Clinical Practice Guideline: Age-Related Hearing Loss.

OBJECTIVE: Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE: The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS: The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life (QOL). (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related QOL at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

Clinical Practice Guideline: Age-Related Hearing Loss Executive Summary.

OBJECTIVE: Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. PURPOSE: The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS: The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

[Early management of presbycusis: recommendations from the French Society of Otorhinolaryngology and Head and Neck Surgery, the French Society of Audiology, and the French Society of Geriatrics and Gerontology]. / Recommandations de la Société française d'otorhinolaryngologie et de chirurgie de la face et du cou, la Société française d'audiologie et la Société française de gériatrie et gérontologie pour la prise en charge précoce de la presbyacousie.

INTRODUCTION: Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. RESULTS: The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its management in face-to-face or even distance learning. CONCLUSION: In case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. It is recommended to perform free-field speech audiometry in noise to measure intelligibility in an environment as close as possible to reality. Questionnaires can be used in addition to audiometry to best assess the patient's disability. It is recommended that hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time elapsed since the fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, integrating different training domains in addition to face-to-face sessions.

Post-translational modifications and age-related hearing loss.

Post-translational modifications (PTMs) affect nearly all systems of the human body due to their role in protein synthesis and functionality. These reversible and irreversible modifications control the structure, localization, activity, and properties of proteins. For this reason, PTMs are essential in regulating cellular processes and maintaining homeostasis. Diseases such as Alzheimer's, cardiovascular disease, diabetes, cancer, and many others have been linked to dysfunctions of PTMs. Recent research has also shown that irregularities in PTMs can be linked to hearing loss, including age-related hearing loss (ARHL) - the number one communication disorder and one of the top neurodegenerative diseases in our aging population. So far, there has been no FDA approved treatment for ARHL; however, translational studies investigating PTMs involvement in ARHL show promising results. In this review, we summarize key findings for PTMs within the auditory system, the involvement of PTMs with aging and ARHL, and lastly discuss potential treatment options focusing on utilizing PTMs as biomarkers and therapeutic pathway components.

Quality Improvement in Otolaryngology-Head and Neck Surgery: Age-Related Hearing Loss Measures.

BACKGROUND AND SIGNIFICANCE: There is a high and growing prevalence of age-related hearing loss (ARHL), defined as presbycusis or bilateral, symmetric sensorineural hearing loss in older adults. Due to the increasing prevalence of ARHL, the potential delays in its diagnosis and treatment, and the significant disability associated with ARHL, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) convened a Measures Development Group (MDG) to develop quality measures (QMs) of clinical practice that could be incorporated into the AAO-HNSF's data registry Reg-ent. Although the AAO-HNSF has been engaged in robust clinical practice guideline development since 2006, the development of quality and performance measures is more recent. METHODS: We report the process, experience, and outcomes in developing a de novo QM set for ARHL in the absence of a preexisting clinical practice guideline on this topic. Steps include the MDG review of evidentiary literature on ARHL, followed by stakeholder discussions to develop measure specifications. Key considerations included discussion on the relative importance, usability, and feasibility of each measure within the Reg-ent or similar databases. RESULTS: The MDG created 4 QMs for the diagnosis and treatment of AHRL. These measures represent the AAO-HNSF's quality initiatives to develop evidence-based QMs and improve patient care and outcomes, and they are intended to assist providers in enhancing quality of care. CONCLUSION: Development of the ARHL measures is intended for clinicians to evaluate the patient perception, structure, process, and outcomes of care. This process represents a new stage in the AAO-HNSF's measure development efforts to facilitate future efforts in evidence-based QM.

Efeito do treinamento musical em idosos candidatos ao uso de próteses auditivas / Effect of musical training in older adults candidates to the use of hearing aids / Efecto de la formación musical en ancianos candidatos al uso de audífonos

Introdução: Associação entre adaptação de próteses auditivas e treinamento auditivo pode melhorar a comunicação do indivíduo e reduzir os déficits funcionais. Objetivo: verificar o benefício na qualidade de vida, sintomas depressivos, aspectos cognitivos, resolução temporal e limitação em atividades de vida em idosos com perda auditiva, após adaptação de próteses auditivas associadas ou não ao treinamento auditivo musical. Métodos: Grupo Experimental - GE: cinco idosos (64 a 79 anos) e Grupo Controle - GC: cinco idosos (62 a 77 anos), todos com perda auditiva neurossensorial simétrica de grau moderado. Foram submetidos à anamnese, miniteste de triagem cognitiva CASI-S, avaliação audiológica incluindo Índice Porcentual de Reconhecimento de Fala (IPRF), Client-Oriented Scale of Improvement (COSI), resolução temporal (teste GIN), triagem para sintomas depressivos (EDG-15), questionários de qualidade de vida (SF-36) e de autoavaliação para próteses auditivas (QI-AASI). Todos receberam próteses auditivas, e apenas o GE, o treinamento auditivo musical. Avaliação realizada em três momentos: antes da adaptação das próteses auditivas; 11 semanas após a adaptação das mesmas, sendo o GE submetido ao treinamento musical por sete semanas; e quatro meses depois. Resultados: Não houve diferença entre grupos segundo idade, escolaridade e triagem cognitiva. Todos apresentaram melhores limiares no teste de resolução temporal após a intervenção. Os escores dos testes de qualidade de vida e sintomas depressivos não foram significantemente diferentes entre grupos e avaliações. Conclusão: O uso efetivo de próteses auditivas, associado ou não ao treinamento musical, melhorou a resolução temporal. Não houve melhora significativa na qualidade de vida, sintomas depressivos, cognição e COSI.

Introduction: Association between hearing aid fitting and auditory training can improve an individual's communication and reduce functional deficits. Objective: to verify benefit in quality of life, depressive symptoms, cognitive aspects, temporal resolution, and limitation in daily activities for elderly people with hearing loss, after adaptation of hearing aids associated or not with musical auditory training. Methods: Experimental Group - EG: five elderly (64 to 79 years old) and Control Group - CG: five elderly (62 to 77 years old), all with moderate symmetric sensorineural hearing loss. They underwent anamnesis, cognitive screening CASI-S, audiological evaluation including Percentage Index of Speech Recognition (PISR), Client-Oriented Scale of Improvement (COSI), temporal resolution (GIN), screening for depressive symptoms (GDS-15), quality of life questionnaires (SF-36) and IOI-HA self-assessment. All received hearing aids but only the EG received the auditory musical training. Evaluation performed in three moments: before the fitting of the hearing aids; 11 weeks after their adaptation, with the EG undergoing musical training for seven weeks; and four months later. Results: There was no difference between groups according to age, education, and cognitive screening. All had better thresholds in the GIN after the intervention. The GDS-15 and SF-36 scores were not significantly different between groups and assessments. Conclusion: Using hearing aids associated or not with musical training improved temporal resolution. There was no improvement in the quality of life, depressive symptoms, cognition, and COSI scale.

Introducción: Asociación entre adaptación de prótesis auditivas y entrenamiento auditivo puede mejorar la comunicación del individuo y reducir los déficits funcionales. Objetivo: verificar el beneficio en la calidad de vida, síntomas depresivos, aspectos cognitivos, resolución temporal y limitación de la vida de las personas mayores con hipoacusia, tras adaptación de audífonos asociada o no al entrenamiento auditivo musical. Métodos: Grupo Experimental ­ GE: cinco ancianos (64 a 79 años) y Grupo Control - GC: cinco ancianos (62 a 77 años) todos con hipoacusia neurosensorial simétrica moderada. Fueron sometidos a la anamnesis, miniprueba de triaje cognitiva CASI-S, evaluación audiológica incluyendo Índice Porcentual de Reconocimiento de Habla (IPRH), Client-Oriented Scale of Improvement (COSI), resolución temporal (prueba GIN), classificación para síntomas depresivos (EDG-15), cuestionarios de calidad de vida (SF-36) y autoevaluación de audífonos (QI-AASI). Todos recibieron los audífonos, sólo el GE, el entrenamiento auditivo musical. Evaluación realizada en tres momentos: antes de la adaptación de los audífonos; 11 semanas después de la adaptación de las mismas siendo el GE sometido al entrenamiento musical por siete semanas; y cuatro meses después. Resultados: No hubo diferencia entre grupos según edad, escolaridad y triaje cognitivo. Todos presentaron mejores umbrales en la prueba de resolución temporal después de la intervención. Los resultados de las pruebas de calidad de vida y los síntomas depresivos no fueron significativamente diferentes entre grupos y evaluaciones. Conclusión: Usar audífonos asociados o no con entrenamiento musical mejoró la resolución temporal. No hubo mejora significativa en la calidad de vida, síntomas depresivos, cognición y COSI.

The Role of the General Practitioner in Managing Age-Related Hearing Loss: A Scoping Review.

Purpose The purpose of this review was to examine the research activity relating to the role of the general practitioner (GP) in managing age-related hearing loss in older adults. Method A literature search of peer-reviewed journal articles published in English was conducted in online bibliographic databases using multiple variations of the keywords "general practitioner" and "hearing." Results The search strategy identified 3,255 articles. The abstracts of all articles were screened with 124 full-text records subsequently assessed for eligibility. Forty-nine articles met the inclusion criteria and were included in this review. Conclusions For people with hearing loss, the GP can play an instrumental role in guiding appropriate and timely choices for addressing hearing concerns. There are a range of quick, easy, and sensitive methods available to GPs to assist the objective evaluation of hearing. The evidence suggests that implementing hearing screening programs targeting older adults will increase rates of hearing loss detection and subsequently increase the number of patients receiving hearing loss intervention. Education and training appear key to improving GPs' screening, management, and referral of patients with hearing loss in the primary health care setting.

Lyric hearing aid: a rare cause of benign necrotising otitis externa/external ear canal cholesteatoma.

An 80-year-old Caucasian man presented with an incidental and asymptomatic lesion in his right ear thought to be secondary to his use of hearing aids for presbycusis. He used Lyric hearing aids, designed for 24 hours-a-day use for 4 months at a time and had no other previous otological problems. He underwent a bony meatoplasty and vascular flap reconstruction via a retroauricular approach to remove the lesion for histological analysis and regrafting of the area. The lesion was confirmed on histopathology as an ear canal cholesteatoma.

Utilização de aparelhos de amplificação sonora individual em idosos residentes no estado do Rio Grande do Sul / Use of hearing aids among older adults residents in the state of Rio Grande do Sul

Este estudo teve o objetivo de verificar a associação do uso de aparelho auditivo a sexo, faixa etária, atividades sociais/laborais, de lazer e autopercepção de saúde e audição em idosos. Foramentrevistados 7315 idosos em 59 cidades do Rio Grande do Sul. Os dados foram coletados na pesquisa Perfil dos Idosos do Rio Grande do Sul, que foi desenvolvida entre os anos de 2010 e 2011 pelo Instituto de Geriatria e Gerontologia da PUCRS em parceria com a Escola de Saúde Pública do Estado do Rio Grande do Sul. Os critérios de inclusão foram ter 60 anos e mais de idade e aceitar participar da pesquisa. Quando o idoso apresentava comprometimento cognitivo e de comunicação, familiares foram entrevistados. O questionário utilizado foi elaborado a partir do Guia Global Cidade Amiga do Idoso (OMS, 2008). A entrevista incluía questões a respeito da autopercepção de audição e saúde geral, do uso de próteses auditivas, da participação em atividades sociais e/ou laborais, de hábitos de lazer (assistir televisão e ouvir rádio) e de dados sociodemográficos. Verificou-se que apenas 3,8% dos idosos utilizavam aparelho auditivo. Houve associação significativa (p<0,001) entre o uso de aparelho auditivo e faixa etária, atividade laboral e/ou social e autopercepção de saúde e de audição. (AU)

This study aimed to verify the association of the use of hearing aids to gender, age, social/work, leisure and self-perception of health and hearing in the elderly. 7315 elderly people were interviewed in 59 cities of Rio Grande do Sul. The data were collected in the survey Profile of the Elderly in Rio Grande do Sul, which was developed between 2010 and 2011 by the Institute of Geriatrics and Gerontology of PUCRS in partnership with the School of Public Health of the State of Rio Grande do Sul. The inclusion criteria were to be 60 years and over and accept to participate in the research. When the elderly had cognitive and communication impairment, family members were interviewed. The questionnaire used was elaborated from the Global City Guide for the Elderly (WHO, 2008). The interview included questions about self-perception of hearing and general health, use of hearing aids, participation in social and/or work activities, leisure habits (watching television and listening to the radio) and sociodemographic data. It was verified that only 3.8% of the elderly used a hearing aid. There was a significant association (p <0.001) between hearing aid use and age, work and/or social activity and self-perception of health and hearing. (AU)

[The evaluation of hearing aid effect in presbycusis].

Objective:To evaluate the effect of hearing aid in presbycusis. Method:Using the method of international outcome inventory for hearing aids(IOI-HA)and medium acoustic intensity(65 dBSPL) word recognition score(WRS), to evaluate the effect of hearing aid in moderate and severe presbycusis. Result:After the hearing aid of moderate presbycusis, The improved value of monosyllabic words and recognition rate in quite and noise statement(SNR=5) were 31.15%, 23.21%, 44.11%.However, improved values in severe presbycusis were 37.51%, 48.47%，50.17%, before and after hearing aid, the difference of the improved average value was statistically significant(P <0.05); Both the moderate and severe presbycusis were satisfacted with hearing aid.The IO-HA scores of moderate and severe presbycusis ranged from 15 to 34.The difference of IOIHA score of moderate and severe presbycusis had no statistical significance(P >0.05); moderate and severe presbycusis with high satisfaction with HA of quiet statement,and low satisfaction of monosyllabic words listening, and the degree of satisfaction was higher in patients with moderate to severe hearing loss in noise statement.Conclusion:Speech audiometry is an important method to assess the effect of hearing aid; IOI-HA is a timeconsuming short, subjective method.The combine of multiple evaluations have guiding significance to debugging of hearing aid expected effect and hearing aid device.

Physiological and neurobiological bases of age-related hearing loss: biotherapeutic implications.

PURPOSE: The aim of this study was to highlight growing evidence of interactions between hormones and the structure and function of the auditory system. METHOD: Recent studies implicating sex hormones and other natural hormones in the modulation of hearing status in age-related hearing loss were reviewed. RESULTS: Progesterone, a sex hormone, has been shown to have negative effects on the hearing of older women and aging mice, whereas, in contrast, estrogen was found in some cases to have a positive influence. Aldosterone, used in studies of animal models of autoimmune hearing loss, slowed the progression of hearing loss. Follow-up studies in humans revealed that auditory measures varied as serum aldosterone levels shifted within the normal range, in otherwise healthy older subjects. This was true for simple as well as complex auditory tasks (i.e., sound spatial processing), suggesting benefits of aldosterone to postperipheral auditory processing as well. In addition, evidence suggests that this functional hearing improvement occurred in association with anatomical improvements to the stria vascularis--an important site of anatomical change in presbycusis. CONCLUSIONS: Audiology is now at the point where the search for biomedical interventions to modulate or prevent age-related hearing loss can move forward. Such interventions would require multidisciplinary collaborative initiatives by researchers in such areas as drug development, anatomy, auditory physiological and perceptual testing, and drug microdelivery systems.

Comprehensive management of presbycusis: central and peripheral.

The prevailing otolaryngologic approach to treatment of age-related hearing loss (ARHL), presbycusis, emphasizes compensation of peripheral functional deficits (ie, hearing aids and cochlear implants). This approach does not address adequately the needs of the geriatric population, 1 in 5 of whom is expected to consist of the "old old" in the coming decades. Aging affects both the peripheral and central auditory systems, and disorders of executive function become more prevalent with advancing age. Growing evidence supports an association between age-related hearing loss and cognitive decline. Thus, to facilitate optimal functional capacity in our geriatric patients, a more comprehensive management strategy of ARHL is needed. Diagnostic evaluation should go beyond standard audiometric testing and include measures of central auditory function, including dichotic tasks and speech-in-noise testing. Treatment should include not only appropriate means of peripheral compensation but also auditory rehabilitative training and counseling.

Intracerebral neural stem cell transplantation improved the auditory of mice with presbycusis.

Stem cell-based regenerative therapy is a potential cellular therapeutic strategy for patients with incurable brain diseases. Embryonic neural stem cells (NSCs) represent an attractive cell source in regenerative medicine strategies in the treatment of diseased brains. Here, we assess the capability of intracerebral embryonic NSCs transplantation for C57BL/6J mice with presbycusis in vivo. Morphology analyses revealed that the neuronal rate of apoptosis was lower in the aged group (10 months of age) but not in the young group (2 months of age) after NSCs transplantation, while the electrophysiological data suggest that the Auditory Brain Stem Response (ABR) threshold was significantly decreased in the aged group at 2 weeks and 3 weeks after transplantation. By contrast, there was no difference in the aged group at 4 weeks post-transplantation or in the young group at any time post-transplantation. Furthermore, immunofluorescence experiments showed that NSCs differentiated into neurons that engrafted and migrated to the brain, even to sites of lesions. Together, our results demonstrate that NSCs transplantation improve the auditory of C57BL/6J mice with presbycusis.

[Clinical analysis of short-term efficacy in senile sudden deafness].

OBJECTIVE: To analysis the short-term medicinal treating effects in senile sudden deafness. METHOD: According the age. The sudden deafness patients were divided into to groups, older age-group (age > or = 60, a total of 70 cases), control group (age < 60, a total of 70 cases), period of treatment was 7 days, the result of pure tone test were reviewed, compared the improvement before and after treatment. RESULT: After treatment, the average hearing threshold of the older age-patients was improved. There was statistical difference (P < 0.05); effective rate of the senile sudden deafness patients (disease time < or = 7 days) was 61.76%, (disease time > 7 days) was 38.89%. There was statistical difference (P < 0.05); the total effective rate of the senile sudden deafness patients was 49.9%; the senile sudden deafness patients which following moderate deafness (hearing threshold < 55 dB), effective rate was 52%, control group was 84.62%. There was statistical difference (P < 0.05), but there was no significant difference in the patients with severe hearing loss. CONCLUSION: The Course of disease has important significance for the prognosis of the senile sudden deafness patients. As soon as possible to improve peripheral vascular microcirculation, the prognosis could be improve conspicuously the prognosis of the senile sudden deafness patients were worse than the young patients.

Adherencia y desempeño auditivo en uso de audífonos en pacientes adultos hipoacúsicos atendidos en la Red de Salud UC / Hearing aids' adherence and performance in adults with hearing loss at Red de Salud UC

Introducción: La presbiacusia es un problema frecuente y con gran impacto en la calidad de vida. El uso de audífonos es la principal estrategia de tratamiento aunque se han descrito adherencia y desempeño auditivo subóptimos en la mayoría de los pacientes. Objetivo: Evaluar adherencia, desempeño auditivo subjetivo y satisfacción en adultos hipoacúsicos usuarios de audífono en la Red de Salud UC. Material y método: Estudio transversal descriptivo de seguimiento telefónico a 84 pacientes usuarios de audífono según criterio GES, atendidos entre agosto 2010-julio 2011. Además de preguntas acerca de conductas sobre el uso de los audífonos, el desempeño auditivo fue evaluado mediante encuesta validada ®Hearing Handicap Inventory for the Elderly-Screening (HHIES)¼, y la satisfacción con una nota subjetiva (1-7 puntos). Resultados: Se encuestaron 84 pacientes, edad promedio 74,6 años. El 48 por ciento de los pacientes ocupa su audífono 1 o más días a la semana, con una satisfacción en escala subjetiva (nota 1 a 7) de 5,4. El desempeño auditivo subjetivo fue de HHIEs 18 puntos (dificultad leve-moderada). Discusión: Uno de cada dos pacientes a quien se le indica y recibe un audífono no lo ocupa. A pesar de una adecuada implementación en la mayoría persiste una discapacidad auditiva subjetiva moderada (HHIEs), Nuestros hallazgos en adherencia y desempeño son semejantes a los descritos en la literatura nacional.

Introduction: Presbiacusy is a frequent problem with high impact in quality of life. Use of hearing aids is the main strategy of treatment, although low adherence and subjective performance has been described in most patients. Aim: Assess the adherence, subjective hearing performance and satisfaction of adult patients with hearing loss users of hearing aids from Red de Salud UC. Material and method: Cross sectional, descriptive, follow up study of 84 patients with hearing loss and indication of hearing aid use according to ®GES¼ criteria, evaluated between August 2010 and July 2011. Questions about behaviour on the use of hearing aid were done, subjective performance was evaluated trough the validated ®Hearing Handicap Inventory for the Elderly-Screening (HHIES)¼ and a satisfaction score (from 1 to 7). Results: 84 patients were surveyed 64.3 percent female and had a mean age of 74.6 years. 48 percent percent of patients used the hearing aid 1 or more days of the week, satisfaction (subjective scale from 1 to 7) was 5.4. The subjective hearing performance was HHIEs 18 points (mild-moderate impairment). Discussion: One out of two patients to whom a hearing aid is indicated is not using it. Although there is an adequate implementation, in most patients persists a moderate subjective impairment (HHIEs). Our findings of adherence and performance are similar to the described in the national literature.

Presbycusis and its management.

Age-related hearing loss, or presbycusis, is becoming a public health issue. With the large number of ageing baby boomers, primary care providers can expect to see an increase in older adults suffering from chronic health problems such as presbycusis. It is the primary care provider's responsibility to perform prompt auditory screenings and to recognize the early clinical signs and symptoms of hearing loss. Early interventions, such as hearing aids or surgery, could help to improve the client's quality of life. Primary care providers should also teach older adults proper auditory hygiene, and provide information regarding support groups to the family and the caregiver as needed.

[Pathogenesis and treatment of presbyacusis. Current status and future perspectives]. / Die Entstehung und Behandlung der Presbyakusis. Heutiger Stand und Perspektiven für die Zukunft.

Factors responsible for presbyacusis include physiological ageing processes as well as endogenous or exogenous causes. In the industrial countries, two main exogenous causes are exposure to loud noise and obesity. Pathomechanisms contributing to presbyacusis are hypoxia/ischemia, reactive species formation and oxidative stress, apoptotic and necrotic death of hair cells and spiral ganglion cells as well as inherited and acquired mutations in the mitochondrial DNA. Important for the successful treatment of presbyacusis is a timely fitting of hearing aids on both ears to improve communication and provide the auditory system with acoustic information. Using the hearing aids will also elevate the detection threshold of an existing tinnitus signal. At present, several therapeutic strategies based on pharmacological intervention are under discussion. The application of antioxidants or caloric restriction are considered to prevent or reduce oxidative stress-induced damage. Animal experiments evidenced that superoxide dismutase 2 (SOD2) strongly decreases in age; thus, a further approach may be the overexpression or modulation of the SOD2 within the cochlea. Adenoviral-mediated gene transfer technology would be a tempting approach to address this type of therapy. Finally, hair cell regeneration could be a possible treatment of presbyacusis in the future.