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Ear-Related Problems in the Elderly

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Chapter
  • 1.8k Downloads

Abstract

With ageing, there are a number of structural and pathological processes associated with changes to functional components of the ear. Some of the common ear problems in the elderly are hearing impairment or loss, tinnitus, imbalance and vertigo. Presbycusis is the most common type of hearing impairment in the elderly and is age-related. Exposure to low and repeated sounds over an extended period results in damage to the inner ear. In tinnitus, it had been proposed that the changes are within the auditory pathways, auditory cortex and emotional limbic systems. Vertigo is a feeling of movement in space and this could be objective when the surrounding objects appear to turn in relation to the individual or subjective, the reverse. Balance or the sensation of equilibrium is maintained by visual, vestibular and somatosensory functions of the sensory systems and integrated sensory inputs within the central nervous system. Falls result from a single or combination of environmental and medical factors that interact with physiological changes which increase with age.

Keywords

Age-related changes Hearing loss Presbycusis Tinnitus Vertigo Falls 

Supplementary material

References

Anatomical and Physiological Changes with Ageing-EAR

  1. 1.
    Liu XZ, Yan D. Aging and hearing loss. J Pathol. 2007;211(2):188–97 (abstract).CrossRefPubMedGoogle Scholar
  2. 2.
    Niwa H, Yanagita N. Presbyacusis. Nippon Ronen Igakkai Zasshi. 1990;27(5):545–9 (abstract).CrossRefPubMedGoogle Scholar
  3. 3.
    Belal A. Prebyacusis: physiological or pathological. J Laryngol Otol. 1975;89:1011–25.Google Scholar
  4. 4.
    Weinstein BE. Geriatric audiology. New York: Thieme Medical Publishers; 2000.Google Scholar
  5. 5.
    Rosenwasser H. Otic problems in the aged. Geriatrics. 1964;1911:17.Google Scholar
  6. 6.
    Schuknecht HF, Gacek MR. Cochlear pathology in presbyacusis. Ann Otol Rhinol Laryngol. 1993;1021:16.Google Scholar
  7. 7.
    Browning GG. Clinical otology and audiology. London: Arnold; 2001.Google Scholar
  8. 8.
    Rosenhall U, Rubin W. Degenerative changes in the human vestibular sensory epithelia. Acta Otolaryngol. 1975;79:67–81.CrossRefPubMedGoogle Scholar

Common ear Problems in the Elderly

  1. 9.
    Herlost KG, Humphrey C. Hearing impairment and mental state in the elderly living at home. Br Med J. 1980;281:903–5.CrossRefGoogle Scholar
  2. 10.
    Britt H, Miller GC, Charles J, Pan Y, Valenti L, Henderson L, et al. General practice activity in Australia 2005–06. Canberra: Institute of Health and Welfare; 2007.Google Scholar
  3. 11.
    Angell SL, YYan D, Telischi F, Malkany TJ, Ouyang XM, Du LL, et al. Etiologic diagnosis of sensorineural hearing loss in adult. Otolaryngol Head Neck Surg. 2005;132:890–5.CrossRefGoogle Scholar
  4. 12.
    Balasubramaniam T. Presbyacusis. Website: http://www.drtbalu.com/presbyacusis.html.
  5. 13.
    Bergman M. Aging and the perception of speech. Baltimore: University Park Press; 1980.Google Scholar
  6. 14.
    Sensear. 2009. www.sensear.com/noise-induced-hearingloss.php. Retrieved 20 June 2014.
  7. 15.
    Thorne PR, Ameratunge SN, Stewart J, Reid N, Williams W, et al. Epidemiology of noise-induced hearing loss. N Z Med J. 2008;121(1280):33–44.PubMedGoogle Scholar

Imbalance and Vertigo

  1. 16.
    Hanley K, Dowd T, Crosindine N. A systematic review of vertigo in primary care. Br J Clin Pract. 2001;51:666–71.Google Scholar
  2. 17.
    Colledge NR, Barr-Hamilton M, Lewis SJ, Sellar RJ, Wilson JA. Evaluation of investigation to diagnosis of the cause of dizziness in elderly people in community and controlled study. Br Med J. 1996;313:788–92.CrossRefGoogle Scholar
  3. 18.
    Bird JC, Beynon GJ, Prevost AT, Baguley DM. Analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract. 1998;48:1828–32.PubMedCentralPubMedGoogle Scholar
  4. 19.
    Drachman DA, Hart CW. A approach to the dizzy patient. Neurology. 1992;22:341–54.Google Scholar
  5. 20.
    Troost T. Dizziness and vertigo in vertebrobasilar disease. Stroke. 1990;11:301–3, 413–5.CrossRefGoogle Scholar
  6. 21.
    Charles J, Fahridin S, Britt H. The BEACH program. Australian GP Statistical Classification Centre. University of Sydney; 2007Google Scholar

Tinnitus

  1. 22.
    Davis A, El Rafaie A. Epidemiology of tinnitus. In: Tyler R, editor. Tinnitus handbook. San Diego: Singular Publishing Group. 2000. p. 1–23.Google Scholar
  2. 23.
    Richmond BS. Tinnitus: prevalence, causes and treatment approaches. Geriatric Times 2003; vol. iv. website: http://www.cmellc.com/geriatrictimes/g030821.html.
  3. 24.
    Benson AG, McGuire JF, Djalilian HR, Hanks KM, McGuire JF. Inner ear, tinnitus Overview. eMedicine Otolaryngology and Facial plastic surgery. 2008. website: http://emedicine.medscape.com/article/856916-overview. Accessed 4/8/2009.
  4. 25.
    Moller AR. Tinnitus: presence and future. Prog Brain Res. 2007;166:3–16 (abstract).CrossRefPubMedGoogle Scholar
  5. 26.
    Lockwood AH, Salvi RJ, Coad ML, Towsley ML, Wack DS, Murphy BW, et al. The functioning neuroanatomy of tinnitus: evidence for limbic system, tinnitus and neural plasticity. Neurology. 1998;50(1):114–24.CrossRefPubMedGoogle Scholar
  6. 27.
    Moller AR. Pathophysiology of tinnitus. Otolaryngol Clin North Am. 2003;36(2):249–66 (abstract).CrossRefPubMedGoogle Scholar

Falls

  1. 28.
    Gibson MJ, Andres K, Isaacs B, Radebaugh T, Worm-Petersen J. Prevention of falls in later life. Dan Med Bull S. 1987;34(Supp 4):1–24.Google Scholar
  2. 29.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among the elderly persons in the community. N Engl J Med. 1988;319(26):1701–7.CrossRefPubMedGoogle Scholar
  3. 30.
    Tinetti ME, Williams CS. Falls injuries and the risk of admission to a nursing home. N Engl J Med. 1997;337:1279–94.CrossRefPubMedGoogle Scholar
  4. 31.
    Lord S, Ward J, Williams P, Anstey K. An epidemiological study of falls in older community-dwelling women. The Randwick falls and fractures study. Aust J Public Health. 1993;17:240–5.CrossRefPubMedGoogle Scholar
  5. 32.
    Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P, et al. Falls in the elderly: a study of risk factors and risk profiles. Am J Epidemiol. 1996;143:1129–36.CrossRefPubMedGoogle Scholar
  6. 33.
    Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003;18:343–51.CrossRefPubMedGoogle Scholar
  7. 34.
    Lee D, Lishman R. Vision in movement and balance. New Sci. 1975;9:59–61.Google Scholar
  8. 35.
    Baloh RW, Fife TD, Zwerling L, Socotch T, Jacobson K, Bell T, et al. Comparison of static and dynamic posturography in young and older normal people. J Am Geriatr Soc. 1994;42:404–16.CrossRefGoogle Scholar
  9. 36.
    Manchester D, Woollacott M, Zoderbauer-Hylton N, Marino O. Visual, vestibular and somato-sensory contributions to balance control in older adults. J Gerontol. 1989;44:M118–27.CrossRefPubMedGoogle Scholar
  10. 37.
    Stelmach GE, Worringham CJ. Sensation for deficits related to postural stability implications for falling in the elderly. Clin Geriatr Med. 1984;1:679–94.Google Scholar
  11. 38.
    Woollacott M, Shunway-Cook SA, Nashner L. Aging and postural control. Changes in sensory organization in muscular co-ordination. Int J Aging Hum Dev. 1986;23:97–114.CrossRefPubMedGoogle Scholar
  12. 39.
    Spirduso WW. Physical dimensions of aging. Champaign: Human Kinetics; 1995.Google Scholar
  13. 40.
    Gerson LW, Jarjoura D, McCord G. Risk of imbalance in elderly people with impaired hearing or vision. Age Ageing. 1989;18:31–4.CrossRefPubMedGoogle Scholar
  14. 41.
    Brockelhurst JC, Robertson D, James-Groin P. Clinical correlates of sway in old age-sensory modalities. Age Ageing. 1982;11:1–10.CrossRefGoogle Scholar
  15. 42.
    Nagaratnam N, Leung H, Bou-Haider P. Lacunar stroke proclivity for falls. Int J Clin Pract. 2004;58:83–6.CrossRefPubMedGoogle Scholar
  16. 43.
    Ashburn A, Stack E, Pickering PM, Ward CD. A community –dwelling sample of people with Parkinson’s disease: characteristic of fallers and non-fallers. Age Ageing. 2001;30:47–52.CrossRefPubMedGoogle Scholar
  17. 44.
    Overstall PW. Epidemiology and pathophysiology of falls. In: Katara MS, editor. Fits, faints and falls in old age. Lancaster: MTP Press; 1985. p. 15–26.CrossRefGoogle Scholar
  18. 45.
    Segev-Jacubovski O, Herman T, Yogev-Seligman G, Mirelman A, Giladi N, Hausdirff JM, et al. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Rev Neurother. 2011;11(7):1057–75.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 46.
    Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006;35 suppl 2:ii7–11.PubMedGoogle Scholar
  20. 47.
    Atkinson HH, Rosano C, Simmonsick EM, Williamson JD, Davis C, Ambrosius WT, et al. Cognitive function speed decline and comorbidities: the health aging and body composition study. J Gerontol A Biol Med Sci. 2007;62:844–50.CrossRefGoogle Scholar
  21. 48.
    Muir SW, Gopaul K, Odasso MMM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing. 2012;41(3):299–308.CrossRefPubMedGoogle Scholar
  22. 49.
    Allan IM, Ballard CG, Burn DJ, Kenny RA. Prevalence and severity of gait disorders in Alzheimer’s and non-Alzheimer’s dementias. J Am Geriatr Soc. 2005;53:1681–7.CrossRefPubMedGoogle Scholar
  23. 50.
    Nadkarni NK, Mawji E, Mcllroy WE, Black SE. Spatial and temporal gait parameters in Alzheimer’s disease and aging. Gait Posture. 2009;30:542–4.CrossRefGoogle Scholar
  24. 51.
    Stuss DT, Alexander MP. Executive functions and the frontal lobes : a conceptual view. Psychol Res. 2000;63:289–98.CrossRefPubMedGoogle Scholar
  25. 52.
    Herman T, Mirelman A, Giladi N, Schweiger A, Hausdorff JM. Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking and falling. J Gerontol A Biol Sci Med Sci. 2010;65(10):1086–92 (abstract).CrossRefPubMedGoogle Scholar
  26. 53.
    Mirelman A, Herman T, Brozgol M, Dorfmn M, Sprecher E, Schweiger A, et al. Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition. PLoS One. 2012;7(6):240297. doi: 10.1371/journal.pone.0040297. Epub 2012 Jun 29 (abstract).CrossRefGoogle Scholar
  27. 54.
    Hauer K, Pfisterer M, Weber C, Wezler N, Keigel M, Oster P. Cognitive impairment decreases postural control during dual tasks in geriatric patients with history of falls. J Am Geriatr Soc. 2003;51:1638–44.CrossRefPubMedGoogle Scholar
  28. 55.
    Soto D, Blanco MJ. Spatial attention and object –based attention : a comparison within a single task. Vision Res. 2004;44:69–81.CrossRefPubMedGoogle Scholar
  29. 56.
    Nagamutsu LS, Liu-Ambrose TYL, Carolan P, Handy TC. Are impairments in visual-spatial attention a critical factor for increased risk in seniors? An event –related potential study. Neuropsychologia. 2009;47:2749–55.CrossRefGoogle Scholar
  30. 57.
    Davies AJ, Kenny CA. Falls presenting to the accident and emergency department. Types of presentation and risk factor profile. Age Ageing. 1996;25:362–6.CrossRefPubMedGoogle Scholar
  31. 58.
    Shaw FE, Kenny RA. The overlap between syncope and falls in the elderly. Postgrad Med J. 1997;73(864):635–9.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 59.
    Kenny RA. Syncope in the elderly. J Cardiovasc Electrophysiol. 2003;14(S9):S74–7 (abstract).CrossRefPubMedGoogle Scholar
  33. 60.
    Horlick MF, Matsuoka LY, Wartsmann J. Age, vitamin D and solar ultraviolet. Lancet. 1989;2:1104–5.CrossRefGoogle Scholar
  34. 61.
    Sakuma M, Endo N. Muscle and bone health as a risk factor of fall among the elderly. Vitamin D for prevention of fall and fracture. Clin Calcium. 2008;18(6):816–20 (abstract).PubMedGoogle Scholar
  35. 62.
    Dharmarajan TS, Akula M, Kuppachi S, Norkus EP. Vitamin D deficiency in community older adults with falls of gait imbalance: an under-recognized problem in the inner city. J Nutr Elder. 2005;25:7–19 (abstract).CrossRefPubMedGoogle Scholar
  36. 63.
    Anneweiler C, Montero-Odasso M, Schott AM, Berut G, Fantino B, Beauchet O. Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuroeng Rehabil. 2010;7:50.CrossRefGoogle Scholar
  37. 64.
    Gerdheim P, Ringsberg KA, Obrant KJ, Akesson K. Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and function in the prospective population based OPRA study of elderly women. Osteoporos Int. 2005;16:1425–31.CrossRefGoogle Scholar
  38. 65.
    Dey AB, Stout NR, Kenny RA. Cardiovascular syncope is the most common cause of drop attacks in the elderly. Pacing Clin Electrophysiol. 1997;20:818–9.CrossRefPubMedGoogle Scholar
  39. 66.
    Dhesi JK, Jackson SH, Bearne LM, Moniz C, Hurley MV, Swift CG, et al. Vitamin D supplemental improve neuromuscular function in older people with fall. Age Ageing. 2004;33:589–95.CrossRefPubMedGoogle Scholar
  40. 67.
    Bischoff-Ferrari HA, Borcbers M, Gudat F, Durmuller V, Stahelin HB, Dick W. Vitamin D receptor expression in human muscle decreases with age. J Bone Miner Res. 2004;19:265–9.CrossRefPubMedGoogle Scholar
  41. 68.
    Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbocks S, Thomsen J, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int. 2000;66:419–24.CrossRefPubMedGoogle Scholar
  42. 69.
    Nagagawa K. Effect of vitamin D on the nervous system and the skeletal muscle. Clin Calcium. 2006;16(2):1182–7 (abstract).Google Scholar
  43. 70.
    Nyberg L, Gustafson Y. Patient falls in stroke rehabilitation. Stroke. 1995;26:838–42.CrossRefPubMedGoogle Scholar
  44. 71.
    Aizen E, Shugaer I, Lenger R. Risk factors and characteristics of falls during inpatient rehabilitation of elderly patients. Arch Gerontol Geriatr. 2007;44:1–12.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 2
  • Gary Cheuk
    • 3
  1. 1.Sydney Medical School (Westmead)The University of SydneyNorth RocksAustralia
  2. 2.Norwest Specialist Medical GroupBella VistaAustralia
  3. 3.Blacktown-Mt Druitt HospitalBlacktownAustralia

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