Being a form of hypoacusis, presbycusis is characterized by a reduced auditory sensitivity (more or less marked), by the slowing down of the central processing of the sound stimulus, by the difficulty in locating sound sources and by the difficulty in understanding a conversation, especially in particularly noisy places. It is therefore clear how this deficit can have a decidedly negative impact on the life of the elderly.
Generally, the hearing deficit that occurs in the case of presbycusis is both qualitative and quantitative and tends to proceed and evolve rather slowly. Initially, in fact, the patient may find it difficult to perceive only certain types of sounds (usually the higher frequencies), later, however, the hearing loss tends to become accentuated and worsen.
Usually, presbycusis becomes an obvious disorder from the age of 65 onwards and manifests itself with a "higher incidence in male patients than in female patients."
and which can then lead to the onset of presbycusis. These include:
- Thickening of the tympanic membrane;
- Degeneration of the cells of the organ of Corti (an organ located in the cochlear duct, responsible for the transmission of the sound impulse at a central level);
- Loss of elasticity of the basilar membrane of the cochlea;
- Reduction in the number of cilia present in the auditory system;
- Degenerative processes that occur at the level of the ossicular joints;
- Alteration of the vascular stria that initially manifests itself at the base and at the apex of the cochlea, and then also affects the central areas;
- Compression of nerve fibers caused by hyperostosis phenomena.
In light of what has been said, it can be understood how presbycusis can be caused by age-related alterations that occur in the inner ear, while those that occur in the middle ear and the outer ear seem to have a great influence lower in the etiology of this form of age-related hearing loss.
affected and the resulting type of damage that led to hearing loss.
Based on this classification we can therefore distinguish:
- Neural presbycusis, due to alterations of the basilar membrane and characterized by a progressive difficulty in distinguishing words.
- Sensory presbycusis, characterized by a degeneration that occurs mainly at the cochlear level.
- Atrial or metabolic presbycusis, characterized by the alterations that can occur at the level of the vascular stria.
- Mixed presbycusis, in which the hearing deficit is caused not by a single pathogenetic mechanism, but by a set of different types of degeneration and alterations that can arise in different districts of the same auditory system.
- Indeterminate presbycusis.
With the progress of time, however, the individual struggles to perceive even sounds at lower frequencies, up to the point of understanding conversations with great difficulty, especially if these occur between several people and / or in the presence of surrounding noises. .
Furthermore, it is not uncommon for patients with presbycusis to also suffer from other hearing disorders, such as tinnitus and balance disorders.
Finally, given the marked way in which presbycusis can negatively affect the life of the elderly, patients who suffer from it can often experience social isolation and depressive phenomena.
. Patients suffering from this hearing deficit, in fact, present a typical increase in the hearing threshold in the high frequency area which is highlighted by the tonal audiometric examination.
Also, presbycusis usually occurs bilaterally.
and cochlear implants.
Hearing aids are electronic devices that can detect sound thanks to the presence of a microphone. The sound is then amplified by a special amplifier and sent to the ear via a loudspeaker.
Cochlear implants are indicated for those who do not benefit from the use of the aforementioned hearing aids; these aids must be surgically inserted into the patient's ear.
While hearing aids are limited to amplifying and conveying sound into the ear, cochlear implants are designed to perform the function of the altered or degenerated part of the inner ear, sending information directly to the cochlear nerve which, therefore, must not be damaged. , but fully functional.
In some cases, moreover, the aforementioned implants can also be used in association with external hearing aids.
Finally, for the patient suffering from presbycusis, it could be useful to associate the aforementioned therapeutic approaches with an auditory rehabilitation that also provides for the teaching or strengthening of the ability to recognize and interpret lip language.
In any case, the doctor will determine - on a strictly individual basis - which is the best therapeutic strategy to be adopted for each patient, both according to the type of damage that caused the presbycusis, and according to the degree of severity of the hearing deficit. presented by the same patient.
