Issues concerning“aging and hearing” were reviewed from the classics to the recent findings.
Subjects were discussed under the following headings:
Part I: Presbycusis
Basics 1: Pathology
Basics 2: Physiology
Basics 3: Molecular Biology
Basics 4: Epidemiology
Audiological test results in presbycusis
Part II: Management of hearing loss in the elderly
Influence of hearing loss in the elderly
Basics of management of hearing loss in the elderly
Cochlear implantation in the elderly
Recent Topic: Hearing Loss and Dementia
Since this study field has a promising future, the author hopes for further investigation.
In 2017, district welfare officers met the elderly living alone and performed a questionnaire survey about subjective hearing loss, usage of hearing aids, knowledge of recent news, and so on, in the Daitoku area (population 11000) in Ichinomiya City, Aichi Prefecture, Japan. There were 161 persons who hoped looked forward to the visits of the district welfare officer to their home, and the response rate was 100%. The subjects ranged in age from 66 to 99 years (average 80.7 years) and 85% were female. The subjective hearing was significantly worse in the elderly in their nineties than in those in their eighties, and similarly worse in the elderly in their eighties than in those in their seventies. Fourteen persons reported using hearing aids - a half of them continuously and a half of them sometimes. Only seven of the hearing aid users had consulted otolaryngologists about their hearing loss.
When they are unaware of any recent news, the possibility of social isolation or dementia should be considered. The incorrect reply rate to questions about recent news was closely associated with aging and significantly higher in the subjects in their nineties than in those in their eighties. It was found that the incorrect reply rate was influenced independently by subjective hearing loss.
Cognitive function was examined using the Mini-Mental State Examination (MMSE) in hearing-impaired elderly outpatients visiting the Center for Memory Disorders, before and after 6 months of the introduction of hearing aids. We examined whether there were any characteristic features related to the hearing level or maximum discrimination score in the group with maintained or improved cognitive function after 6 months, comparing with the group with deterioration of cognitive function. There were 38 subjects in whom the assessments were able to be conducted before and after 6 months, and there was no significant difference in the MMSE scores before and after the start of hearing aid use. The results of logistic regression analysis to identify factors influencing maintenance of cognitive function failed to show any significant effect of age, gender, average hearing level of the better ear, or maximum discrimination score. On the other hand, it was shown that it is possible to continue hearing aid use and maintain cognitive function even if the cognitive function and discrimination ability are poor at the baseline. In the sub-analysis of 54 entry cases, a tendency towards correlation between good discrimination ability and a good MMSE score was seen. Further investigation in a larger group would be required.
Seventeen patients who had received adult cochlear implantation were divided into an elderly group, consisting of patients over 65 years of age, and the youth group, consisting of patients younger than 65 years of age. In these patients, we investigated the results of the egograms obtained at Tokyo University before and after the operation. The subjects were further divided into two groups according to the duration of hearing loss: less than two years or two or more years. After the operation, the tendency for “other-centered, self-repressive, self-denial” decreased in all the patients, including in the elderly group. In the youth group, an increase was observed in the “free, active, self-affirmative” tendency. The results suggest a tendency towards becoming more independent in the elderly and towards becoming more active in the younger subjects as a result of improved hearing of sounds following the cochlear implantation. In regard to the effect depending on the duration of hearing loss, the decrease in the “other-centered, self-repressive, self-denial” after the operation was more marked in the group of patients with hearing loss for two or more years. We assumed that the self-repressive condition was relieved as the subjects could hear sounds and became more active. Then, we considered that cochlear implantation could be effective for reducing the tendency towards self-denial in the elderly and in patients who have been deaf for many years.
We investigated the role of the study group that has been conducting cochlear implant mapping in the Tohoku area from 2012 for supporting children with cochlear implants, by a questionnaire-based survey of speech-language-hearing therapists who were members of the study group. The following 3 points were clarified: (1) Specialist training on cochlear implant mapping and rehabilitation is required for incumbent therapists; (2) the number of children with cochlear implants and multiple disabilities is increasing, which necessitates training for speech-language-hearing therapists in rehabilitation hospitals and welfare facilities; (3) training medical, welfare, and educational personnel and provision of venues for collaboration through ongoing exchange of information and case study examination are needed. This study group should train medical, welfare, and educational organizations in the Tohoku area on cochlear implants and work towards building a collaborative system.
In this paper, we report on the outcomes of clinical practice for pediatric patients with hearing loss from the preverbal period, mainly before and after cochlear implant surgery. The patients started training based on the Kanazawa method at the age of 0 to 1 year and cochlear implant use combined with training at the age of 2 to 3 years. There were 8 infants with congenital severe hearing loss, 6 and 2 of whom underwent surgery at the age of 2 and 3 years, respectively. The single-unit cochlear implant of Cochlear Ltd. was used in all the patients, after they had received training based on the Kanazawa method alone. By the age of 1.5 years, initial speech using sign language was observed in all cases. At the age of 1.5 to 2.5 years, two-word phrases combining voice and sign language were observed in all cases. Subsequently, by the age of 2.5 years, spontaneous expressions with postpositional particles inserted using fingerspelling were observed in all cases. Within 1 year after surgery, all infants began to use sign language less frequently for spontaneous expressions, which was finally replaced by speech. Thus, using a cochlear implant, the infants became able to converse with others solely using speech within 1 year, suggesting that the initiation of speech-language-hearing therapy focusing on sentence structures before surgery may promote language development of children with severe hearing loss.
We investigated the average ages at which 8 cochlear implant (CI) recipients between pre-school and early elementary school age underwent sound-field audiometry testing. We investigated the average ages at which the 8 participants reached the standard hearing scores in audiometry testing of the 6 pediatric CI recipients from our prior research, who are attending regular school. We also investigated the language abilities of the 8 participants and the time it took to set suitable stimulation levels. The average ages at which the 8 participants underwent testing of the sound field threshold, the speech discrimination test, speech recognition tests, and the speech discrimination test in noise were 16 months, 47 months, 49 months and 58 months, respectively. The average ages at which the 8 participants reached standard hearing scores on the sound field threshold, the highest speech discrimination score, in the speech discrimination test in noise, in the speech recognition tests, and the speech discrimination score at the thresholds were 33 months, 55 months, 56 months, 66 months and 67 months, respectively. We found that language development delay in CI recipients could be attributable to issues regarding the time taken to set suitable stimulation levels, frequent device issues and family problems.