CHAPTER 13: Otolaryngology in the Elderly

Question 1

The normal process of aging affects all parts of the ear, but the greatest clinical impact is on…

Answer 1

Cochlear and vestibular function

Question 2

Most common type of auditory dysfunction and is thought to be due to a series of insults over time that include age-related degeneration, noise exposure, and diseases of the ear

Answer 2

Age-related hearing loss or Presbycusis

Question 3

TRUE or FALSE
Presbycusis is greatly affected by genetic background, diet, and systemic disease

Answer 3

TRUE

Question 4

TRUE or FALSE
The EAC suffres a decrease in cerumen production because of degeneration of cerumen glands and a reduction in the total number of glands
*this may lead to drier cerumen that is less protective of the underlying skin—>higher incidence of impaction and infection

Answer 4

TRUE

Question 5

Who defined the 4 histopathologic types of presbycusis

Answer 5

Gacek and Schuknecht

Question 6

Presbycusis is a multifactorial condition that represents the lifetime accumulation of both intrinsic and extrinsic insults on the inner ear, including…

Answer 6

1. Inner and outer hair cells
2. Stria vascularis
3. Afferent spiral ganglion neurons

Question 7

Suggested 4 primary categories of risk factors for presbycusis…

Answer 7

1. Cochlear aging
2. Noise exposure
3. Genetic predisposition
4. Health comorbidities

Question 8

Histologic subtypes of presbycusis

Answer 8

1. Sensory
2. Neural
3. Strial (metabolic)
4. Inner ear conductive

Question 9

Audiometric characteristic:
Steep, high-frequency loss with slow, symmetric, bilateral progression

Answer 9

Sensory

Question 10

Histologic findings:
1. Flattening and atrophy of the organ of Corti
2. Accumulation of lipofuscin (aging pigment)
3. Affects first few millimeters of basal turn

Answer 10

Sensory

Question 11

Audiometric characteristic:
1. Gradual hearing loss with moderate slope in high frequencies
2. Disproportionate decline in speech discrimination
3. Often refractory to amplification

Answer 11

Neural presbycusis

Question 12

Histologic findings:
1. Atrophy of the spiral ganglion and nerves of osseous spiral lamina in the basal turn
2. Organ of Corti is largely intact

Answer 12

Neural

Question 13

Audiometric characteristics:
1. Flat sensory loss beginning in 3rd-6th decades and progressing slowly
2. Preserved speech discrimination
3. Does well with amplification

Answer 13

Strial

Question 14

Histologic findings:
1. Atrophy of the stria vascularis can be patchy in the basal and apical turns or diffuse
2. Organ of Corti is unaffected

Answer 14

Strial presbycusis

Question 15

Audiometric findings:
1. Bilateral symmetric loss with upward slope in high frequencies
2. Preserved speech discrimination

Answer 15

Inner ear conductive

Question 16

Histologic findings:
1. Atrophy of the spiral ligament
2. Primarily affects the apical turn
3. Cystic degeneration may cause detachment of the Organ of Corti from the lateral cochlear wall

Answer 16

Inner ear conductive

Question 17

Steep, high frequency loss with slow, symmetric bilateral progression

Answer 17

Sensory presbycusis

Question 18

Gradual hearing loss with moderate slope in high frequencies

Answer 18

Neural presbycusis

Question 19

Flat sensory loss beginning in 3rd-6th decades and progressing slowly

Answer 19

Strial presbycusis

Question 20

Bilateral symmetric loss with upward slope in high frequencies

Answer 20

Inner ear conductive presbycusis

Question 21

Disproportionate decline in speech discrimination

Answer 21

Neural presbycusis

Question 22

Often refractory to amplification

Answer 22

Neural presbycusis

Question 23

Preserved speech discrimination

Answer 23

Strial and Inner ear conductive presbycusis

Question 24

Does well with amplification

Answer 24

Strial presbycusis

Question 25

Flattening and atrophy of the organ of Corti

Answer 25

Sensory presbycusis

Question 26

Atrophy of the spiral ganglion and nerves of osseous spiral lamina in the basal turn

Answer 26

Neural presbycusis

Question 27

Atrophy of the stria vascularis can be patchy in the basal and apical turns or diffuse

Answer 27

Strial presbycusis

Question 28

Atrophy of the spiral ligament

Answer 28

Inner ear conductive presbycusis

Question 29

Accumulation of lipofuscin

Answer 29

Sensory presbycusis

Question 30

Organ of Corti is largely intact/unaffected

Answer 30

Neural and Strial presbycusis

Question 31

Primarily affects the apical turn

Answer 31

Inner ear conductive presbycusis

Question 32

Affects first few millimeters of basal turn

Answer 32

Sensory presbycusis

Question 33

Cystic degeneration may cause detachment of the organ of Corti from the lateral cochlear wall

Answer 33

Inner ear conductive presbycusis

Question 34

Is a well-established cause of hearing loss and risk factor for presbycusis

Answer 34

Noise exposure

Question 35

A potent vasoactive peptide involved in the development of atherosclerosis, can also produce long-term constriction of the spiral modiolar artery, leading to ischemia in the inner ear

Answer 35

Endothelin 1

Question 36

Mainstay of treatment for age-related hearing loss

Answer 36

Amplification

Question 37

Dysequilibrium of aging

Answer 37

Presbystasis

Question 38

Most common nasal complaints in older adults are

Answer 38

1. Nasal drainage 2. Postnasal drip 3. Sneezing 4. Coughing 5. Olfactory loss 6. Gustatory rhinitis

Question 39

Nasal discharge stimulated by eating, caused by over-stimulation of the autonomic control of Bowman glands initiated by the sight of food or the act of eating

Answer 39

Gustatory rhinitis

Question 40

TRUE or FALSE Sense of smell typically peaks in the 3rd to 4th decades of life and begins to decline in the 5th decade

Answer 40

TRUE