Relation Between Hearing Loss and Otolith Dysfunction in Elderly
Nancy Metwally Aly;
Abstract
SUMMARY
T
he auditory and vestibular systems experience age- related changes causing functional decline that is considered part of the normal aging process (Dalton et al., 2003).
The older adult with hearing impairment is more limited in verbal communication, with effects on productivity, quality of life, cognitive and emotional status (Van Eyken et al., 2007), whereas the individual with balance dysfunction is more prone to experience dizziness and has an increased risk for falls, which is a major public health problem (Agrawal et al., 2009).
VEMP is considered an objective, secure, simple and comfortable method to evaluate vestibular pathology particularly the otolith function mainly in people with balance dysfunction. In more recent years, it have been demonstrated that short latency potentials can also be recorded from the extraocular muscles as part of the vestibulo-ocular reflex which is called ocular VEMP (oVEMP) (Todd et al., 2007).
Few investigations had evaluated the relationship of the functional decline in the audio -vestibular system. Accordingly this work was designed to investigate the association between hearing loss and deficits in otolith organs in elderly and to evaluate whether hearing loss and otolith end-organ deficits share any risk factors.
Fifty subjects included in the study, ten as a control group & 40 as study group complain from diminution of hearing with or without dizziness (22 male, 18 female) there age range from 60 to 80 years there mean age was 67.6±5.8. Both the control and the study group are age matched.
They were submitted to:
1. Full history taking, otologic examination.
2. Pure tone and speech audiometry using two channel audiometer Ineracoustics, model AC 40; Middle ear function were assessed using tympanometry MAICO model MI 34.
3. Vestibular evaluation included Vestibular Evoked potential (cVEMP& oVEMP) using Bio-logic Model Navigator PRO (for Vestibular Evoked Myogenic Potential tests).
The hearing sensitivity of the control group was 23.8 ± 7.1 and was comparable with the mean hearing thresholds as a function of age. The mean hearing sensitivity in the study group was 48.1 ± 13.6. 20% had been exposed to noise, 32.5% had hypertension and 12.5% had HTN and exposed to noise.
cVEMPs were successfully recorded in all control group subjects, on the other hand, oVEMPs were recorded in 50% only. Comparing latencies of VEMPs wave components between study and control groups revealed no significant difference. However, diminished cVEMPs P13-N23 inter-amplitude in the study group than the control group was observed that didn’t reach the significant level. In addition, individual analysis of the VEMPs data revealed significant reduction cVEMPs response rate in the study group in comparison to the control group.
Furthermore, there was significant inverse correlation between the hearing loss and cVEMP amplitude in the study group However, there were no significant associations in oVEMP parameters.
Globally, there were significant decreased wave amplitudes for both cVEMP and oVEMP in the elderly subjects in comparison with adults’ normative data as well as a significant positive correlation between age and cVEMP & oVEMP latencies.
Patients with a history of noise exposure showed absent cVEMPs response in 40% of them, it was significantly associated with elevated high frequency hearing thresholds and prolonged cVEMP latencies. Unlike noise exposure, hypertension didn’t show any significant association between hearing thresholds or cVEMP, oVEMP parameters.
IN conclusion the concomitant results suggesting that there is an association between cochlear and saccular dysfunction with aging, noise exposure seems to be a common risk factor to both saccular and cochlear dysfunction.
According to these results; it is recommended to do saccular function assessment in the battery of examination of elderly patients with SNHL -especially those exposed to noise- and to take age factor into account when interpreting cVEMP and oVEMP results in elderly.
T
he auditory and vestibular systems experience age- related changes causing functional decline that is considered part of the normal aging process (Dalton et al., 2003).
The older adult with hearing impairment is more limited in verbal communication, with effects on productivity, quality of life, cognitive and emotional status (Van Eyken et al., 2007), whereas the individual with balance dysfunction is more prone to experience dizziness and has an increased risk for falls, which is a major public health problem (Agrawal et al., 2009).
VEMP is considered an objective, secure, simple and comfortable method to evaluate vestibular pathology particularly the otolith function mainly in people with balance dysfunction. In more recent years, it have been demonstrated that short latency potentials can also be recorded from the extraocular muscles as part of the vestibulo-ocular reflex which is called ocular VEMP (oVEMP) (Todd et al., 2007).
Few investigations had evaluated the relationship of the functional decline in the audio -vestibular system. Accordingly this work was designed to investigate the association between hearing loss and deficits in otolith organs in elderly and to evaluate whether hearing loss and otolith end-organ deficits share any risk factors.
Fifty subjects included in the study, ten as a control group & 40 as study group complain from diminution of hearing with or without dizziness (22 male, 18 female) there age range from 60 to 80 years there mean age was 67.6±5.8. Both the control and the study group are age matched.
They were submitted to:
1. Full history taking, otologic examination.
2. Pure tone and speech audiometry using two channel audiometer Ineracoustics, model AC 40; Middle ear function were assessed using tympanometry MAICO model MI 34.
3. Vestibular evaluation included Vestibular Evoked potential (cVEMP& oVEMP) using Bio-logic Model Navigator PRO (for Vestibular Evoked Myogenic Potential tests).
The hearing sensitivity of the control group was 23.8 ± 7.1 and was comparable with the mean hearing thresholds as a function of age. The mean hearing sensitivity in the study group was 48.1 ± 13.6. 20% had been exposed to noise, 32.5% had hypertension and 12.5% had HTN and exposed to noise.
cVEMPs were successfully recorded in all control group subjects, on the other hand, oVEMPs were recorded in 50% only. Comparing latencies of VEMPs wave components between study and control groups revealed no significant difference. However, diminished cVEMPs P13-N23 inter-amplitude in the study group than the control group was observed that didn’t reach the significant level. In addition, individual analysis of the VEMPs data revealed significant reduction cVEMPs response rate in the study group in comparison to the control group.
Furthermore, there was significant inverse correlation between the hearing loss and cVEMP amplitude in the study group However, there were no significant associations in oVEMP parameters.
Globally, there were significant decreased wave amplitudes for both cVEMP and oVEMP in the elderly subjects in comparison with adults’ normative data as well as a significant positive correlation between age and cVEMP & oVEMP latencies.
Patients with a history of noise exposure showed absent cVEMPs response in 40% of them, it was significantly associated with elevated high frequency hearing thresholds and prolonged cVEMP latencies. Unlike noise exposure, hypertension didn’t show any significant association between hearing thresholds or cVEMP, oVEMP parameters.
IN conclusion the concomitant results suggesting that there is an association between cochlear and saccular dysfunction with aging, noise exposure seems to be a common risk factor to both saccular and cochlear dysfunction.
According to these results; it is recommended to do saccular function assessment in the battery of examination of elderly patients with SNHL -especially those exposed to noise- and to take age factor into account when interpreting cVEMP and oVEMP results in elderly.
Other data
| Title | Relation Between Hearing Loss and Otolith Dysfunction in Elderly | Other Titles | العلاقة بين ضعف السمع والإختلال الوظيفي في حصاه الأذن في الأفراد كبار السن | Authors | Nancy Metwally Aly | Issue Date | 2015 |
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