deafness is one of the most common disabilities in France: 7.6 million French adults say they suffer from hearing impairment, i.e. 09, 7% of over 18 years. From 74 years, this proportion increases to 31%, a large part of which is presbycusis .

This hearing disorder begins very early, from 24 years, but generally becomes observable from 45 years. Even though it is inevitable, age-related hearing loss and its consequences can be prevented, compensated for and taken care of.

Speak louder , but not only… Presbycusis is due to the degradation of the auditory organ, in particular of the cochlea , where the sensory cells are located, but also at the level of the pathways and nerve centers that carry auditory information to the brain. The eardrum and the ossicles, which mechanically transmit the sound wave in the inner ear, also lose their flexibility and elasticity.

Besides genetic causes, the main factor of risk of occurrence of presbycusis is repeated exposure to sound trauma. Its prevention therefore depends above all on reducing exposure to these traumas, whether professional or, and above all, linked to the use of headsets connected to a source sound , duration, frequency of use, and intensity.

Figure 2: Cross section of the ear © JNA Association for the Development of Hearing Health for All (via The Conversation)

Occurring gradually, hearing loss mainly concerns high-pitched sounds. Presbycusis mainly affects the cells at work in the perception of these sounds. In doing so, it alters the ability to distinguish the different sound components of speech. In environments saturated with parasitic and aggressive noises, having a conversation becomes difficult, sometimes even impossible, because the difficulty of hearing is added to that of understanding.

Paradoxically, the one of the first signs of presbycusis is hypersensitivity or even intolerance to noisy environments, and more simply to noises .

Influence of age on the degree of hearing loss © Cochlea (via The Conversation)

Compensation strategies Presbycusis can hear but do not understand. Each interaction is costly in attention and concentration, so much so that the pleasure of communication suffers. To avoid having people repeat too often or quickly finding themselves in a misunderstanding, they tend to use and abuse a compensation strategy which consists of keeping the floor.

Localization of speech phonemes on hearing loss curves © André Chays / CHU Reims (via The Conversation)

By dint of misunderstandings and misunderstandings in the exchanges, presbyacusics manifest sometimes aggressive behaviors and end up isolating themselves. Presbycusis is also associated with the occurrence of depressive syndromes , falls and loss of autonomy.

In addition, hearing impairment is a risk factor for Alzheimer’s disease or related. Recent data has also shown that wearing a hearing aid helps reduce the risk of cognitive decline .

Screening, diagnosis, rehabilitation It is important to detect early for possible loss of hearing on high frequencies, before the first signs of social discomfort arise. Currently, it is recommended to consult an otolaryngologist (ENT) in case of hearing loss, but no systematic screening is recommended.

However, there are tests hearing aids that can be implemented alone, via applications or online. This is for example the case of the test Höra of the Foundation for hearing, or of Digit Triplet Test . However, at the end of these self-tests, a possible suspicion will not replace a diagnosis. Additional examinations will therefore be necessary. Indeed, only an ENT is authorized to make a diagnosis of presbycusis from a series of specific examinations:

an otoscopic examination, to auscultate the external and middle part of the ear. tonal audiometry, to measure the pure perception of sounds. speech audiometry, to measure speech understanding. The purpose of these examinations is to confirm the diagnosis of presbycusis and to eliminate other pathologies causing hearing loss, such as earwax plug, chronic otitis, or benign tumor of the auditory nerve for example. Depending on the results of these examinations, the ENT can then recommend and prescribe a hearing aid. and optimum hearing rehabilitation, and take care of the follow-up. There are many hearing aids available to restore a comfortable level of hearing. In this rehabilitation process, speech therapy sessions may be prescribed.

In the case of profound deafness, when certain conditions are met, the installation of a cochlear implant may be considered. This device converts surrounding sounds, picked up by a microphone, into digital signals (electrical impulses), which directly stimulate the auditory nerve via electrodes inserted into the tympanic ramp of the cochlea . The brain then interprets them as sounds.

Taboos and stubborn resistance As we have seen, the benefit of rehabilitation extends beyond mere hearing gain. 80% of people with hearing aids express satisfaction with the benefits of their hearing aids. However, only 36% of French people who are hard of hearing would be fitted .

Different types of hearing aids depending on the degree of deafness © https://lanielaudio.com/ (via The Conversation)

The main ones device brakes are linked to the perception of hearing disorders in our society – negative image of aging, reduced cognitive functions – as well as preconceived ideas about the effectiveness of hearing aids and their reimbursement.

The situation could however change: since January 1 2018, reform ” Remains at zero charge »improves accessibility to quality equipment by allowing support to 82% by Health insurance and complementary health insurance or by complementary solidarity health .

This analysis has was written by Anaïs Cloppet-Fontaine, geriatrician and project manager at Gérond’if, holder of the DIM (area of ​​major interest) longevity and aging labeled by the Ile-de-France Region, Île-de-France Region.
This article was co-written by André Chays, professor of otolaryngology at the UFR of Medicine of Reims and member of the scientific committee of Infosens (network of actions at the service inclusion of deaf or hard of hearing people) and Frédéric Brossier, deputy director of “partnerships and innovations” projects at Infosens.
The original article was published on the website of The Conversation .

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