Nursing Interventions and Management for Managing Age-Related Hearing Loss in Elderly Patients

Age-related hearing loss (presbycusis) is one of the most common health conditions in adults over 50 years old. It is important to recognize and treat acquired hearing loss because it is linked to many adverse consequences, such as communication difficulties, social isolation, depression, and diminished quality of life.1,2 Despite the high prevalence of age-related hearing loss, many adults have hearing loss that goes unrecognized. People may miss identifying their age-related hearing loss because the onset is typically slow and gradual. They may not notice subtle changes in their hearing-related behaviors that attempt to compensate for the loss, such as increasing the volume on audio devices. Of course, someone who is not aware of their hearing loss is not likely to report the problem to health care providers, and he or she is subsequently less likely to receive screenings or referrals to audiology. This is a problem because early identification of age-related hearing loss allows for timely intervention and improved outcomes.3 In fact, adults who delay treatment until their hearing loss is severe do not respond to interventions as well as those who initiate interventions early in the course of their hearing loss.3 A good deal of research has focused on adults with diagnosed hearing loss that goes untreated (e.g., the problem of low uptake and use of hearing aids).4 Unfortunately, little is known about people who are unaware of their hearing loss.iStock/Manuel-F-O, internet, telehealth, hearing loss.Our research aimed to explore characteristics that differentiate adults with unrecognized hearing loss from those with recognized hearing loss and adults with normal hearing.5 By definition, it is difficult to conduct systematic research on a population of individuals who are unaware of their impairment and not seeking evaluation or treatment for it. We had a serendipitous opportunity to do so in the process of completing a study on assessment of verbal memory among adults with diagnosed hearing loss. In our initial study, we sought a comparison group of older adults with hearing in the normal range. We then worked with older adults who presented themselves as healthy volunteers for a study that specifically required participants with normal hearing.6 Each participant completed a hearing screen as part of a larger assessment. The screening paradigm identified a surprisingly large subgroup of people who had substantial hearing loss but self-reported that their hearing was normal. Although this unique group was excluded from the original study, we understood that their data presented a rare opportunity to learn more about the characteristics of people with unrecognized hearing loss, which might eventually improve efforts in identifying individuals who are least likely to seek out services independently. STUDY HIGHLIGHTS Our study recruited older adults with and without hearing loss from the Henry Ford Health System (HFHS), Wayne State University (WSU), and the greater Metropolitan Detroit community. Thus, there was an opportunity for participation regardless of hearing status, and no requirement was placed that might motivate potential volunteers to misreport their self-perceived hearing abilities. The total sample comprised 130 adults aged 55 to 85 years old. Of these, 61 were diagnosed with age-related sensorineural hearing loss; they were largely recruited from the audiology services at HFHS and WSU. These volunteers were documented to have speech-frequency pure-tone average (PTA) of air-conduction thresholds of > 25 decibels hearing level (dB HL) at 0.5, 1, 2, and 4 kHz in the better ear. Participants who volunteered for the normal hearing group underwent hearing screens using a portable audiometer as part of the research study. Of the 69 adults who volunteered for that group, our hearing screens indicated that only 39 had hearing in the normal range. Unrecognized hearing loss was identified in 30 volunteers who had described themselves as having no hearing difficulty, but whose hearing thresholds were >25 dB at 0.5, 1, 2, or 4 kHz. As part of the original study, participants completed a subjective and objective assessment of their physical health, various measures of cognition, and personality assessment of their traits for positive and negative affectivity (emotionality). The groups were equivalent in general physical health status, education, estimated IQ, and various cognitive abilities. Marital status and likelihood of living alone also did not differ among the groups. However, consistent with the known risk factors for hearing loss, individuals with unrecognized hearing loss were more likely to be men (60%) and tended to be older (average age of 70 years old) compared with participants with normal hearing (31% men, average age of 65 years old). Importantly, participants with hearing loss were similar in age and proportion of men regardless of whether the hearing loss was recognized or not. Thus, age and gender alone cannot be used to identify individuals particularly at risk for unrecognized hearing loss. Interestingly, individuals in the unrecognized hearing loss group could be differentiated from the groups with hearing in the normal range and recognized hearing loss by their higher levels of positive affectivity. In fact, positive affectivity predicted group membership in the unrecognized hearing loss group even after accounting for age, gender, physical health, and cognitive health. In contrast, negative affectivity did not differ meaningfully among the groups. These results suggest that high positive affectivity may be related to discounting health declines and subsequently delaying intervention. CLINICAL IMPLICATIONS It is widely accepted that hearing screening is an important component of health care for older adults. However, the method used to identify hearing loss and the effectiveness of screening are quite variable. Frequently used techniques include self-report questionnaires or even simply asking if a person has noticed any difficulty hearing.7 However, as highlighted in our study, there is a sizeable subset of people who are likely to deny hearing difficulty upon questioning but have meaningful hearing loss. Individuals who report high positive affectivity are particularly at risk for biased responding on self-reported hearing measures. Typically, positive affectivity is associated with physical health, self-esteem, and subjective well-being;8 yet, it may also be associated with an overly rosy outlook that downplays negative things such as age-related decline, including hearing loss. Some studies have linked optimism and positive affectivity to denial and avoidance. For example, research indicates that people who engage in optimistic denial also tend to underrate their level of health risk.9 Providing educational materials on hearing screening and support for interdisciplinary referrals of patients to audiology services can help promote early identification of and intervention for individuals with age-related hearing loss.10,11 In light of the findings from our study, it is important to keep in mind that a patient's denial of hearing difficulty does not preclude the need for a referral for a hearing screening or assessment. Further research should explore the best practices in psychoeducation about hearing screening that targets patients who do not endorse hearing loss. This may help optimize the likelihood of patient follow-up with assessment and intervention. Previous research has shown that self-perceived hearing problems and hearing-related functional impairment are positively related to help-seeking, hearing aid use, and hearing aid satisfaction across the spectrum of mild-to-severe hearing loss.12,13 Broadly targeted screening programs that specifically comment on the high prevalence (and associated risks) of unrecognized hearing loss may help increase the identification of hearing loss through heightened self-awareness and/or awareness within the person's family and social network. Subsequently, highlighting the importance of early intervention and prevention may enhance motivation and adherence with follow-up treatment among people with unrecognized hearing loss who are identified via screening. Including psychological assessment of readiness for change may also help in understanding a patient's level of awareness of hearing loss and motivation for intervention compliance.14 It may also be useful in engaging family members in discussions about hearing interventions for patients with poor awareness of their hearing impairment.

Hearing Loss in Older Adults

This scoping review aims to synthesize peer-reviewed literature exploring quality of life (QoL) for individuals with age-related hearing loss (ARHL), age-related central auditory processing (ARCAP) deficits, and age-related cognitive decline. A growing body of research has identified ARHL as a risk factor for the development of dementia, highlighting the connection between the sensory and cognitive systems. As the aging population continues to grow, examining comorbid age-related hearing and cognitive decline is especially relevant. These conditions may have potential negative consequences on the daily functioning, social participation, mental health, and overall wellbeing of older adults. A systematic search of peer-reviewed literature was conducted across multiple databases, adhering to the PRISMA guidelines for scoping reviews. Studies that focused on the impact of ARHL, ARCAP deficits, and/or related cognitive deficits on QoL were included in the present review. Key data extracted included QoL measures categorized into the ICF framework, the effects of hearing loss intervention on QoL, and the impact of ARHL on QoL for aging individuals. This review summarizes the reported effects that ARHL, ARCAP, and/or cognitive decline have on older adults, and discusses the clinical and practical implications for managing clients with these conditions. In addition to preventative measures and deficit management, maintenance of life participation, social engagement, and overall wellbeing should be considered when caring for aging adults with hearing and/or cognitive impairment.

When selectively attending to a speech stream in multi-talker scenarios, low-frequency cortical activity is known to synchronize selectively to fluctuations in the attended speech signal. Older listeners with age-related sensorineural hearing loss (presbycusis) often struggle to understand speech in such situations, even when wearing a hearing aid. Yet, it is unclear whether a peripheral hearing loss degrades the attentional modulation of cortical speech tracking. Here, we used psychoacoustics and electroencephalography (EEG) in male and female human listeners to examine potential effects of hearing loss on EEG correlates of speech envelope synchronization in cortex. Behaviorally, older hearing-impaired (HI) listeners showed degraded speech-in-noise recognition and reduced temporal acuity compared with age-matched normal-hearing (NH) controls. During EEG recordings, we used a selective attention task with two spatially separated simultaneous speech streams where NH and HI listeners both showed high speech recognition performance. Low-frequency (<10 Hz) envelope-entrained EEG responses were enhanced in the HI listeners, both for the attended speech, but also for tone sequences modulated at slow rates (4 Hz) during passive listening. Compared with the attended speech, responses to the ignored stream were found to be reduced in both HI and NH listeners, allowing for the attended target to be classified from single-trial EEG data with similar high accuracy in the two groups. However, despite robust attention-modulated speech entrainment, the HI listeners rated the competing speech task to be more difficult. These results suggest that speech-in-noise problems experienced by older HI listeners are not necessarily associated with degraded attentional selection.SIGNIFICANCE STATEMENT People with age-related sensorineural hearing loss often struggle to follow speech in the presence of competing talkers. It is currently unclear whether hearing impairment may impair the ability to use selective attention to suppress distracting speech in situations when the distractor is well segregated from the target. Here, we report amplified envelope-entrained cortical EEG responses to attended speech and to simple tones modulated at speech rates (4 Hz) in listeners with age-related hearing loss. Critically, despite increased self-reported listening difficulties, cortical synchronization to speech mixtures was robustly modulated by selective attention in listeners with hearing loss. This allowed the attended talker to be classified from single-trial EEG responses with high accuracy in both older hearing-impaired listeners and age-matched normal-hearing controls.

Presbycusis or age related hearing loss (ARHL) is the most common sensory deficit in the elderly. It is a multifactorial condition that involves a multitude of intrinsic and extrinsic factors acting on the inner ear over a lifetime, which cumulatively lead to impairments in cochlear transduction of acoustic signals. ARHL is characterized by a loss of hearing sensitivity and a decreased ability to understand speech in the presence of background noise. Epidemiological studies have shown that in the USA hearing loss prevalence approximately doubles every decade of life from the second through to the seventh decade. In Europe, approximately 30% of males and 20% of females have a hearing loss of 30dB HL or more at age 70 years, and 55% of males and 45% of females at age 80 years. Central auditory processing disorders (CAPD) refer to an impairment in the central auditory pathways that leads to impaired speech understanding. The prevalence of CAPD in subjects older than 65 years has been reported to be between 9% and 14%. Recent studies have highlighted the strict correlation between ARHL and cognition in older adults; in particular, hearing impairment could precede the onset of mild cognitive impairment and dementia. The use of hearing tests, and the early diagnosis and treatment of ARHL, may potentially represent a way to prevent cognitive impairment and deserves further research.

You have accessThe ASHA LeaderFeature1 Feb 2012The American Hearing Loss Epidemic: Few of 46 Million With Hearing Loss Seek Treatment Anne OylerAuD, CCC-A Anne Oyler Google Scholar , AuD, CCC-A https://doi.org/10.1044/leader.FTR4.17022012.5 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Hearing loss is the third most prevalent chronic health condition facing older adults (Collins, 1997). But the treatment gap is significant: Only 20% of people who might benefit from treatment actually seek help. Most tend to delay treatment until they cannot communicate in even the best of listening situations. On average, hearing aid users wait more than 10 years after their initial diagnosis to be fit with their first set of hearing aids (Davis, 2007). And the incidence of hearing loss only increases with age—approximately one-third of Americans between ages 65 and 74 and nearly half of those older than 75 have hearing loss (National Institute on Deafness and Other Communication Disorders, 2011). With the population of individuals older than 65 expected to double between 2008 and 2030 to a projected 72.1 million (U.S. Administration on Aging, 2011), audiologists are poised to close the treatment gap. Early and careful evaluation and treatment show great promise in lessening the negative impact of hearing loss on clients' long-term health and quality of life. A Slow Decline Audiologists typically aren't surprised to hear that a spouse or significant other has been frustrated by hearing loss long before the affected individual acknowledges it. The insidious nature of age-related hearing loss—or presbycusis—allows many adults to ignore their hearing loss for years or even decades. One of the first signs of hearing loss often is an inability to hear and understand speech in noisy environments, but communication in all situations is hindered as the condition progresses. Gagné (2011), in explaining why individuals delay seeking hearing health services, eloquently describes the phenomenon of stigma: "In order to live well with hearing loss, one must recognize and accept hearing loss. Specifically, many people must overcome the misplaced shame and poor self-esteem that they may experience." A number of factors contribute to hearing loss in adults, including age, genetics, noise exposure, and chronic disease (e.g., diabetes, chronic kidney disease, and heart disease). Presbycusis advances gradually over time, affects both ears equally, and begins in the high frequencies before spreading to the lower. Because of this slow progression, many adults with presbycusis don't readily acknowledge their hearing loss, instead considering it a normal sign of aging. Not Just Decibels The impact of hearing loss is measured not only in decibels. Hearing loss is an individual experience—how a person copes depends on a great many factors, including early vs. late onset, progressive or sudden loss, the severity of the loss, and communication demands and personality (Kaland & Salvator, 2002). Regardless of the combination of these presenting factors, hearing loss has been linked to feelings of depression, anxiety, frustration, social isolation, and fatigue. Several studies have documented the impact of untreated hearing loss. An oft-cited survey was commissioned by the National Council on Aging in 1999 (Kochkin & Rogin, 2000). This nationwide survey of nearly 4,000 adults with hearing loss and their significant others showed significantly higher rates of depression, anxiety, and other psychosocial disorders in individuals with hearing loss who did not wear hearing aids. The survey examined the positive benefits of amplification and showed that hearing aid use positively affected quality of life for both the hearing aid wearers and their significant others. These findings were consistent with those of a large, randomized control study that found hearing loss to be associated with increased depression and decreased social/emotional, communicative, and cognitive functions for participants who were unaided as compared to those who received hearing aids. These conditions improved after hearing aids were fit (Mulrow, 1990). More recently, Frank Lin and colleagues (2011)at Johns Hopkins found a strong link between degree of hearing loss and risk of developing dementia. Individuals with mild hearing loss were twice as likely to develop dementia as those with normal hearing, those with moderate hearing loss were three times more likely, and those with severe hearing loss had five times the risk. This study could not definitively conclude that early treatment with hearing aids would reduce the risk of dementia, but there was a positive correlation between degree of hearing loss and risk of dementia. Hearing loss is an invisible handicap. Despite its increasing prevalence with age, hearing loss is often ignored during the diagnosis and treatment of cognitive and memory disorders in elderly patients (Chartrand, 2005). The comorbidity of hearing loss and cognitive disorders makes it even more important to determine hearing status prior to any diagnostic protocol. This determination would undoubtedly lead to more appropriate diagnoses and treatment and thus likely to result in better outcomes for individuals with cognitive impairments. Closing the Treatment Gap The impact of untreated hearing loss cannot be ignored. Educating consumers about the importance of seeking early treatment for themselves and their loved ones should be part of the equation. But with the U.S. population aging so rapidly, a health care system that recognizes the importance of early identification and treatment is also critical. Healthy People 2020—a government-sponsored, 10-year agenda for improving the nation's health—outlines several goals related to improving hearing health outcomes for adults. Specifically, Healthy People 2020 calls for an increase in the number of adults older than 70 who use hearing aids and hearing assistive technology, as well as in the number of adults ages 20–70 who have had a hearing evaluation in the past five years (U.S. Department of Health and Human Services, 2010). The fitting of hearing aids should be part of a larger treatment program that includes the person with hearing loss and his or her significant others. Research has shown improved quality of life and overall satisfaction when significant others receive support and education on hearing loss and communication strategies (Kramer, 2005). Group and individual audiologic rehabilitation programs tailored to the individual's communication needs have been shown to encourage feelings of acceptance and confidence that lead to earlier acceptance and improved benefits from carefully fit technology (Chisolm et al., 2004). Holistic rehabilitation approaches that take into consideration other age-related changes such as vision impairment, cognitive decline, and manual dexterity are needed to meet the needs of our growing elder population (Saunders, 2011). Ongoing research and advocacy on the efficacy of early identification and management of hearing loss may encourage better funding for hearing aids, as well as for important audiologic rehabilitation services. Before that change takes place, audiologists can help close the treatment gap. To increase the number of individuals who ultimately benefit from early management, we need to change commonly held perceptions of hearing loss. Audiologists who fit hearing aids must implement audiologic rehabilitation as part of their patient's plan of care, and ensure that individuals who ultimately seek hearing services are treated in a holistic, evidence-based manner that takes their psychosocial, physical, and communication needs into consideration. This article was adapted from "Untreated Hearing Loss in Adults: A Growing National Epidemic," which appeared in the Feb. 2 issue of ASHA Access Audiology. Read the original essay at Access Audiology. Tips for Achieving Better Audiology Outcomes Three dispensing audiologists supplied their tips for achieving optimal relationships with clients and therefore better client outcomes. Although especially relevant for older clients, these suggestions work well with all clients. Frank "Mac" Butts, PhD, CCC-A Hearing Clinics of Virginia Richmond, Virginia Your evaluation should be sufficient to convince yourself of the correctness of your recommendation. Do not confuse empowerment with enabling. Empowering a client to take responsibility for his or her rehabilitation is not the same as giving a modest recommendation and then allowing the client to continue resisting change. The medical model—in which the client brings symptoms that you treat—will not succeed in a private audiology practice. Automation will replace your technical skills. The ability to inspire, motivate, and change people's lives will never be replaceable. Your value as a clinician can be improved exponentially by your understanding of auditory processing in adults and by your ability to evaluate and treat auditory processing disorders. Hearing aids are remarkably better than just a few years ago, but trying to impress the client with technical features undermines your real value to them. We miss the opportunity to help many more people with hearing loss by treating it as an acute condition corrected by a hearing aid instead of a chronic disease managed by amplification and aural rehabilitation. Validation will save you time and frustration when the client starts demanding changes in the search for an unrealistic result. I have never observed an audiologist who could not have improved his or her listening skills. An outcome measure that reveals the impact of the hearing loss is helpful to the clinician, client, and significant others in that person's life. Louis R. Sieminski, PhD, CCC-A The Hearing Center Kingston, Pennsylvania How an elderly client and his or her loved ones are greeted by office staff—and especially the audiologist—is critical. The first few minutes can set the stage for successful outcomes. Older adults—indeed, all clients—should be treated with kindness, respect, and competence. The older adult must immediately feel liked and respected. If clients like and trust you, you will be successful. Trust is vitally important when trying to help someone. Never underestimate the power of a smile and good manners, especially with older adults. Kent E. Weaver, AuD, CCC-A Woodard Hearing Centers Des Moines, Iowa Be genuinely curious about the client as a person. What is the client's perspective on good communication, interaction, and hearing? Find out what the client values. What does the person expect and want, and in what order? Help clients define their goals. Then ask yourself, "What do I have available to help meet their needs?" Get to the demonstration! Demonstrate the benefits of using hearing aids in varied listening situations, as opposed to having no hearing aids. Let clients know you will do everything you can to help them reach their goals through technology and your knowledge. But tell them that treatment is a two-way street, that they must also make an effort. Overcome fear. Defuse uncertainty. Erase doubt. Sources Administration on Aging (2011). Aging statistics. Retrieved from http://www.aoa.gov/aoaroot/aging_statistics/index.aspx. Google Scholar Chartrand M. S.Undiagnosed pre-existing hearing loss in Alzheimer's disease patients.Audiology Online. Retrieved from http://www.audiologyonline.com/articles/article_detail.asp?article_id=1444. Google Scholar Chisolm T. H., Abrams H. B., & McArdle R. (2004). Short- and long-term outcomes of adult audiological rehabilitation.Ear and Hearing, 25(5), 464–477. CrossrefMedlineGoogle Scholar Collins J. G. (1997). Prevalence of selected chronic conditions: United States 1990–1992. National Center for Health Statistics.Vital Health Statistics, 10, 194. Google Scholar Davis A., Smith P., Ferguson M., Stephens D., & Gianopoulos I. (2007). Acceptability, benefit, and costs of early screening for hearing disability: A study of potential screening tests and models.Health Technology Assessment, 11, 1–294. CrossrefGoogle Scholar Gagné J-P, Southall K., & Jennings M. B. (2011). Stigma and self-stigma associated with acquired hearing loss in adults.Hearing Review, 18(8), 16–22. Google Scholar Kaland M., & Salvatore K. (2002). The psychology of hearing loss.The ASHA Leader, 7(5), 4–5, 14–15. Google Scholar Kochkin S., & Rogin C. M. A. (2000). Quantifying the obvious: The impact of hearing instruments on quality of life.The Hearing Review, 7(1), 8–34. Google Scholar Kramer S. E., Allessie G. H., Dondorp A. W., Zekveld A. A., & Kapteyn T. S. (2005). A home education program for older adults with hearing impairment and their significant others: a randomized trial evaluating short- and long-term effects.International Journal of Audiology, 44(5), 255–264. CrossrefGoogle Scholar Lin F. R., Metter E. J., O'Brien R.J., Resnick S.M., Zonderman A.B., & Ferrucci L. (2011). Hearing loss and incident dementia.Archives of Neurology, 68, 214–220. CrossrefGoogle Scholar Mulrow C. D., Aguilar C., Endicott J. E., Tuley M. R., Velez R., Charlip W.S., Rhodes M. C., Hill J. A., & DeNino L. A. (1990). Quality-of-life changes and hearing impairment: A randomized trial.Annals of Internal Medicine, 113(3), 188–194. CrossrefGoogle Scholar National Institute on Deafness and Other Communication Disorders. (n.d.). Quick statistics. Retrieved from http://www.nidcd.nih.gov/health/statistics/Pages/quick.aspx. Google Scholar Saunders G. H., & Echt K. (2011). Dual sensory impairment in an aging population.The ASHA Leader, 16(3), 5–7. LinkGoogle Scholar U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (2010). Healthy people 2020. Washington, DC: Author. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. Google Scholar Author Notes Anne Oyler, AuD, CCC-A, associate director of audiology professional practices, can be reached at [email protected]. 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Hearing Wellness Toolkit for Primary Care

Age-related hearing loss is associated with a decrease in hearing abilities for high frequencies and therefore leads to impairments in understanding speech—in particular, under adverse listening conditions. Growing evidence suggests that age-related hearing loss is related to various neural changes, for instance, affecting auditory and frontal brain regions. How the decreased auditory input and the increased listening effort in daily life are associated with structural changes is less clear, since previous evidence is scarce and mostly involved low sample sizes. Hence, the aim of the current study was to investigate the impact of age-related untreated hearing loss and subjectively rated daily life listening effort on grey matter and white matter changes in a large sample of participants (n = 71). For that aim, we conducted anatomical MRI and diffusion tensor imaging (DTI) in elderly hard-of-hearing and age-matched normal-hearing participants. Our results showed significantly lower grey matter volume in the middle frontal cortex in hard-of-hearing compared to normal-hearing participants. Further, higher listening effort was associated with lower grey matter volume and cortical thickness in the orbitofrontal cortex and lower grey matter volume in the inferior frontal cortex. No significant relations between hearing abilities or listening effort were obtained for white matter integrity in tracts connecting auditory and prefrontal as well as visual areas. These findings provide evidence that hearing impairment as well as daily life listening effort seems to be associated with grey matter loss in prefrontal brain regions. We further conclude that alterations in cortical thickness seem to be linked to the increased listening effort rather than the hearing loss itself.

Objective: The aim of this work was to provide updated epidemiological data regarding the aging population, dementia and age related hearing loss. Study design: This was a review of available data. Results: Aging of the population has resulted in an important epidemiological transition, marked by a widespread increase in the prevalence of chronic diseases, including dementia, a disease with a devastating impact, for which currently there is no cure. In 2010 there were 35.6 million people with dementia worldwide and it is estimated that 48.1 million persons will be affected with dementia in 2020, and 90.3 million in 2040. It is therefore essential to identify known risk factors and to look for new ones, in order to be able to act quickly and effectively on those modifiable. Age related hearing loss or presbyacusis, an extremely common condition among aged individuals, is one of several factors that certainly plays an important role in increasing the risk of cognitive deficit and of developing dementia. The prevalence of hearing loss in American adults aged 70 years and above is 63%; in Europe nearly 30% of males and 20% of females have a hearing loss of 30 decibels or more at 70 years; and 55% of males, 45% of females at the age of 80 years; in Italy one individual in three over 60 years of age, and nearly 60% over 85 years, is affected by age related hearing loss. Conclusion: Several studies have underlined the association between dementia and age related hearing loss, although the underlying mechanisms are not yet clear; the risk of dementia increases three-fold for every 10 decibels of hearing loss.

Functional Mutation of SMAC/DIABLO, Encoding a Mitochondrial Proapoptotic Protein, Causes Human Progressive Hearing Loss DFNA64

Introduction: Age related hearing loss starts at mid to late adulthood. With ageing, cognitive ability also declines. The aims of this study were to assess, compare and correlate cognition of elderly people having bilateral moderate to profound sensorineural hearing loss with the population of normal hearing for age. Methods: This observational analytical study included 25 elderly participants between 55 to 75 years of age in each group; Hearing loss Group with moderate to profound sensorineural hearing loss and Normal hearing Group with normal hearing. Based on pure tone audiometry, hearing loss was classified into moderate (41-60 dB), severe (61-80 dB) and profound (81 and above). Cognition status was assessed using a Nepali version of Mini-mental state examination and classified into no cognitive impairment, mild cognitive impairment and severe cognitive impairment. Comparison and correlation of the cognitive impairment was done between the groups. Results: In Hearing loss Group, 8 (32%) participants and in Normal Hearing Group, 3 (12%) participants had mild cognitive impairment. Means of total Mini-mental state examination scores between the two groups had statistically significant difference (p=0.02) but no significant correlation (Kendall tau b =0.20) between age related hearing loss and cognitive impairment was found. Conclusion: Though cognitive impairment was found more in participants with age related hearing loss, there was no correlation between age related hearing loss and cognitive impairment.

Age-related hearing loss (presbycusis) is a highly prevalent disease and can have a severe negative impact on social interactions, and eventually on the quality of life of the people affected. It is therefore of the utmost importance to find biomarkers from which to evaluate presbycusis. Studying presbycusis comprehensively constitutes a complex undertaking because hearing problems are frequently reported by older adults whose hearing impairment has failed to be identified through the traditional assessment of hearing loss, in which such impairment is viewed as a phenomenon occurring at the auditory periphery only. This PhD thesis is among the first to report behavioral consequences and biomarkers of hearing and speech processing problems in older adults which occur independently of peripheral hearing loss. This PhD thesis provides new insights into auditory perceptual difficulties in older adults and their most common treatment. It extends present frameworks of age- related hearing loss by suitably combining EEG, structural MRI and behavior. The results of the experimental work done in this PhD thesis have several implications: first, novel hearing tests assessing multifactorial aspects of hearing loss, especially central hearing loss, should be implemented in clinics; second, central hearing loss emerges as a function of age-related changes in the morphology and functional lateralization of the auditory areas of the brain; third, peripheral hearing impairment delays central auditory plasticity, which suggests that preventive treatment is the key to understanding speech into old age; and fourth, hearing aids are indispensable for rehabilitation, but clinics need to inform older adults that the hearing aid type and algorithm can only be evaluated after intensive hearing aid usage, across 12 weeks for approximately 12 hours a day. Finally, the fact that hearing aids mainly focus on peripheral hearing treatment points to the necessity for new rehabilitation ideas. It is hoped that the accumulated findings of this PhD thesis will open the door for such novel innovation.

Commentary on “Occupational Noise, Smoking and a High Body Mass Index are Risk Factors for Age-Related Hearing Impairment and Moderate Alcohol Consumption is Protective: a European Population-Based Multicentre Study” by Fransen et al., J. Assoc. Res. Otolaryngol. DOI 10.1007/s10162-008-0123-1

Globally, it is estimated that approximately 1.3billion people live with some form of hearing impairment. Major causes of hearing loss include infection/disease, age-related factors, and occupational factors. Numerous systematic reviews and meta-analyses have attempted to synthesise literature on these topics. To date there has not been asystematic evaluation of the relationships between hearing impairment and diverse physical, mental, and social outcomes. We performed an umbrella review of systematic reviews of observational studies with meta-analyses for any physical disease, biomarkers of disease, mental health or cognitive outcomes, and/or modifiable risk factors associated with hearing impairment. For each meta-analytic association, random effects summary effect size, 95% confidence intervals, heterogeneity, evidence for small-study effect, excess significance bias and 95% prediction intervals were calculated, and risk of bias was assessed via the AMSTAR2 tool. These were used to grade significant evidence (p < 0.05) fromI toIV, using the recommendations from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. From 3747studies, 21 were included covering 54outcomes. Overall, 44/54 outcomes (82%) yielded significant results. Of the highest quality evidence, age-related hearing loss and non-specific hearing impairment were negatively associated with several types of cognitive impairments; pediatric bilateral hearing loss was negatively associated with quality of life, sensorineural hearing loss was positively associated with rheumatoid arthritis and tinnitus was positively associated with temporomandibular disorders. Results show moderate quality evidence for associations between several types of hearing impairments and cognitive difficulties, quality of life and systemic diseases such as rheumatoid arthritis. Practitioners and public health policies should note these findings when developing relevant healthcare policies.

ObjectivesAge-related hearing loss (ARHL), also known as presbycusis, is a chronic disorder characterized by impairment of the transduction of acoustic signals. This study analysed the prevalence and demographic characteristics of ARHL in the Korean population.MethodsWe used the data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2012 and analysed the association between age and hearing impairment. A total of 16,799 adults were selected for the current study. Physical examinations, blood tests, otoscopic examinations, and hearing tests were performed. The demographic variables included age, gender, obesity, economic status, education level, noise exposure history, and underlying diseases.ResultsAmong 16,799 participants, the prevalence of unilateral hearing loss was 8% (1,349 people), and bilateral hearing loss was 5.9% (989 people). Men were 53.4% more likely to have hearing loss than women. Age and underlying diseases, like hypertension, diabetes, and abdominal obesity, were significantly associated with hearing loss (P < 0.0001). Further, mental health factors, such as cognitive function, depression, and suicidal ideation, were related to hearing loss. The prevalence of hearing loss increased with advancing years, especially in the high frequency of 6 kHz, with a sharply increase in patients aged 65 and over.ConclusionThe analysis of auditory performance in the Korean population confirmed the association of high-frequency hearing loss with advancing age. A threshold of 6 kHz should be included to correctly diagnose hearing impairment in elderly patients. Patients with ARHL should be provided with suitable aural rehabilitation that includes active high-frequency control.