed in quiet, there is little

performance difference between

young and elderly individuals.

HEARING & THE

EFFECTS OF AGING

Various studies of the elderly and

speech recognition in noise

environments have concluded that

aging changes mechanisms within

the central auditory system.

HEARING & THE

EFFECTS OF AGING

Dr. Jerger and colleagues

concluded that the understanding

problem of the elderly cannot be

totally explained by cognitive

decline or peripheral hearing loss.

Central deficits have to be a

contributing to the recognition

problem.

HEARING & THE

EFFECTS OF AGING

Individuals with Central processing

disorders (CAPD), of any age, have

difficulty comprehending speech in

background noise.

HEARING & THE

EFFECTS OF AGING

After reviewing the table on page

#204 of Northern, it is interesting

to see the nature of longstanding—

relatively mild hearing loss and its

effects upon the brain’s ability to

perform in background noise.

HEARING & THE

EFFECTS OF AGING

Early intervention is

considered an important

rehabilitative strategy for

elderly individuals.

HEARING & THE

EFFECTS OF AGING

Physicians help the elderly

maintain a quality of life. The vast

majority of elderly see physicians

for periodic health assessments.

However, physicians treat hearing

loss more as a benign condition

than truly posing a threat to the

more basic areas of human

performance.

HEARING & THE

EFFECTS OF AGING

Let’s review the Sickness

Impact Profile (SIP) on page

#207 of Northern.

You can see that hearing loss

was strongly associated with

increased dysfunction in the

elderly.

HEARING & THE

EFFECTS OF AGING

Efforts to improve the hearing

of elderly patients could result

in a significant and meaningful

improvement in the life quality

of older individuals.

HEARING & THE

EFFECTS OF AGING

HEARING & THE

EFFECTS OF AGING

SYMPTOMATIC SIMILARITIES OF

ALZHEIMER’S DISEASE &

UNTREATED HEARING LOSS

HEARING & THE

EFFECTS OF AGING

Alzheimer’s

Disease

• Depression,

Anxiety,

Disorientation

Untreated Hearing

Loss

• Depression,

Anxiety, Feelings

of Isolation

HEARING & THE

EFFECTS OF AGING

Alzheimer’s

Disease

• Reduced

language

comprehension

Untreated Hearing

Loss

• Reduced

communication

ability

HEARING & THE

EFFECTS OF AGING

Alzheimer’s

Disease

• Impaired

Memory (esp.

short term

memory loss)

Untreated Hearing

Loss

• Reduced

cognitive ability

HEARING & THE

EFFECTS OF AGING

Alzheimer’s

Disease

• Inappropriate

psychosocial

responses

Untreated Hearing

Loss

• Inappropriate

psychosocial

responses

HEARING & THE

EFFECTS OF AGING

Alzheimer’s

Disease

• Loss of ability

to recognize

(agnosia)

Untreated Hearing

Loss

• Reduced mental

scores

HEARING & THE

EFFECTS OF AGING

Alzheimer’s

Disease

• Denial,

defensiveness,

negativity

Untreated Hearing

Loss

• Denial,

heightened

defensiveness,

negativity

HEARING & THE

EFFECTS OF AGING

Alzheimer’s

Disease

• Distrust &

paranoia (e.g.

belief that

others may be

talking about

them)

Untreated Hearing

Loss

• Distrust &

suspicion

regarding

others’ motives

Evidence of degeneration in

cortical areas and nuclei

associated with auditory function

in Alzheimer’s Disease is well

documented. Plaques within the

primary auditory area of the brain

have been revealed.

HEARING & THE

EFFECTS OF AGING

In 1990, Mulrow and colleagues

reported that patients who

received amplification, exhibited

significant improvements in social

and emotional function, cognitive

function and reduced depression.

HEARING & THE

EFFECTS OF AGING

Some reasons often cited as to

why the elderly do not access

hearing instruments are:

1. Insufficient knowledge about

hearing instruments

2. Unrealistic expectations of

hearing instruments

HEARING & THE

EFFECTS OF AGING

Additional reasons for reduced

access may also include:

1. They have accepted the hearing

loss as a part of getting older.

2. Primary care physicians fail to

recognize and appreciate the

hearing impairment.

HEARING & THE

EFFECTS OF AGING

Even if the patient complains

to the physician, more than

half of them will not be

referred for audiologic

evaluation.

HEARING & THE

EFFECTS OF AGING

Unresolved widespread

acceptance of amplification by the

elderly has been the failure to

demonstrate that the use of a

hearing instrument (amplification)

will result in an improvement in

functional status and/or a quality

of life.

HEARING & THE

EFFECTS OF AGING