Disease Index Ear, Nose and Throat Geriatric Health

Presbycusis

Presbycusis is defined in general terms as sensorineural hearing loss associated with advanced chronological age.There are many causes of hearing loss in older people, including environmental factors such as exposure to noise and ototoxic drugs, genetic factors, and generalized effects of aging such as cell damage and neural degeneration.

What is Presbycusis?

Hearing loss is classified as sensorineural (inner ear or neural etiology), conductive (due to the inability of sound to reach the inner ear from an external ear, tympanic membrane or middle ear problem), or mixed (a combination of sensorineural and conductive hearing loss).

Presbycusis is defined in general terms as sensorineural hearing loss associated with advanced chronological age. Some discrepancy exists in the medical literature regarding the use of this term. Most clinicians define Presbycusis as age related hearing loss that is due to the effects of aging in addition to the combined effects of lifelong noise exposure, trauma, ototoxic agents, and other factors. Other clinicians have used a more restrictive definition of the term to indicate that portion of hearing loss that is attributable solely to advanced age.

In general, however, Presbycusis refers to hearing loss associated with advancing age but of multifactorial etiology where no specific cause can be identified.

How common is Presbycusis?

Presbycusis is a very common problem. It is the most common type of sensorineural hearing loss in industrialized countries. Approximately 40% of the population of the United States over age 65 is affected.

This loss increase with advancing age, Presbycusis is generally more common and more severe in men, whose hearing diminishes at a rate about twice that of women.

Causes of Presbycusis

The term Presbycusis, refers to age related hearing loss. There are many causes of hearing loss in older people, including environmental factors such as exposure to noise and ototoxic drugs, genetic factors, and generalized effects of aging such as cell damage and neural degeneration.

Many age related hearing impairments are types of sensorineural hearing loss involving damage to the cochlea, or inner ear. The hallmark of this damage is the elevation of the thresholds of audibility for high frequency pure tones.

Our knowledge of cochlear pathology, its effects on perception, and many issues pertaining to treatment and rehabilitation can be generalized across the adult age range. In addition to types of cochlear damage that are common to adult across the age range, the peripheral and central auditory systems of older adults may also be damaged in ways that are not typical in younger adults. Furthermore, older adults often exhibit perceptual deficits that are disproportionate to the problems observed in younger adults with similar hearing thresholds. Importantly, studies of several species of mammals have demonstrated that hearing declines as a function of chronological age, even when all genetic and potentially damaging environmental effects have been carefully controlled.

The classification of subtypes of Presbycusis, defined according to the particular structures of the auditory system that are affected by age, has continued to be refined for over four decades. Unfortunately, there is not straightforward correspondence between damage to particular structures and perceptual deficits.

Damage at multiple sites likely contributes to the differences in auditory processing that are observed between younger and older adults with similar hearing thresholds. Although high frequency pure-tone threshold elevation is very common in older adults, the more age specific structural and perceptual aspects of Presbycusis have been the focus of most research conducted in the past decade.

(Mary Ann Forciea, Risa Lavizzo-Mourey, Edna P. Schwab-Geriatric secrets 2004:140-43)

What are the clinical characteristics of Presbycusis?

Presbycusis presents as bilateral, symmetric, sensorineural hearing loss of insidious onset. Often conversation, especially in a quiet environment, remains unaffected because the frequencies involved in hearing loss are higher that those encountered in normal speech (500-200Hz).

This high frequently hearing loss, however, can make it more difficult to hear clearly in the presence of background sound because the high frequency consonant sounds are most affected.

One subtype of Presbycusis presents with very poor speech discrimination at a relatively early stage of the disease. There tends to be a progressive loss in hearing with advancing age. The ear examination is normal, and no other otologic disease can account for the hearing deficits observed.

What are the treatment options for Presbycusis?

The sensorineural hearing loss of Presbycusis is not in itself reversible; however, the ability to function with hearing loss can be greatly enhanced by technological advances made in the hearing sciences. Current treatment regimens include:

  • Hearing aids. Many patients with Presbycusis benefit from the use of hearing aids. The recent advances made in hearing aid technology, including the use of digital hearing aids, has improved the sound quality and functional usefulness or hearing aids. The current hearing aids can function better in the presence of background sound amplification has models, although unfortunately the interference from background sound amplification has not been eliminated totally. Some patients with severe to profound hearing loss, complex audiometric configurations, or neural Presbycusis with very poor speech discrimination, however, may receive limited benefit from even the current hearing aid technology.
  • Assistive listening devices can help patient with activities of daily living. Such devices as telephone earphone amplifiers, loud door buzzers, and television and radio amplifiers can be of great use for the elderly patient with hearing loss.
  • Implantable sound conduction devices, also known as implantable hearing aids, have just been approved by the FDA for use in the United States. These devices can provide increased gain and sound clarity compared to conventional hearing aids but requires surgery to be implanted. They work by surgically attaching a magnet to move the ossicles, which amplifiers the sound.
  • Cochlear implants are used for patients with severe to profound bilateral sensorineural hearing loss who no longer obtain significant benefit from hearing aids. Multichannel electrodes are surgically implanted into the cochlea. When these electrodes are stimulated by the externally worn sound processor and transmitter, the remaining auditory nerve is electrically stimulated in a coded pattern bringing sound to the brain. In the proper candidate the hearing results can be quite dramatic.
  • Counseling and emotional support. It is vitally important that health care professionals and family members provide support to the elderly patient with Presbycusis. Those close to the patient must understand the social aspects involved in Presbycusis. Hearing loss is a significant source of disability, and any support that can be provided to the patient with Presbycusis helps the patient to cope with this problem.

Homeopathic treatment of Presbycusis – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat Presbycusis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat Prebycusis that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of Presbycusis:

Graphites, Baryta Carb, China, Petrolium, Nitric Acid, Causticum, Silicea, Natrum Mur, Lycopodium, Phosphorous, Alium Cepa, Natrum Mur, Carbo Animalis and many other medicines.

(Patrick R. Hof. Charles V. Mobbs- Handbook of the neuroscience of aging 2009:193)

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Ashish Sharma

Ashish Sharma

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  • The topic is informative and useful. Could I get an homeopathy expert advise free of charge on my hearing problem.