Presbiacusia it’s characterized by a progressive deterioration of the capacity to hear and/or understand the verbal message.
It can be also start early, but it becomes evident, and therefore clinical problem, in the moment
in which the mechanisms of cochlear analysis are affected (alteration of the band mechanism
criticism) of language.
In general, the problem is around 65 years of age. In some cases the can Introduce yourself
before and in others, afterwards.
Urban populations show a significant deterioration in the auditory threshold
compared to peers age who, on the other hand, live in the countryside.
The noise in the civilization Industrial it’s the catalyst in the aging process of the system
together with nutrition, the condition of continuous stress, and the drugs used and
abused in a high percentage by the population.
Among the possible causes of presbiacusia, hypertension should also be taken into account
arterial and/or arteriosclerosis. Vascular deficiency can in fact cause serious alterations of the structures
of the inner ear, and precisely of the cells ciliated in the basal gyro of the cochlea, of the cells
gangliari, vascular stria, etc. Calcification of the basic membrane in the basal terminal
of the cochlea, the tendency to cell body atrophy in spiral ganglion cells,
cell degeneration in the central auditory pathways, with a marked reduction in the number of cells
of the auditory cortex are lesions found in presbiacusia.
Symptomatology:
Clinical manifestations of presbiacusia are characterized by a more or not accentuated
reduction of the capacity discriminating of the verbal message, and this is what especially in the presence of ambient noise or when more people speak at the same time (cocktail-party effect). It is it should also be noted that the
elderly person has more difficulty to understand rather than actually feel this is what that the
is said.
The fundamental reason for this peculiarity it’s due to the fact that the auditory deficit on high frequencies (as found in presbiacusia) reduces the discrimination of consonants that are fundamental for the understanding of
Word. The acoustic localization of consonants occurs mainly on high frequencies. The
which contain a higher percentage of energy are located mainly on the
frequencies and are better perceived by the subject presbiacusic. The resultant it’s masking vowels on consonants resulting in impossibility to discriminate against words.
The presbiacusic, in fact, he misses the doorbell, the trill of the phone, the trill of the electronic alarm clock, follows the news quite well, bad the dubbed films, and has difficulty to perceive the voice of children or
Women (who have a pherquence more compared to adult males).
A further feature of the deafness that intervenes to age Advanced it’s related to the delay of time
cortical integration. When communicating with an elderly person it’s so it’s important to speak slowly and clearly.
Acute stamp tinnitus are present in about 35% of the population and often associated a dizzying subjective symptomatology with sensations of imbalance such as “walking on a water carpet”.
The objectivity highlights nothing significant and related to the pathology in question.
Tonal audiometry:
Presbiacusia must be understood, in its age pathology, as an alteration of peripheral structures and, above all, of the inner ear.
It manifests itself, audiometrically, as a bilateral and symmetrical neurosensory auditory loss.
The appearance more important of this pathology does not it’s so much the tonal hearing loss liminar Bensi’ the data that is provided to us by voice audiometry, which it’s able to reveal the real difficulties of the patient presbiacusic.
In the framework of presbiacusia, the physiopathological picture of decay must be evaluated in full and therefore:
A) constant sensory degradation;
B) the growing difficulty in the differentiation of complex stimuli;
C) the increase in learning time;
D) the delay in decision-making processes.
Both sensory receptors, cortical centres and intermediate transfer stations ninformation are involved in this process of “decay”.
From a character point of view, involution leads to introversion, with a reduction in reagentity towards the phenomena of the outside world. We therefore have a decrease in emotional expressions, as if we had reduced our affection for others and increased the affection for If Same. Conservatism and difficulty the logical consequences are the most innovative decisions.
The elderly come to suffer from loneliness, often accentuated by the reduced exacerbated Auditory.
Voice audiometry:
Poiche, Ias’ in presbiacusia coexist different quotas from subject to subject to peripheral and central problems not it’s a characteristic trend of the vocal articulation curve can be observed.
When the injury it’s mainly peripheral, the percentage of intelligity reaches 100%, while when the damage it’s at the expense of neural and central structures intelligie it will be compromised with a greater bending of the articulation curve with evidence of the phenomenon of verbo-tonal dissociation.
When choosing voice material it should be borne in mind that the elderly patient has a different time of attention and response from the adult patient. So the use of complex materials like sentences can ingenerate difficulty that may distort the result of the test.
Associating competitive noise with word bisyllabics allows you to evaluate the performaces property vowels bringing their extrinsic redundancy to critical values.
In the diagnostic phase it is recommended to carry out the examination in the headset while to carry out the prosthetic audiometry tests it’s Certainly more the exam in the free field should be carried out.
In order not to incur false evaluations of the results that can be altered by the elongated reaction times it’s time between the words presented should be lengthened.
PROSTHETIC THERAPY:
The problem it’s closely linked to the capacity integration of the subject. If the voice test carried out with logotomes and bisillabic words highlights a good capacity integration, then it’s prosthesis is definitely advisable. Otherwise, you will can Come To prosthesis subject, aware of the limited results. It should be pointed out that, the prosthesis however, it must necessarily be related by a period of rehabilitation training that allows the patient to make the best use of the prosthesis.
This rehabilitation aspect of the elderly patient new user of the acoustic prosthesis it’s little known and also used for concrete difficulty organisational changes resulting from constraints on staff and availability funding for the social recovery of the elderly citizen.
Support for speech rehabilitation at the very delicate stage of the approach to acoustic prosthesis in the elderly, who often do not it’s completely convinced of the choice made allows to avoid waste and difficulty often result in the abandonment of the acoustic prosthesis which, in any case, represents a considerable cost for the collectiv.
The NHS must not seek to reduce possibility the prosthetic prescription by interpreting the legal regulations in a captious way but should ensure that the patient who needs prosthetic help is helped by the audiological structures to obtain maximum social recovery.
The rehabilitation and support support that can to do a speech therapy treatment would make it possible to contain the waste of prosthesis not used but necessary for communication and to facilitate even late age the life of the elderly by reintegrating it fully into the social context.