Acceso a la provisión de salud auditiva en pacientes con Presbiacusia: Un modelo para la atención pública en Chile / Access to the provision of hearing health in patients with presbycusis: A new model of care for public hospitals in Chile

Introducción: La Presbiacusia es frecuente, genera un impacto negativo en la calidad de vida de las personas y costos para la sociedad. En Chile el acceso a salud auditiva está garantizado por GES, pero está limitado por disponibilidad de médicos especialistas. Objetivo: Evaluar un modelo de atención de pacientes con Presbiacusia en el sistema público que sea seguro, eficaz y eficiente. Material y Método: Pacientes mayores de 65 años que consultaron por primera vez en el Servicio de Otorrinolaringología del Hospital Padre Hurtado por hipoacusia entre junio y noviembre de 2022. Se realizó anamnesis, otomicroscopía y audiometría tonal. Se definieron signos de alarma en la audiometría: hipoacusia asimétrica y presencia de diferencia osteo-aérea. Estadística descriptiva con programa SSPS. Protocolo aprobado por el Comité de Ética de Investigación de Seres Humanos del SSMSO. Resultados: Se reclutaron 267 pacientes, 57,7% sexo femenino, mediana edad 77 años (rango 65 a 100 años). En la otomicroscopía se identificó tapón de cerumen en 15,7% (IC 95% 11,6%-20,6%) y otitis media crónica en 7,5% (IC 95% 4,5%-10,9%). Signos de alarma en la audiometría: hipoacusia sensorioneural asimétrica 21,7% (IC 95% 17,2%-26,6%) y gap osteo-aéreo 12,4% (IC 95% 8,6%-16,5%). En 62,2% (IC 95% 56,2%-68,2%) de los pacientes no había signo de alar-ma en al audiometría ni tapón de cerumen. Conclusión: La derivación de pacientes con Presbiacusia directamente a examen de audiometría es seguro en al menos un 62,2% de los pacientes, lo que disminuye las barreras en la provisión de salud auditiva en el sistema público en Chile.

Introduction: Presbycusis affects a significant proportion of elderly subjects with negative impact in the quality of life and economic costs for society. In Chile, GES guarantees the provision of hearing aids, but the access to medical specialists is scarce. Objective: Explore a model of care for patients with Presbycusis in the public sector of health that provides a secure protocol of care and reduces the barriers to access. Material and Method: Patients that attended the outpatient clinic of Otorhinolaryngology from Hospital Padre Hurtado because of hearing loss, between the months of June and November of 2022. All patients were subject to anamnesis, otomicroscopy, and tonal audiometry. Red flags in the audiometry: asymmetric hearing loss or the presence of an air-bone gap. Descriptive statistical analysis with SSPS. The protocol was approved by the local ethics committee. Results: We included 267 patients, 57, 7% female, median age 77 years (range 65 to 100). Earwax prevalence 15.7% (IC 95% 11.6%, 20.6%), chronic otitis media prevalence 7.5% (IC 95% 4.5%, 10.9%). Audiometric red flags_ asymmetric hearing loss in 21.7% (IC 95% 17.2%-26.6%), air-bone gap in 12.4% (IC 95% 8.6%-16.5%). In 62, 2% (IC 95% 56, 2%-68, 2%) of the subjects there were no red flags or earwax. Conclusion: A model of care for patients with Presbycusis that includes direct assessment with audiometry in the public health system is safe in at least 62, 2% of the cases. This observation can lead to an important reduction in the waiting time to access a hearing aid.

Research Progress on the Etiopathogenesis of Presbycusis / 听力学及言语疾病杂志

Presbycusis is a disease characterized by hidden and slowly progressive bilateral sensorineural hear-ing loss.Its occurrence and development is a multifactorial process.The expression of each factor varies greatly a-mong individuals.Currently,there have been some studies on the pathogenesis of presbycusis,which can be catego-rized into ion channel abnormalities,cochlear synaptopathy,reactive oxygen species,hormone effects,mitochondrial abnormalities,genetic factors and vari other factors.This review summarizes the pathogenesis of presbycusis in re-cent years.

Protective effects of Ginkgo biloba extract on presbycusis in the rat model via autophagy pathway / 中成药

AIM To investigate the effects of Ginkgo biloba extract on hearing function,cochlear morphology and autophagy-related protein expression in a rat model of presbycusis.METHODS Forty-five rats were randomly divided into the control group,the model group and the low,medium and high dose G.biloba extract groups(10,20 and 30 mg/kg),with 9 rats in each group.The rat model of presbycusis was established by intraperitoneal injection of 500 mg/kg D-galactose(D-gal).Eight weeks after the corresponding administration,the rats had their changes of hearing threshold detected by the auditory brainstem evoked potential(ABR);their morphological changes of cochlear hair cells,stria vascularis(SV)and spiral ganglion cells observed by HE staining;their number of hair cells inside and outside the cochlea detected by immunofluorescence staining;their ultrastructure changes of cochlear hair cells observed by transmission electron microscopy;and their expression of autophagy-related proteins in cochlea tissue detected by Western blot.RESULTS Compared with the control group,the model group displayed increased ABR threshold(P<0.01);more severely damaged inner and outer hair cells,spiral ganglion cells and SV,decreased SV thickness and numbers of spiral ganglion cells,inner and outer hair cells and autophagosomes(P<0.01);decreased protein expressions of Beclin1 and LC3 Ⅱ and ratio of LC3 Ⅱ/LC3 Ⅰ in cochlear tissue(P<0.01),and higher P62 protein expression(P<0.01).Compared with the model group,the medium and high dose G.biloba extract groups shared decreased ABR thresholds(P<0.01);improved morphology of inner and outer hair cells and SV in the cochlea,normalized,morphology of spiral ganglion cells,and increased SV thickness and the numbers of spiral ganglion cells,inner and outer hair cells and autophagosomes(P<0.05,P<0.01);increased protein expressions of Beclin1 and LC3 Ⅱ and the ratio of LC3 Ⅱ/LC3 Ⅰ in the cochlea(P<0.01),and decreased P62 protein expression(P<0.01).CONCLUSION The protective effects G.biloba extract on hearing function and cochlear cells in the rat model of presbycusis may be associated with the up-regulated expression of Beclin1 and LC3 Ⅱ proteins and down-regulated P62 protein expression in cochlear tissues.

Ligustilide delays senescence of auditory cortex in mice by inhibiting ferritinophagy / 中国药理学通报

Aim To investigate the mechanism of ligu aged 2 months of the same strain were used as the constilide (LIG) in delaying the senescence of auditory trol (Ctrl) group. Auditory brainstem response test was cortex and treating central presbycusis. Methods used to detect the auditory threshold of mice before and Forty C57BL/6J mice aged 13 months were randomly di after treatment. Levels of serum MDA and activity of vided into ligustilide low-dose(L-LIG) group, ligustil serum SOD were detected to display the level of oxidative ide medium-dose (M-LIG) group, ligustilide high-dose stress. The pathological changes of auditory cortex were (H-LIG) group and aging (Age) group, and 10 mice observed by HE staining. Ferroptosis was observed by

Correlación entre pérdida auditiva y deterioro cognitivo en el adulto mayor / Correlation between hearing loss and cognitive impairment in the elderly

RESUMEN Introducción: La pérdida auditiva o hipoacusia en el adulto mayor se produce, generalmente, por cambios degenerativos propios del envejecimiento y puede influir en el deterioro cognitivo de la persona, que se manifiesta por distintos cambios en la memoria a medida que se incrementa la edad. Objetivo: Determinar la relación entre la pérdida auditiva y el deterioro cognitivo en el adulto mayor. Métodos: Estudio descriptivo, correlacional y transversal. Se realizó otoscopía, audiometría y se aplicó el cuestionario de Pfeiffer en 104 adultos mayores de 65 años, que acudieron al servicio de Otorrinolaringología del Hospital Nacional Arzobispo Loayza. Se empleó como instrumento el otoscopio, el audiómetro y el cuestionario de Pfeiffer. Se analizó la relación mediante el coeficiente de correlación de Rho de Spearman. Resultados: Se encontró pérdida auditiva en 58 casos (55.8%) y normoacusia en 46 (44.2%). Al aplicar el cuestionario de Pfeiffer para determinar el estado cognitivo, se obtuvo una puntuación global promedio de 8.5, determinándose que los valores menores a 8 se consideran como deterioro cognitivo leve. Se evidenció deterioro cognitivo leve en el 7% de normoacúsicos y en el 26% de hipoacúsicos. Al realizar la correlación de Rho de Spearman, se encontró correlación positiva alta entre la pérdida auditiva y deterioro cognitivo (0.864), significativa (0,000<0,05). Conclusión: Existe relación positiva alta entre la pérdida auditiva y el deterioro cognitivo en el adulto mayor.

ABSTRACT Introduction: Hearing loss or hearing loss in the elderly is generally caused by degenerative changes typical of aging and can influence the cognitive deterioration of the person, which is manifested by different changes in memory as age increases. Objective: To determine the relationship between hearing loss and cognitive impairment in the elderly. Methods: Descriptive, correlational and cross-sectional study. Otoscopy, audiometry and the Pfeiffer questionnaire were performed in 104 adults over 65 years of age, who attended the Otorhinolaryngology service of the Arzobispo Loayza National Hospital. The otoscope, the audiometer and the Pfeiffer questionnaire were used as instruments. Analyzing the relationship using Spearman's Rho correlation coefficient. Results: Hearing loss was found in 58 cases (55.8%) and normal hearing in 46 cases (44.2%). When applying the Pfeiffer questionnaire to determine cognitive status, an average global score of 8.5 was obtained, determining that values less than 8 are considered mild cognitive impairment. Evidencing mild cognitive impairment in 7% of normoacusics and in 26% of hypoacusics. When performing Spearman's Rho correlation, a high positive correlation was found between hearing loss and cognitive impairment (0.864), significant (0.000<0.05). Conclusion: There is a high positive relationship between hearing loss and cognitive impairment in the elderly.

Medical Therapy of Hearing Impairment and Tinnitus with Chinese Medicine: An Overview / 中国结合医学杂志

The current review gives a comprehensive overview of the recent development in Chinese medicine (CM) for treating several kinds of acquired nerve deafness and tinnitus, as well as links the traditional principle to well-established pharmacological mechanisms for future research. To date, about 24 herbal species and 40 related ingredients used in CM to treat hearing loss and tinnitus are reported for the treatment of endocochlear potential, endolymph growth, lowering toxic and provocative substance aggregation, inhibiting sensory cell death, and retaining sensory transfer. However, there are a few herbal species that can be used for medicinal purposes. Nevertheless, clinical studies have been hampered by a limited population sample, a deficiency of a suitable control research group, or contradictory results. Enhanced cochlear blood flow, antiinflammatory antioxidant, neuroprotective effects, and anti-apoptotic, as well as multi-target approach on different auditory sections of the inner ear, are all possible benefits of CM medications. There are numerous unknown natural products for aural ailment and tinnitus identified in CM that are expected to be examined in the future utilizing various aural ailment models and processes.

Older adults hearing screening strategies: a bibliometric review / Revisão bibliométrica: estratégias de triagem auditiva de idosos

ABSTRACT Purpose: to analyze the profile of publications on methods and instruments used to screen older adults hearing. Methods: the scientific production on older adults hearing screening methods, searching for articles published between 2016 and 2022. Data were collected from PubMed, Scopus, LILACS, Web of Science, and Google Scholar databases and the articles were categorized according to their year, study type, authors, and screening instrument. Data were also analyzed to suggest potential aspects to be addressed in future research in the area. Literature Review: altogether, 26 articles were found based on the eligibility criteria. Publications peaked in 2016, followed by 2020. Articles published in the United States predominated (18%), and HHIE-S (hearing handicap inventory for the elderly screening version) was the most used instrument; 90% of the publications were in English, and the most recurrent study type was cross-sectional, followed by instrument validation studies. Conclusion: the review points out the scarcity of scientific production on older adults hearing screening in both national and international research. The studies approached different populations, screening methods, hearing loss definitions, health systems, and public policies in the countries where they were conducted. Better methodologies must be implemented for future research in the area.

RESUMO Objetivo: analisar o perfil das publicações a respeito dos métodos e instrumentos utilizados para realizar triagem auditiva em idosos. Métodos: esta pesquisa revisou a produção científica sobre métodos de triagem auditiva no idoso. A busca deu-se com artigos publicados entre 2016 e 2022. Os dados foram coletados nas bases de dados: PubMed, Scopus, LILACS, Web of Science e Google Scholar. Os artigos foram categorizados quanto ao ano, tipo de artigo, autores e instrumento de triagem. Além disto, os dados foram analisados com sugestões de aspectos potenciais a serem considerados para futuras pesquisas na área. Revisão da Literatura: foram encontrados 26 artigos com base nos critérios de elegibilidade. O pico de publicações referente ao estudo ocorreu no ano de 2016, seguido por 2020. Predominaram os estudos publicados no Estados Unidos (18%), o instrumento mais utilizado foi o HHIE-S, 90% das publicações estão na língua inglesa, e o tipo de estudo mais realizado é a pesquisa transversal, seguida dos Estudos de validação dos instrumentos. Conclusão: o estudo mostra a escassez de produção científica sobre triagem auditiva do idoso nas pesquisas nacionais e internacionais. Foram observadas variações da população e dos métodos de triagem, diferenças nas definições de perda auditiva entre os estudos elegíveis e diferenças nos sistemas de saúde e políticas públicas dos países em que esses estudos foram realizados. É necessária melhor implementação metodológica em futuras pesquisas na área.

Negative self-perception of hearing and depression in older adults: a population-based study / Autopercepção negativa da audição e depressão em idosos: um estudo de base populacional

ABSTRACT OBJECTIVE To estimate the association between negative self-perception of hearing and depression in older adults in Southern Brazil. METHODS This is a cross-sectional study conducted with data from the third wave of the EpiFloripa Idoso 2017/19 study, a population-based cohort of older adults (60+). A total of 1,335 older adults participated in this wave. The dependent variable was self-reported depression, and the main exposure was self-perception of hearing (negative; positive). For both the crude (bivariate) and adjusted analysis, the odds ratio (OR) was used as a measure of association and estimated by means of binary logistic regression analysis. The exposure variable was adjusted by sociodemographic and health covariates. A p value < 0.05 was adopted as statistically significant. RESULTS The prevalence of negative self-perception of hearing and depression was 26.0% and 21.8%, respectively. In the adjusted analysis, the older adults with negative self-perception of hearing were 1.96 times more likely to report depression when compared to the ones with positive self-perception of hearing (p = 0.002). CONCLUSION The association between negative self-perception of hearing and depression reflects the importance of reviewing health care actions for older adults, incorporating hearing-related issues, to ensure comprehensive care for this growing segment of the population.

RESUMO OBJETIVO Estimar a associação entre a autopercepção negativa da audição e a depressão em idosos do sul do Brasil. MÉTODOS Trata-se de um estudo transversal realizado com dados da terceira onda do estudo EpiFloripa Idoso 2017/19, de coorte de base populacional de idosos (60+). Participaram desta onda 1.335 idosos. A variável dependente foi a depressão autorreferida e a exposição principal foi a autopercepção auditiva (negativa; positiva). Tanto para a análise bruta (bivariada) quanto para a ajustada, a odds ratio (OR) foi utilizada como medida de associação e estimada por meio da análise de Regressão Logística Binária. A variável de exposição foi ajustada pelas covariáveis sociodemográficas e de saúde. Adotou-se o valor de p < 0,05 como estatisticamente significativo. RESULTADOS A prevalência da autopercepção negativa da audição e depressão foi de 26,0% e 21,8%, respectivamente. Na análise ajustada, idosos com autopercepção negativa da audição apresentaram 1,96 vezes mais chance de referirem depressão quando comparados aos idosos com autopercepção positiva da audição (p = 0,002). CONCLUSÃO A associação encontrada entre a autopercepção negativa auditiva e a depressão reflete a importância de rever as ações de atenção à saúde do idoso, incorporando questões relacionadas à audição para a garantia da atenção integral a esta parcela crescente da população.

La presbiacusia y su relación con el deterioro cognitivo en el adulto mayor / Presbycusis and its relationship with cognitive impairment in the elderly

Este análisis exhaustivo aborda la presbiacusia, una pérdida auditiva vinculada al envejecimiento, y su estrecha relación con el deterioro cognitivo en adultos mayores. Siguiendo el protocolo PRISMA, se seleccionaron cuidadosamente 26 estudios recientes para explorar los cambios anatomofisiológicos en el órgano auditivo durante el envejecimiento. La presbiacusia, afectando a personas mayores de 65 años, se revela como un fenómeno multifactorial que va más allá de la mera pérdida de audición, vinculándose al agotamiento de recursos cognitivos y aumentando el riesgo de demencia. El estudio destaca la necesidad de abordar tempranamente la presbiacusia, considerándola como un indicador potencial de problemas cognitivos en la vejez. La revisión, que incluyó una diversidad de estudios metodológicos, revela la compleja interacción entre la pérdida auditiva y el deterioro cognitivo. No solo explora los aspectos fisiológicos de la presbiacusia, sino que también resalta su impacto en la percepción auditiva y las capacidades cognitivas, enfocándose en el agotamiento de las reservas cognitivas y el aumento de la activación de las regiones frontales del cerebro. En conclusión, este análisis subraya la conexión sólida entre la pérdida auditiva asociada al envejecimiento y el declive cognitivo, resaltando la importancia de abordar la salud auditiva en estrategias preventivas del deterioro cognitivo en la población mayor. Con un enfoque integral, este estudio aporta a la comprensión de una relación crítica en el proceso de envejecimiento, destacando la necesidad de investigaciones continuas para informar intervenciones efectivas

This comprehensive analysis addresses presbycusis, hearing loss linked to aging, and its close relationship with cognitive impairment in older adults. Following the PRISMA protocol, 26 recent studies were carefully selected to explore anatomophysiological changes in the auditory organ during aging. Presbycusis, affecting people over 65 years of age, is revealed as a multifactorial phenomenon that goes beyond mere hearing loss, being linked to the depletion of cognitive resources and increasing the risk of dementia. The study highlights the need to address presbycusis early, considering it as a potential indicator of cognitive problems in old age. The review, which included a diversity of methodological studies, reveals the complex interaction between hearing loss and cognitive impairment. It not only explores the physiological aspects of presbycusis, but also highlights its impact on auditory perception and cognitive abilities, focusing on the depletion of cognitive reserves and increased activation of frontal brain regions. In conclusion, this analysis underscores the robust connection between aging-associated hearing loss and cognitive decline, highlighting the importance of addressing hearing health in preventive strategies for cognitive decline in the older population. With a comprehensive approach, this study contributes to the understanding of a critical relationship in the aging process, highlighting the need for continued research to inform about effective interventions

Análisis de correlación entre la audición y la flexibilidad cognitiva en una población adulta mayor de Sincelejo, Colombia / Correlation analysis between hearing and cognitive flexibility in the older adult population of Sincelejo, Colombia

Resumen Introducción: La presente investigación estudió el sistema auditivo y las habilidades ejecutivas, específicamente la flexibilidad cognitiva, en población longeva y buscó aportar a la evidencia científica existente, el impacto que pueden tener ambas en la calidad de vida de la población adulta mayor. Objetivo: Se determinó la relación entre la función auditiva y la flexibilidad cognitiva de una población adulta mayor del municipio de Sincelejo, Colombia. Método: Se realizó un estudio cuantitativo, no experimental, correlacional, transversal, a una población de 140 adultos mayores, para la selección de la muestra se aplicó un muestreo intencional por criterios de inclusión (pertenecientes a la institución, que firmarán el consentimiento informado) y de exclusión (déficit cognitivo, diabetes, enfermedades neurológicas diagnosticadas, alteraciones visuales o auditivas, sobrepasar la edad del test), la muestra quedo conformada por 49 adultos mayores. Se empleó como instrumentos de recolección de la información para la audición, pruebas audiológicas de audiometría tonal y logoaudiometría; y para la medición de la función ejecutiva, Test de clasificación de tarjetas de Wisconsin. Resultados: se demostraron diferencias entre la variable respuesta de nivel conceptual del test entre los grupos de edad (p: 0,037), pérdidas auditivas de alta frecuencia entre leve y moderado (25-40DbBHL; 40-60DBHL), buen nivel de discriminación del habla, y una asociación estadística entre sensibilidad auditiva y número total de errores (0,336, 0,357 p=0,05); la sensibilidad auditiva y las respuestas perseverativas y errores perseverativos (0,343, 0,301 p=0,05), discriminación del habla, respuesta a nivel conceptual (-0,375;-0,397p=0,0) y fallos para mantener actitud (0,441; 0,456 p=0,01). Conclusión: Cuanto mayor deterioro en el procesamiento periférico y central auditivo exista, mayor es la tendencia perseverativa, la dificultad para abstracción y formación de conceptos, así como el cambio de estrategias de un adulto mayor en tareas que impliquen funcionamiento ejecutivo.

Abstract Introduction: The present research study the auditory system and executive skills, specifically cognitive flexibility, in long-lived population to contribute to the existing scientific evidence, the impact that both can have on the quality of life of the elderly population. Objective: the relationship between the hearing function and cognitive flexibility an older adult population was determined in Sincelejo, Colombia. Method: A quantitative, non-experimental, correlational, cross-sectional study was conducted in a population (140) older adults, intentional sampling by inclusion criteria was applied for the selection of the sample (belonging to the institution, who will sign the informed consent) and exclusion (cognitive deficit, diabetes, diagnosed neurological diseases, visual or auditory alterations, exceeding the age of the test), the sample was made up of 49 older adults. It was used as instruments for collecting information for hearing, audiological tests of tone audiometry and logoaudiometry, for the measurement of executive function, Wisconsin Card Classification Test. Results: The results showed mean differences in the conceptual level response variable between age groups (p: 0.037), high-frequency hearing losses between mild and moderate (25-40Dbhl; 40-60Dbhl), good level of speech discrimination and a statistical association between hearing sensitivity and total number of mistakes (0.336, 0.357 p=0.05), and perseverance(0.343, 0.301 p=0.05), speech discrimination, response at the conceptual level(-0.375;-0.397p=0.0), lack of attitude(0.441; 0.456 p=0.01). Conclusion: The greater the deterioration in the peripheral and central auditory processing, the greater the perseverative tendency, the difficulty in abstraction and concept formation, as well as the change of strategies of an older adult in tasks that involve executive functioning.

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.

Acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos / Accuracy of affordable instruments for hearing screening in adults and the elderly

RESUMO Objetivo Avaliar a acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos. Método Este estudo foi realizado com usuários de um Serviço de Saúde Auditiva do SUS. Todos foram submetidos a triagem com o aplicativo de smartphone MoBASA, o audiômetro Telessaúde (TS) e a versão eletrônica do Questionário de Handicap da Audição para Idosos (Hearing Handicap Inventory for the Elderly - screening version - eHHIE-S). Os examinadores foram cegos quanto aos resultados dos testes de triagem e para os dados de audiometria de tom puro (ATP). Foram considerados com deficiência auditiva aqueles com média quadritonal na ATP maiores que 40 dB na melhor orelha. Sensibilidade, especificidade e valores preditivos positivo (VPP) e negativo (VPN) foram calculados. O índice Kappa foi usado como um indicador de concordância entre ATP e os resultados da triagem. Resultados A amostra constou de 80 indivíduos entre 18 a 94 anos (55,18 ± 20,21). Na ATP, 21 indivíduos (26,25%) apresentaram audição normal e 59 (73,75%) perda auditiva incapacitante. Nos testes de triagem auditiva observou-se valores de sensibilidade, especificidade, VPP e VPN maiores do que 75% no MoBASA e na sensibilidade e VPN do TS e eHHIE-S. Já a especificidade e VPP do TS e eHHIE-S foram inferiores a 75%. O índice Kappa indicou concordância substancial (0,6) entre o ATP e os resultados do MoBASA. No TS e eHHIE-S foi constatada regular concordância (0,3). Conclusão O MoBASA demonstrou ser um método acurado para triagem auditiva de adultos e idosos com perda auditiva incapacitante.

ABSTRACT Purpose To evaluate the accuracy of affordable instruments for hearing screening of adults and the elderly. Methods This study was carried out with users of a Hearing Health Service of the Unified Health System. All were screened with the MoBASA smartphone application, the Telehealth audiometer (TH) and the electronic version of the Hearing Handicap Inventory for the Elderly - screening version - eHHIE-S. The examiners were blinded to the results of the screening tests and pure tone audiometry (PTA). Hearing impairment was considered for those with a PTA quadritonal mean greater than 40 dB in the best ear. Sensitivity, specificity and positive and negative predictive values (PPV and NPV, respectively) were calculated. The Kappa index was used as an agreement indicator between the PTA and the screening results. Results The sample consisted of 80 individuals between 18 and 94 years old (55.18 ± 20.21). In the PTA test, 21 individuals (26.25%) had typical hearing and 59 (73.75%) hearing loss. In the hearing screening tests, sensitivity, specificity, PPV and NPV values greater than 75% were observed with the MoBASA as well as in terms of sensitivity and NPV of the TH and the eHHIE-S. The TH and the eHHIE-S specificity and PPV were less than 75%. The Kappa index indicated a substantial agreement (0.6) between the PTA and the MoBASA screening results. The TH and the eHHIE-S showed regular agreement (0.3). Conclusion MoBASA proved to be an accurate method for hearing screening of adults and the elderly with disabling hearing loss.

Age-related hearing loss and its association with central obesity: experience at a tertiary centre

Background: Presbycusis is a slow, progressive, age-related sensorineural hearing loss, which is insidious, slow, progressive and irreversible disease and usually affects high pitch sound. It can be associated with various factors. Obesity is such a modifiable factor and its independent role with age-related hearing loss needs to be explored.Methods: This is a prospective study carried out over a period of three years in department of otorhinolaryngology at study institute. It included 1000 cases with symmetrical sensorineural hearing loss.Results: Among obese cases, high frequency hearing loss was found in significantly large number of cases. The most common audiogram in both male and female was Abrupt high tone loss type, irrespective of presence or absence of obesity.Conclusions: Obesity is a modifiable factor which has a significant association with high frequency hearing loss among the elderly population.

Hipoacusia como factor de riesgo para demencia

In the last decades, there has been an increase in life expectancy in the world, with the consequent modification in the proportion of adults over 60 years. This is accompanied by an increase in pathologies for which aging is the main risk factor, such as dementia and hearing loss, which profoundly affect the quality of life of individuals and their family and impact health system costs. Given the lack of disease-modifying treatments for dementia, the study of mechanisms to prevent its occurrence has become a world priority. In the year 2017, the Lancet "Commission for dementia prevention, intervention, and care" proposed a model, in which hearing loss emerged as a new modifiable risk factor for the development of dementia. This result undoubtedly has important consequences for the understanding the multifactorial nature of dementia, our daily clinical practice and public policies aimed at its prevention and treatment. In this article, we review the current evidence supporting the association between dementia and hearing loss, discussing the available strategies for prevention, detection and treatment of hearing loss and its possible impact on the natural course of dementia. A flow chart for the clinical management of different subgroups of patients is proposed.

Application of the Chinese version of the Addenbrooke＇s cognitive examination－Ⅲ in presbycusis with mild cognitive impairment / 中国基层医药

Objective To explore the reliability , validity and best cut －off value of Chinese version Addenbrooke＇s cognitive examination －Ⅲ(ACE－Ⅲ) in presbycusis patients with mild cognitive impairment (MCI). Methods A total of 43 presbycusis patients with mild cognitive impairment ,61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE),Montreal cognitive assessment ( MoCA) and ACE －Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE －Ⅲwere analyzed with the SPSS 21.0,and the cut－off point was confirmed with the receiver operating characteristic ( ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed.Results Chinese version of ACE －Ⅲhad betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach＇s alpha,split－half reliability and intraclass correlation coefficient were 0.870(P＜0.05), 0.874(P＜0.05) and 0.880(P＜0.05),respectively.The patients in MCI group got a lower score in the sub －scale of attention／orientation,memory,verbal fluency,language and visual space of ACE －Ⅲ compared with those in NCI group and healthy control group ,and the differences were statistically significant ( F ＝48.042,46.594,35.442, 19.374,256.19,140.319,all P＜0.001).The criteria validity calculated between the Chinese version of ACE －Ⅲand MMSE was 0.802 (P＜0.001).Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals (P＜0.05).The Chinese version of ACE －Ⅲ showed significantly correlation with the total scores of MoCA ( r＝0.802,P＜0,001).When the cut －off value for diagnosis was 86.5,the largest area under the ROC curve for the Chinese version of ACE－Ⅲwas 0.98(95%CI:0.897－0.996).The relative sensitivity and specificity were 100.0%and 95.0%,respectively.Conclusion The Chinese version of ACE －Ⅲ had better internal consistency ,reliability and validity,and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.

Changes of BKCa on vascular striaepericytes of D-galactose-induced aging model in guinea pigs / 中华耳鼻咽喉头颈外科杂志

Objective@#The aging model of guinea pigs induced by D-galactose was set up to investigate the changes of BKCa expression and function on cochlear pericytes and their relationship with age-related hearing loss.@*Methods@#Thirty healthy 8-week-old guinea pigs were randomly divided into three groups, with 10 in each group: D-galactose aging model group, subcutaneous injection of D-galactose (500 mg/kg) daily for 6 weeks; saline control group, the same amount of saline was injected into the neck of the aging model group for 6 weeks; the blank control group, no treatment was performed. The threshold of auditory brainstem response (ABR) was detected. The content of BKCa in the perivascular cells of the guinea pig cochlear cells was detected by immunofluorescence technique. The changes of peripheral current density and BKCa current were detected by patch clamp technique. The data were analyzed by GraphPad Prism software.@*Results@#Compared with the saline group and the control group, the ABR threshold and the amplitude of the wave I were significantly decreased in the aging model group, and the difference was statistically significant (P<0.01). Compared with the control group, the expression of BKCa in the vascular pericytes of guinea pigs in the aging model group was significantly reduced (1.00±0.08 vs 0.27±0.03,the difference was statistically significant P<0.01), and the cell current density and BKCa net current value were also significantly reduced with statistically significant (P<0.01).@*Conclusions@#D-galactose can successfully induce guinea pig aging model, in which BKCa expression decreases and net current value decreases in pericytes of cochlear striavascularis, and changes in BKCa expression and function may be related to age-related hearing loss.

Application of the Chinese version of the Addenbrooke's cognitive examination-Ⅲ in presbycusis with mild cognitive impairment / 中国基层医药

Objective@#To explore the reliability, validity and best cut-off value of Chinese version Addenbrooke's cognitive examination-Ⅲ(ACE-Ⅲ) in presbycusis patients with mild cognitive impairment(MCI).@*Methods@#A total of 43 presbycusis patients with mild cognitive impairment, 61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE), Montreal cognitive assessment(MoCA) and ACE-Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE-Ⅲ were analyzed with the SPSS 21.0, and the cut-off point was confirmed with the receiver operating characteristic(ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed.@*Results@#Chinese version of ACE-Ⅲ had betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach's alpha, split-half reliability and intraclass correlation coefficient were 0.870(P<0.05), 0.874(P<0.05) and 0.880(P<0.05), respectively.The patients in MCI group got a lower score in the sub-scale of attention/orientation, memory, verbal fluency, language and visual space of ACE-Ⅲ compared with those in NCI group and healthy control group, and the differences were statistically significant (F=48.042, 46.594, 35.442, 19.374, 256.19, 140.319, all P<0.001). The criteria validity calculated between the Chinese version of ACE-Ⅲ and MMSE was 0.802 (P<0.001). Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals(P<0.05). The Chinese version of ACE-Ⅲ showed significantly correlation with the total scores of MoCA(r=0.802, P<0, 001). When the cut-off value for diagnosis was 86.5, the largest area under the ROC curve for the Chinese version of ACE-Ⅲ was 0.98(95% CI: 0.897-0.996). The relative sensitivity and specificity were 100.0% and 95.0%, respectively.@*Conclusion@#The Chinese version of ACE-Ⅲ had better internal consistency, reliability and validity, and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.

Expression of NKCC1 and Na-K-ATPase in C57BL/6J mice with age-related hearing loss / 中国耳鼻咽喉头颈外科

OBJECTIVE Disturbance of K+ ion balance in inner ear is associated in age-related hearing loss. Our study is to investigate the role of NKCC1 and Na-K-ATPase in cochlea and auditory function regulated by with different expression of NKCC1 and Na-K-ATPase. METHODS Auditory threshold of young or old C57BL/6J mice was measured by auditory brainstem response(ABR). The expression of NKCC1 and Na-K-ATPase in mice cochlea were evaluated by reverse transcription polymerase chain reaction(RT-PCR) and western blotting. Furosemide and Ouabain were applied in vivo to inhibit NKCC1 and Na-K-ATPase in C57BL/6J mice. RESULTS C57BL/6J mice developed hearing loss at 12M by ABR threshold shifting to (75±10), (78±26) and (81±14)dB SPL at frequencies of 8, 16 and 32 kHz; PCR showed that the relative expression of NKCC1 and Na-K-ATPase mRNA in the aged group decreased, which were 0.52±0.06 and 0.35±0.04 times higher than those in the young control group, the difference was statistically significant(t =7.466 and 16.11, all P＜0.05). WB showed that relative expression of NKCC1 and Na-K-ATPase protein level in the aged group decreased by 0.79±0.02 and 0.68±0.05 times as much as that of the young control group, the difference was statistically significant(t =8.857 and 6.771, P all＜0.05). After applied with Furosemide and Ouabain to suppress the two ion transporters, the ABR threshold increased to (50±17), (53±21), (55±17)dB SPL and (56±6), (70±17), (73±6)dB SPL at frequencies of 8, 16 and 32 kHz. CONCLUSION In vivo experiment of C57BL/6J suggested that NKCC1 and Na-K-ATPase might be related to age related hearing loss.

Psychopathological characteristics and its influencing factors in families of presbycusis patients / 中国基层医药

Objective To investigate the psychopathological characteristics in families of presbycusis patients and its influencing factors.Methods The psychopathological characteristics were evaluated with the Symptom Checklist-90(SCL-90) Chinese version in 157 families of presbycusis patients(FPP) in the Affiliated Hospital of Yangzhou University from July 2015 to July 2017. Somatization, obsessive - compulsive disorder, interpersonal sensitivity,depression,anxiety,hostility,phobic anxiety,paranoid ideation,psychoticism and other were assessed and compared with the Chinese standard norm.The correlation between SCL-90 and related data had also been analyzed. The general information and clinical data of patients were analyzed.Results The SCL-90 score in the FPP group was (146.3 ± 42.8)points.The total score and total average score of SCL-90 had statistically significant difference between the FPP group and the Chinese standard group(t=14.557,14.765,all P<0.05).The scores of somatiza-tion,interpersonal sensitivity,depression and anxiety factors in the FPP group were higher than those in the Chinese standard group(t=5.417,13.588,20.857,22.475,all P<0.05).Age,sleeping condition,educational level,hearing aids and the level of patients＇hearing loss were correlated with the total score of SCL-90( TSCL-90) in FPP( all P<0.05).Multiple linear regression analysis showed that age(t=2.550,P<0.000),the educational level( t =4.087,P<0.000),and the level of patients＇hearing loss ( t =2.188, P <0.05 ) were positively correlated with TSCL-90,and sleeping condition(t= -2.004,P<0.05) and hearing aids(t= -4.643,P<0.05) were negatively associated with TSCL-90.Conclusion The psychopathological characteristics are generally poor in families with presbycusis patients,accompanied by obvious depression and anxiety;and age,sleeping condition,educational level, hearing aids and the level of patients＇hearing loss are important influencing factors.It is important to pay attention to overall health in families with presbycusis patients.

Percepção de idosos sobre a restrição da participação relacionada à perda auditiva / Perception of elderly people about the restriction of participation related to hearing loss / Restrición de la participación en idosos relacionada a la pérdida auditiva

Introdução: Dentre as alterações fisiológicas do processo de envelhecimento humano, a perda auditiva relacionada à idade é uma das mais frequentes e incapacitantes, pois diminui o contato social do idoso, podendo afetar suas condições de saúde. Objetivo: Verificar a percepção de idosos sobre a restrição da participação relacionada à perda auditiva. Método: Estudo transversal e quantitativo com idosos maiores de 60 anos que têm perda auditiva, usuários ou não de aparelho de amplificação sonora. Analisou-se a audiometria tonal convencional e aplicou-se o questionário Hearing Handicap Inventory for the Elderly. Resultado: A amostra foi composta por 46 indivíduos, sendo 43,48% (n=20) do sexo feminino e 56,52% (n=26) do sexo masculino. A idade média foi 74,78 anos, com desvio padrão de 7,96 anos. A perda auditiva de maior ocorrência, em 73,91% (n=34) da amostra, foi do tipo neurossensorial bilateral e de configuração descendente, sendo que 50% (n=23) não usava aparelho de amplificação sonora individual, 45,65% (n=21) afirmou usá-lo e 4,35 (n=2) não respondeu essa questão. Quanto à participação, 82,6% dos idosos relatou restrições para participar de atividades sociais, sendo 50% da amostra (n=23) com percepção significativa. No geral, tal restrição foi maior no gênero masculino, na perda auditiva neurossensorial de grau moderado e configuração descendente, com idade até 79 anos e que não utilizavam o referido aparelho. Conclusão: Os idosos com perda auditiva apresentaram percepção significativa da restrição da participação, principalmente os que não utilizam aparelho de amplificação sonora individual, impactando negativamente sua qualidade de vida.

Introduction: Among the physiological alterations of the human aging process, age-related hearing loss is one of the most frequent and disabling, since it reduces the social contact of the elderly, and can generate impact on health conditions. Objective: to verify the perception of the elderly about the restriction of participation related to hearing loss. Method: A cross-sectional and quantitative study with elderly individuals over 60 years of age, all with hearing loss, users of hearing aids or not. The Hearing Handicap Inventory for the Elderly (HHIE) questionnaire was applied. Results: The sample consisted of 46 individuals, 43.48% (n = 20) of the female sex and 56.52% (n = 26) of the male sex. The average age was 74.78 years, with a standard deviation of 7.96 years. The most frequent hearing loss, in 73.91% (n = 34) of the sample, was bilateral sensorineural type with a descending configuration, with 50% (n = 23) not using hearing aids, 45.65% (n = 21) stated using it and 4.35% (n = 2) did not answer that question. The results showed that 82.6% of the elderly reported restrictions to participate in social activities, being 50% of the sample (n = 23) with significant perception. In general, such a restriction was higher in males, sensorineural hearing loss of moderate degree and descending configuration, ages up to 79 years, who did not use hearing aids, although the differences between the variables were not significant. Conclusion: Elderly people with hearing loss had a significant perception of the restriction of participation, especially among those who did not use PSAPI, which could negatively impact quality of life.

Introducción: Entre las alteraciones fisiológicas del proceso de envejecimiento humano, la pérdida auditiva relacionada a la edad es una de las más frecuentes e incapacitantes, pues disminuye la participación social del anciano, pudiendo generar impacto en las condiciones de salud. Objetivo: verificar la percepción de los ancianos, sobre la restricción de la participación relacionada a la pérdida auditiva. Método: Estudio transversal y cuantitativo con ancianos mayores de 60 años, con pérdida auditiva, usuarios o no de audífonos. Se analizó la audiometría tonal convencional y se aplicó el cuestionario Hearing Handicap Inventory for the Elderly. Resultado: La muestra fue compuesta por 46 individuos, siendo 43,48% (n = 20) del sexo femenino y 56,52% (n = 26) del sexo masculino. La edad media fue 74,78 años, con desviación estándar de 7,96 años. La pérdida auditiva de mayor ocurrencia, el 73,91% (n = 34) de la muestra, fue del tipo neurosensorial bilateral y de configuración descendente, siendo que el 50% (n = 23) no usaba audífonos, 45,65 % (n = 21) afirmó usarlo y 4,35 (n = 2) no respondió esta cuestión. Los resultados mostraron que el 82,6% de los ancianos relató restricciones para participar en actividades sociales, siendo el 50% de la muestra (n = 23) con percepción significativa. En general, tal restricción fue mayor en el género masculino, en la pérdida auditiva neurosensorial, de grado moderado y configuración descendente, con edad de hasta 79 años y que no utilizaban audífonos, aunque las diferencias entre las variables no fueron significativas. Conclusión: Los ancianos con pérdida auditiva presentaron percepción significativa de la restricción de la participación, principalmente aquellos que no utilizan audífonos, pudiendo así impactar negativamente en la calidad de vida.