ABSTRACT
OBJECTIVE: To determine factors influencing help-seeking behaviour in hearing-impaired persons aged > or = 55 years MATERIAL AND METHODS: The study comprised 1,419 persons (480 females, 939 males) aged > or = 55 years who participated voluntarily in a driving test. Pure-tone audiometry was performed in all subjects. Participants without a hearing aid with an average hearing loss of > or = 30 dB in the better ear for the frequencies 0.5, 1, 2 and 4 kHz were asked how they perceived their hearing by means of a structured questionnaire. The questionnaire provided insight into why some hearing-impaired people seek help from a general practitioner (GP) and others do not. Four factors were examined. RESULTS: A total of 483/1.419 (34%) participants tested had a hearing loss exceeding 30 dB. Fewer than half of these had visited their GP with complaints of hearing impairment. Of those who had not sought help from a GP, 57% nevertheless judged their hearing as poor. Social pressure exerted by significant others was less in the non-consulters group. Hearing aid image did not differ significantly between the two groups. CONCLUSION: The help-seeking behaviour of hearing-impaired elderly people is related to the degree of hearing disability and the social pressure exerted by significant others as well as the willingness to try hearing aids.
Subject(s)
Attitude to Health , Hearing Aids , Hearing Loss/rehabilitation , Persons With Hearing Impairments , Aged , Female , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Severity of Illness Index , Social Behavior , Surveys and QuestionnairesABSTRACT
The case history of a 61-year-old male patient is described, who presented with severe stomatitis, conjunctivitis and leukocytosis. The diagnosis chronic lymphocytic leukemia (CLL) stage A (0) was made, for which no treatment was necessary. Progression of stomatitis and conjunctivitis and erythosquamous skin lesions with bullae and vesiculae formation developed. Under the diagnosis of bullous pemphigoid the patient was treated with corticosteroids. The histologic and immunofluorescence examination of a skin biopsy was compatible with this diagnosis, and antibodies to skin could not be detected in a first serum sample. Pseudomonas was cultured from all lesions, the corticosteroids were stopped and antibiotic treatment was started, without clear effect. Because of progression of skin lesions and debilitation, the patient finally declined all treatment and died five weeks after admission. Post-mortem examination showed enlarged lymphnodes in the cervical, aortal en iliacal areas, with histology confirming the diagnosis of CLL. Indirect immunofluorescence with the second serum sample showed auto-antibodies in high titer directed against the intercellular epithelial substance. Immunoblot studies showed binding with the classic target antigens in paraneoplastic pemphigus. Re-examination of the histologic skin specimen and the result of direct immunofluorescence were in retrospect compatible with the diagnosis of paraneoplastic pemphigus.
Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/complications , Paraneoplastic Syndromes/pathology , Pemphigus/pathology , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Autoantibodies/analysis , Diagnosis, Differential , Fatal Outcome , Humans , Immunohistochemistry , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Male , Middle Aged , Paraneoplastic Syndromes/diagnosis , Paraneoplastic Syndromes/immunology , Pemphigus/diagnosis , Pemphigus/immunology , Pseudomonas Infections/drug therapyABSTRACT
In order to explain the variation found in the literature, this article describes how the definition of hearing impairment affects reported prevalence when applied to the same population. The study comprised 1041 persons (354 women, 687 men) aged 55 years or older (mean age 67 years, SD 7 years). Pure tone audiometry was performed on all subjects. They were asked about their hearing by means of a structured questionnaire. The prevalences of hearing impairment were calculated based on nine criteria including: participants' subjective impression, five Dutch and international audiometric definitions, consultation of a General Practitioner, referral to an ENT specialist and hearing aid possession. Results showed a variation in prevalence figures from 6 to 30% and 10 to 49%, for women and men, respectively. Definitions including 4 kHz emphasized sex differences more strongly. In conclusion, gross differences in prevalence figures on hearing impairment are found as a result of the definition used. The variation in prevalence figures found in the literature can, at least partly, be explained by the use of different definitions.
