Jenny BashiruddinDepartemen THT FKUI-RSCM

Jakarta

Introduction Presbyacusis : sensory neural hearing

loss, gradually ,in elderly, degeneration disorders, bilateral, symmetric, start in high frequencies

Limitation in communicationIsolated

Epidemiology demography1990, >65 yr : 6,7 million people 2020 estimation :18,8 million

people Prevalence presbyacusis >65 yr : 30 %>75 yr : 50%

Presbyacusis in Indonesia : 9,3 million peopleUS census Bureau International

Data Base th 2004

Epidemiology1 off 3 American, age 65-75 yr suffer

hearing loss The National Institute on Deafness &

other Communication Disorders

(NIDCD)

8,58 million England suffer hearing loss : 75% age >60 yr

The UK National Study of Hearing Disorder 1995

Industrial population >>

Prevalence

National Academy on an aging society Hearing loss-A Growing Problem that effect quality of life.Des 1999

EtiologiAtherosclerosis /cardiovascular diseasesDiet and metabolismAccumulation noise inducedDrugs/ toxic substances StressGenetic

DIAGNOSIS• Screening • Anamnesis Otoscopy Tuning fork tes Pure tone Audiometri Speech Reception Test (SRT) Speech discrimination scor (SDS)

Anamnesis : Aged >60 yearsHearing impaired slowly, progressive,&

symmetries, TinnitusDifficulties hearing in noise

(Cocktail party deafness)Pain in hearing loud sound(recruitment)

Diagnosis

SymptomSlowlyImpaired in high frequenciesWomen and children voice difficult to hearTinnitusRecruitment

Sign and Symptom

High frequency hearing loss. Gradually, bilateral and symetricDifficulty in differentiated the consonant

s, r, n, c , h, ch. Coctail party deafness. Recruitment : over increasing sensitivity

Audiology Test DiagnosticPure tone

Audiometry

Speech Reception Test (SRT)

Speech Discrimination Score (SDS)

Physical examination/ Otoscopy normal

Audiogram : sensory neural hearing loss in >1000Hz frequency

Speech Audiometric test : Speech discrimination score decrease

Presbyacusis: sensoris

Atrophy epithel, hair cell, organ Corty

Basal chochleaHigh frequency

loss.Steeply sloping

high frequency hearing loss

Presbyacusis NeuralAtrophy neuron cell in

cochleaSpiral gangglion, in

auditory central pathway2100 neuron loss every

decadeSpeech Discrimination

score loss unproporsional

Regresi fonemSloping audiogram

Presbyacusis metabolic (strial)

Atrophy stria vascularBioelectrika dan

biochemical endolimfaFlat audiogramSpeech

Discrimination score normal

Aged 30-60 yrGenetic influence

Presbyacusis mechanicThickening basal

membrane cochleaHigh frequency

loss, slowly progressive

Slowly progressive sloping high frequency sensoryneural hearing loss

Management:NeurotonicAvoid loud noise, ototoxic Annual hearing testRehabilitation:

Hearing aid, lip reading & auditory training

ManagementHearing aidHearing devicesLip readingImplant cochleaConsultationDietActivities

PrognosisProgressiveAvoid etiology factors

Impact of lifeQuality of lifeSocial isolatedLess activitiesDepression emotional problemFrustrated othersLess Interpersonal relationship Lonely

Quality of life Hearing problem could impact function

and psichosocial life such as :Daily comunication Phone comunication (social and

emergency) Social attitudeFamily relationship, activity and time

leisureSafetyIndependent living.

SummaryChanges in Presbyacusis :Changes cochlea structures and audit0ry

nerves Atrophy and hair cell degeneration in organ

CortyChanges vascularisation and decreasing

volume and size of nerves

SummaryPresbyacusis could

managed properlyNeed early

identification Psychosocial impact

should be consider Try to identification of

etiology and specific problem.

Need support from family, friends and surrounding