Early management of presbycusis: recommendations from the French Society of Otorhinolaryngology and Head and Neck Surgery, the French Society of Audiology, and the French Society of Geriatrics and Gerontology.

INTRODUCTION: Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of ENT physicians, audiologists, geriatricians and hearing specialists from all over France. They are classified as grade A, B, C or professional agreement according to a decreasing level of scientific evidence. RESULTS: The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its face-to-face or remote management. CONCLUSION: In the case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. Free-field speech audiometry in noise is recommended to measure intelligibility in a realistic environment. Questionnaires in addition to audiometric tests would allow the best assessment of the patient's disability. Hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time since the hearing was fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, that include different training domains to complement face-to-face sessions.

[Early management of presbycusis: recommendations from the French Society of Otorhinolaryngology and Head and Neck Surgery, the French Society of Audiology, and the French Society of Geriatrics and Gerontology]. / Recommandations de la Société française d'otorhinolaryngologie et de chirurgie de la face et du cou, la Société française d'audiologie et la Société française de gériatrie et gérontologie pour la prise en charge précoce de la presbyacousie.

INTRODUCTION: Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. RESULTS: The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its management in face-to-face or even distance learning. CONCLUSION: In case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. It is recommended to perform free-field speech audiometry in noise to measure intelligibility in an environment as close as possible to reality. Questionnaires can be used in addition to audiometry to best assess the patient's disability. It is recommended that hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time elapsed since the fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, integrating different training domains in addition to face-to-face sessions.

Rehabilitation for high-frequency sensorineural hearing impairment in adults with the symphonix vibrant soundbridge: a comparative study.

OBJECTIVE: To assess and compare the benefits for patients with high-frequency hearing loss obtained from an implantable middle ear implant, the Symphonix Vibrant Soundbridge using the SIGNIA processing circuitry, to those derived from conventional amplification using the same integrated circuitry and to those derived from a variety of preoperatively worn hearing aids. STUDY DESIGN: A single-subject, repeated-measures study design was used for a comparative evaluation of the benefits derived from the Symphonix Vibrant Soundbridge and conventional amplification. Objective audiometric measures were performed postoperatively to compare the Symphonix Vibrant Soundbridge (404) and SIGNIA hearing aid, both using the SIGNIA processing chip. Tests were performed under three conditions: unaided, aided Symphonix Vibrant Soundbridge (404), and aided SIGNIA hearing aid. Subjective self-assessment scales, standardized and nonstandardized, were completed for the Symphonix Vibrant Soundbridge (404) and the preoperative hearing aid to compare the personally perceived benefits. Statistical comparison of the data sets with each device type was performed using the nonparametric Wilcoxon test. SETTING: One tertiary teaching hospital and one hearing aid specialist fitting office. SUBJECTS: Six patients displaying a high-frequency hearing loss who had the Symphonix Vibrant Soundbridge implanted for an average of 17 months. INTERVENTION: Rehabilitative. RESULTS: Aided thresholds with the Symphonix Vibrant Soundbridge (404) and the SIGNIA hearing aid showed no significant difference. Speech comprehension scores in quiet and in noise were significantly improved with each device type over the unaided condition scores. Individual performance on speech test measures was equivalent or superior with the Symphonix Vibrant Soundbridge (404) in comparison with that with the SIGNIA hearing aid. When using the Symphonix Vibrant Soundbridge (404) in quiet, the group achieved 50% speech comprehension at significantly softer presentation levels (p = 0.027) than when wearing the SIGNIA hearing aid. Similarly, in noise, 50% speech comprehension was achieved at significantly lower (more difficult) signal-to-noise ratios (p = 0.028) with the Symphonix Vibrant Soundbridge (404) than with the SIGNIA hearing aid. The level of satisfaction for various aspects of the device and performance and listening ease, particularly in the presence of aversive sounds and in reverberant conditions, was reported as significantly better with the Symphonix Vibrant Soundbridge (404) than with the preoperative hearing aid. CONCLUSIONS: Despite similar gain with each device type using the same SIGNIA processing technology, the patient group demonstrated significant advantages for speech comprehension in quiet and in noise when using the Symphonix Vibrant Soundbridge (404). Such an effect may be attributed to higher fidelity sound transmission by means of the direct-drive mechanism used by the implant. Subjective reports support the results from the objective assessments, both being in favor of the implant over conventional amplification. In conclusion, the Symphonix Vibrant Soundbridge (404) is a suitable treatment option offering advantages over conventional amplification to the hearing-impaired person with a high-frequency hearing loss.