• 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 . 2  -  Central nervous system impairment leading to equilibrium problems

2 . 2 . 1  -  Vascular etiology

• Wallenberg syndrome.
• Hemiplegia.
• Transient ischemic attacks of the vertebrobasilar territory.
• Cerebellar ataxia or pseudo-tabetic ataxia.
• Lacunar or pseudobulbar syndrome.

2 . 2 . 2  -  Parkinson’s disease

This condition is a classic cause of equilibrium problems in the aged subject.

2 . 2 . 3  -  Causes due to medication

The association of antihypertensive agents, anxiolytics, and hypnotics leads, without fail, to problems of equilibrium: One must be able to propose a “cleaning” of the prescriptions.

2 . 3  -  Equilibrium problems in the elderly without a particular pathology

2 . 3 . 1  -  Physiological reminder

Afferent abnormalities

Vision can be progressively altered in the aged subject either due to cataracts or involvement of the retina. The problems may be caused by the absence of correction of convergence problems. Fortunately, the visual function of the peripheral retina is preserved, which has the most important role in equilibrium function

Deep sensitivity and epicritic problems involved in posture can be present.

Vestibular omissions: This involves the non-utilization of the vestibular function in a subject with a normal vestibular function (tested using electro- or video-nystagmography), which is however not used. The condition is characterized a progressive loss of this function by the patient due to the progressive decrease in movements of the body and, in particular, the head. Equilibrium becomes controlled mainly by vision, which accounts for the disequilibrium in a moving environment (street, large store, etc.). A well conducted vestibular examination (associating caloric tests that are normal and the Equitest for which the vestibular score is zero) should allow for detecting this problem and permit support via the reeducation of use of the vestibular system.


Central information processing

Alteration of information processing by the central nervous system, with involvement of the following centers: cerebral trunk and the cerebellum. The dysfunction could be related to vascular problems that alter :

• The equilibrium function;
• The pyramidal system;
• The extra-pyramidal system;
• The basal ganglia.

2 . 3 . 2  -  Aggravating factors to consider

• Lack of physical activity.
• Undernourishment, nutritive factors, and amyotrophy.
• Morphological abnormalities in the aged subject (e.g., articular abnormalities of the inferior limbs, deformed feet, and rheumatological pathologies).
• Deleterious effects of medications.

2 . 3 . 3  -  Recommended strategies

• Stimulation and physical exercise.
• Vestibular reeducation.
• Protein supplementation.
• Reduction of psychotropic drugs.