8/25/2016

Hearing Loss in the Aging Population Taylor D. Widener Au.D, CCC-A

Objectives • Understand the importance of regular hearing screening for all patients over 60 years old, and/or those with significant noise exposure history. • Recognize the effects of hearing loss, including cognitive decline • Provide appropriate counseling to patients, as patient perceptions and expectations are the most important factors in patients acquiring and using hearing aids. • Acknowledge that hearing aid success is largely dependent on motivation and realistic expectations. • Discuss multiple technology options (other than hearing aids) that may help individuals with all types of hearing loss. A referral to an audiologist is the best option to determine which options are available for a patient.

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Prevalence • • • •

3 in 10 people over age 60 have hearing loss 1 in 6 baby boomers (ages 52-70) have a hearing problem 1 in 14 Generation Xers (ages 29-51) already have hearing loss Only 13% of physicians routinely screen for hearing loss during a physical • Most people with hearing impairments hear well in a quiet environment like a doctor’s office (those with high-frequency hearing loss typically do okay in quiet) • Hearing Loss Simulator - Find Out What Hearing Loss is Like

• The average patient waits 7-10 years before seeking treatment for hearing loss

Signs of Hearing Loss Socially: • require frequent repetition • have difficulty following conversations involving more than 2 people • think that other people sound muffled or like they're mumbling • have difficulty hearing in noisy situations, like conferences, restaurants, malls, or crowded meeting rooms • have trouble hearing children and women • have your TV or radio turned up to a high volume • answer or respond inappropriately in conversations • read lips more intently

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Signs of Hearing Loss Emotionally: • feel stressed out from straining to hear what others are saying • feel annoyed at other people because you can't hear or understand them • feel embarrassed to meet new people or from misunderstanding what others are saying • feel nervous about trying to hear and understand • withdraw from social situations that you once enjoyed because of difficulty hearing Medically: • have a family history of hearing loss • presence of tinnitus • take medications that can harm the hearing system (ototoxic drugs) • have diabetes, heart, circulation or thyroid problems • have been exposed to very loud sounds over a long period or single exposure to explosive noise

Changes to outer ear common with aging • External Auditory Canal • Thinning and drying of skin • Prone to trauma, itching

• Collapsed canals • Atrophy of cartilage

• Impacted cerumen • Growths (exostosis, carcinomas) RcSullivan.com

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Middle ear and aging • Stiffening of tympanic membrane • Acute Otitis Media • Otosclerosis • Cholesteotoma • Glomus tumors • Squamous cell carcinomas • Trauma Dallasear.com

Inner ear and aging • Cochlea • Presbycusis • Hormonal changes

• Vestibular System • • • •

Dizziness: BPPV, Postural hypotension Visual Deficits Somatosensory Responses Musculoskeletal Deficits

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Other Causes of Hearing Loss • Cardiovascular Disease • Many studies show a tie between cardiovascular disease and hearing loss • A research review looking at over 70 studies over 60 years from Wichita State University confirmed a direct link between cardiovascular health and hearing loss (Hull & Kerschen, 2010)

• In a separate study when controlling for age, hypertension, diabetes, smoking and hyperlipidemia, low-frequency hearing loss was significantly associated with intracranial vascular pathology such as stroke and TIA • Significant associations were also seen with peripheral vascular disease, coronary artery disease and a history of MI

Other Causes of Hearing Loss • Diabetes • Those with diabetes are twice as likely to have hearing loss than non-diabetics (American Diabetes Association, 2016)

• Kidney Disorders • Genetic Factors • Ototoxicity • Antibiotics (aminoglycosides, erythromycin)

• • • •

Anti-inflammatory drugs (NSAIDs) Loop diuretics Chemotherapy Drugs Cardiac medications (tinnitus)

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Hearing loss and cognition • Presbycusis, is one of the top three chronic medical conditions of older people, along with high blood pressure, and arthritis. • Nearly 60 % of people age 80 and over report hearing difficulties (Newman DL, et al. 2012)

• Dr. Frank Lin, an otologist and epidemiologist, and his colleagues at Johns Hopkins University found a strong link between degree of hearing loss and risk of developing dementia. • Mild hearing loss patients are twice as likely to develop dementia • Moderate hearing loss were three times more likely • Severe hearing loss have 5x the dementia risk as normal hearing patients

Hearing loss and cognition • Current estimate that 36% of the dementia risk is attributable to hearing impairment • This is a theoretical estimate that is currently being tested

• Increased listening effort and atrophy in underused brain regions • Likely causing changes in brain structure and function

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Hearing Loss and Cognition

Lin et al.

Hearing loss and falls • 2,017 participants ages 40 to 69 had their hearing tested and answered questions about whether they had fallen over the past year. • People with a 25-decibel hearing loss, classified as mild, were nearly three times more likely to have a history of falling. • Every additional 10-decibels of hearing loss increased the chances of falling by 1.4 fold.

• Gait and balance are cognitively demanding • Likely result of environmental awareness and cognitive load (Kamil, et al., 2016)

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Other effects of untreated hearing loss • Higher rates of depression, anxiety, and other psychosocial disorders in individuals with hearing loss who were not wearing hearing aids • Compared to HA users • Hearing aid use was found to positively affect quality of life for both the hearing aid wearer and his or her significant other. (Kochkin & Rogin, 2000)

The role of primary care • 63 percent of people listed their primary care physician as the most important source of information about where to go for hearing health care services • Persons with hearing loss are eight times more likely to be positively inclined to purchase a hearing instrument if their physician has recommended one (Popp & Hackett, 2002)

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Screening Tests • Available tests include physical diagnostic tests, such as the whispered voice, finger rub, and watch tick tests • Patient Questionnaires • Hearing Handicap for the Elderly-Screening • 10 items • Yes, No, Sometimes

Hearing aids • Current hearing aids are more than simple amplifiers • Typical high-end hearing aids have around 20 frequency channels that can be independently adjusted at 4 input levels, changing gain and compression of sounds

• Hearing aids can identify environments and self-adjust with more than 90% accuracy • Capacity to handle 1.2 billion operations per second

• Wireless connectivity • 2.4 GHz, made for-iPhone • Bluetooth • IFTTT (If This Then That) is an ever expanding internet-based service, which enables you to integrate your hearing solution with a vast range of online products and solutions such as your home lighting, doorbell, alarm system, and mobile phone

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Other solutions • • • • •

FM systems TV streamers CROS/BICROS systems Bone-anchored devices Cochlear implantation (including Hybrid) • ‘Permanent’ hearing aids

Cochlear Americas

Other Solutions

Sonova.com

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Wrapping it up • Screen patients over 60 years old • HHIE can be completed with intake paperwork • Refer to audiologist for complete evaluation • http://www.asha.org/profind/

• Counsel regarding effects of untreated hearing loss • Recommend seeking hearing aids or other assistive devices • Patients must acclimate to hearing things they aren’t used to hearing

References Bogardus, Jr, S. T., Yueh, B., & Shekelle, P. G. (2003). Screening and Management of Adult Hearing Loss in Primary Care. JAMA, 289(15), 1986. doi:10.1001/jama.289.15.1986 Friedland, D. R., Cederberg, C., & Tarima, S. (2009). Audiometric pattern as a predictor of cardiovascular status: Development of a model for assessment of risk. The Laryngoscope, 119(3), 473-486. doi:10.1002/lary.20130 Hull, R. H., & Kerschen, S. R. (2010). The Influence of Cardiovascular Health on Peripheral and Central Auditory Function in Adults: A Research Review. American Journal of Audiology, 19(1), 9. doi:10.1044/1059-0889(2010/08-0040) Kamil, R. J., Betz, J., Powers, B. B., Pratt, S., Kritchevsky, S., Ayonayon, H. N., … Lin, F. R. (2015). Association of Hearing Impairment With Incident Frailty and Falls in Older Adults. Journal of Aging and Health, 28(4), 644-660. doi:10.1177/0898264315608730 Kates, J. M. (1995). Classification of background noises for hearing-aid applications. The Journal of the Acoustical Society of America, 97(1), 461. doi:10.1121/1.412274 Newman, D. L., Fisher, L. M., Ohmen, J., Parody, R., Fong, C., Frisina, S. T., … Friedman, R. A. (2012). GRM7 variants associated with age-related hearing loss based on auditory perception. Hearing Research, 294(1-2), 125-132. doi:10.1016/j.heares.2012.08.016 Popp, Paul & Hackett, Gregg (2002). Survey of Primary Care Physicians: Hearing Loss Identification and Counseling Audiology Online Scheck, Anne (2012). Breaking New: Hearing Tests by ADA Reveal Link between Hearing Loss and Diabetes. The Hearing Journal, 65(6), 20-22. doi: 10.1097/01.HJ0000415185.65419.05

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