Presbycusis Slides PDF

12/12/2022 ENT TOPICS: PRESBYCUSIS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES At the completion of this lecture, the student will be able to: List the risk factors associated with presbycusis Recognize the pathophysiology of pres...

12/12/2022 ENT TOPICS: PRESBYCUSIS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES At the completion of this lecture, the student will be able to: List the risk factors associated with presbycusis Recognize the pathophysiology of presbycusis Describe the clinical presentation and work up of a person with presbycusis Develop a medical plan for a person with presbycusis 1  12/12/2022 INTRODUCTION The term presbycusis refers to age-related, sensorineural hearing impairment in elderly individuals Presbycusis arises from multiple factors that, over a number of years, result in progressive and symmetrical hearing loss. RISK FACTORS -MULTIFACTORIAL Aging Stress Arteriosclerosis may cause diminished Genetics perfusion and oxygenation of the cochlea. Salicylates, loop diuretics, cisplatin Diabetes accelerates the process of atherosclerosis, which may interfere and quinine with perfusion and oxygenation of the Chronic middle ear infections and cochlea. chronic ceruman impaction Accumulated exposure to noise Drug and environmental chemical exposure Ototoxic drugs 2  12/12/2022 PREVALENCE OF PRESBYCUSIS One in three older adults over age 65 has hearing loss. About half of people over age 75 have hearing loss. Presbycusis usually occurs gradually, and typically in both ears equally, with some people not immediately aware of the change. 3  12/12/2022 PATHOPHYSIOLOGY Histologic changes associated with aging Neural presbycusis: This refers to atrophy of occur throughout the auditory system nerve cells in the cochlea and central neural pathways from the hair cells of the cochlea to the auditory cortex in the temporal lobe of Metabolic (ie, strial) presbycusis: This condition the brain. results from atrophy of the stria vascularis. Mechanical (ie, cochlear conductive) Sensory presbycusis: This refers to presbycusis:This condition results from epithelial atrophy with loss of sensory thickening and secondary stiffening of hair cells and supporting cells in the organ the basilar membrane of the cochlea. of Corti. CLINICAL PRESENTATION- THE PATIENT REPORTS: Speech of others sounds mumbled or slurred High-pitch sounds, such a ”s’, or “th” are hard to distinguish Conversations are difficult to understand, particularly when there is background noise Men's voices are easier to hear than women's Some sounds seem overly loud and annoying Tinnitus (ringing in the ears) may occur in one or both ears 4  12/12/2022 WORK-UP OF PRESBYCUSIS Evaluation may entail a variety of tests, Audiometric testing with pure- including blood tests for autoimmune- tone average and speech induced hearing loss. discrimination forms the cornerstone Evaluation may entail a variety of tests, of diagnostic testing for presbycusis. including CT scanning or MRI to exclude The need for additional testing can anatomic abnormalities or mass lesions usually be determined from the that may cause hearing loss. audiometric test results. Rinne and Weber tests TREATMENT OF PRESBYCUSIS Specific treatment for presbycusis will be determined by the provider based on age, extent of loss, tolerance for specific therapies/procedures, and expectations for the course of the disease. Avoiding loud noises and reducing noise exposure. Wearing ear plugs or special fluid-filled ear-muffs. Refer to an audiologist for hearing aid(s). Refer the patient for lip-reading instruction. Assistive devices, such as telephone amplifiers. Training in speech reading. Some patients with presbycusis benefit from cochlear implants. 5  12/12/2022 CONSIDERATIONS FOR THE GERIATRIC POPULATION The American Speech-Language-Hearing Association recommends a hearing screening every 3 years for adults aged 50 years old and greater. Many patients are not aware of the change in their hearing at first. When engaging with this population, utilizing proper lighting and visibility can be helpful. Presbycusis can significantly impact everyday life causing loneliness, isolation, dependence and frustration as well as depression. REFERENCES Buttaro, T.M, Trybulski, J., Bailey, P.P. & Sandburg-Cook, J. (2017). Primary care a collaborative practice. (5th ed). St Louis, Missouri: Mosby Elsevier. Saadi, R. & Meyers, A. (2021, March 29). Presbycusis. Retrieved June 16, 2022, from https://reference.medscape.com/article/855989-overview 6