Sunday, January 15, 2006

presbycusis (hearing loss)

Presbycusis is the loss of hearing that accompanies advancing age. This nerve type hearing loss in older people has been attributed to atrophy of the end-organ, neural degeneration, vascular changes in the stria vascularis (fibrous tissue that covers the cochlea duct), or other changes in the inner ear.
Etiology of this condition has not been clearly established but the role of circulation, nutrition, heredity, tissue changes, climate, accumulative exposure to daily noise, and the stress of modern civilization all have been suggested as contributing factors. In some people, presbycusis may be compounded by the presence of a treatable disorder such as diabetes, multiple sclerosis and metabolic disorders, or the toxicity of the use of certain drugs. Drugs that are known to cause hearing loss after prolonged use are aspirin, quinine, caffeine, aminoglycosides, and other antibiotics and some diuretics. Often a change in the drug will alleviate the problem.
Symptoms are minimal for most of these patients because of the slow progression of the hearing loss. Loss of higher-frequency sounds associated with high-pitched tinnitus is an early symptom.
Family members and friends are usually more aware of the problem than the patient is. They have learned to speak more clearly, loudly, and slowly to the patient. Older people may also unknowingly have learned to engage in face-to-face conversation, and to eliminate as many external noises as possible.
The patient may begin to withdraw from outside contacts and social encounters because of his or her inability to hear or understand conversation. Frequently, patients resist rehabilitative efforts, possibly because of the supposed stigma of a handicap created by wearing a hearing aid. It is important for these patients to maintain hope and realize that hearing loss is not always progressive and that many advances are continually being achieved through research.
Ballenger, J. J. Diseases of the Nose, Throat, Ear, Head and Neck, 13th ed. Philadelphia: Lea & Febiger, 1985.


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