Abstract
Normal aging affects all parts of the ear and represents a major health concern in geriatric medicine. As a result, otologic complaints are increasingly common with age. In fact, hearing loss, external ear disorders, tinnitus, Eustachian tube dysfunction, and vestibular disorders represent the top 5 most common complaints that patients over the age of 65 present to an otolaryngologist. Presbycusis, or age-related hearing loss, is the most common age-associated otologic dysfunction and affects half of people aged 75 and older in the United States. Presbystasis, or the disequilibrium of aging, is a group of disorders that primarily affects mobility and affects over 75% of those 70 years and older. As a result, presbycusis and presbystasis result in everyday challenges that affect both the aging patient and treating provider. Furthermore, management of aging otologic sequela is expensive and contributes significantly to health care expenditures. However, recognition of these aging otologic diseases may help improve access to proper care and treatment while improving overall quality of life. Here we review the basic physiology of the vestibulocochlear system, the pathogenesis and risk factors for presbycusis and presbystasis, and diagnostic and treatment considerations for the general practitioner.
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Creighton FX Jr, Poliashenko SM, Statham MM, Abramson P, Johns MM 3rd. The growing geriatric otolaryngology patient population: a study of 131,700 new patient encounters. Laryngoscope. 2013;123(1):97–102.
Age-related hearing loss. NIDCD fact sheet: hearing and balance web site. https://www.nidcd.nih.gov/sites/default/files/Documents/health/hearing/AgeRelatedHearingLoss.pdf. Updated 17 July 2018. Accessed 21 May 2020.
Kral A, Kronenberger WG, Pisoni DB, O’Donoghue GM. Neurocognitive factors in sensory restoration of early deafness: a connectome model. Lancet Neurol. 2016;15(6):610–21.
Kral A, O’Donoghue GM. Profound deafness in childhood. N Engl J Med. 2010;363(15):1438–50.
Peelle JE, Troiani V, Grossman M, Wingfield A. Hearing loss in older adults affects neural systems supporting speech comprehension. J Neurosci. 2011;31(35):12638–43.
O’Donoghue G. Auditory and linguistic outcomes in pediatric cochlear implantation. In: Waltzman SB, Roland Jr JT, editors. Cochlear implants. 3rd ed. New York: Thieme; 2014. p. 158–65.
Harrison Bush AL, Lister JJ, Lin FR, Betz J, Edwards JD. Peripheral hearing and cognition: evidence from the staying keen in later life (SKILL) study. Ear Hear. 2015;36(4):395–407.
Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neurol. 2011;68(2):214–20.
Ruben RJ. How did otolaryngology – head & neck surgery become an essential medical discipline for the 21st century? Int J Pediatr Otorhinolaryngol. 2015;79(6):783–5.
Dalton DS, Cruickshanks KJ, Klein BE, Klein R, Wiley TL, Nondahl DM. The impact of hearing loss on quality of life in older adults. Gerontologist. 2003;43(5):661–8.
Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013;173(4):293–9.
Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med. 2012;172(4):369–71.
Foley DM, Frick KD, Lin FR. Association between hearing loss and healthcare expenditures in older adults. J Am Geriatr Soc. 2014;62(6):1188–9.
Genther DJ, Betz J, Pratt S, et al. Association between hearing impairment and risk of hospitalization in older adults. J Am Geriatr Soc. 2015;63(6):1146–52.
Uhlmann RF, Larson EB, Rees TS, Koepsell TD, Duckert LG. Relationship of hearing impairment to dementia and cognitive dysfunction in older adults. JAMA. 1989;261(13):1916–9.
Gates GA, Mills JH. Presbycusis. Lancet. 2005;366(9491):1111–20.
Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care: scientific review. JAMA. 2003;289(15):1976–85.
Fernandez L, Breinbauer HA, Delano PH. Vertigo and dizziness in the elderly. Front Neurol. 2015;6:144.
Jonsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res. 2004;14(1):47–52.
Barin K, Dodson EE. Dizziness in the elderly. Otolaryngol Clin N Am. 2011;44(2):437–54. x
Dillon CF, Gu Q, Hoffman HJ, Ko CW. Vision, hearing, balance, and sensory impairment in Americans aged 70 years and over: United States, 1999–2006. NCHS Data Brief. 2010;31:1–8.
Ekvall Hansson E, Magnusson M. Vestibular asymmetry predicts falls among elderly patients with multi-sensory dizziness. BMC Geriatr. 2013;13:77.
Zalewski CK. Aging of the human vestibular system. Semin Hear. 2015;36(3):175–96.
Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and nutrition examination survey, 2001–2004. Arch Intern Med. 2009;169(10):938–44.
Kannus P, Parkkari J, Koskinen S, et al. Fall-induced injuries and deaths among older adults. JAMA. 1999;281(20):1895–9.
Shapiro DP. Geriatric demographics and the practice of otolaryngology. Ear Nose Throat J. 1999;78(6):418–21.
Parham K, McKinnon BJ, Eibling D, Gates GA. Challenges and opportunities in presbycusis. Otolaryngol Head Neck Surg. 2011;144(4):491–5.
Goman AM, Reed NS, Lin FR. Addressing estimated hearing loss in adults in 2060. JAMA Otolaryngol Head Neck Surg. 2017;143(7):733–4.
Goycoolea MV, Goycoolea HG, Farfan CR, Rodriguez LG, Martinez GC, Vidal R. Effect of life in industrialized societies on hearing in natives of Easter Island. Laryngoscope. 1986;96(12):1391–6.
Ruberg K. Untreated disabling hearing loss costs billions – in the US and the rest of the world. The Hearing Review Surveys & Statistics Web site https://www.hearingreview.com/practice-building/marketing/surveys-statistics/untreated-disabling-hearing-loss-costs-billions-us-rest-world. Published 2019. Updated March 18, 2019. Accessed 14 June 2020.
Deafness and hearing loss. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. Published 2020. Updated March 1, 2020. Accessed 14 June 2020.
Hearing health care for adults: Priorities for improving access and affordability. Washington, DC, 2016.
Aging America and hearing loss: Imperative of improved hearing technologies. Washington, DC, 2015.
Cassel C, Penhoet E, Saunders R. Policy solutions for better hearing. JAMA. 2016;315(6):553–4.
Warren E, Grassley C. Over-the-counter hearing aids: the path forward. JAMA Intern Med. 2017;177(5):609–10.
Wiley TL, Cruickshanks KJ, Nondahl DM, Tweed TS. Aging and middle ear resonance. J Am Acad Audiol. 1999;10(4):173–9.
Mills J, Weber P. Anatomy and physiology of hearing. In: Bailey B, editor. Otolaryngology-head and neck surgery. 3rd ed. USA: Lippincott Williams and Wilkins; 2001. p. 1621–40.
Spicer SS, Schulte BA. Spiral ligament pathology in quiet-aged gerbils. Hear Res 2002;172(1–2):172–185.
Spiess AC, Lang H, Schulte BA, Spicer SS, Schmiedt RA. Effects of gap junction uncoupling in the gerbil cochlea. Laryngoscope. 2002;112(9):1635–41.
Schulte BA, Schmiedt RA. Lateral wall Na,K-ATPase and endocochlear potentials decline with age in quiet-reared gerbils. Hear Res 1992;61(1–2):35–46.
Lanska DJ. Geriatric neurology. Chichester: West Sussex; 2014.
Gates GA, Rees TS. Otologic changes and disorders. In: Geriatric medicine. 4th ed. Springer; 2003. p. 893–900.
Cruickshanks KJ, Wiley TL, Tweed TS, et al. Prevalence of hearing loss in older adults in beaver dam, Wisconsin. The epidemiology of hearing loss study. Am J Epidemiol. 1998;148(9):879–86.
Schuknecht HF. Presbycusis Laryngoscope 1955;65(6):402–419.
Mills JH, Schmiedt RA, Kulish LF. Age-related changes in auditory potentials of Mongolian gerbil. Hear Res. 1990;46(3):201–10.
Emmett SD, Seshamani M. Otolaryngology in the elderly. In: Cummings otolaryngology: head and neck surgery. 6th ed. Philadelphia: Saunders; 2015. p. 231–9.
Schuknecht HF, Watanuki K, Takahashi T, et al. Atrophy of the stria vascularis, a common cause for hearing loss. Laryngoscope. 1974;84(10):1777–821.
Gratton MA, Schulte BA. Alterations in microvasculature are associated with atrophy of the stria vascularis in quiet-aged gerbils. Hear Res. 1995;82(1):44–52.
Gates GA, Couropmitree NN, Myers RH. Genetic associations in age-related hearing thresholds. Arch Otolaryngol Head Neck Surg. 1999;125(6):654–9.
Gates GA. Central presbycusis: an emerging view. Otolaryngol Head Neck Surg. 2012;147(1):1–2.
Speech understanding and aging. Working group on speech understanding and aging. Committee on hearing, bioacoustics, and biomechanics, commission on behavioral and social sciences and education, National Research Council. J Acoust Soc Am. 1988;83(3):859–95.
Moscicki EK, Elkins EF, Baum HM, McNamara PM. Hearing loss in the elderly: an epidemiologic study of the Framingham heart study cohort. Ear Hear. 1985;6(4):184–90.
Helfer KS, Wilber LA. Hearing loss, aging, and speech perception in reverberation and noise. J Speech Hear Res. 1990;33(1):149–55.
Yamasoba T, Lin FR, Someya S, Kashio A, Sakamoto T, Kondo K. Current concepts in age-related hearing loss: epidemiology and mechanistic pathways. Hear Res. 2013;303:30–8.
Cooper JC Jr. Health and nutrition examination survey of 1971–75: part II. Tinnitus, subjective hearing loss, and well-being. J Am Acad Audiol. 1994;5(1):37–43.
Cruickshanks KJ, Tweed TS, Wiley TL, et al. The 5-year incidence and progression of hearing loss: the epidemiology of hearing loss study. Arch Otolaryngol Head Neck Surg. 2003;129(10):1041–6.
Cruickshanks KJ, Klein R, Klein BE, Wiley TL, Nondahl DM, Tweed TS. Cigarette smoking and hearing loss: the epidemiology of hearing loss study. JAMA. 1998;279(21):1715–9.
Bai U, Seidman MD, Hinojosa R, Quirk WS. Mitochondrial DNA deletions associated with aging and possibly presbycusis: a human archival temporal bone study. Am J Otol. 1997;18(4):449–53.
Markaryan A, Nelson EG, Hinojosa R. Quantification of the mitochondrial DNA common deletion in presbycusis. Laryngoscope. 2009;119(6):1184–9.
Christensen K, Frederiksen H, Hoffman HJ. Genetic and environmental influences on self-reported reduced hearing in the old and oldest old. J Am Geriatr Soc. 2001;49(11):1512–7.
Karlsson KK, Harris JR, Svartengren M. Description and primary results from an audiometric study of male twins. Ear Hear. 1997;18(2):114–20.
Agrawal Y, Platz EA, Niparko JK. Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and nutrition examination survey, 1999–2004. Arch Intern Med. 2008;168(14):1522–30.
Cooper JC Jr. Health and nutrition examination survey of 1971–75: part I. Ear and race effects in hearing. J Am Acad Audiol. 1994;5(1):30–6.
Helzner EP, Cauley JA, Pratt SR, et al. Race and sex differences in age-related hearing loss: the health, aging and body composition study. J Am Geriatr Soc. 2005;53(12):2119–27.
Lin FR, Maas P, Chien W, Carey JP, Ferrucci L, Thorpe R. Association of skin color, race/ethnicity, and hearing loss among adults in the USA. J Assoc Res Otolaryngol. 2012;13(1):109–17.
Murillo-Cuesta S, Contreras J, Zurita E, et al. Melanin precursors prevent premature age-related and noise-induced hearing loss in albino mice. Pigment Cell Melanoma Res. 2010;23(1):72–83.
Riley PA. Melanin. Int J Biochem Cell Biol. 1997;29(11):1235–9.
Ohlemiller KK. Mechanisms and genes in human strial presbycusis from animal models. Brain Res. 2009;1277:70–83.
Ohlemiller KK, Rice ME, Lett JM, Gagnon PM. Absence of strial melanin coincides with age-associated marginal cell loss and endocochlear potential decline. Hear Res. 2009;249(1–2):1–14.
Fransen E, Topsakal V, Hendrickx JJ, et al. Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: a European population-based multicenter study. J Assoc Res Otolaryngol 2008;9(3):264–276; discussion 261–263.
Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734.
Prince M, Wimo A, Guerchet M, Ali G, Wu Y, Prina M. World Alzheimer report 2015 – the global impact of dementia: an analysis of prevalence, incidence, cost and trends. In: Paper presented at: Alzheimer’s Disease International. London; 2015.
Claes AJ, Van de Heyning P, Gilles A, Hofkens-Van den Brandt A, Van Rompaey V, Mertens G. Impaired cognitive functioning in Cochlear implant recipients over the age of 55 years: a cross-sectional study using the repeatable battery for the assessment of neuropsychological status for hearing-impaired individuals (RBANS-H). Front Neurosci. 2018;12:580.
McCoy SL, Tun PA, Cox LC, Colangelo M, Stewart RA, Wingfield A. Hearing loss and perceptual effort: downstream effects on older adults’ memory for speech. Q J Exp Psychol A. 2005;58(1):22–33.
Huang CQ, Dong BR, Lu ZC, Yue JR, Liu QX. Chronic diseases and risk for depression in old age: a meta-analysis of published literature. Ageing Res Rev. 2010;9(2):131–41.
Gopinath B, Wang JJ, Schneider J, et al. Depressive symptoms in older adults with hearing impairments: the Blue Mountains study. J Am Geriatr Soc. 2009;57(7):1306–8.
Lin FR, Albert M. Hearing loss and dementia – who is listening? Aging Ment Health. 2014;18(6):671–3.
Klein AJ, Armstrong BL, Greer MK, Brown FR 3rd. Hyperacusis and otitis media in individuals with Williams syndrome. J Speech Hear Disord. 1990;55(2):339–44.
Gates GA, Murphy M, Rees TS, Fraher A. Screening for handicapping hearing loss in the elderly. J Fam Pract. 2003;52(1):56–62.
Primary ear and hearing care training resource. www.who.int/pbd/deafness/activities/hearing_care/trainer.pdf. Published 2006. Accessed 2 July 2015.
Bogardus ST Jr, Yueh B, Shekelle PG. Screening and management of adult hearing loss in primary care: clinical applications. JAMA. 2003;289(15):1986–90.
Gates GA, Rees TS. Hear ye? Hear ye! Successful auditory aging. West J Med. 1997;167(4):247–52.
McBride WS, Mulrow CD, Aguilar C, Tuley MR. Methods for screening for hearing loss in older adults. Am J Med Sci. 1994;307(1):40–2.
Louw C, Swanepoel W, Eikelboom RH, Myburgh HC. Smartphone-based hearing screening at primary health care clinics. Ear Hear. 2017;38(2):e93–e100.
Mahomed-Asmail F, Swanepoel de W, Eikelboom RH, Myburgh HC, Hall J 3rd. Clinical validity of hearScreen smartphone hearing screening for school children. Ear Hear. 2016;37(1):e11–7.
Mulrow CD, Aguilar C, Endicott JE, et al. Quality-of-life changes and hearing impairment. A randomized trial. Ann Intern Med. 1990;113(3):188–94.
Heron M. Deaths: leading causes for 2017. Natl Vital Stat Rep. 2019;68(6):1–77.
Houston DK, Johnson MA, Nozza RJ, et al. Age-related hearing loss, vitamin B-12, and folate in elderly women. Am J Clin Nutr. 1999;69(3):564–71.
Szeto B, Valentini C, Lalwani AK. Low vitamin D status is associated with hearing loss in the elderly: a cross-sectional study. Am J Clin Nutr. 2021;113(2):456–66.
Berner B, Odum L, Parving A. Age-related hearing impairment and B vitamin status. Acta Otolaryngol. 2000;120(5):633–7.
Kim JY, Lee SB, Lee CH, Kim HM. Hearing loss in postmenopausal women with low bone mineral density. Auris Nasus Larynx. 2016;43(2):155–60.
Willott JF, Erway LC, Archer JR, Harrison DE. Genetics of age-related hearing loss in mice. II. Strain differences and effects of caloric restriction on cochlear pathology and evoked response thresholds. Hear Res. 1995;88(1–2):143–55.
Lehmann M, Regland B, Blennow K, Gottfries CG. Vitamin B12-B6-folate treatment improves blood-brain barrier function in patients with hyperhomocysteinaemia and mild cognitive impairment. Dement Geriatr Cogn Disord. 2003;16(3):145–50.
Veldurthy V, Wei R, Oz L, Dhawan P, Jeon YH, Christakos S. Vitamin D, calcium homeostasis and aging. Bone Res. 2016;4:16041.
Wells JL, Dumbrell AC. Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clin Interv Aging. 2006;1(1):67–79.
Yueh B, Souza PE, McDowell JA, et al. Randomized trial of amplification strategies. Arch Otolaryngol Head Neck Surg. 2001;127(10):1197–204.
Jerger J. Directional microphones – they work. J Am Acad Audiol. 2000;11(10) 3 p following table of contents
Li-Korotky HS. Age-related hearing loss: quality of care for quality of life. Gerontologist. 2012;52(2):265–71.
Haynes DS, Young JA, Wanna GB, Glasscock ME 3rd. Middle ear implantable hearing devices: an overview. Trends Amplif. 2009;13(3):206–14.
Luetje CM, Brackman D, Balkany TJ, et al. Phase III clinical trial results with the vibrant Soundbridge implantable middle ear hearing device: a prospective controlled multicenter study. Otolaryngol Head Neck Surg. 2002;126(2):97–107.
Truy E, Philibert B, Vesson JF, Labassi S, Collet L. Vibrant soundbridge versus conventional hearing aid in sensorineural high-frequency hearing loss: a prospective study. Otol Neurotol. 2008;29(5):684–7.
Tisch M. Implantable hearing devices. GMS Curr Top Otorhinolaryngol Surg. 2017;16. Doc06
Linstrom CJ, Silverman CA, Yu GP. Efficacy of the bone-anchored hearing aid for single-sided deafness. Laryngoscope. 2009;119(4):713–20.
Galvin JJ 3rd, Fu QJ, Wilkinson EP, et al. Benefits of Cochlear implantation for single-sided deafness: data from the house clinic-University of Southern California-University of California, Los Angeles clinical trial. Ear Hear. 2019;40(4):766–81.
Levy DA, Lee JA, Nguyen SA, McRackan TR, Meyer TA, Lambert PR. Cochlear implantation for treatment of tinnitus in single-sided deafness: a systematic review and meta-analysis. Otol Neurotol. 2020;41. e1004-e1012
Anzivino R, Conti G, Di Nardo W, et al. Prospective evaluation of cognitive functions after rehabilitation with Cochlear implant or hearing aids: preliminary results of a multicentric study on elderly patients. Am J Audiol. 2019;28(3S):762–74.
Mosnier I, Vanier A, Bonnard D, et al. Long-term cognitive prognosis of profoundly deaf older adults after hearing rehabilitation using cochlear implants. J Am Geriatr Soc. 2018;66(8):1553–61.
Lenarz M, Sonmez H, Joseph G, Buchner A, Lenarz T. Cochlear implant performance in geriatric patients. Laryngoscope. 2012;122(6):1361–5.
Johnsson LG. Degenerative changes and anomalies of the vestibular system in man. Laryngoscope. 1971;81(10):1682–94.
Richter E. Quantitative study of human Scarpa’s ganglion and vestibular sensory epithelia. Acta Otolaryngol. 1980;90(3–4):199–208.
Merchant SN, Velazquez-Villasenor L, Tsuji K, Glynn RJ, Wall C 3rd, Rauch SD. Temporal bone studies of the human peripheral vestibular system. Normative vestibular hair cell data. Ann Otol Rhinol Laryngol Suppl. 2000;181:3–13.
Agrawal Y, Ward BK, Minor LB. Vestibular dysfunction: prevalence, impact and need for targeted treatment. J Vestib Res. 2013;23(3):113–7.
Davalos-Bichara M, Agrawal Y. Normative results of healthy older adults on standard clinical vestibular tests. Otol Neurotol. 2014;35(2):297–300.
Li C, Layman AJ, Geary R, et al. Epidemiology of vestibulo-ocular reflex function: data from the Baltimore longitudinal study of aging. Otol Neurotol. 2015;36(2):267–72.
Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51.
Dagli RJ, Sharma A. Polypharmacy: a global risk factor for elderly people. J Int Oral Health. 2014;6(6):i–ii.
Brantberg K. Vestibular evoked myogenic potentials (VEMPs): usefulness in clinical neurotology. Semin Neurol. 2009;29(5):541–7.
Soto-Varela A, Faraldo-Garcia A, Rossi-Izquierdo M, et al. Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx. 2015;42(1):8–14.
Strupp M, Brandt T. Vestibular neuritis. Semin Neurol. 2009;29(5):509–19.
Shayman CS, Earhart GM, Hullar TE. Improvements in gait with hearing aids and Cochlear implants. Otol Neurotol. 2017;38(4):484–6.
Louza J, Rosel C, Gurkov R, Krause E, Ihler F. Influence of Cochlear implantation on postural control and risk of falls. Audiol Neurootol. 2019;24(5):245–52.
Bermingham-McDonogh O, Rubel EW. Hair cell regeneration: winging our way towards a sound future. Curr Opin Neurobiol. 2003;13(1):119–26.
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Tipirneni, K.E., Nicholas, B.D. (2024). Otologic Changes and Disorders. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_59
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