Negative self-perception of hearing and depression in older adults: a population-based study / Autopercepção negativa da audição e depressão em idosos: um estudo de base populacional

ABSTRACT OBJECTIVE To estimate the association between negative self-perception of hearing and depression in older adults in Southern Brazil. METHODS This is a cross-sectional study conducted with data from the third wave of the EpiFloripa Idoso 2017/19 study, a population-based cohort of older adults (60+). A total of 1,335 older adults participated in this wave. The dependent variable was self-reported depression, and the main exposure was self-perception of hearing (negative; positive). For both the crude (bivariate) and adjusted analysis, the odds ratio (OR) was used as a measure of association and estimated by means of binary logistic regression analysis. The exposure variable was adjusted by sociodemographic and health covariates. A p value < 0.05 was adopted as statistically significant. RESULTS The prevalence of negative self-perception of hearing and depression was 26.0% and 21.8%, respectively. In the adjusted analysis, the older adults with negative self-perception of hearing were 1.96 times more likely to report depression when compared to the ones with positive self-perception of hearing (p = 0.002). CONCLUSION The association between negative self-perception of hearing and depression reflects the importance of reviewing health care actions for older adults, incorporating hearing-related issues, to ensure comprehensive care for this growing segment of the population.

RESUMO OBJETIVO Estimar a associação entre a autopercepção negativa da audição e a depressão em idosos do sul do Brasil. MÉTODOS Trata-se de um estudo transversal realizado com dados da terceira onda do estudo EpiFloripa Idoso 2017/19, de coorte de base populacional de idosos (60+). Participaram desta onda 1.335 idosos. A variável dependente foi a depressão autorreferida e a exposição principal foi a autopercepção auditiva (negativa; positiva). Tanto para a análise bruta (bivariada) quanto para a ajustada, a odds ratio (OR) foi utilizada como medida de associação e estimada por meio da análise de Regressão Logística Binária. A variável de exposição foi ajustada pelas covariáveis sociodemográficas e de saúde. Adotou-se o valor de p < 0,05 como estatisticamente significativo. RESULTADOS A prevalência da autopercepção negativa da audição e depressão foi de 26,0% e 21,8%, respectivamente. Na análise ajustada, idosos com autopercepção negativa da audição apresentaram 1,96 vezes mais chance de referirem depressão quando comparados aos idosos com autopercepção positiva da audição (p = 0,002). CONCLUSÃO A associação encontrada entre a autopercepção negativa auditiva e a depressão reflete a importância de rever as ações de atenção à saúde do idoso, incorporando questões relacionadas à audição para a garantia da atenção integral a esta parcela crescente da população.

Older adults hearing screening strategies: a bibliometric review / Revisão bibliométrica: estratégias de triagem auditiva de idosos

ABSTRACT Purpose: to analyze the profile of publications on methods and instruments used to screen older adults hearing. Methods: the scientific production on older adults hearing screening methods, searching for articles published between 2016 and 2022. Data were collected from PubMed, Scopus, LILACS, Web of Science, and Google Scholar databases and the articles were categorized according to their year, study type, authors, and screening instrument. Data were also analyzed to suggest potential aspects to be addressed in future research in the area. Literature Review: altogether, 26 articles were found based on the eligibility criteria. Publications peaked in 2016, followed by 2020. Articles published in the United States predominated (18%), and HHIE-S (hearing handicap inventory for the elderly screening version) was the most used instrument; 90% of the publications were in English, and the most recurrent study type was cross-sectional, followed by instrument validation studies. Conclusion: the review points out the scarcity of scientific production on older adults hearing screening in both national and international research. The studies approached different populations, screening methods, hearing loss definitions, health systems, and public policies in the countries where they were conducted. Better methodologies must be implemented for future research in the area.

RESUMO Objetivo: analisar o perfil das publicações a respeito dos métodos e instrumentos utilizados para realizar triagem auditiva em idosos. Métodos: esta pesquisa revisou a produção científica sobre métodos de triagem auditiva no idoso. A busca deu-se com artigos publicados entre 2016 e 2022. Os dados foram coletados nas bases de dados: PubMed, Scopus, LILACS, Web of Science e Google Scholar. Os artigos foram categorizados quanto ao ano, tipo de artigo, autores e instrumento de triagem. Além disto, os dados foram analisados com sugestões de aspectos potenciais a serem considerados para futuras pesquisas na área. Revisão da Literatura: foram encontrados 26 artigos com base nos critérios de elegibilidade. O pico de publicações referente ao estudo ocorreu no ano de 2016, seguido por 2020. Predominaram os estudos publicados no Estados Unidos (18%), o instrumento mais utilizado foi o HHIE-S, 90% das publicações estão na língua inglesa, e o tipo de estudo mais realizado é a pesquisa transversal, seguida dos Estudos de validação dos instrumentos. Conclusão: o estudo mostra a escassez de produção científica sobre triagem auditiva do idoso nas pesquisas nacionais e internacionais. Foram observadas variações da população e dos métodos de triagem, diferenças nas definições de perda auditiva entre os estudos elegíveis e diferenças nos sistemas de saúde e políticas públicas dos países em que esses estudos foram realizados. É necessária melhor implementação metodológica em futuras pesquisas na área.

Análisis de correlación entre la audición y la flexibilidad cognitiva en una población adulta mayor de Sincelejo, Colombia / Correlation analysis between hearing and cognitive flexibility in the older adult population of Sincelejo, Colombia

Resumen Introducción: La presente investigación estudió el sistema auditivo y las habilidades ejecutivas, específicamente la flexibilidad cognitiva, en población longeva y buscó aportar a la evidencia científica existente, el impacto que pueden tener ambas en la calidad de vida de la población adulta mayor. Objetivo: Se determinó la relación entre la función auditiva y la flexibilidad cognitiva de una población adulta mayor del municipio de Sincelejo, Colombia. Método: Se realizó un estudio cuantitativo, no experimental, correlacional, transversal, a una población de 140 adultos mayores, para la selección de la muestra se aplicó un muestreo intencional por criterios de inclusión (pertenecientes a la institución, que firmarán el consentimiento informado) y de exclusión (déficit cognitivo, diabetes, enfermedades neurológicas diagnosticadas, alteraciones visuales o auditivas, sobrepasar la edad del test), la muestra quedo conformada por 49 adultos mayores. Se empleó como instrumentos de recolección de la información para la audición, pruebas audiológicas de audiometría tonal y logoaudiometría; y para la medición de la función ejecutiva, Test de clasificación de tarjetas de Wisconsin. Resultados: se demostraron diferencias entre la variable respuesta de nivel conceptual del test entre los grupos de edad (p: 0,037), pérdidas auditivas de alta frecuencia entre leve y moderado (25-40DbBHL; 40-60DBHL), buen nivel de discriminación del habla, y una asociación estadística entre sensibilidad auditiva y número total de errores (0,336, 0,357 p=0,05); la sensibilidad auditiva y las respuestas perseverativas y errores perseverativos (0,343, 0,301 p=0,05), discriminación del habla, respuesta a nivel conceptual (-0,375;-0,397p=0,0) y fallos para mantener actitud (0,441; 0,456 p=0,01). Conclusión: Cuanto mayor deterioro en el procesamiento periférico y central auditivo exista, mayor es la tendencia perseverativa, la dificultad para abstracción y formación de conceptos, así como el cambio de estrategias de un adulto mayor en tareas que impliquen funcionamiento ejecutivo.

Abstract Introduction: The present research study the auditory system and executive skills, specifically cognitive flexibility, in long-lived population to contribute to the existing scientific evidence, the impact that both can have on the quality of life of the elderly population. Objective: the relationship between the hearing function and cognitive flexibility an older adult population was determined in Sincelejo, Colombia. Method: A quantitative, non-experimental, correlational, cross-sectional study was conducted in a population (140) older adults, intentional sampling by inclusion criteria was applied for the selection of the sample (belonging to the institution, who will sign the informed consent) and exclusion (cognitive deficit, diabetes, diagnosed neurological diseases, visual or auditory alterations, exceeding the age of the test), the sample was made up of 49 older adults. It was used as instruments for collecting information for hearing, audiological tests of tone audiometry and logoaudiometry, for the measurement of executive function, Wisconsin Card Classification Test. Results: The results showed mean differences in the conceptual level response variable between age groups (p: 0.037), high-frequency hearing losses between mild and moderate (25-40Dbhl; 40-60Dbhl), good level of speech discrimination and a statistical association between hearing sensitivity and total number of mistakes (0.336, 0.357 p=0.05), and perseverance(0.343, 0.301 p=0.05), speech discrimination, response at the conceptual level(-0.375;-0.397p=0.0), lack of attitude(0.441; 0.456 p=0.01). Conclusion: The greater the deterioration in the peripheral and central auditory processing, the greater the perseverative tendency, the difficulty in abstraction and concept formation, as well as the change of strategies of an older adult in tasks that involve executive functioning.

Efeito do treinamento musical em idosos candidatos ao uso de próteses auditivas / Effect of musical training in older adults candidates to the use of hearing aids / Efecto de la formación musical en ancianos candidatos al uso de audífonos

Introdução: Associação entre adaptação de próteses auditivas e treinamento auditivo pode melhorar a comunicação do indivíduo e reduzir os déficits funcionais. Objetivo: verificar o benefício na qualidade de vida, sintomas depressivos, aspectos cognitivos, resolução temporal e limitação em atividades de vida em idosos com perda auditiva, após adaptação de próteses auditivas associadas ou não ao treinamento auditivo musical. Métodos: Grupo Experimental - GE: cinco idosos (64 a 79 anos) e Grupo Controle - GC: cinco idosos (62 a 77 anos), todos com perda auditiva neurossensorial simétrica de grau moderado. Foram submetidos à anamnese, miniteste de triagem cognitiva CASI-S, avaliação audiológica incluindo Índice Porcentual de Reconhecimento de Fala (IPRF), Client-Oriented Scale of Improvement (COSI), resolução temporal (teste GIN), triagem para sintomas depressivos (EDG-15), questionários de qualidade de vida (SF-36) e de autoavaliação para próteses auditivas (QI-AASI). Todos receberam próteses auditivas, e apenas o GE, o treinamento auditivo musical. Avaliação realizada em três momentos: antes da adaptação das próteses auditivas; 11 semanas após a adaptação das mesmas, sendo o GE submetido ao treinamento musical por sete semanas; e quatro meses depois. Resultados: Não houve diferença entre grupos segundo idade, escolaridade e triagem cognitiva. Todos apresentaram melhores limiares no teste de resolução temporal após a intervenção. Os escores dos testes de qualidade de vida e sintomas depressivos não foram significantemente diferentes entre grupos e avaliações. Conclusão: O uso efetivo de próteses auditivas, associado ou não ao treinamento musical, melhorou a resolução temporal. Não houve melhora significativa na qualidade de vida, sintomas depressivos, cognição e COSI.

Introduction: Association between hearing aid fitting and auditory training can improve an individual's communication and reduce functional deficits. Objective: to verify benefit in quality of life, depressive symptoms, cognitive aspects, temporal resolution, and limitation in daily activities for elderly people with hearing loss, after adaptation of hearing aids associated or not with musical auditory training. Methods: Experimental Group - EG: five elderly (64 to 79 years old) and Control Group - CG: five elderly (62 to 77 years old), all with moderate symmetric sensorineural hearing loss. They underwent anamnesis, cognitive screening CASI-S, audiological evaluation including Percentage Index of Speech Recognition (PISR), Client-Oriented Scale of Improvement (COSI), temporal resolution (GIN), screening for depressive symptoms (GDS-15), quality of life questionnaires (SF-36) and IOI-HA self-assessment. All received hearing aids but only the EG received the auditory musical training. Evaluation performed in three moments: before the fitting of the hearing aids; 11 weeks after their adaptation, with the EG undergoing musical training for seven weeks; and four months later. Results: There was no difference between groups according to age, education, and cognitive screening. All had better thresholds in the GIN after the intervention. The GDS-15 and SF-36 scores were not significantly different between groups and assessments. Conclusion: Using hearing aids associated or not with musical training improved temporal resolution. There was no improvement in the quality of life, depressive symptoms, cognition, and COSI scale.

Introducción: Asociación entre adaptación de prótesis auditivas y entrenamiento auditivo puede mejorar la comunicación del individuo y reducir los déficits funcionales. Objetivo: verificar el beneficio en la calidad de vida, síntomas depresivos, aspectos cognitivos, resolución temporal y limitación de la vida de las personas mayores con hipoacusia, tras adaptación de audífonos asociada o no al entrenamiento auditivo musical. Métodos: Grupo Experimental ­ GE: cinco ancianos (64 a 79 años) y Grupo Control - GC: cinco ancianos (62 a 77 años) todos con hipoacusia neurosensorial simétrica moderada. Fueron sometidos a la anamnesis, miniprueba de triaje cognitiva CASI-S, evaluación audiológica incluyendo Índice Porcentual de Reconocimiento de Habla (IPRH), Client-Oriented Scale of Improvement (COSI), resolución temporal (prueba GIN), classificación para síntomas depresivos (EDG-15), cuestionarios de calidad de vida (SF-36) y autoevaluación de audífonos (QI-AASI). Todos recibieron los audífonos, sólo el GE, el entrenamiento auditivo musical. Evaluación realizada en tres momentos: antes de la adaptación de los audífonos; 11 semanas después de la adaptación de las mismas siendo el GE sometido al entrenamiento musical por siete semanas; y cuatro meses después. Resultados: No hubo diferencia entre grupos según edad, escolaridad y triaje cognitivo. Todos presentaron mejores umbrales en la prueba de resolución temporal después de la intervención. Los resultados de las pruebas de calidad de vida y los síntomas depresivos no fueron significativamente diferentes entre grupos y evaluaciones. Conclusión: Usar audífonos asociados o no con entrenamiento musical mejoró la resolución temporal. No hubo mejora significativa en la calidad de vida, síntomas depresivos, cognición y COSI.

Acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos / Accuracy of affordable instruments for hearing screening in adults and the elderly

RESUMO Objetivo Avaliar a acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos. Método Este estudo foi realizado com usuários de um Serviço de Saúde Auditiva do SUS. Todos foram submetidos a triagem com o aplicativo de smartphone MoBASA, o audiômetro Telessaúde (TS) e a versão eletrônica do Questionário de Handicap da Audição para Idosos (Hearing Handicap Inventory for the Elderly - screening version - eHHIE-S). Os examinadores foram cegos quanto aos resultados dos testes de triagem e para os dados de audiometria de tom puro (ATP). Foram considerados com deficiência auditiva aqueles com média quadritonal na ATP maiores que 40 dB na melhor orelha. Sensibilidade, especificidade e valores preditivos positivo (VPP) e negativo (VPN) foram calculados. O índice Kappa foi usado como um indicador de concordância entre ATP e os resultados da triagem. Resultados A amostra constou de 80 indivíduos entre 18 a 94 anos (55,18 ± 20,21). Na ATP, 21 indivíduos (26,25%) apresentaram audição normal e 59 (73,75%) perda auditiva incapacitante. Nos testes de triagem auditiva observou-se valores de sensibilidade, especificidade, VPP e VPN maiores do que 75% no MoBASA e na sensibilidade e VPN do TS e eHHIE-S. Já a especificidade e VPP do TS e eHHIE-S foram inferiores a 75%. O índice Kappa indicou concordância substancial (0,6) entre o ATP e os resultados do MoBASA. No TS e eHHIE-S foi constatada regular concordância (0,3). Conclusão O MoBASA demonstrou ser um método acurado para triagem auditiva de adultos e idosos com perda auditiva incapacitante.

ABSTRACT Purpose To evaluate the accuracy of affordable instruments for hearing screening of adults and the elderly. Methods This study was carried out with users of a Hearing Health Service of the Unified Health System. All were screened with the MoBASA smartphone application, the Telehealth audiometer (TH) and the electronic version of the Hearing Handicap Inventory for the Elderly - screening version - eHHIE-S. The examiners were blinded to the results of the screening tests and pure tone audiometry (PTA). Hearing impairment was considered for those with a PTA quadritonal mean greater than 40 dB in the best ear. Sensitivity, specificity and positive and negative predictive values (PPV and NPV, respectively) were calculated. The Kappa index was used as an agreement indicator between the PTA and the screening results. Results The sample consisted of 80 individuals between 18 and 94 years old (55.18 ± 20.21). In the PTA test, 21 individuals (26.25%) had typical hearing and 59 (73.75%) hearing loss. In the hearing screening tests, sensitivity, specificity, PPV and NPV values greater than 75% were observed with the MoBASA as well as in terms of sensitivity and NPV of the TH and the eHHIE-S. The TH and the eHHIE-S specificity and PPV were less than 75%. The Kappa index indicated a substantial agreement (0.6) between the PTA and the MoBASA screening results. The TH and the eHHIE-S showed regular agreement (0.3). Conclusion MoBASA proved to be an accurate method for hearing screening of adults and the elderly with disabling hearing loss.

Age-related hearing loss and its association with central obesity: experience at a tertiary centre

Background: Presbycusis is a slow, progressive, age-related sensorineural hearing loss, which is insidious, slow, progressive and irreversible disease and usually affects high pitch sound. It can be associated with various factors. Obesity is such a modifiable factor and its independent role with age-related hearing loss needs to be explored.Methods: This is a prospective study carried out over a period of three years in department of otorhinolaryngology at study institute. It included 1000 cases with symmetrical sensorineural hearing loss.Results: Among obese cases, high frequency hearing loss was found in significantly large number of cases. The most common audiogram in both male and female was Abrupt high tone loss type, irrespective of presence or absence of obesity.Conclusions: Obesity is a modifiable factor which has a significant association with high frequency hearing loss among the elderly population.

Hipoacusia como factor de riesgo para demencia

In the last decades, there has been an increase in life expectancy in the world, with the consequent modification in the proportion of adults over 60 years. This is accompanied by an increase in pathologies for which aging is the main risk factor, such as dementia and hearing loss, which profoundly affect the quality of life of individuals and their family and impact health system costs. Given the lack of disease-modifying treatments for dementia, the study of mechanisms to prevent its occurrence has become a world priority. In the year 2017, the Lancet "Commission for dementia prevention, intervention, and care" proposed a model, in which hearing loss emerged as a new modifiable risk factor for the development of dementia. This result undoubtedly has important consequences for the understanding the multifactorial nature of dementia, our daily clinical practice and public policies aimed at its prevention and treatment. In this article, we review the current evidence supporting the association between dementia and hearing loss, discussing the available strategies for prevention, detection and treatment of hearing loss and its possible impact on the natural course of dementia. A flow chart for the clinical management of different subgroups of patients is proposed.

Application of the Chinese version of the Addenbrooke's cognitive examination-Ⅲ in presbycusis with mild cognitive impairment / 中国基层医药

Objective@#To explore the reliability, validity and best cut-off value of Chinese version Addenbrooke's cognitive examination-Ⅲ(ACE-Ⅲ) in presbycusis patients with mild cognitive impairment(MCI).@*Methods@#A total of 43 presbycusis patients with mild cognitive impairment, 61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE), Montreal cognitive assessment(MoCA) and ACE-Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE-Ⅲ were analyzed with the SPSS 21.0, and the cut-off point was confirmed with the receiver operating characteristic(ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed.@*Results@#Chinese version of ACE-Ⅲ had betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach's alpha, split-half reliability and intraclass correlation coefficient were 0.870(P<0.05), 0.874(P<0.05) and 0.880(P<0.05), respectively.The patients in MCI group got a lower score in the sub-scale of attention/orientation, memory, verbal fluency, language and visual space of ACE-Ⅲ compared with those in NCI group and healthy control group, and the differences were statistically significant (F=48.042, 46.594, 35.442, 19.374, 256.19, 140.319, all P<0.001). The criteria validity calculated between the Chinese version of ACE-Ⅲ and MMSE was 0.802 (P<0.001). Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals(P<0.05). The Chinese version of ACE-Ⅲ showed significantly correlation with the total scores of MoCA(r=0.802, P<0, 001). When the cut-off value for diagnosis was 86.5, the largest area under the ROC curve for the Chinese version of ACE-Ⅲ was 0.98(95% CI: 0.897-0.996). The relative sensitivity and specificity were 100.0% and 95.0%, respectively.@*Conclusion@#The Chinese version of ACE-Ⅲ had better internal consistency, reliability and validity, and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.

Changes of BKCa on vascular striaepericytes of D-galactose-induced aging model in guinea pigs / 中华耳鼻咽喉头颈外科杂志

Objective@#The aging model of guinea pigs induced by D-galactose was set up to investigate the changes of BKCa expression and function on cochlear pericytes and their relationship with age-related hearing loss.@*Methods@#Thirty healthy 8-week-old guinea pigs were randomly divided into three groups, with 10 in each group: D-galactose aging model group, subcutaneous injection of D-galactose (500 mg/kg) daily for 6 weeks; saline control group, the same amount of saline was injected into the neck of the aging model group for 6 weeks; the blank control group, no treatment was performed. The threshold of auditory brainstem response (ABR) was detected. The content of BKCa in the perivascular cells of the guinea pig cochlear cells was detected by immunofluorescence technique. The changes of peripheral current density and BKCa current were detected by patch clamp technique. The data were analyzed by GraphPad Prism software.@*Results@#Compared with the saline group and the control group, the ABR threshold and the amplitude of the wave I were significantly decreased in the aging model group, and the difference was statistically significant (P<0.01). Compared with the control group, the expression of BKCa in the vascular pericytes of guinea pigs in the aging model group was significantly reduced (1.00±0.08 vs 0.27±0.03,the difference was statistically significant P<0.01), and the cell current density and BKCa net current value were also significantly reduced with statistically significant (P<0.01).@*Conclusions@#D-galactose can successfully induce guinea pig aging model, in which BKCa expression decreases and net current value decreases in pericytes of cochlear striavascularis, and changes in BKCa expression and function may be related to age-related hearing loss.

Application of the Chinese version of the Addenbrooke＇s cognitive examination－Ⅲ in presbycusis with mild cognitive impairment / 中国基层医药

Objective To explore the reliability , validity and best cut －off value of Chinese version Addenbrooke＇s cognitive examination －Ⅲ(ACE－Ⅲ) in presbycusis patients with mild cognitive impairment (MCI). Methods A total of 43 presbycusis patients with mild cognitive impairment ,61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE),Montreal cognitive assessment ( MoCA) and ACE －Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE －Ⅲwere analyzed with the SPSS 21.0,and the cut－off point was confirmed with the receiver operating characteristic ( ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed.Results Chinese version of ACE －Ⅲhad betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach＇s alpha,split－half reliability and intraclass correlation coefficient were 0.870(P＜0.05), 0.874(P＜0.05) and 0.880(P＜0.05),respectively.The patients in MCI group got a lower score in the sub －scale of attention／orientation,memory,verbal fluency,language and visual space of ACE －Ⅲ compared with those in NCI group and healthy control group ,and the differences were statistically significant ( F ＝48.042,46.594,35.442, 19.374,256.19,140.319,all P＜0.001).The criteria validity calculated between the Chinese version of ACE －Ⅲand MMSE was 0.802 (P＜0.001).Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals (P＜0.05).The Chinese version of ACE －Ⅲ showed significantly correlation with the total scores of MoCA ( r＝0.802,P＜0,001).When the cut －off value for diagnosis was 86.5,the largest area under the ROC curve for the Chinese version of ACE－Ⅲwas 0.98(95%CI:0.897－0.996).The relative sensitivity and specificity were 100.0%and 95.0%,respectively.Conclusion The Chinese version of ACE －Ⅲ had better internal consistency ,reliability and validity,and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.

Psychopathological characteristics and its influencing factors in families of presbycusis patients / 中国基层医药

Objective To investigate the psychopathological characteristics in families of presbycusis patients and its influencing factors.Methods The psychopathological characteristics were evaluated with the Symptom Checklist-90(SCL-90) Chinese version in 157 families of presbycusis patients(FPP) in the Affiliated Hospital of Yangzhou University from July 2015 to July 2017. Somatization, obsessive - compulsive disorder, interpersonal sensitivity,depression,anxiety,hostility,phobic anxiety,paranoid ideation,psychoticism and other were assessed and compared with the Chinese standard norm.The correlation between SCL-90 and related data had also been analyzed. The general information and clinical data of patients were analyzed.Results The SCL-90 score in the FPP group was (146.3 ± 42.8)points.The total score and total average score of SCL-90 had statistically significant difference between the FPP group and the Chinese standard group(t=14.557,14.765,all P<0.05).The scores of somatiza-tion,interpersonal sensitivity,depression and anxiety factors in the FPP group were higher than those in the Chinese standard group(t=5.417,13.588,20.857,22.475,all P<0.05).Age,sleeping condition,educational level,hearing aids and the level of patients＇hearing loss were correlated with the total score of SCL-90( TSCL-90) in FPP( all P<0.05).Multiple linear regression analysis showed that age(t=2.550,P<0.000),the educational level( t =4.087,P<0.000),and the level of patients＇hearing loss ( t =2.188, P <0.05 ) were positively correlated with TSCL-90,and sleeping condition(t= -2.004,P<0.05) and hearing aids(t= -4.643,P<0.05) were negatively associated with TSCL-90.Conclusion The psychopathological characteristics are generally poor in families with presbycusis patients,accompanied by obvious depression and anxiety;and age,sleeping condition,educational level, hearing aids and the level of patients＇hearing loss are important influencing factors.It is important to pay attention to overall health in families with presbycusis patients.

Expression of NKCC1 and Na-K-ATPase in C57BL/6J mice with age-related hearing loss / 中国耳鼻咽喉头颈外科

OBJECTIVE Disturbance of K+ ion balance in inner ear is associated in age-related hearing loss. Our study is to investigate the role of NKCC1 and Na-K-ATPase in cochlea and auditory function regulated by with different expression of NKCC1 and Na-K-ATPase. METHODS Auditory threshold of young or old C57BL/6J mice was measured by auditory brainstem response(ABR). The expression of NKCC1 and Na-K-ATPase in mice cochlea were evaluated by reverse transcription polymerase chain reaction(RT-PCR) and western blotting. Furosemide and Ouabain were applied in vivo to inhibit NKCC1 and Na-K-ATPase in C57BL/6J mice. RESULTS C57BL/6J mice developed hearing loss at 12M by ABR threshold shifting to (75±10), (78±26) and (81±14)dB SPL at frequencies of 8, 16 and 32 kHz; PCR showed that the relative expression of NKCC1 and Na-K-ATPase mRNA in the aged group decreased, which were 0.52±0.06 and 0.35±0.04 times higher than those in the young control group, the difference was statistically significant(t =7.466 and 16.11, all P＜0.05). WB showed that relative expression of NKCC1 and Na-K-ATPase protein level in the aged group decreased by 0.79±0.02 and 0.68±0.05 times as much as that of the young control group, the difference was statistically significant(t =8.857 and 6.771, P all＜0.05). After applied with Furosemide and Ouabain to suppress the two ion transporters, the ABR threshold increased to (50±17), (53±21), (55±17)dB SPL and (56±6), (70±17), (73±6)dB SPL at frequencies of 8, 16 and 32 kHz. CONCLUSION In vivo experiment of C57BL/6J suggested that NKCC1 and Na-K-ATPase might be related to age related hearing loss.

Percepção de idosos sobre a restrição da participação relacionada à perda auditiva / Perception of elderly people about the restriction of participation related to hearing loss / Restrición de la participación en idosos relacionada a la pérdida auditiva

Introdução: Dentre as alterações fisiológicas do processo de envelhecimento humano, a perda auditiva relacionada à idade é uma das mais frequentes e incapacitantes, pois diminui o contato social do idoso, podendo afetar suas condições de saúde. Objetivo: Verificar a percepção de idosos sobre a restrição da participação relacionada à perda auditiva. Método: Estudo transversal e quantitativo com idosos maiores de 60 anos que têm perda auditiva, usuários ou não de aparelho de amplificação sonora. Analisou-se a audiometria tonal convencional e aplicou-se o questionário Hearing Handicap Inventory for the Elderly. Resultado: A amostra foi composta por 46 indivíduos, sendo 43,48% (n=20) do sexo feminino e 56,52% (n=26) do sexo masculino. A idade média foi 74,78 anos, com desvio padrão de 7,96 anos. A perda auditiva de maior ocorrência, em 73,91% (n=34) da amostra, foi do tipo neurossensorial bilateral e de configuração descendente, sendo que 50% (n=23) não usava aparelho de amplificação sonora individual, 45,65% (n=21) afirmou usá-lo e 4,35 (n=2) não respondeu essa questão. Quanto à participação, 82,6% dos idosos relatou restrições para participar de atividades sociais, sendo 50% da amostra (n=23) com percepção significativa. No geral, tal restrição foi maior no gênero masculino, na perda auditiva neurossensorial de grau moderado e configuração descendente, com idade até 79 anos e que não utilizavam o referido aparelho. Conclusão: Os idosos com perda auditiva apresentaram percepção significativa da restrição da participação, principalmente os que não utilizam aparelho de amplificação sonora individual, impactando negativamente sua qualidade de vida.

Introduction: Among the physiological alterations of the human aging process, age-related hearing loss is one of the most frequent and disabling, since it reduces the social contact of the elderly, and can generate impact on health conditions. Objective: to verify the perception of the elderly about the restriction of participation related to hearing loss. Method: A cross-sectional and quantitative study with elderly individuals over 60 years of age, all with hearing loss, users of hearing aids or not. The Hearing Handicap Inventory for the Elderly (HHIE) questionnaire was applied. Results: The sample consisted of 46 individuals, 43.48% (n = 20) of the female sex and 56.52% (n = 26) of the male sex. The average age was 74.78 years, with a standard deviation of 7.96 years. The most frequent hearing loss, in 73.91% (n = 34) of the sample, was bilateral sensorineural type with a descending configuration, with 50% (n = 23) not using hearing aids, 45.65% (n = 21) stated using it and 4.35% (n = 2) did not answer that question. The results showed that 82.6% of the elderly reported restrictions to participate in social activities, being 50% of the sample (n = 23) with significant perception. In general, such a restriction was higher in males, sensorineural hearing loss of moderate degree and descending configuration, ages up to 79 years, who did not use hearing aids, although the differences between the variables were not significant. Conclusion: Elderly people with hearing loss had a significant perception of the restriction of participation, especially among those who did not use PSAPI, which could negatively impact quality of life.

Introducción: Entre las alteraciones fisiológicas del proceso de envejecimiento humano, la pérdida auditiva relacionada a la edad es una de las más frecuentes e incapacitantes, pues disminuye la participación social del anciano, pudiendo generar impacto en las condiciones de salud. Objetivo: verificar la percepción de los ancianos, sobre la restricción de la participación relacionada a la pérdida auditiva. Método: Estudio transversal y cuantitativo con ancianos mayores de 60 años, con pérdida auditiva, usuarios o no de audífonos. Se analizó la audiometría tonal convencional y se aplicó el cuestionario Hearing Handicap Inventory for the Elderly. Resultado: La muestra fue compuesta por 46 individuos, siendo 43,48% (n = 20) del sexo femenino y 56,52% (n = 26) del sexo masculino. La edad media fue 74,78 años, con desviación estándar de 7,96 años. La pérdida auditiva de mayor ocurrencia, el 73,91% (n = 34) de la muestra, fue del tipo neurosensorial bilateral y de configuración descendente, siendo que el 50% (n = 23) no usaba audífonos, 45,65 % (n = 21) afirmó usarlo y 4,35 (n = 2) no respondió esta cuestión. Los resultados mostraron que el 82,6% de los ancianos relató restricciones para participar en actividades sociales, siendo el 50% de la muestra (n = 23) con percepción significativa. En general, tal restricción fue mayor en el género masculino, en la pérdida auditiva neurosensorial, de grado moderado y configuración descendente, con edad de hasta 79 años y que no utilizaban audífonos, aunque las diferencias entre las variables no fueron significativas. Conclusión: Los ancianos con pérdida auditiva presentaron percepción significativa de la restricción de la participación, principalmente aquellos que no utilizan audífonos, pudiendo así impactar negativamente en la calidad de vida.

Características clínico-epidemiológicas de pacientes ancianos con Hipoacusia atendidos en el Hospital Calixto García / Clinical and epidemiological characteristics of elderly patients with hearing loss treated in Calixto García University Hospital

Introducción: El envejecimiento en Cuba constituye el principal problema demográfico y la Hipoacusia es una de las condiciones crónicas más frecuentes en los adultos mayores. Objetivo: Describir las características clínico-epidemiológicas de los pacientes de la tercera edad con Hipoacusia atendidos en el Hospital Universitario General Calixto García en el período de septiembre de 2015 hasta septiembre de 2016. Material y Método: Se realizó un estudio descriptivo, transversal en el Hospital Universitario General Calixto García durante el período de septiembre de 2015 hasta septiembre de 2016. La población (N) estuvo constituida por 387 pacientes de la tercera edad, quienes asistieron a consulta en el período estudiado. Resultados: Predominó la Hipoacusia en los pacientes con edades entre 65 y 79 años (67,2 por ciento) y el sexo masculino fue el más afectado con esta discapacidad (69,5 por ciento). La Hipoacusia en el anciano se asoció con frecuencia a otras afecciones crónicas como las enfermedades cardiovasculares. La Presbiacusia o Hipoacusia asociada a la edad fue la causa más frecuente de sordera. Conclusiones: La Hipoacusia resultó ser una discapacidad frecuente en los pacientes masculinos de la tercera edad. La misma estuvo asociada a enfermedades crónicas no trasmisibles. Las perdidas auditivas neurosensoriales y mixtas, de moderada y severa intensidad, fueron las más frecuentemente encontradas en la audiometría tonal(AU)

Introduction: Aging constitutes the main demographic problem in Cuba, and hearing loss is one of the most frequent chronic conditions in older adults. Objective: To describe the clinical and epidemiological characteristics of elderly patients with hearing loss, treated in Calixto Gracía University Hospital during the period from September 2015 to September 2016. Material and Method: A descriptive cross-sectional study was conducted in Calixto Garcia University Hospital during the period from September 2015 to September 2016. The population (N) was composed of 387 elderly patients, who went to the doctor´s office during the period under study. Results: Hearing loss predominated in patients aged from 65 to 79 years (67,2 percent), and the male sex was the most affected by this disability (69,5 percent). Hearing loss in the elderly was frequently associated with other chronic conditions such as cardiovascular diseases. Age-related hearing loss (Presbycusis) or hearing loss associated with age was the most frequent cause of deafness. Conclusions: Hearing loss was a frequent disability in male elderly patients. It was associated with non-communicable chronic diseases. Sensorineural and mixed hearing losses of moderate and severe intensity were the most frequent ones found in the tonal audiometry(AU)

Estado funcional y cognitivo de los adultos mayores con hipoacusia en el Hospital Español de México / Functional and cognitive status of elderly people with hypoacusia at Hospital Español de México

Resumen Antecedentes Aproximadamente del 25 al 30% de los adultos mayores presentan hipoacusia. La presbiacusia es una pérdida auditiva por cambios degenerativos propios del envejecimiento. El estado funcional se define como la capacidad de cumplir acciones para la vida diaria, mantenerse y subsistir de manera independiente. El estado cognitivo es el conocimiento adquirido para procesar cualquier tipo de información para valorar aspectos determinados. Objetivo Determinar si existe alguna relación entre la prevalencia de hipoacusia y el deterioro funcional y cognitivo de pacientes de la tercera edad. Material y métodos Estudio prospectivo, transversal, observacional y analítico en adultos mayores asilados en el Hospital Español de México. Se realizó una historia clínica abreviada, estudio audiológico y escalas de valoración funcional (Lawton-Brody) y cognitiva (Minimental). Resultados Se contó con una muestra de 35 adultos mayores con audiometrías tonales y aplicación de escalas funcionales y cognitivas; se encontró que existe una amplia relación entre el puntaje de las escalas funcionales (p = 0.0260) y cognitivas (p = 0.0049) con un mayor grado de hipoacusia. Discusión A mayor grado de hipoacusia, menor es el puntaje de las escalas funcional y cognitiva; aun teniendo hipoacusias superficiales, las escalas tienen algún cambio significativo.

Abstract Background Approximately 25-30% of elderly people present with hearing loss. Presbycusis is due to degenerative changes typical of aging. Functional status is defined as the ability to perform actions for daily living, support oneself and subsist independently. The cognitive state is the knowledge acquired to process any type of information to assess certain aspects. Objective To determine if there is any relationship between the prevalence of hearing loss and the functional and cognitive impairment in the elderly. Material and methods Prospective, cross-sectional, observational and analytical study in elderly patients at the Hospital Español de México. An abbreviated medical history, audiological study, and functional (Lawton-Brody) and cognitive (Minimental) scales were performed. Results A sample of 35 older adults was gathered, and tonal audiometry and the application of functional and cognitive scales were made, finding that there is a relation of the functional (p = 0.0260) and cognitive scales (p = 0.0049) with a higher degree of hearing loss. Discussion A higher degree of hearing loss impacts the score of the functional and cognitive scales; even with superficial hearing loss, the scales have a significant change.

Hearing Loss in the Elderly: Is the Hearing Handicap Inventory for the Elderly - Screening Version Effective in Diagnosis When Compared to the Audiometric Test?

Abstract Introduction Hearing losses inherent to the natural process of aging represent today a major public health issue, despite the little attention that their adequate care still receives. Early recognition and proper management of these shortcomings can significantly improve hearing, as well as the patient's general quality of life, reducing the overall impact of this important and prevalent condition of the aging process. Objective The aim of this research was to evaluate the accuracy of the Hearing Handicap Inventory for the Elderly - Screening Version (HHIE-S) in the diagnosis of hearing loss in the elderly when compared with the audiometric test. Methods Through a cross-sectional study, our target population was composed of 138 individuals, aged over 60 and with any otorhinolaryngological complaints, recruited at the Clinic of Otorhinolaryngology and Speech Therapy of the Faculdade de Medicina de Marília (Famema), in the city ofMarília, SP, Brazil. Patients already in the process of auditory rehabilitation were excluded, as well as those who did not demonstrate the minimum level of oral understanding necessary to allow the interview. Results The prevalence of hearing loss according to the questionnaire was of 76.1%, while audiometry showed 79.7%. We found the diagnostic accuracy of the instrument to be of 86.2%, with a sensitivity of 89.1% and a specificity of 75.0%, regardless of gender. Conclusion Thereby, we conclude that the standardized questionnaire under rating is suitable for the screening of hearing loss in the elderly, given its high accuracy and userfriendly quality.

Quality of life, symptoms of anxiety and depression, and their influencing factors in elderly patients with presbycusis / 中华老年医学杂志

Objective To evaluate the quality of life,emotional symptoms (anxiety and depressive symptoms)and their influencing factors in elderly patients with presbycusis.Methods From May 2015 to May 2017,288 patients with presbycusis and 123 healthy controls were consecutively included into this study.Quality of life and emotional symptoms were evaluated by a series of questionnaires including the generic questionnaire medical outcomes study short-form 36 items health survey(SF-36),self-rating depression scale (SDS) and self-rating anxiety scale (SAS).Results The prevalences of anxiety(SAS score≥50)and depression(SDS scores≥53)were 23.3％ (67/288)and 20.1％(58/288),respectively;and the prevalence of the two in combination was 13.2％ (38/288).When assessed with SF-36,the scores of physical functioning,physical role,bodily pain,general health,social functioning,emotional role,and mental health were 71.0 ± 9.0,77.3 ± 9.1,73.3 -±9.6,69.6±8.6,71.9±9.9,72.1±12.7,and 73.1±10.5,respectively,which were lower than those in the control group(82.1±10.2,82.4±4.3,86.4±11.3,2.1±7.9,82.8±9.9,83.1±7.7,and 82.2 ±3.6,respectively;all P＜0.05).The scores of SDS and SAS in the presbyacsis group were 53.2± 13.3 and 51.9 ± 11.2,respectively,which were higher than those in the control group(42.5± 10.3 and 43.9± 6.2,respectively;t =10.09 and 7.52,respectively;all P＜0.05).SDS was negatively correlated with general physical and mental health (r =-0.787,P ＜ 0.05;r =-0.743,P ＜ 0.05);SAS was negatively associated with general physical and mental health(r =-0.801,P ＜0.05;r =0.750,P＜0.05,respectively);and SDS was positively correlated with SAS(r =0.958,P ＜0.05).Multiple linear regression analysis showed that concomitant hearing impairment,educational level,marital status,living condition,and sleep condition were positively correlated with SF-36 general health scores;severity of hearing loss and number of comorbidities were negatively associated with general health.However,severity of hearing loss,concomitant hearing impairment,educational level,marital status,and number of comorbidities were positively correlated with SAS and SDS scores;educational level and sleeping were negatively associated with SAS and SDS scores.Conclusions Poor quality of life and high prevalences of depression and anxiety are found in elderly patients with presbycusis,and their influencing factors include severity of hearing loss,concomitant hearing impairment,education level,marital status,sleeping and number of comorbidities.

Relationship between plasma endothelin-1 and nitric oxide levels and hearing impairment in elderly patients with hyperuricemia / 中国医师进修杂志

Objective To investigate the relationship between plasma endothelin-1 and nitric oxide levels and hearing impairment in elderly patients with hyperuricemia (HUA). Methods The clinical data of 174 physical examination elderly from September 2013 to March 2016 were retrospectively analyzed. Among them, the HUA was in 81 cases (HUA group), and no HUA was in 93 cases (control group). The pure tone hearing and high stimulation rate of auditory brainstem response were tested, and the plasma endothelin and nitric oxide levels were detected. Results The pure tone hearing of 250, 500, 1 000,2 000, 4 000 and 8 000 Hz in HUA group were significantly higher than those in control group: (33.03 ± 12.09) dB vs. (28.49 ± 9.89) dB, (35.56 ± 13.47) dB vs. (27.31 ± 9.34) dB, (38.81 ± 14.94) dB vs. (29.78 ± 9.39) dB, (43.62 ± 16.45) dB vs. (37.06 ± 12.66) dB, (51.07 ± 18.36) dB vs. (46.29 ± 15.15) dB and (65.75 ± 18.76) dB vs. (57.71 ± 20.26) dB, and there were statistical differences (P＜0.01). The Ⅰ wave, Ⅲ wave, Ⅴ wave latency and Ⅰ to Ⅲ wave, Ⅰ to Ⅴwave intervals in HUA group were significantly longer than those in control group: (2.10 ± 0.26) ms vs. (2.03 ± 0.24) ms, (4.11 ± 0.38) ms vs. (3.89 ± 0.31) ms, (5.94 ± 0.31) ms vs. (5.69 ± 0.29) ms, (2.01 ± 0.26) ms vs. (1.86 ± 0.22) ms and (3.83 ± 0.28) ms vs. (3.65 ± 0.25) ms, and there were statistical differences (P＜0.01). There was no statistical difference inⅢtoⅤwave interval between 2 groups (P＞0.05). The Ⅴ wave threshold value in HUA group was significantly higher than that in control group:(45.61 ± 11.18) dB vs. (41.98 ± 9.37) dB, and there was statistical difference (P＜0.05). The plasma endothelin-1 level in HUA group was significantly higher than that in control group: (16.96 ± 3.45) ng/L vs. (11.64 ± 3.81) ng/L, the plasma nitric oxide level was significantly lower than that in control group:(0.98 ± 0.66) μmol/L vs. (1.36 ± 1.08) μmol/L, and there were statistical differences (P＜0.05 or＜0.01). Conclusions Elevated plasma endothelin-1 level and reduced nitric oxide level may be a possible mechanism for hearing impairment in elderly patients with hyperuricemia.

Cervical vestibular evoked myogenic potential in patients with presbycusis / 实用医学杂志

Objective To explore the association between hearing loss and dysfunction of the vestibular end-organ in older individuals. To evaluate the common risk factors for hearing loss and otolith dysfunction. Meth-ods A total of 120 elderly patients without any vestibular symptoms were recruited in this study. They were divid-ed into two groups:a study group(patients with presbycusis)and a control group(patients without presbycusis). Audiological status was measured with pure tone audiometry and the saccular function was tested with cervical ves-tibular evoked myogenic potential(cVEMP). The results of cVEMP were calculated and compared between the two groups. Results Comparing to the control group,mean P1 and N1 latencies were significantly prolonged(t =4.67,4.59,P < 0.05)and the amplitudes were signi cantly reduced(t = 6.72,P < 0.05)in the study group. A sig-nificant correlation between hearing loss at high frequencies and reduced cVEMP amplitudes(r = -0.41,P < 0.05) were observed in the study group. Noise exposure was significantly associated with cVEMP amplitude(β = -0.52, P < 0.05). Conclusions Presbycusis may be accompanied by the hypofunction of saccular function without any vestibular symptoms,and the high frequency hearing threshold is closely related to the saccular function. Noise ex-posure appears to be related to both cochlear and saccular dysfunction.

Percepção da perda auditiva: utilização da escala subjetiva de faces para triagem auditiva em idosos / Perception of hearing loss: use of the subjective faces scale to screen hearing among the elderly

Resumo A presbiacusia é uma alteração prevalente na população idosa, porém subdiagnosticada, desta forma, é importante aprimorar instrumentos de triagem simples. A escala subjetiva de faces foi proposta como forma de avaliar a autopercepção auditiva do idoso e sua correlação com exames audiológicos. Foram avaliados todos os pacientes encaminhados para o serviço de audiologia de um centro de referência de atenção à saúde do idoso no período de fevereiro a novembro de 2013. Os pacientes foram examinados por meatoscopia, audiometria tonal e vocal e responderam a escala subjetiva de faces e o teste do sussurro. Participaram 164 idosos com média de idade de 77 anos. Encontrou-se boa correlação entre a escala subjetiva de faces e o limiar audiométrico (r = 0,66). Houve correspondência entre as faces e o grau da perda auditiva, sendo a face 1 correspondente a audição normal, face 2 a perda auditiva leve e face 3 a perda auditiva moderada grau I. Ao avaliar as qualidades psicométricas da escala subjetiva de faces, verificou-se que as faces 2 e 3 apresentam bons índices de sensibilidade e especificidade, com área sob a curva ROC de 0,81. A escala subjetiva de faces parece ser um bom instrumento complementar de triagem auditiva em serviços gerontológicos, de fácil aplicação e baixo custo.

Abstract Presbycusis is a disorder present among the elderly. However, it is under-diagnosed, making it important to develop and enhance simple screening tools. Objective: The subjective faces scale has been proposed as a method to assess auditory self-perception among the elderly, and its correlation with audiological tests. Methods: We looked at elderly patients referred to the audiology service of a reference center for the care of the elderly in a public university hospital between February and November 2013. Patients were submitted to meatoscopy, tonal and vocal audiometry and the whisper test. They also answered the subjective faces scale. A total of 164 elderly individuals participated, and the average age was 77. Results: We found a good correlation between the subjective faces scale and audiometry thresholds (r = 0.66). Our results show that the faces and hearing loss correlate, with face 1 corresponding to normal hearing, face 2 to mild hearing loss, and face 3 to Grade I moderate hearing loss. When evaluating the psychometric qualities of the subjective faces scale, we found that faces 2 or 3 have good sensitivity and specificity, with the area under the ROC curve being 0.81. Conclusion: The subjective faces scale seems to be a good, low-cost and easy to use supplementary tool for auditory screening in geriatric services.