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Presbycusis
Introduction
Presbycusis refers to bilateral age-related hearing loss. In literal terms, presbycusis means "old hearing" or "elder hearing."[1] It becomes noticeable around age 60 and progresses slowly; however, there is evidence that certain stressors can speed the rate of deterioration. The diagnosis can be confirmed with audiometry.[2] The hallmark of presbycusis is the impaired ability to understand high-frequency components of speech (voiceless consonants, such as p, k, f, s, and ch).[3] There is no cure; however, hearing aids that amplify sounds can be used to mitigate symptoms. Anatomically, presbycusis involves multiple components of the auditory system. It is primarily due to age-related changes in hair cells, the stria vascularis, and afferent spiral ganglion neurons.[4]
During the normal hearing, sound, in the form of air vibration, is captured by the funnel-shaped external ear and is directed to the tympanic membrane. This causes the tympanic membrane to vibrate at a specific frequency and amplitude. This movement is amplified by three small bones in the middle ear: the malleus, incus, and stapes. From there, the signal proceeds as vibrations that are transmitted through the fluid within the inner ear to the cochlea. In the cochlea, receptors known as hair cells transform the information encoded in the vibrations into a neurologic signal which travels to the auditory cortex via the cochlear nerve.[5]
Etiology
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Etiology
Presbycusis is multifactorial in origin. In addition to age-related degeneration leading to physiologic and anatomic changes, other contributing factors include genetic factors, hormones, exposure to loud noises or ototoxic agents, history of ear infection, and the presence of certain systemic diseases.[6][7]
Age-Related Factors
Presbycusis can be broken down further with regards to which structures and functions are primarily affected. Some argue that there is little clinical utility in subdividing presbycusis as there is no significant change in approach or treatment, and oftentimes mixed pathology is present.[6][8][9] Presently, there are thought to be six categories of presbycusis: sensory, neural, strial, mechanical, mixed, and indeterminate.[4][10]
- Sensory presbycusis: loss of receptor hair cells at the basal aspect of the cochlea resulting in characteristic high-frequency hearing loss.[6]
- Neural presbycusis: loss of cochlear nerve fibers as well as the loss of spiral ganglion neurons.
- Strial presbycusis: degeneration of stria vascularis cells. These cells are essential for maintaining the appropriate ion composition of endolymph to generate the endocochlear potential for signal transduction.[11] Sometimes referred to as metabolic presbycusis.
- Mechanical presbycusis (cochlear conductive): due to physical changes of the cochlear duct. This is accompanied by a specific audiogram pattern.[4]
- Mixed presbycusis: characterized by pathologic changes in more than one of the above structures.
- Indeterminate presbycusis: cases in which changes to the above structures are not significant.[4]
Genetic Factors
Genetic factors, specifically, differences in mitochondrial DNA expression genes related to oxidative stress, have been found in patients with presbycusis when compared to controls.[12][13][14]
Ototoxic Factors
There are multiple medications associated with ototoxicity, including salicylates, loop diuretics, aminoglycoside, and certain chemotherapeutic agents.[15][16][17] Additionally, some work and environmental-related exposures to chemicals such as toluene, styrene, lead, carbon monoxide, mercury, and other toxins have been shown to cause ototoxicity.[18] Minimizing exposure to these agents can help to prevent age-related hearing loss.[19]
Noise Exposure Factors
Some long-term studies have shown that individuals who have sustained noise-induced cochlear damage in their youth go on to develop more severe presbycusis. Anatomically, noise exposure may lead to damage and subsequent loss of spiral ganglion neurons.[14][20]
Hormonal Factors
Glucocorticoids, sex hormones, and glutamate signaling are thought to play a role in presbycusis.[14] Prolonged corticosterone levels and loss of nuclear factor kappa B have been associated with increased spiral ganglion neuron loss.[21][22] The use of progestin and combination hormone replacement therapy in postmenopausal is associated with a more frequent incidence of hearing loss.[23]
Epidemiology
Presbycusis is the most common cause of hearing loss worldwide and is estimated to affect approximately two-thirds of Americans aged 70 or older.[24] It is difficult to determine the exact prevalence because the criteria used to define hearing loss differs among investigators. There have been multiple attempts to assess the frequency of hearing loss among large cohort populations, including participants from studies such as the national health and nutrition examination survey (NHANES), and the health aging and body composition (ABC) study.[25] According to data from NHANES, which represents a cross-section of non-institutionalized Americans, the prevalence of hearing loss approximately doubles with each subsequent decade from age 12 to age 79.[26] Among participants in the Health ABC study, hearing loss was most prevalent in white men, followed by white women, black men, and black women.[27]
Worldwide, there are similar increases in prevalence with age. Presbycusis affects more than half of older adults by age 75 and nearly all adults over age 90.[28] The World Health Organization estimates that by 2025, among those aged 60 and above, greater than 500 million will have significant age-related hearing loss.[29]
Pathophysiology
Presbycusis is thought to be multifactorial in origin, and some components are not fully understood. Both intrinsic factors, such as genetics, as well as external factors (noise exposure, smoking, medications, and certain co-morbidities), are involved.[3] It is primarily due to age-related changes in hair cells, the stria vascularis, and afferent spiral ganglion neurons.[4] Presbycusis is a type of sensorineural hearing loss with the involvement of the inner ear or neurologic pathways that form connections to the auditory cortex.[2]
History and Physical
Presbycusis is generally insidious in onset, and mild cases are difficult to detect. It is imperative that primary care providers screen for hearing loss, especially geriatricians and those caring for adults age 60 and beyond. Often, family members and friends are more aware of hearing loss than patients themselves. A common initial presentation is difficulty discriminating speech in specific situations, such as a room with significant background noise.[30] Some patients complain of tinnitus, or ringing in the ears, however, this is not specific to presbycusis.[3] Formal questionnaires exist, such as the hearing handicap inventory for the elderly-screening (HHIE-S). However, some investigators found this formal screening tool to be less sensitive and more time-consuming than the single question "Do you have a hearing problem now?"[31] Gathering a thorough history regarding the patient's ability to communicate, and ideally getting input from close contact can help to identify individuals who should be sent for further audiometry testing. Asking about recreational or occupational exposure to loud noises, the use of ototoxic medications, and family history of age-related hearing loss is also important. Referral to an otolaryngologist should be considered if the patient's hearing loss is acute, unilateral, or accompanied by neurologic symptoms, such as facial numbness or weakness, loss of balance, or dizziness.
The general physical exam is usually unremarkable in patients with presbycusis. It is common for older adults to have age-related benign opacification of the tympanic membrane and build-up of cerumen.[3] If a moderate amount of cerumen is present, this should be removed to rule out impaction or obstruction as a potential cause of hearing loss. Tuning forks may be used to discriminate between conductive and sensorineural hearing loss; however, their use is limited by patient cooperation and provider subjectivity. Determining whether the pattern of hearing loss is sensorineural or conductive is an important first step in the diagnosis. This can be done by performing both the Weber and the Rinne test using a tuning fork. These tests should not be used as screening or diagnostic tools, but simply for differentiating between conductive and sensorineural hearing loss.[32][33] Presbycusis is sensorineural in origin; therefore, the Rinne test should reveal that air conduction is heard longer than bone conduction in both ears. Weber's test should localize toward the ear with better hearing, signifying a contralateral sensorineural loss.[34] Weber's test may vary and may result in a falsely normal result if hearing loss is symmetric.
Evaluation
Routine physical exam maneuvers alone are not sufficient for diagnosing presbycusis. An in-office screening audiometry test administered by trained personnel should be considered by providers such as geriatricians who have a large population of older adults at high risk of presbycusis. There should be a low threshold for referral for definitive auditory testing in patients suspected of presbycusis. Imaging is usually not performed except in cases in which there is a discrepancy between presentation and auditory testing, or there are associated neurological changes.[3]
There are many variations of audiometry testing and central auditory testing that are beyond the scope of this review. In general, an audiometry exam tests the ability to hear sounds at varying intensity (loudness) and frequencies (tone). Commonly, pure tone testing (also known as an audiogram) is performed in patients with suspected age-related hearing loss. Pure tones are delivered through the use of headphones to one ear at a time. Patients are asked to respond if they hear a sound. The results are presented in the form of an audiogram, a graph with hearing level (in decibels) on the y-axis and frequency (in hertz) on the x-axis. In presbycusis, the highest frequency sounds are typically affected first, followed by lower and lower frequency sounds as the condition progresses.[30] Presbycusis is characterized by bilateral hearing loss above 2000 Hertz. On a standard audiogram, presbycusis appears as an overall down-sloping line that represents impaired hearing at higher frequency sounds.
Laboratory testing for diseases commonly associated with hearing loss, such as dyslipidemia, diabetes, and renal dysfunction, may be indicated but are not required for diagnosis.[3]
Treatment / Management
There is no cure for presbycusis. Hearing aids are the mainstay of treatment and have been shown to have a significantly positive effect on the quality of life and communication.[3] Hearing aids do have limitations. They do not repair normal hearing, but instead simply amplify sounds. Devices can be very expensive and often are not covered by the patient's insurance.[3][35] While smaller hearing aids are potentially more comfortable and discrete, decreased dexterity in geriatric patients may make these devices less convenient. Importantly, the management of hearing aids does not stop once the devices are fitted. Learning to use hearing aids and adjusting to both the physical discomfort and cognitive adjustment takes significant effort and practice. A collaborative, interdisciplinary approach involving the primary care provider and audiologist is recommended for continued auditory rehabilitation.[36] Patients often require encouragement as many find hearing aids uncomfortable, unattractive, and embarrassing.[3] Hearing aids are indicated at certain thresholds of hearing loss. Cochlear implants can be offered to patients with severe bilateral hearing loss that is not improved with hearing aids. Specific criteria exist for patients to be considered candidates, and often include a predetermined level of impairment in word identification.(B3)
As extrinsic factors are thought to have a role in the progression of presbycusis, wearing earplugs or earmuffs to attenuate sounds may be helpful if the patient needs to be exposed to loud noises. A diet low in saturated fat may help slow hearing loss.[37] Maintaining a healthy, active lifestyle is a logical form of risk reduction in light of the fact that hearing loss is associated with stroke, myocardial ischemia, hypertension, hyperlipidemia, and diabetes. Smoking should be discouraged, as cessation has been shown to delay age-related hearing loss.[38]
There is an abundance of ongoing research regarding the genetic and metabolic components of age-related hearing loss. Due to the potential role of oxidative damage, it was thought that antioxidants might slow the progression of hearing loss. While the administration of alpha-lipoic acid has been shown to prevent age-related hearing loss in rats, an antioxidant-enriched diet in humans did not delay the progression of hearing loss. Other agents, such as coenzyme Q-10 and ginkgo biloba, have been studied and lack sufficient evidence for use. Additionally, the use of these supplements is controversial as prolonged administration has been associated with an increase in overall mortality.[1] There are ongoing investigations into potential gene and hormone therapies for hearing loss.(B3)
Differential Diagnosis
Presbycusis is a diagnosis of exclusion.[39] If the pattern is consistent with sensorineural hearing loss, the patient should be referred for formal audiometry testing. The differential diagnosis for sensorineural hearing loss includes:[2][36]
- Noise exposure
- Infection
- Ménière disease
- Trauma
- Autoimmune disease
- Perilymph fistula
- Genetically-inherited hearing loss
- Otosclerosis
- Tumor
- Exposure to ototoxic agents
- Metabolic dysfunction
In addition to audiometry, further testing such as imaging or metabolic assessment can be considered if hearing loss does not follow classic presbycusis characteristics. Other conditions associated with presbycusis, such as diabetes, hypertension, renal impairment, and hyperlipidemia, should be evaluated.
If the pattern of hearing loss is conductive, then an alternative diagnosis to presbycusis should be considered. These include:[36]
- Cerumen impaction
- Foreign body
- Tumor obstruction
- Infection
- Perforation
- Otosclerosis
- Cholesteatoma
Presbycusis should be considered in older adults presenting with changes in mood and cognition as these may be due to underlying hearing impairment.[40]
Prognosis
Age-related changes in hearing are a natural consequence of getting older. Typically, presbycusis does not lead to deafness but ignored or untreated presbycusis can have serious consequences on mental, cognitive, and even physical health.[41][42][43] While there is no cure for presbycusis, hearing aids can help to improve symptoms and prevent or delay other consequences of impaired hearing.[3][30] To obtain the full benefit of hearing aids, it is important to encourage regular device use and participation in auditory rehabilitation so that the patient can adapt cognitively and behaviorally.[3] Hearing aids do not reverse age-related changes, and these changes will continue to occur even with treatment. If hearing aids are unsuccessful in helping to hear, surgical treatment options exist.
Complications
Impaired hearing contributes to cognitive dysfunction in older adults.[44] It has been shown that those with age-related hearing loss have an increased risk of developing dementia.[45][46][47] While there have been numerous studies that confirm the connection between the severity of hearing loss and cognitive impairment, the relationship is not completely understood. Some suggest that hearing impairment requires the brain to recruit more resources to make up for the deficits in auditory perception. Because there is a finite neurologic reserve, this recruitment takes away resources that could be used for other cognitive functions, such as memory.[48][49][50]
Hearing permeates through numerous aspects of daily living, including communication, safety, social interaction. Loss of hearing is believed to lead to increased social isolation and decreased autonomy in older adults.[41] Negative effects on mood, such as increased incidence of anxiety, depression, and lethargy, can be present.[42][51] Treatment of hearing impairment with such devices as hearing aids has been shown to have a significantly positive effect on the quality of life.[3][30]
Impaired high-frequency hearing can pose serious safety concerns, as it may be difficult for older adults to respond to warnings and signals, such as doorbells, ringing phones, smoke alarms, and turn signals. There is evidence for a relationship between hearing loss and postural control in older adults, which may be related to the perception of one's motion and position in space.[43][52] A deeper understanding of this connection may potentially impact the frequency of falls, a significant source of morbidity and mortality in the elderly.
Consultations
Management of patients suffering from presbycusis is teamwork, following specialties can help in the management of these patients to improve outcomes.
- Audiology: referral for formal audiometry testing, hearing aid fitting, and education
- Otolaryngology: if the hearing impairment is sudden in onset, asymmetric, or concern for different auditory pathology
- Neurology: for further investigation into other causes of hearing impairment, especially if there are cooccurring neurologic signs and symptoms (headache, loss of balance, vertigo, facial numbness/weakness, visual changes)
- Gerontology: if there are concerns for concurrent cognitive impairment or dementia
- Oncology: if there are concerns for ototoxicity related to specific cancer treatment regimens
- Psychiatry: for negative effects on mood, anxiety, and depression
Deterrence and Patient Education
A certain degree of presbycusis is inevitable with aging. It is important to educate patients, caretakers, and colleagues about the high prevalence of age-related hearing impairment and its many consequences. Successful interventions do exist. Early identification and treatment may help to slow progression and improve the quality of life.[3] It is important to screen all older patients (age 60 and beyond) for hearing impairment regularly. This can be as simple as asking, "Do you have trouble hearing?.
Because poor hearing is associated with cardiovascular risk factors, maintaining a healthy lifestyle, avoiding smoking, staying physically and cognitively active may help to delay the onset and slow the progression of hearing loss.[3][53] There are other well-established health benefits to these interventions; therefore, there suggesting to patients at risk of presbycusis may be appropriate, assuming there is simply an association that does not necessarily mean causation. Older adults should pay attention to the effect the environment has on their ability to understand sounds, especially in the presence of competing for auditory input and background noise.
Maintaining clean ears by safely removing cerumen and avoiding loud noises without ear protection may help to prevent other causes of hearing loss that can worsen the symptoms of presbycusis.
Enhancing Healthcare Team Outcomes
Presbycusis is very common and can have profound consequences on the quality of life. Due to wide variations in presentation, diagnosis may be delayed if patients are not specifically screened for hearing loss. Collaboration in care is an integral component of delivering efficient and effective health care. While the responsibility for screening rests mainly among primary care providers, most do not consistently assess hearing due to various barriers such as lack of time and reimbursement and the onus to address more pressing health issues.[35][54]
Prompt referral to an audiometrist or other care provider who can perform specific audiometric testing is warranted in patients who are suspected of having age-related hearing loss. Subspecialties in areas such as otolaryngology, neurology, and geriatrics also have an opportunity to screen for presbycusis. Additionally, nurses and other allied health professionals can help to screen older patients by asking about hearing problems during an encounter. Collaboration between audiologists and primary care providers has the potential to increase awareness of the prevalence of hearing loss and the importance of audiological rehabilitation.[55][56] [Level 1]
Interprofessional communication remains important after the diagnosis of presbycusis is made. Aural rehabilitation is essential in the management of age-related hearing loss. Hearing aids require significant time and effort from the patient and continued encouragement by the primary care provider and audiometry team.[57] As more information regarding the connection between cognitive impairment and hearing loss emerges, teamwork among geriatricians, neurologists, otolaryngologists, and audiologists will be even more important.
References
Miller RA. Evaluating evidence for aging. Science (New York, N.Y.). 2005 Oct 21:310(5747):441-3; author reply 441-3 [PubMed PMID: 16239461]
Level 3 (low-level) evidenceZahnert T. The differential diagnosis of hearing loss. Deutsches Arzteblatt international. 2011 Jun:108(25):433-43; quiz 444. doi: 10.3238/arztebl.2011.0433. Epub 2011 Jun 24 [PubMed PMID: 21776317]
Gates GA, Mills JH. Presbycusis. Lancet (London, England). 2005 Sep 24-30:366(9491):1111-20 [PubMed PMID: 16182900]
Level 3 (low-level) evidenceSchuknecht HF, Gacek MR. Cochlear pathology in presbycusis. The Annals of otology, rhinology, and laryngology. 1993 Jan:102(1 Pt 2):1-16 [PubMed PMID: 8420477]
White HJ, Helwany M, Biknevicius AR, Peterson DC. Anatomy, Head and Neck, Ear Organ of Corti. StatPearls. 2023 Jan:(): [PubMed PMID: 30855919]
Wang J, Puel JL. Presbycusis: An Update on Cochlear Mechanisms and Therapies. Journal of clinical medicine. 2020 Jan 14:9(1):. doi: 10.3390/jcm9010218. Epub 2020 Jan 14 [PubMed PMID: 31947524]
Frisina RD, Frisina DR. Physiological and neurobiological bases of age-related hearing loss: biotherapeutic implications. American journal of audiology. 2013 Dec:22(2):299-302. doi: 10.1044/1059-0889(2013/13-0003). Epub [PubMed PMID: 24018570]
Level 3 (low-level) evidenceOhlemiller KK. Age-related hearing loss: the status of Schuknecht's typology. Current opinion in otolaryngology & head and neck surgery. 2004 Oct:12(5):439-43 [PubMed PMID: 15377958]
Level 3 (low-level) evidenceLee KY. Pathophysiology of age-related hearing loss (peripheral and central). Korean journal of audiology. 2013 Sep:17(2):45-9. doi: 10.7874/kja.2013.17.2.45. Epub 2013 Sep 24 [PubMed PMID: 24653905]
Kearns JR. Presbycusis. Canadian family physician Medecin de famille canadien. 1977 Sep:23():96-100 [PubMed PMID: 21304839]
Salt AN, Melichar I, Thalmann R. Mechanisms of endocochlear potential generation by stria vascularis. The Laryngoscope. 1987 Aug:97(8 Pt 1):984-91 [PubMed PMID: 3613802]
Level 3 (low-level) evidenceFalah M, Farhadi M, Kamrava SK, Mahmoudian S, Daneshi A, Balali M, Asghari A, Houshmand M. Association of genetic variations in the mitochondrial DNA control region with presbycusis. Clinical interventions in aging. 2017:12():459-465. doi: 10.2147/CIA.S123278. Epub 2017 Mar 3 [PubMed PMID: 28424544]
Ciorba A, Hatzopoulos S, Bianchini C, Aimoni C, Skarzynski H, Skarzynski PH. Genetics of presbycusis and presbystasis. International journal of immunopathology and pharmacology. 2015 Mar:28(1):29-35. doi: 10.1177/0394632015570819. Epub [PubMed PMID: 25816403]
Kidd Iii AR, Bao J. Recent advances in the study of age-related hearing loss: a mini-review. Gerontology. 2012:58(6):490-6. doi: 10.1159/000338588. Epub 2012 Jun 15 [PubMed PMID: 22710288]
Level 3 (low-level) evidenceBrien JA. Ototoxicity associated with salicylates. A brief review. Drug safety. 1993 Aug:9(2):143-8 [PubMed PMID: 8397891]
Hoffman DW, Whitworth CA, Jones KL, Rybak LP. Nutritional status, glutathione levels, and ototoxicity of loop diuretics and aminoglycoside antibiotics. Hearing research. 1987 Dec 31:31(3):217-22 [PubMed PMID: 3436849]
Level 3 (low-level) evidenceRybak LP, Whitworth C, Somani S. Application of antioxidants and other agents to prevent cisplatin ototoxicity. The Laryngoscope. 1999 Nov:109(11):1740-4 [PubMed PMID: 10569399]
Level 3 (low-level) evidenceNies E. Ototoxic substances at the workplace: a brief update. Arhiv za higijenu rada i toksikologiju. 2012 Jun 1:63(2):147-52. doi: 10.2478/10004-1254-63-2012-2199. Epub [PubMed PMID: 22728796]
Level 3 (low-level) evidenceBielefeld EC, Tanaka C, Chen GD, Henderson D. Age-related hearing loss: is it a preventable condition? Hearing research. 2010 Jun 1:264(1-2):98-107. doi: 10.1016/j.heares.2009.09.001. Epub 2009 Sep 6 [PubMed PMID: 19735708]
Level 3 (low-level) evidenceGates GA, Schmid P, Kujawa SG, Nam B, D'Agostino R. Longitudinal threshold changes in older men with audiometric notches. Hearing research. 2000 Mar:141(1-2):220-8 [PubMed PMID: 10713509]
Level 2 (mid-level) evidenceShen H, Lin Z, Lei D, Han J, Ohlemiller KK, Bao J. Old mice lacking high-affinity nicotine receptors resist acoustic trauma. Hearing research. 2011 Jul:277(1-2):184-91. doi: 10.1016/j.heares.2011.01.009. Epub 2011 Jan 25 [PubMed PMID: 21272629]
Level 3 (low-level) evidenceLang H, Schulte BA, Zhou D, Smythe N, Spicer SS, Schmiedt RA. Nuclear factor kappaB deficiency is associated with auditory nerve degeneration and increased noise-induced hearing loss. The Journal of neuroscience : the official journal of the Society for Neuroscience. 2006 Mar 29:26(13):3541-50 [PubMed PMID: 16571762]
Level 3 (low-level) evidenceGuimaraes P, Frisina ST, Mapes F, Tadros SF, Frisina DR, Frisina RD. Progestin negatively affects hearing in aged women. Proceedings of the National Academy of Sciences of the United States of America. 2006 Sep 19:103(38):14246-9 [PubMed PMID: 16959884]
Level 2 (mid-level) evidenceTu NC, Friedman RA. Age-related hearing loss: Unraveling the pieces. Laryngoscope investigative otolaryngology. 2018 Apr:3(2):68-72. doi: 10.1002/lio2.134. Epub 2018 Feb 21 [PubMed PMID: 29721536]
Yamasoba T, Lin FR, Someya S, Kashio A, Sakamoto T, Kondo K. Current concepts in age-related hearing loss: epidemiology and mechanistic pathways. Hearing research. 2013 Sep:303():30-8. doi: 10.1016/j.heares.2013.01.021. Epub 2013 Feb 16 [PubMed PMID: 23422312]
Level 3 (low-level) evidenceLin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Archives of internal medicine. 2011 Nov 14:171(20):1851-2. doi: 10.1001/archinternmed.2011.506. Epub [PubMed PMID: 22083573]
Level 3 (low-level) evidenceHelzner EP, Cauley JA, Pratt SR, Wisniewski SR, Zmuda JM, Talbott EO, de Rekeneire N, Harris TB, Rubin SM, Simonsick EM, Tylavsky FA, Newman AB. Race and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study. Journal of the American Geriatrics Society. 2005 Dec:53(12):2119-27 [PubMed PMID: 16398896]
Level 2 (mid-level) evidenceWattamwar K, Qian ZJ, Otter J, Leskowitz MJ, Caruana FF, Siedlecki B, Spitzer JB, Lalwani AK. Increases in the Rate of Age-Related Hearing Loss in the Older Old. JAMA otolaryngology-- head & neck surgery. 2017 Jan 1:143(1):41-45. doi: 10.1001/jamaoto.2016.2661. Epub [PubMed PMID: 27632707]
Level 2 (mid-level) evidenceSprinzl GM, Riechelmann H. Current trends in treating hearing loss in elderly people: a review of the technology and treatment options - a mini-review. Gerontology. 2010:56(3):351-8. doi: 10.1159/000275062. Epub 2010 Jan 12 [PubMed PMID: 20090297]
Löhler J, Cebulla M, Shehata-Dieler W, Volkenstein S, Völter C, Walther LE. Hearing Impairment in Old Age. Deutsches Arzteblatt international. 2019 Apr 26:116(17):301-310. doi: 10.3238/arztebl.2019.0301. Epub [PubMed PMID: 31196393]
Gates GA, Murphy M, Rees TS, Fraher A. Screening for handicapping hearing loss in the elderly. The Journal of family practice. 2003 Jan:52(1):56-62 [PubMed PMID: 12540314]
Level 2 (mid-level) evidenceKieran SM, Fenton JE. Clinical assessment of hearing impairment. JAMA. 2007 Feb 21:297(7):695; author reply 695-6 [PubMed PMID: 17312283]
Level 3 (low-level) evidenceHolman C, Roberts S, Nicol M. Promoting good care for people with hearing impairment. Nursing older people. 2005 Apr:17(2):31-2 [PubMed PMID: 15835506]
Isaacson JE, Vora NM. Differential diagnosis and treatment of hearing loss. American family physician. 2003 Sep 15:68(6):1125-32 [PubMed PMID: 14524400]
Chou R, Dana T, Bougatsos C, Fleming C, Beil T. Screening for Hearing Loss in Adults Ages 50 Years and Older: A Review of the Evidence for the U.S. Preventive Services Task Force. 2011 Mar:(): [PubMed PMID: 21542547]
Ko J. Presbycusis and its management. British journal of nursing (Mark Allen Publishing). 2010 Feb 11-24:19(3):160-5 [PubMed PMID: 20220659]
Rosen S, Olin P, Rosen HV. Diery prevention of hearing loss. Acta oto-laryngologica. 1970 Oct:70(4):242-7 [PubMed PMID: 5491161]
Matschke RG. [Tobacco smoking and hearing in the elderly. Can presbycusis be prevented by smoking cessation?]. HNO. 1999 Jul:47(7):599-600 [PubMed PMID: 10463110]
Bance M. Hearing and aging. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2007 Mar 27:176(7):925-7 [PubMed PMID: 17389438]
Lin FR, Ferrucci L, Metter EJ, An Y, Zonderman AB, Resnick SM. Hearing loss and cognition in the Baltimore Longitudinal Study of Aging. Neuropsychology. 2011 Nov:25(6):763-70. doi: 10.1037/a0024238. Epub [PubMed PMID: 21728425]
Level 2 (mid-level) evidenceParham K, McKinnon BJ, Eibling D, Gates GA. Challenges and opportunities in presbycusis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2011 Apr:144(4):491-5. doi: 10.1177/0194599810395079. Epub 2011 Feb 10 [PubMed PMID: 21493222]
Level 3 (low-level) evidenceHeine C, Browning CJ. Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions. Disability and rehabilitation. 2002 Oct 15:24(15):763-73 [PubMed PMID: 12437862]
Level 3 (low-level) evidenceCampos J, Ramkhalawansingh R, Pichora-Fuller MK. Hearing, self-motion perception, mobility, and aging. Hearing research. 2018 Nov:369():42-55. doi: 10.1016/j.heares.2018.03.025. Epub 2018 Mar 31 [PubMed PMID: 29661612]
Uhlmann RF, Larson EB, Rees TS, Koepsell TD, Duckert LG. Relationship of hearing impairment to dementia and cognitive dysfunction in older adults. JAMA. 1989 Apr 7:261(13):1916-9 [PubMed PMID: 2926927]
Level 2 (mid-level) evidenceFortunato S, Forli F, Guglielmi V, De Corso E, Paludetti G, Berrettini S, Fetoni AR. A review of new insights on the association between hearing loss and cognitive decline in ageing. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2016 Jun:36(3):155-66. doi: 10.14639/0392-100X-993. Epub [PubMed PMID: 27214827]
Lin FR, Metter EJ, O'Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Archives of neurology. 2011 Feb:68(2):214-20. doi: 10.1001/archneurol.2010.362. Epub [PubMed PMID: 21320988]
Lin FR, Yaffe K, Xia J, Xue QL, Harris TB, Purchase-Helzner E, Satterfield S, Ayonayon HN, Ferrucci L, Simonsick EM, Health ABC Study Group. Hearing loss and cognitive decline in older adults. JAMA internal medicine. 2013 Feb 25:173(4):293-9. doi: 10.1001/jamainternmed.2013.1868. Epub [PubMed PMID: 23337978]
Wingfield A, Grossman M. Language and the aging brain: patterns of neural compensation revealed by functional brain imaging. Journal of neurophysiology. 2006 Dec:96(6):2830-9 [PubMed PMID: 17110737]
Level 3 (low-level) evidencePichora-Fuller MK, Schneider BA, Daneman M. How young and old adults listen to and remember speech in noise. The Journal of the Acoustical Society of America. 1995 Jan:97(1):593-608 [PubMed PMID: 7860836]
Rabbitt P. Mild hearing loss can cause apparent memory failures which increase with age and reduce with IQ. Acta oto-laryngologica. Supplementum. 1990:476():167-75; discussion 176 [PubMed PMID: 2087959]
Mohlman J. Cognitive self-consciousness--a predictor of increased anxiety following first-time diagnosis of age-related hearing loss. Aging & mental health. 2009 Mar:13(2):246-54. doi: 10.1080/13607860802428026. Epub [PubMed PMID: 19347691]
Agmon M, Lavie L, Doumas M. The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review. Journal of the American Academy of Audiology. 2017 Jun:28(6):575-588. doi: 10.3766/jaaa.16044. Epub [PubMed PMID: 28590900]
Level 1 (high-level) evidenceHelzner EP, Patel AS, Pratt S, Sutton-Tyrrell K, Cauley JA, Talbott E, Kenyon E, Harris TB, Satterfield S, Ding J, Newman AB. Hearing sensitivity in older adults: associations with cardiovascular risk factors in the health, aging and body composition study. Journal of the American Geriatrics Society. 2011 Jun:59(6):972-9. doi: 10.1111/j.1532-5415.2011.03444.x. Epub 2011 Jun 7 [PubMed PMID: 21649629]
Level 2 (mid-level) evidenceJames J, Chappell R, Mercante DE, Gunaldo TP. Promoting Hearing Health Collaboration Through an Interprofessional Education Experience. American journal of audiology. 2017 Dec 12:26(4):570-575. doi: 10.1044/2017_AJA-17-0040. Epub [PubMed PMID: 29075750]
Öberg M. Hearing Care for Older Adults: Beyond the Audiology Clinic. American journal of audiology. 2015 Jun:24(2):104-107. doi: 10.1044/2015_AJA-14-0077. Epub 2015 Apr 7 [PubMed PMID: 25856775]
Jenstad LM, Donnelly M. Hearing care for elders: a personal reflection on participatory action learning with primary care providers. American journal of audiology. 2015 Mar:24(1):23-30. doi: 10.1044/2014_AJA-14-0051. Epub [PubMed PMID: 25551627]
Parham K, Lin FR, Coelho DH, Sataloff RT, Gates GA. Comprehensive management of presbycusis: central and peripheral. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2013 Apr:148(4):537-9. doi: 10.1177/0194599813477596. Epub 2013 Feb 8 [PubMed PMID: 23396589]