CHAPTER 13: Otolaryngology in the Elderly Flashcards
The normal process of aging affects all parts of the ear, but the greatest clinical impact is on…
Cochlear and vestibular function
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
Age-related hearing loss or Presbycusis
TRUE or FALSE
Presbycusis is greatly affected by genetic background, diet, and systemic disease
TRUE
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
TRUE
Who defined the 4 histopathologic types of presbycusis
Gacek and Schuknecht
Presbycusis is a multifactorial condition that represents the lifetime accumulation of both intrinsic and extrinsic insults on the inner ear, including…
- Inner and outer hair cells
- Stria vascularis
- Afferent spiral ganglion neurons
Suggested 4 primary categories of risk factors for presbycusis…
- Cochlear aging
- Noise exposure
- Genetic predisposition
- Health comorbidities
Histologic subtypes of presbycusis
- Sensory
- Neural
- Strial (metabolic)
- Inner ear conductive
Audiometric characteristic:
Steep, high-frequency loss with slow, symmetric, bilateral progression
Sensory
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
Sensory
Audiometric characteristic:
1. Gradual hearing loss with moderate slope in high frequencies
2. Disproportionate decline in speech discrimination
3. Often refractory to amplification
Neural presbycusis
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
Neural
Audiometric characteristics:
1. Flat sensory loss beginning in 3rd-6th decades and progressing slowly
2. Preserved speech discrimination
3. Does well with amplification
Strial
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
Strial presbycusis
Audiometric findings:
1. Bilateral symmetric loss with upward slope in high frequencies
2. Preserved speech discrimination
Inner ear conductive
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
Inner ear conductive
Steep, high frequency loss with slow, symmetric bilateral progression
Sensory presbycusis
Gradual hearing loss with moderate slope in high frequencies
Neural presbycusis
Flat sensory loss beginning in 3rd-6th decades and progressing slowly
Strial presbycusis
Bilateral symmetric loss with upward slope in high frequencies
Inner ear conductive presbycusis
Disproportionate decline in speech discrimination
Neural presbycusis
Often refractory to amplification
Neural presbycusis
Preserved speech discrimination
Strial and Inner ear conductive presbycusis
Does well with amplification
Strial presbycusis
Flattening and atrophy of the organ of Corti
Sensory presbycusis
Atrophy of the spiral ganglion and nerves of osseous spiral lamina in the basal turn
Neural presbycusis
Atrophy of the stria vascularis can be patchy in the basal and apical turns or diffuse
Strial presbycusis
Atrophy of the spiral ligament
Inner ear conductive presbycusis
Accumulation of lipofuscin
Sensory presbycusis
Organ of Corti is largely intact/unaffected
Neural and Strial presbycusis
Primarily affects the apical turn
Inner ear conductive presbycusis
Affects first few millimeters of basal turn
Sensory presbycusis
Cystic degeneration may cause detachment of the organ of Corti from the lateral cochlear wall
Inner ear conductive presbycusis
Is a well-established cause of hearing loss and risk factor for presbycusis
Noise exposure
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
Endothelin 1
Mainstay of treatment for age-related hearing loss
Amplification
Dysequilibrium of aging
Presbystasis
Most common nasal complaints in older adults are
- Nasal drainage
- Postnasal drip
- Sneezing
- Coughing
- Olfactory loss
- Gustatory rhinitis
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
Gustatory rhinitis
TRUE or FALSE
Sense of smell typically peaks in the 3rd to 4th decades of life and begins to decline in the 5th decade
TRUE
