Disorders that Commonly Occur in the Hearing System of Elderly

Kezia Arihta Sembiring, 1906400646, Kep. Gerontik-A

Hearing loss is common in elders and increases with age. The age-related changes of the
inner ear are affecting how the ear works. Elderly people are mostly have lost their hair cells of
inner ear, reduction of bloody supply, diminution of endolymph production, decreased basilar
membrane flexibility, degeneration of spiral ganglion cells, and loss of neurons in the cochlear
nuclei. These changes may result some disorders occur. The disorders are presbycusis,
otosclerosis, tinnitus, and many more. This essay will discuss mostly about the presbycusis since
it's the most common disorder of hearing system of elderly (Tabloski, 2018). The presbycusis
affects approximately 75% of adults who are 70 years of age or older; this increases to almost
80% for those older than age 85 (Cash & Glass, 2019).

Presbycusis is a diminished ability to hear high-pitched sounds, especially in the presence

of background noise (Miller, 2012). This bilateral hearing loss, when both of ears are affected, is
associated with aging due to the progressive degeneration of cochlear structures and central
auditory pathways (Reis & Escada, 2016). The presbycusis has four classifications based on the
specific structural source of the impairment, as follows (Miller, 2012):

1. Sensory presbycusis. This type of presbycusis is caused by the degeneration of hair cells
and Corti's organ. It is characterized by a sharp-hearing loss at high frequencies.
2. Neural presbycusis. The neural presbycusis is caused by the degeneration of nerve fibers
in the cochlea and spiral ganglion and characterized by reduced speech discrimination.
3. Metabolic presbycusis, which is associated with degeneration of stria vascularis and
subsequent interruption in essential nutrient supply. The metabolic presbycusis is
characterized by the reduction of sensitivity to all sound frequencies, leads to reducing
the speech discrimination.
4. Mechanical presbycusis. It is related to the mechanical changes of inner ear structures,
characterized by a hearing loss which initially involves lower frequencies and spreads to
high frequencies and interfere with speech discrimination gradually.

The factors influencing presbycusis are age, heredity, cumulative noise exposure, and
age-related physiologic changes to the ear. The physiologic changes of cochlea are identified as
the primary cause of presbycusis. Many other factors are the illness and progression of disease,
for example hypertension and hyperlipidemia, the use of ototoxic medications such as
gentamicin and aspirin, and smoking (Cash & Glass, 2019).

The presbycusis makes elderly people have some difficulties in communicating. It

interferes the enjoyment of certain forms of music or television, the safety, and independence
(Tabloski, 2018). As an example, older adults might mishear a sentence like "I think she should
go to the store" as "I wish we could go to the show". This shows the filtered out of high-pitched
sounds, it makes words become distorted and jumbled. The diminished speech discrimination is
related to speaker's rate of speech; rapid, slow, or slurred speech patterns, it can cause difficulty
for older people to discern the words. As the hearing loss progresses, explosive consonants, such
as b, d, k, p, and t, also become distorted (Miller, 2012).

Another pathologic condition that affects hearing is tinnitus. Tinnitus, originally from the
Latin word tinnire which means "to ring", is the persistent sensation of ringing, hissing, sizzling,
buzzing, bowling, or roaring types of noise that is actually not originate in the external
environment. Some older people might experience tinnitus temporarily, but other people
experience it in long-term (Mauk, 2014). It is similar to the internal noise one hears after being
exposed to loud noises. Tinnitus can be categorized as rhythmical or pulsatile and corresponding
with a heartbeat. It is estimated that approximately 10% to 15% of the adult population has
experienced tinnitus. (Cash & Glass, 2019).

This pathologic condition is highly related to hearing loss, ototoxic medications, and
Ménière disease. Ménière disease is an idiopathic peripheral audio vestibular disorder, it is
characterized by episodic vertigo, unilateral fluctuating hearing loss, tinnitus, and aural fullness
(Christopher & Wilkinson, 2021). Factors that predisposing tinnitus are high levels of noise
exposure, otological conditions, for example neoplasms, hearing loss, cerumen impaction, otitis
media, mastoiditis, and labyrinthitis. The other factors are related to neurologic conditions, it can
be found at people who suffer from vertigo, migraines, epilepsy, meningitis, and multiple
sclerosis. People who have trauma from head or neck might have tinnitus, too. Immune system
disorders, endocrine influences, psychological disorders, and hypertension are also related to
tinnitus. The pathophysiology of tinnitus is still unknown, it is poorly understood and mostly
described as a nonspecific manifestation of pathology of the inner ear, eighth cranial nerve, or
the central auditory mechanism (Cash & Glass, 2019).

The hearing loss disorders have some impacts to the quality of life, safety, and
functioning. Hearing is important to enjoy entertainment, gain information, communicate to
people, and respond to threats. It can interfere the mental status. It makes older people reluctant
to respond to questions and may refrain from answering. To help elderly people, the use of
hearing aids may indicate. The hearing aids amplify sounds and deliver them directly into the
ear. It is appropriate for people who have hearing impairments. The components of hearing aids
are amplifier, microphone, and receiver, it also has some many types. Something that should be
noted that as a gerontic nurse, we should be aware of the cleaning, inserting, and troubleshooting
the hearing aids. It is important to identify that older people wearing the hearing aids on
admission to the hospital or nursing home (Tabloski, 2018).

Nurses can make a plan to do the examinations of auditory systems, the cause of
disorders, and refer to otolaryngologist if the pathologic conditions lasting longer than three
weeks. The geriatric nurse should let patients know that a follow-up with a specialist is important
to identify the correct diagnosis. For tinnitus, a nurse can educate the patient about therapies.
Nurse can summarize the treatment options of aural rehabilitation, hearing aids, and cochlear
implants for presbycusis if it's indicated. The nurse can also teach the patient about what are
consequences of excessive environmental noise (Cash & Glass, 2019).
 References

Cash, J. C., & Glass, C. A. (2019). Adult-Gerontology Practice Guidelines. In J. C. Cash & C. A.
Glass (Eds.), Adult-Gerontology Practice Guidelines (2nd ed.). Springer.
https://doi.org/10.1891/9780826195197

Christopher, L. H., & Wilkinson, E. P. (2021). Meniere’s disease: Medical management,

rationale for vestibular preservation and suggested protocol in medical failure. American
Journal of Otolaryngology - Head and Neck Medicine and Surgery, 42(1), 102817.
https://doi.org/10.1016/j.amjoto.2020.102817

Mauk, K. L. (2014). Gerontology Nursing Campetencies For Care. In Chief Executive (3rd ed.).
Jones & Bartlett Learning.

Miller, C. A. (2012). Nursing for Wellness in Older Adults (E. Nieginski (ed.); 6th ed.). Wolters
Kluwer Health.

Reis, L. R., & Escada, P. (2016). Presbycusis: Do we Have a Third Ear? Brazilian Journal of
Otorhinolaryngology, 82(6), 710–714. https://doi.org/10.1016/j.bjorl.2015.12.006

Tabloski, P. A. (2018). Gerontological Nursing The Essential Guide to Clinical Practice (4th
ed.). Pearson.