Age-related hearing loss and its consequences can be prevented, compensated and managed, according to our partner The Conversation.
Prevention is all the more important as hearing disorders constitute a risk factor for Alzheimer's disease or related.
The analysis of this phenomenon was carried out by Anaïs Cloppet-Fontaine, geriatrician.
Deafness is one of the most common disabilities in France: 7.6 million French adults say they suffer from hearing loss, or 12.7% of those over 18.
From the age of 74, this proportion rises to 31%, a large part of which is presbycusis.
This hearing disorder begins very early, at age 25, but generally becomes observable from age 55.
Even if it is inevitable, age-related hearing loss and its consequences can be prevented, compensated and managed.
Speak louder, but not only ...
Presbycusis is due to the degradation of the auditory organ, in particular of the cochlea, where the sensory cells are located, but also at the level of the nervous pathways and centers which carry auditory information to the brain.
The eardrum and ossicles, which mechanically transmit the sound wave to the inner ear, also lose their flexibility and elasticity.
Along with genetic causes, the main risk factor for the onset of presbycusis is repeated exposure to sound trauma.
Its prevention therefore depends above all on reducing exposure to these traumas, whether occupational or, and above all, linked to the use of headphones connected to a sound source, in terms of duration, frequency of use, and in intensity.
Figure 2: Cross section of the ear © JNA Association for the Development of Hearing Health for All (via The Conversation)
Occurring gradually, hearing loss mainly involves high-pitched sounds.
Presbycusis mainly affects the cells at work in the perception of these sounds.
In doing so, it alters the ability to distinguish the different sound components of speech.
In environments saturated with parasitic and aggressive noises, having a conversation becomes difficult, sometimes even impossible, because the difficulty of hearing is added to the difficulty of understanding.
Paradoxically, one of the first signs of presbycusis is hypersensitivity or even intolerance to noisy environments, and more simply to noise.
Influence of age on the degree of hearing loss © Cochlea (via The Conversation)
Compensation strategies
Presbycusis can hear but do not understand.
Each interaction is costly in attention and concentration, so much so that the pleasure of communication suffers.
To avoid having people repeat too often or quickly finding themselves in a misunderstanding, they tend to use and abuse a compensation strategy which consists of keeping the word.
Localization of speech phonemes on hearing loss curves © André Chays / CHU Reims (via The Conversation)
By dint of misunderstandings and misunderstandings in the exchanges, presbyacusics sometimes display aggressive behaviors and end up isolating themselves.
Presbycusis is also associated with the occurrence of depressive syndromes, falls and loss of autonomy.
In addition, hearing problems are a risk factor for Alzheimer's or related disease.
Recent data has also shown that wearing a hearing aid helps reduce the risk of cognitive decline.
Screening, diagnosis, rehabilitation
It is important to detect any high frequency hearing loss early on, before the first signs of social discomfort arise.
Currently, it is recommended to consult an otolaryngologist (ENT) in case of hearing loss, but no systematic screening is recommended.
However, there are hearing tests that can be performed alone, via apps or online.
This is the case, for example, with the Höra test of the Hearing Foundation, or the Digit Triplet Test.
However, at the end of these self-tests, a possible suspicion will not replace a diagnosis.
Additional examinations will therefore be necessary.
Indeed, only an ENT is authorized to make a diagnosis of presbycusis based on a series of specific examinations:
an otoscopic examination, to auscultate the outer and middle part of the ear.
tonal audiometry, to measure the pure perception of sounds.
speech audiometry, to measure speech understanding.
These examinations aim to confirm the diagnosis of presbycusis and to eliminate other pathologies causing hearing loss, such as earwax plug, chronic otitis, or benign tumor of the auditory nerve, for example.
Depending on the results of these examinations, the ENT may then recommend and prescribe a hearing aid.
Said equipment will be put in place by an audioprosthetist, who will operate the various settings allowing optimum hearing comfort and rehabilitation, and take charge of the follow-up.
There are many hearing aids available to restore a comfortable level of hearing.
In this rehabilitation process, speech therapy sessions may be prescribed.
In the case of profound deafness, when certain conditions are met, the placement of a cochlear implant may be considered.
This device converts surrounding sounds, picked up by a microphone, into digital signals (electrical impulses), which directly stimulate the auditory nerve via electrodes inserted into the tympanic ramp of the cochlea.
The brain then interprets them as sounds.
Taboos and stubborn resistance
As we have seen, the benefit of rehabilitation extends beyond simple hearing gain.
82% of people with hearing aids express satisfaction with the benefits of their hearing aids.
However, only 41% of French people who are hard of hearing would be fitted.
Different types of hearing aids depending on the degree of deafness © https://lanielaudio.com/ (via The Conversation)
The main obstacles to hearing aids are linked to the perception of hearing disorders in our society - negative image of aging, reduced cognitive functions - as well as preconceived ideas about the effectiveness of hearing aids and their reimbursement.
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However, the situation could change: since January 1, 2021, the reform "Remainder at zero charge" improves accessibility to quality equipment by allowing 100% coverage by health insurance and complementary health insurance or by health insurance. complementary solidarity health.
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This analysis was written by Anaïs Cloppet-Fontaine, geriatrician and project manager at Gérond'if, holder of the DIM (area of major interest) longevity and aging labeled by the Ile-de-France Region, Île-de-France Region .
This article was co-authored by André Chays, professor of otolaryngology at the UFR de Médecine de Reims and member of the scientific committee of Infosens (network of actions serving the inclusion of deaf or hard of hearing people) and Frédéric Brossier, deputy director of “partnerships and innovations” projects at Infosens.
The original article was published on The Conversation website.
Declaration of interests
Anaïs Cloppet-Fontaine does not work, does not advise, does not own shares, does not receive funds from any organization that could benefit from this article, and has not declared any affiliation other than her research organization.
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