Hearing Impairment in Old Age

Abstract

Background: Hearing impairment associated with old age (presbycusis) is becoming more common because the population is aging.

Methods: This review is based on publications retrieved by a selective search in Medline and Google Scholar, including individual studies, meta-analyses, guidelines, Cochrane reviews, and other reviews.

Results: The cardinal symptom of presbycusis is impaired communication due to bilateral hearing impairment. Patients may be unaware of the problem for a long time because of its insidious progression. Evidence suggests that untreated hearing impair- ment in old age can have extensive adverse effects on the patient's mental, physical, and social well-being. Early detection is possible with the aid of simple diagnostic tests or suitable questionnaires. In most cases, bilateral hearing aids are an effective treatment. Surgery is rarely indicated. For patients with uni- or bilateral deafness, a cochlear implant is the treatment of choice. These treatments can improve many patients' quality of life.

Conclusion: The small amount of evidence that is currently available suggests that presbycusis is underdiagnosed and under- treated in Germany. Early detection by physicians of all specialties, followed in each case by a specialized differential diagnostic evaluation, is a desirable goal.

Figure 1:

a) Weber test. For this test, the handle of a vibrating (440 Hz) tuning fork is placed on the top of the patient’s head. Patients with normal hearing in both ears will hear the sound equally in both ears. In a patient with right-side hearing loss, if the sound of the tuning fork is heard as louder on the right side, this suggests either a conductive or an outer-ear impairment. If, however, the sound is heard as louder on the left side, this indicates sensorineural hearing impairment on the right side. b) and c) Rinne test. In this test, the vibrating tuning fork is placed first on the mastoid (to test bone conduction) behind the affected ear. The patient is asked to say whether he or she can hear the tone, and the moment at which the sound is no longer heard. The tuning fork is then immediately held just by the outer ear (to test air conduction). If the patient can still hear the tone with the tuning fork in this position, the Rinne test result is positive (“normal finding”). If the tone is not heard, the test result is negative.

Figure 2:

Mini Audio Test for early screening of hearing impairment (16). Further specialist otolaryngological diagnostic investigation is required in patients aged 50 or over (age group [AG] 1) with a total score of 2 or more, or patients aged 60 or over (AG 2) with a total score of 3 or more (sensitivity AG1: 0.66. AG2: 0.69; specificity AG1: 0.62, AG2: 0.80; positive predictive value AG1: 0.60, AG2: 0.89; negative predictive value AG1: 0.49, AG2: 0.30). Answer scores: “Agree“ ……………………………… 2 points “Partly agree“ ……………………….. 1 point “Disagree“ …………………………... 0 point Add up the total number of points.

Figure 3

Typical pure-tone audiogram in presbycusis (bilateral, almost symmetrical, predominantly high-frequency sensorineural hearing impairment)

Figure 4

Types of hearing aid design (schematic), from left to right: Completely In Canal (CIC), In The Ear (ITE), Receiver In Canal (RIC), and Behind The Ear (BTE)