Otologic Changes and Disorders

  • Ernest E. Mhoon


Hearing impairment is the most common medical problem affecting persons over 65 years of age.1 Moreover, the most common cause of sensorineural hearing loss in the adult population is presbycusis,2 hearing loss attributed to aging. Once a diagnosis of presbycusis or another disorder is established, a program of aural rehabilitation can be initiated. Dizziness and imbalance are very common complaints among older persons but are often difficult to diagnose and manage because balance is subserved by a complex interrelationship between the vestibular, visual, and somatosensory systems, along with their central nervous system connections and pathways. Furthermore, each system is subject to the degenerative processes of aging. This chapter focuses on those problems affecting the elderly patient relative to the field of otology: the auditory system, clinical audiology, and the vestibular system.


Hearing Loss Tympanic Membrane Semicircular Canal External Auditory Canal Benign Paroxysmal Positional Vertigo 
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  1. 1.
    Prevalence of Selected Chronic Conditions: U.S., 1986–88. Publication (PHS) 93–1510. Hyattsville, MD: U.S. Dept. of Health and Human Services; 1993.Google Scholar
  2. 2.
    Hinojosa R, Naunton RF. Presbycusis. In: Paparella MM, Shumrick DA, Gluckman JL, et al., eds. Otolaryngology. 3rd ed. Philadelphia: WB Saunders; 1991; 2: 1629–1637.Google Scholar
  3. 3.
    Hetu R, Jones L. The impact of acquired hearing impairment on intimate relationships: implications for rehabilitation. Audiology. 1993; 32: 363–381.PubMedCrossRefGoogle Scholar
  4. 4.
    Klotz RE, Kilbane M. Hearing in an aging population, preliminary report. N Engl J Med. 1962; 266: 277–280.PubMedCrossRefGoogle Scholar
  5. 5.
    McShane DP, Dayal VS. Hearing impairment: diagnostic and therapeutic measures. Geriatr Med. 1986; 2: 32–36.Google Scholar
  6. 6.
    Salomon G. Hearing problems and the elderly. Dan Med Bull. 1986;33(suppl 3):l-22.Google Scholar
  7. 7.
    Eastwood MR, Corbin SL, et al. Acquired hearing loss and psychiatric illness: an estimate of prevalence and comorbidity in a geriatric setting. Br J Psychiatry. 1985; 147: 552–556.PubMedCrossRefGoogle Scholar
  8. 8.
    Jones DA, Victor CR, Vetter NJ. Hearing difficulty and its psychological implications for the elderly. J Epidemiol Community Health. 1984; 38: 75–78.PubMedCrossRefGoogle Scholar
  9. 9.
    Mader S. Hearing impairment in elderly persons. J Am Geriatr Soc. 1984; 32: 548–553.PubMedGoogle Scholar
  10. 10.
    Uhlmann RF, Larson EB, Koepsell TD. Hearing impairment and cognitive decline in senile dementia of the Alzheimer type. J Am Geriatr Soc. 1986; 34: 207–210.PubMedGoogle Scholar
  11. 11.
    Senturia BH, Marcus MD, Lucente FE. Diseases of the External Ear. 2nd ed. New York: Grune Stratton; 1980: 4–6.Google Scholar
  12. 12.
    Perry ET. The Human Ear Canal, Springfield, IL: Charles C. Thomas; 1957: 57–70.Google Scholar
  13. 13.
    Waisman M. A clinical look at the aging skin. Postgrad Med. 1979; 66: 87–94.PubMedGoogle Scholar
  14. 14.
    Anderson RG, Meyerhoff WL. Otologic manifestations of aging. Otolaryngol Clin North Am. 1982; 15: 353–370.PubMedGoogle Scholar
  15. 15.
    Horn KL, Gherini S. Malignant external otitis in children. Am J Otol. 1981; 2: 402–404.PubMedGoogle Scholar
  16. 16.
    Dehna LP, Chen KTK. Primary tumors of the external and middle ear. Arch Otolaryngol Head Neck Surg. 1980; 106: 13–19.CrossRefGoogle Scholar
  17. 17.
    Etholm B, Belai A. Senile changes in the middle ear joints. Ann Otol Rhinol Laryngol. 1974; 83: 49–54.PubMedGoogle Scholar
  18. 18.
    Elpern BS, Greisen D, Anderson HC. Experimental studies on sound transmission in the human ear. Acta Otolaryngol. 1965; 60: 223–230.CrossRefGoogle Scholar
  19. 19.
    Melrose J, Welsh OL, Luterman DM. Auditory responses in selected elderly men. J Gerontol. 1963; 18: 267–270.PubMedCrossRefGoogle Scholar
  20. 20.
    Sataloff J, Vassallo L, Menduke H. Presbycusis: air and bone conduction thresholds. Laryngoscope. 1965; 75: 889–901.PubMedCrossRefGoogle Scholar
  21. 21.
    Honrubia V, Goodhill V. Clinical anatomy and physiology of the peripheral ear. In: Goodhill V, ed. Ear Diseases, Deafness and Dizziness. Hagerstown, MD: Harper Row; 1979: 4–63.Google Scholar
  22. 22.
    Sevy RW. Drugs as a cause of dizziness and vertigo. In: Finestone AS, ed. Evaluation and Clinical Management of Dizziness and Vertigo. Boston: John Wright PSG; 1982: 105–113.Google Scholar
  23. 23.
    Zwaardemaker H. Der Verlust an hochen Toenen mit Zunehmendem Alfer: Ein neues Gesetz. Arch Ohrenheilk. 1981; 32: 53–56.Google Scholar
  24. 24.
    Goodhill V. Ear Diseases, Deafness and Dizziness. Hagerstown, MD: Harper Row; 1979.Google Scholar
  25. 25.
    Glorig A, Davis H. Age, noise and hearing loss. Ann Otol Rhinol Laryngol. 1961; 70: 556–571.PubMedGoogle Scholar
  26. 26.
    Rosen S, Bergman M. Plester D, et al. Presbycusic study of a relatively noise-free population in Sudan. Ann Otol Rhinol Laryngol. 1962; 71: 727–743.PubMedGoogle Scholar
  27. 27.
    Royster LH, Thomas WG. Age effect hearing levels for a white nonindustrial noise exposed population (NINEP) and their use in evaluating industrial hearing conservation programs. Ann Ind Hyg Assoc J. 1979; 40: 504–511.CrossRefGoogle Scholar
  28. 28.
    Crowe SJ, Guild SR, Polvogt LM. Observations on the pathology of high tone deafness. Bull Johns Hopkins Hosp. 1934; 54: 315–379.Google Scholar
  29. 29.
    Saxen A. Pathologie und Klinik der Altersschwer-huerigkeit. Acta Otolaryngol. 1937;(suppl 23):l-85.Google Scholar
  30. 30.
    Schuknecht HF. Further observations on the pathology of presbycusis. Arch Otolaryngol Head Neck Surg. 1964; 80: 369–382.CrossRefGoogle Scholar
  31. 31.
    Schuknecht HF, Gacek MR. Cochlear pathology in presbycusis. Ann Otol Rhinol Laryngol. 1993;102(suppl):l- 16.Google Scholar
  32. 32.
    Prevalence and Characteristics of Persons with Hearing Trouble: United States 1990–91. Publication (PHS) 94–1516. Hyattsville, MD: U.S. Dept. of Health and Human Services; 1994.Google Scholar
  33. 33.
    1990 Census of Population and Housing. Bureau of the Census publication 1990 CPH-1. Washington, DC: Bureau of the Census; 1992.Google Scholar
  34. 34.
    Martin F. Introduction to Audiology. Englewood Cliffs, NJ: Prentice-Hall; 1975.Google Scholar
  35. 35.
    Gang R. The effects of age on the diagnostic utility of the rollover phenomenon. J Speech Hear Disord. 1976; 41: 63–69.PubMedGoogle Scholar
  36. 36.
    Jerger J, Jerger S. Psychoacoustic comparison of cochlear and VHIth nerve disorders. J Speech Hear Res. 1967; 10: 659–688.PubMedGoogle Scholar
  37. 37.
    Stelmachowicz PG, Gorga MP. Auditory function tests. In: Cummings WC, Fredrickson JM, Harker LA, et al., eds. Otolaryngology—Head and Neck Surgery. 2nd ed. St. Louis: CV Mosby; 1993; 4: 2698–2717.Google Scholar
  38. 38.
    Harper-Barduch P, Harker A. Advances for the hearing impaired. In: Cummings WC, Fredrickson JM, Harker LA, et al., eds. Otolaryngology—Head and Neck Surgery. St. Louis: CV Mosby, 1986; 4: 3247–3277.Google Scholar
  39. 39.
    Miller MH. Restoring hearing to the older patient: the physician’s role. Geriatrics. 1986; 41: 75–88.PubMedGoogle Scholar
  40. 40.
    Silman S, Geltand SA, Silverman CA. Late-onset auditory deprivation: effects of monaural vs binaural hearing aids. J Acoust Soc Am. 1984; 76: 1357–1362.PubMedCrossRefGoogle Scholar
  41. 41.
    Corrado OJ. Hearing aids. Br Med J. 1988; 296: 33–35.CrossRefGoogle Scholar
  42. 42.
    Brooks D. Hearing aid use and the effects of counseling. AustJ Audiol. 1979; 1: 1–6.Google Scholar
  43. 43.
    Franks JR, Beckmann NJ. Rejection of hearing aids: attitudes of a geriatric sample. Ear Hear. 1985; 6: 161–166.PubMedCrossRefGoogle Scholar
  44. 44.
    Kapteyn T. Satisfaction with fitted hearing aids, II: an investigation into the influence of psychosocial factors. Scand Audiol. 1977; 6: 171–177.PubMedCrossRefGoogle Scholar
  45. 45.
    Matkin ND, Hodgson WR. Amplification and the elderly patient. Otolaryngol Clin North Am. 1982; 15: 371–386.PubMedGoogle Scholar
  46. 46.
    McCabe BF. Vestibular physiology: its clinical application in understanding the dizzy patient. In: Paparella MM, Shumrick DA, Gluckman JL, et al., eds. Otolaryngology. 3rd ed. Philadelphia: WB Saunders; 1991; 2: 911–919.Google Scholar
  47. 47.
    Engstrom H, Ades HW, Engstrom D, et al. Structural changes in the vestibular epithelia in elderly monkeys and humans. Adv Otorhinolaryngol. 1977; 22: 93–110.PubMedGoogle Scholar
  48. 48.
    Rosenthal U. Epithelial cysts in the human vestibular apparatus. J Earyngol Otol. 1974; 88: 105–112.CrossRefGoogle Scholar
  49. 49.
    Bergstrom B. Morphology of the vestibular nerve, II: the number of myelinated vestibular nerve fibers in men at various ages. Acta Otolaryngol. 1973; 76: 173–179.PubMedCrossRefGoogle Scholar
  50. 50.
    Richter E. Counts of neurons in Scarpa’s ganglion from human temporal bones. In: Lim DJ, ed. Abstracts of the Second Midwinter Research Meeting of the Association for Research in Otolaryngology; January 22–24, 1979; St. Petersburg Beach, FL. Abstract 38.Google Scholar
  51. 51.
    Ross MD, Peacor D, Johnson L, et al. Observations on normal and degenerating human otoconia. Ann Otol Rhinol Earyngol. 1976; 85: 310–326.Google Scholar
  52. 52.
    Babin RW, Harker LA. The vestibular system in the elderly. Otolaryngol Clin North Am. 1982; 15: 387–393.PubMedGoogle Scholar
  53. 53.
    Johnsson LG. Sensory and neural degeneration with aging, as seen in micro-dissections of the human inner ear. Ann Otol Rhinol Earyngol. 1972; 81: 179–193.Google Scholar
  54. 54.
    Schuknecht HF. Pathology of the Ear. Cambridge, MA: Harvard University Press; 1974.Google Scholar
  55. 55.
    Gacek RR. Transection of the ampullary nerve for relief of benign paroxysmal positional vertigo. Ann Otol Rhinol Earyngol. 1974; 80: 596–605.Google Scholar
  56. 56.
    Katsarkas A. Dizziness in aging: a retrospective study of 1194 cases. Otolaryngol Head Neck Surg. 1994; 110: 296–301.PubMedCrossRefGoogle Scholar
  57. 57.
    Belal A, Glorig A. Dysequilibrium of aging (presbyastasis). J Earyngol Otol. 1986; 100: 1037–1041.CrossRefGoogle Scholar
  58. 58.
    Brandt T, Daroff R. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980; 106: 484.PubMedCrossRefGoogle Scholar
  59. 59.
    Black FO, Effron MZ, Burns DS. Diagnosis and management of drop attacks of vestibular origin: Tumarkin’s otolithic crisis. Otolaryngol Head Neck Surg. 1982; 90: 256–262.PubMedGoogle Scholar
  60. 60.
    Norré ME, Beckers A. Benign paroxysmal positional vertigo in the elderly: treatment by habituation exercises. J Am Geriatr Soc. 1988; 36: 425–429.PubMedGoogle Scholar
  61. 61.
    Horak FB, Jones-Rycowicz C, Black FO, et al. Effect of vestibular rehabilitation on dizziness and imbalance. Otolaryngol Head Neck Surg. 1992; 106: 175–180.PubMedGoogle Scholar
  62. 62.
    Mathog RH, Peppard SB. Exercise and recovery from vestibular injury. Am J Otolaryngol. 1982; 3: 397–407.PubMedCrossRefGoogle Scholar
  63. 63.
    Fujino A, Tokumasu K, Yosio S, et al. Vestibular training for benign paroxysmal positional vertigo: its efficacy in comparison with antivertigo drugs. Arch Otolaryngol. 1994; 120: 497–504.CrossRefGoogle Scholar

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© Springer Science+Business Media New York 1997

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  • Ernest E. Mhoon

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