• Prerequisites and learning objectives
• Lesson
  • Content
    • 1 - Hearing loss in the elderly
      • 1.1 - Presbycusis
        • 1 . 1 . 1 - Pathophysiology
        • 1 . 1 . 2 - Clinical signs
        • 1 . 1 . 3 - Diagnosis
        • 1 . 1 . 4 - Treatment
          • 1 . 1 . 4 . 1 - Hearing aid
          • 1 . 1 . 4 . 2 - Speech and language therapy
      • 1.2 - Other types of hearing loss in the elderly
        • 1 . 2 . 1 - Chronic otitis
        • 1 . 2 . 2 - Otospongiosis
        • 1 . 2 . 3 - Other types of perception hearing loss in the elderly
    • 2 - Vertigo andequilibrium problems in the elderly
      • 2.1 - Vertiginous pathology in the aged subject
        • 2 . 1 . 1 - Benign positional paroxysmal vertigo
        • 2 . 1 . 2 - Menière’s disease
        • 2 . 1 . 3 - Vestibular neuritis
        • 2 . 1 . 4 - Cochleovestibular ischemia
      • 2.2 - Central nervous system impairment leading to equilibrium problems
        • 2 . 2 . 1 - Vascular etiology
        • 2 . 2 . 2 - Parkinson’s disease
        • 2 . 2 . 3 - Causes due to medication
      • 2.3 - Equilibrium problems in the elderly without a particular pathology
        • 2 . 3 . 1 - Physiological reminder
        • 2 . 3 . 2 - Aggravating factors to consider
        • 2 . 3 . 3 - Recommended strategies
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1 . 1 . 3  -  Diagnosis

The ENT examination shows normal tympanic membranes.

The audiogram displays a pure perception deafness, which is bilateral and symmetric, involving the high-pitched frequencies more than the low-pitched frequencies.

Vocal audiometry needs to be undertaken in a systematic manner. The degree of the intelligibility symptoms predicts the results to be obtained with the hearing aid.

The differential diagnosis can pose a problem if an associated pathology remains undetected :

• Otoscopic anomalies permit the simple elimination of wax plugs, tympanic perforation sequelae, or evolving chronic otitis (cholesteatoma);
• In the case of transmission deafness or mixed deafness, it is often necessary to measure impedance in order to diagnose a blockage or interruption of the ossicular chain;
• Finally, if the perception deafness is asymmetric, one needs to look for an acoustic neuroma, in principle.

1 . 1 . 4  -  Treatment

1 . 1 . 4 . 1  -  Hearing aid

A hearing aid should be proposed when the auditive loss is greater than 30 dB from the 2000 Hz frequency. In a general manner, this aid should be prescribed as early as possible without waiting for the effects of nervous senescence.

A hearing aid amplifies the intensity of the perceived sound but does not always allow for a better comprehension due to problems of discrimination. The choice and adjustment of the aid must be performed by an experienced audiologist. Tests of the aid must be carried out prior to purchase. It should be noted that use of a hearing aid in presbycusis is often difficult and can end in failure.

Fig.3 : An air conductive hearing aid permits the amplification of the spoken signal in case of deafness

The sound is captured by a microphone, and the signal is then treated by an electronic circuit before being delivered in the external auditive conduit by the transducer. The intra-conduit aid contains the three elements (microphone, electronics, and transducer) molded in a small rigid shell that is inserted in the external auditive conduit (small size – limited amplification). The intraconque aid contains the same elements in the shell placed in the conque; it has a larger size and allows for greater amplification. The around the ear aid contains the three elements, and the sound is delivered via a silicone ear tip placed in the conduit; it is the type of aid that permits the maximum amplification.

1 . 1 . 4 . 2  -  Speech and language therapy

The prescription of speech and language therapy sessions permits the learning or amelioration of lip reading and is often a useful aid.

Finally, counseling aimed at preventing an aggravation of the situation notably via the prevention of noise trauma and an annual testing of audition are usually proposed.

1 . 2  -  Other types of hearing loss in the elderly

1 . 2 . 1  -  Chronic otitis

Simple perforations of the tympanic membrane (sequelae of suppurating chronic otitis) are easily diagnosed. They should be treated surgically until an advanced age given that the surgery can be performed using a local anesthetic. As tympanic perforations are an obstacle to the use of a hearing aid with a tip, their closure should be proposed.

The cholesteatoma in the aged subject, evolving less rapidly than in a young subject, should follow the same treatment rules as those used for a younger adult.

1 . 2 . 2  -  Otospongiosis

Otospongiosis in the aged subject is not rare. Whether the affection was previously neglected or whether it appeared at a later time-point, the rules for the diagnosis and treatment are the same as those used for otospongiosis in a younger subject.

Surgical intervention can be undertaken up to a very advanced age using local anesthesia.

1 . 2 . 3  -  Other types of perception hearing loss in the elderly

All of the other causes of hearing loss can occur in the aged subject :

• Deafness due to trauma following a fracture of the petrous bone or a labyrinthine concussion during cranial trauma without fracture;
• Deafness due to sound trauma: the activities of the retiree who perform do-it-yourself activities, tree trimming, brush clearing, shooting, and hunting provoke the same sound traumas similar to hearing problems related to professional activities, which are added on to the effects of aging, hence the preventative measures;
• Deafness due toxic agents, infections, vascular problems, or Menière’s disease do not pose any different problems than those that are observed in a younger subject;
• Sudden unilateral deafness should be treated in the same manner as in a young subject.