Screening and management of adult hearing loss in primary care: clinical applications

Hearing loss is one of the most common chronic health conditions and has important implications for patient quality of life. However, hearing loss is substantially underdetected and undertreated. We present clinical cases to illustrate common situations in which primary care physicians may be called on to identify or to manage hearing loss. With the data reported in the companion scientific review as a guide, we present potential answers to important questions pertaining to hearing loss and suggest ways in which primary care physicians can improve the detection, evaluation, and treatment of hearing loss. The cases focus on screening for chronic hearing loss, evaluation of hearing loss, and treatment of patients with presbycusis.     

Screening and management of adult hearing loss in primary care: scientific review

CONTEXT: Hearing loss is the third most prevalent chronic condition in older adults and has important effects on their physical and mental health. Despite these effects, most older patients are not assessed or treated for hearing loss. OBJECTIVE: To review the evidence on screening and management of hearing loss of older adults in the primary care setting. DATA SOURCES AND STUDY SELECTION: We performed a search from 1985 to 2001 using MEDLINE, HealthSTAR, EMBASE, Ageline, and the National Guideline Clearinghouse for articles and practice guidelines about screening and management of hearing loss in older adults, as well as reviewed references in these articles and those suggested by experts in hearing impairment. DATA EXTRACTION: We reviewed articles for the most clinically important information, emphasizing randomized clinical trials, where available, and identified 1595 articles. DATA SYNTHESIS: Screening tests that reliably detect hearing loss are use of an audioscope, a hand-held combination otoscope and audiometer, and a self-administered questionnaire, the Hearing Handicap Inventory for the Elderly-Screening version. The value of routine screening for improving patient outcomes has not been evaluated in a randomized clinical trial. Screening is endorsed by most professional organizations, including the US Preventive Services Task Force. While most hearing loss in older adults is sensorineural and due to presbycusis, cerumen impaction and chronic otitis media may be present in up to 30% of elderly patients with hearing loss and can be treated by the primary care clinician. In randomized trials, hearing aids have been demonstrated to improve outcomes for patients with sensorineural hearing loss. Nonadherence to use of hearing aids is high. Prompt recognition of potentially reversible causes of hearing loss, such as sudden sensorineural hearing loss, is important to maximize the possibility of functional recovery. CONCLUSION: While untested in a clinical trial, older adults can be screened for hearing loss using simple methods, and effective treatments exist and are available for many forms of hearing loss.     

Health professionals' readiness for infant hearing screening in Lagos, Nigeria

The authors set-out to ascertain the readiness of professional healthcare workers in Nigeria for the implementation of the country's new national health policy, which for the first time, seeks to address the impact of infant hearing loss on early childhood development through early detection and timely intervention. A cross-sectional survey of nurses and doctors showed that health professionals had positive attitudes towards early hearing detection but were limited in their knowledge about current possibilities with infant screening. The need for relevant/on-going professional education is indicated to effectively promote hearing screening services in early childhood.     

先天性巨细胞病毒感染筛查策略的研究进展

先天性巨细胞病毒感染是引起听力损失和神经发育障碍的常见原因,但尚未引起足够重视。新生儿筛查有助于早期发现和尽早干预,目前先天性巨细胞病毒感染筛查尚未广泛开展,随着对疾病认识的增加和筛查技术的提高,筛查策略不断进展和完善。本文就目前常见的筛查策略及其特点进行综合评述。     

Hearing loss in elderly patients in a family practice.

OBJECTIVE: To investigate hearing loss in elderly patients. DESIGN: Cohort study. SETTING: Family practice. PATIENTS: All ambulatory patients 65 years of age or older who attended the practice from June to August 1989. OUTCOME MEASURES: The Hearing Handicap Inventory for the Elderly--Screening Version (HHIE-S) and the Welch-Allyn Audioscope. Patients who failed one or both of the screening tests were referred to a speech and hearing clinic for audiologic assessment and treatment recommendations. Those with hearing aids were excluded from the main study but were given the opportunity to have them assessed at the clinic. MAIN RESULTS: Of 157 eligible patients 42 were excluded: 16 refused to participate, 13 already had hearing aids, and 13 could not be contacted. Of the remaining 115, 34 failed one or both of the tests (14 failed the HHIE-S, 9 failed the audioscope test, and 11 failed both). Of the 34, 25 completed the audiologic assessment at the clinic. Fifteen were found to have severe hearing impairment; the recommendation was hearing aids for 12, further assessment for 2 and no treatment for 1. Of the remaining 10 patients it was thought that 6 would benefit from hearing aids. Ten of the 11 patients with hearing aids who agreed to undergo testing at the clinic were found to need an adjustment or replacement of their devices. CONCLUSIONS: Hearing loss is a significant problem in elderly patients in primary practice. Further study is required to determine which of the two screening tools is most effective. Most elderly patients with hearing aids may require modification or replacement of their devices.     

Hearing deficits in the older patient: "I didn't notice anything"

Hearing loss is common in older adults. Patients, clinicians, and health care staff often do not recognize hearing loss, particularly in its early stages, and it is undertreated. Age-related hearing loss or presbycusis, the most common type of hearing loss in older adults, is a multifactorial sensorineural loss that frequently includes a component of impaired speech discrimination. Simple office-based screening and evaluation procedures can identify potential hearing disorders, which should prompt audiologic referral to confirm the diagnosis with audiometric testing. The mainstay of treatment is amplification. For many older adults, accepting the need for amplification, selecting and purchasing a hearing aid, and getting accustomed to its use is a daunting and often frustrating process. There are numerous barriers to hearing aid use, the most common of which is dissatisfaction with its performance across a range of sonic environments. Newer digital hearing aids have many features that improve performance, making them potentially more acceptable to users, but they are expensive and are not covered by Medicare. Hearing aids have been demonstrated to improve hearing function and hearing-related quality of life (QOL), but evidence is less robust for improving overall QOL. Depending upon the etiology of the hearing loss, other medical and surgical procedures, including cochlear implantation, may benefit older adults. Older adults with multiple morbidities and who are frail pose specific challenges for the management of hearing loss. These patients may require integration of hearing assessment and treatment as part of functional assessment in an interdisciplinary, team-based approach to care.     

老年性耳聋的生存质量调查

目的 本文研究老年性耳聋对老年人生存质量的影响,并且以评价问卷方法研究老年性耳聋对生存质量影响中的意义.方法 本文选择80例50岁及以上有听力下降老年人接受了问卷调查,调查中我们使用专用于健康调查的36项调查表(36-item Short-Form Health Survey,SF- 36)和老人听力障碍调查表(the...     

人性化护理在老年股骨粗隆间骨折康复中的应用

随着人口老龄化的增长，骨质疏松已成为威胁老年人健康的社会问题。老年人往往由于外伤、跌倒而导致骨折，尤其容易引起髋部骨折，这突然来的创伤会使老年患者产生较大的心理反应，又因为老年人生理上的特殊性，疾病的康复较慢，住院时间长，易产生多种并发症。因此，护理显得尤为重要，而舒适有效的人性化护理可使患者心情愉悦的配合治疗与护理，增进食欲，使体重下降减少，增加机体抵抗力，自觉地做好主动锻炼和配合辅助功能锻炼，预防和减少各种并发症，加速骨折的愈合，缩短住院天数，尽早恢复肢体功能，早日恢复生活自理能力，从而提高生活质量。     

听力下降预警老年人群3年后认知障碍的发生情况分析

背景　听力下降是老年人普遍存在的健康问题之一，严重影响老年人的身心健康。既往研究表明，听力下降影响老年人的认知水平。目前，国内听力下降与认知关系在老年队列人群中研究较少。目的　探讨江苏省如皋市长寿及衰老队列中听力下降和认知障碍的相关关系，以期为认知障碍在听力方面的早期预防与干预提供理论依据。方法　于2014-11-13至2014-12-21，从江苏省如皋市江安镇卫生局提供的11 198例老年人（70~84岁）名单中采用随机分层抽样法抽取1 960例，共包括江安镇31个自然村，共1 788例组成基线样本。分别于基线调查1.5年后（2016年4-6月）和3年后（2017年11-12月）进行了第一次和第二次重复调查。本研究人群为同时参加基线调查和第二次重复调查的参与者，共1 375例。其中，1 117例具有完整的2014年自评听力数据和2017年简易精神状态评价量表（MMSE）评估的认知障碍数据，最终被纳入本研究。收集受试者的一般资料，听力水平为受试者对自身听力情况进行自我评价，采用MMSE对受试者的认知情况进行评估。结果　1 117例受试者中听力较好916例（82.0%），听力下降201例（18.0%）；认知障碍575例（51.5%），无认知障碍542例（48.5%）。听力下降者年龄高于听力较好者，MMSE评分低于听力较好者（P<0.05）。无认知障碍和认知障碍者性别、年龄、职业、婚姻状况、教育程度、吸烟状况、饮酒状况、自评健康状况、糖尿病所占比例、听力水平比较，差异均有统计学意义（P<0.05）。Logistic回归分析结果显示，听力水平是认知障碍的影响因素〔OR=1.51，95%CI（1.06，2.15），P=0.022〕。结论　听力下降的老年人易发生认知障碍。及时发现老年人听力下降并给予干预措施，可能减少或延缓老年人认知障碍的发生。     

Age related visual impairment in the elderly

Visual impairment among the elderly is a major health problem. With advancing age, the normal function of eye tissues decreases and there is an increased incidence of ocular pathology. Demographic studies have shown that age is the best predictor of blindness and visual impairment. The most common causes of age related visual impairment in the elderly are presbyopia, cataracts, age related macular degeneration, primary open angle glaucoma and diabetic retinopathy. Untreated visual impairment leads to physical handicap, increased incidence of fall, depression, social isolation and dependency. Active screening for visual loss in the elderly should be part of the health examination. The elderly should be encouraged to come for formal 1-2 yearly eye assessment for early detection of visual impairment and to treat all associated problems in order to prevent permanent visual loss.     

听力损失老年人跌倒的研究进展

全球老龄化程度不断加深的背景下,老年人听力损失的发病率越来越高。听力损失会限制老年人监测和感知空间方位的听觉线索能力,导致方向混乱,增加老年人跌倒的风险。本研究介绍了听力损失老年人跌倒的流行病学特征,阐述了其发生机制,包括神经病理学机制、感官剥夺机制、物理学机制,并通过梳理相关文献,总结了影响因素,包括年龄、性别、听力损失程度、听力损失性质、步态表现、助听设备的使用等,最后,提出听力损失老年人跌倒的防治对策。本研究发现,听力损失老年人跌倒发生情况占比增高,听力损失程度、年龄增长、老年女性激素水平改变、平衡能力下降、负性情绪等是听力损失老年人发生跌倒的危险因素,建议从助听设备使用和听觉康复训练、药物治疗、平衡能力评估和身体锻炼、心理干预4个方面对听力损失老年人跌倒进行防治,从而降低患者跌倒的发生率,保障其生活质量和生命安全。     

Hearing impairment and the elderly patient

Hearing impairment is one of the most common causes of disability in the elderly. In addition to its obvious adverse effects on communication, hearing impairment has been associated with impaired mobility, cognitive impairment, and depression. Treatment of hearing impairment can reduce symptoms of depression and improve quality of life in hearing impaired patients. Yet in the Framingham cohort, although 41% of those 65 years of age and older admitted to hearing difficulty, only 10% had ever used a hearing aid. This article discusses the epidemiology of hearing problems in the elderly, types of hearing loss, the adverse effects of hearing loss, the benefits and drawbacks of hearing aids, and the role of the primary care physician in helping hearing impaired.     

一种筛查中国人遗传性耳聋和氨基糖苷耳毒性易感人群的分子遗传学方法

Objective: To develop a molecular screening test for genetic defects on hearing loss related genes has significant impacts on early identification of hereditary hearing loss and genetic susceptibility to aminoglycoside ototoxicity. Early identification of pre-lingual hearing loss is very important for patient‘s language development, academic achievement, and social skill. Two common mutations, the 235delC in GJB2 gene and the mutation A1555G in mitochondrial DNA, are included in the newly developed screening panel for Chinese population. Methods: A molecular genetic assay, based on fluorescent labeled multiplex PCR and automatic DNA fragment analyzing techniques, was developed to detect both mutations simultaneously. Results: This assay was able to detect both mutations from patient‘s samples, and pooled DNA tests, as well as suitable to detect mutation from the DNA extracted from dried blood spot and buccal swab. Conclusion: This assay could be a useful tool for newborn screening and carrier screening for the hereditary hearing loss for the Chinese population。     

Urinary incontinence in the elderly population

Urinary incontinence is an important and common health care problem affecting the elderly population. Common types of incontinence affecting the elderly are: stress incontinence, urge incontinence, overflow incontinence and mixed type. The elderly patient suffering from urinary incontinence does not often seek treatment voluntary due to a misconception that it is part of a normal ageing process. Without treatment, urinary incontinence may lead to serious psychological and social complications such as depression, anxiety, embarrassment, low self-esteem and social isolation. Overall it is associated with significant poor quality of life for the elderly. Life style modification and behavioural therapy with or without pharmacotherapy help in improving the symptoms. Pelvic floor muscles' training is beneficial for stress incontinence in up to fifty percent of the patients. Elderly patients with urinary incontinence should be encouraged to seek treatment early, as the problem can be treated and they will have a better quality of life.     

感官功能障碍在认知功能障碍疾病早期识别与干预中的价值与探索

认知功能障碍疾病初期症状隐匿，发现时多已处于痴呆阶段，而痴呆尚无有效治愈手段，因此探究简便易行的认知功能障碍疾病早期预警信号、开展及时有效的干预是认知功能障碍疾病防治的关键。大量研究表明感官功能障碍在认知功能障碍早期识别、评估、干预中具有重大价值，但目前我国的认知功能筛查多依靠神经心理学测试，未纳入嗅觉、听觉等高敏感性感官指标。本文通过对既往文献进行回顾、分析，得出在神经心理学测试基础上进一步检测老年人感官功能状态将极大提高认知功能障碍疾病筛查的准确性，明确了嗅觉、听觉、视觉、味觉等感官功能障碍在认知功能障碍疾病早期识别与干预中的价值，为临床工作提供新思路。     

2208例新生儿听力筛查的质量控制分析

目的探讨新生儿听力筛查工作质量控制的方法、措施及意义。方法采用美国Bio-logic公司出品的耳声发射听力筛查仪对2208例新生儿进行筛查。结果初筛率99.28%,初筛未通过人数236例,初筛未通过率为10.77%,复筛率94.49%,转诊56例,转诊率2.55%,其中有48例到成都市妇幼保健院听力中心作了听力学诊断,结果9例有轻至中度听力损失,5例有重度、极重度听力损失,且5例已佩戴助听器。结论做好新生儿听力筛查工作,是减少听力障碍对新生儿语言发育和其他神经系统发育的影响,促进儿童健康发展的保障。     

老年及老年前期高血压和冠心病患者听力调查

分析老年常见病──高血压、冠心病对听力的影响及老年人听力障碍的变化规律。对老年及老年前期高血压、冠心病患者103例与相应年龄健康人58例（对照组）进行听力检测和对比分析。结果：（1）患者组的听力减退发生率及平均听力损失均显著高于对照组（P＜0．01）;（2）各频率的平均纯音听阈均随年龄的增长而增加，越到高频区越明显；（3）老年及老年前期听力损失首先从4000Hz上频率开始，随着年龄的增长听力损失逐渐向中颇、低频区扩展，年龄越大全频区听力损失率越高。结论：生物性自然老化所致的听力损失比较轻，而高血区、冠心病则明显加速和加重了老年性聋的发生。     

基层开展新生儿听力筛查模式探讨

目的探讨县级妇幼保健院牵头在基层农村地区开展普遍性新生儿听力筛查模式及方法。方法建立以妇幼保健院为中心,县、镇产科医疗保健机构为重点,县、镇（社区卫生中心）、村为支持的三级筛查网络;依靠网络完成全地区新生儿普遍性听力筛查、追访和质量控制管理模式;筛查设备、人员、流程均执行卫生部《新生儿听力筛查技术规范》《新生儿疾病筛查管理办法》。结果三级网络模式的建立和有效运行,全县新生儿听力筛查率为2007年10.62%、2008年62.57%、2009年96.71%;已查出听力损失患儿58例。结论由妇幼保健院牵头,利用妇幼保健三级网络对属地县、镇产科医疗保健机构进行规范化管理,在县级农村地区进行普遍性地新生儿听力筛查是有效和可行的。     

非耳疾就诊患者的听力筛查意愿与筛查结果分析

目的 调查非耳疾就诊患者的听力筛查意愿及分析筛查结果,提高医护人员与患者对听力健康的重视程度,尽可能避免可控因素致听力损害.方法 记录参与调查患者的临床资料,对其中愿意行听力筛查者行纯音听阈测定并分析结果;对拒绝行听力筛查者完成问卷以明确其拒绝原因.结果 280例参与调查的患者中,72例愿意行听力筛查,208例拒绝听力筛查;拒绝筛查的主要原因为自觉听力正常、自觉听力与本次就诊疾病无关;年龄大于或等于60岁、家属或身边重要人士有听力疾患者较对照组更愿意接受听力筛查(均P＜0.05);约40.00％长期服药患者存在听力障碍,较对照组更多(P＜0.05);自觉听力状况与纯音听阈测定结果之间差异有统计学意义(P＜0.05).结论 听力障碍在非耳疾就诊患者中有极高的患病率,高龄、长期服药等患者应特别重视听力健康状况;自觉听力正常者仍应警惕潜在的听力障碍.     

突发性耳聋60例临床分析

目的探讨突发性耳聋的预后影响因素。方法 60例(60耳)突发性耳聋患者均在声频治疗基础上辅以药物治疗,根据发病年龄、就诊时间、伴随症状、耳聋程度对治疗前后听力检查结果进行分析。结果年轻人突发性耳聋治愈率高于老年人,越早治疗听力预后越好。结论耳聋的改善程度受病因、病程影响较大,早诊断早治疗是提高突发性耳聋治愈率的关键。