• 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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2  -  Vertigo andequilibrium problems in the elderly

2 . 1  -  Vertiginous pathology in the aged subject

The interrogation and clinical examination do not differ, theoretically, from those performed for a younger adult. However, certain frequent pathologies in aged subjects merit particular attention :

• diabetes;
• cardiovascular or neurological pathologies;
• concomitant medications.

2 . 1 . 1  -  Benign positional paroxysmal vertigo

Particularities of this diagnosis in the aged subject : This condition is the most frequent cause of vertigo in the aged subject. The interrogation is often misleading. In effect, the subject does not spontaneously reports the positional character of the vertigo, but it is often described as a simple problem of equilibrium. Cross-examination reveals real attitudes of avoidance during sleep: semi-erect position, for example.

2 . 1 . 2  -  Menière’s disease

This medical condition does not have a specific character and may occur at any age. However, the vestibular compensation capacities in the aged subject are reduced. In addition, it could be the loss of compensation of an ancient or chronic Menière’s disease.

2 . 1 . 3  -  Vestibular neuritis

This medical condition does not have a specific character and may occur at any age. The neurological examination is normal.

The examination must be particularly rigorous in the aged subject and can uncover pre-existing symptoms, which are misleading, since they are not related to the recent vertigo. This highlights the relevance of pre-existing clinical information in order to eliminate involvement of the central nervous system.

2 . 1 . 4  -  Cochleovestibular ischemia

The dizziness symptoms are identical, but a perception hearing loss is present, possibly even an anacousia. The cardiovascular examination may reveal an embolic cardiopathy.