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Journal of Otology 2011 Vol.6 No.1
Original Article
An investigation into hearing loss among patients
of 50 years or older
JI Fei, LEI Lei, ZHAO Su-ping, LIU Ke-fang, ZHOU Qi-you, YANG Shi-ming
Department of Otolaryngology/ Head and Neck Surgery, Chinese PLA Institute of Otolaryngology,
Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
Abstract Objects To investigate the extent of hearing loss in an elderly sample population to estimate hearing dis⁃
orders among the age-equivalent population in China and to study primary clinical characteristics of presbycusis.
Methods Clinical data from 110 hearing loss patients of both senium and pre-senium ages(95 males and 15 fe⁃
males, mean age = 74.4±12.1 years)were reviewed. Patients aged from 50 to 59 years were accepted as the pre-seni⁃
um control group(n=15). The 95 senium patients (> 60 years of age) were divided into 4 groups according to age:
60+ group(60 to 69 years, n=25), 70+ group(70 to79 years, n=26), 80+ group(80 to 89 years, n=32)and 90+
group(90 years or older, n=12). Pure tone audiometry thresholds were measured in all 110 patients. Hearing loss se⁃
verity of each tested ear was rated according to the Goodman classification criteria. Besides, audiometric configura⁃
tion was examined in each ear. Results Audiometric testing showed normal hearing in 65 ears(29.5%), slight to
moderately severe hearing loss in 131 ears(59.5%), and severe and profound loss in 24 ears(11%). Air-bone gaps
were found in 12 ears(5.45%)indicating conductive hearing loss. Except the 12 ears with conductive hearing loss,
audiograms showed gradually sloping loss in 99 ears(45%), sharply sloping loss in 34 ears (15.45%), flat loss in 45
ears(20.45%), notch pattern loss in 5 ears(2.27%), trough and rising pattern loss in 2 ears(0.91%), total deafness
in 2 ears(0.91%), and normal hearing in 21 ears(9.55%). On average, hearing thresholds increased at a rate of ap⁃
proximately 10 dB per 10 year for subjects aged 60 and older. Conclusions Hearing thresholds tend to be stable in
presbycusis patients aged from 50 to 70 years, increase significantly between 70 and 80 years of age, and reach anoth⁃
er stable stage at high levels after 80 years of age, especially in high frequencies. Hearing loss in middle frequencies
accounts for most of recession in loudness perception.
Key words elderly; presbycusis; hearing loss
Introduction
Presbycusis is the third most common chronic disease in
the world, which seriously affects the quality of life in el⁃
der people. The main clinical manifestations of presby⁃
cusis include symmetrical and slowly developing senso⁃
rineural hearing loss, high pitched tinnitus and speech
recognition disorders. As the result of economic growth
and improved health care, China is gradually becoming
an aging society. Hearing loss is one of the most impact⁃
ing chronic diseases on the quality of life in the Chinese
elder population.
1, 2
In clinical practice, an increasing
number of older patients complain of their communica⁃
tion disorders induced by hearing loss. On the other
hand, there is a long way to go in epidemiological data
collection and analysis regarding presbycusis. In view of
this, we have focused on this population and conducted
systematic research. This article will report our primary
results of hearing investigation in patients who are 50
years or older and complain of hearing impairment.
Materials and Methods
Subjects
A survey was done in 110 patients(95 males and 15
females)over the age of 50 years with hearing loss as
the chief complaint. The male to female ratio was 6.3∶
Correspondence author: YANG Shi-ming, Department of Otolaryn⁃
gology/ Head and Neck Surgery, Chinese PLA Institute of Otolaryn⁃
gology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing
100853, China Email: yangsm301@263.net
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Journal of Otology 2011 Vol.6 No.1
1. The age ranged from 50 to 96 years, with a mean age
of 74.4 years and a standard deviation of 12.1 years. The
subjects were divided into five groups: pre-senium con⁃
trol group(50 to 59 years, n=15). 60+ group(60 to 69
years, n=25), 70 + group(70 to79 years, n=26), 80 +
group(80 to 89 years, n=32)and 90+ group(90 years or
older, n=12). History of the following diseases was ex⁃
cluded from all the patients participating in this study:
genetic deafness, congenital deafness, drug-induced
hearing loss, sudden deafness, noise-induced hearing
loss, infections and systemic disease-related hearing
loss.
Test methods
All participants received pure tone audiometry testing
with a GSI61 audiometer in sound proof booth with am⁃
bient noise level in compliance with national standard
GB/T 16403 Acoustics—Audiometric test methods—Ba⁃
sic pure tone air and bone conduction threshold audiom⁃
etry.
3
Both air and bone conduction thresholds were test⁃
ed on each patient, using calibrated TDH 39 earphones
and B-71 bone vibrator respectively. Test procedures
followed GB/T16403. For each patient, the claimed bet⁃
ter ear was tested first and then the other ear. Air con⁃
duction threshold was measured first using Hugh⁃
son-Westlake procedure and then bone conduction. The
frequencies testing sequences was 1 kHz, 2 kHz, 4 kHz,
8 kHz, 500 Hz and 250 Hz in air conduction, and 250
Hz, 500 Hz, 1 kHz, 2 kHz and 4 kHz in bone conduc⁃
tion. The hearing loss severity of each ear was rated ac⁃
cording to the classification criteria by Goodman as: to⁃
tal deafness, profound hearing loss, severe hearing loss,
moderately severe hearing loss, moderate hearing loss,
slight hearing loss, and normal hearing(Table 1).
4
The
audiometric configuration of all tested ears was charac⁃
terized as: conductive(Figure 1-A), gradually sloping
(Figure 1-B), sharply sloping (Figure 1-C), flat(Figure
1-D), notch(Figure 1-E), trough and rising(Figure
1-F), total deafness, and normal.
Figure 1 Audiometric Configurations
A:Conductive hearing loss B:Gradually sloping C:Sharply sloping
D:Flat loss F:trough and risingE:Notch
Classification
Total deafness
Profound
Severe
Moderately severe
Moderate
Slight
Normal hearing
Criterion
(average threshold at 0.5, 1, and 2 kHz)
No response
>91dB
71~90dB
56~70dB
41~55dB
26~40dB
<26dB
n
2
1
21
31
65
35
65
Table 1 Distribution of hearing loss severity
Note: Classification criteria are based on those reported by Goodman(1965)
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Journal of Otology 2011 Vol.6 No.1
Results
Average air conduction thresholds in different age
groups for each octave frequency are listed in Table 2.
According to the Goodman criteria(Table 1), of all the
220 ears, the test showed normal hearing in 65 ears
(29.5% ), mild to severe hearing loss in 131 ears
(59.5%)and worse than severe hearing loss in 24 ears
(11%)(Figure 3).
Hearing thresholds at each frequency were compared
among age groups using rank-sum test. The significance
was adjusted to 0.005 due to repeated use of rank-sum
test. There was no significant difference between 50 + ,
60 + and 70 + age groups at all 6 frequencies except
an age-associated deterioration at 8 kHz(P < 0.005).
Thresholds in patients older than 70 years increased dra⁃
matically at all frequencies(P < 0.005), with those in pa⁃
tients older than 80 years significantly higher than those
in the 70+ group(P < 0.005). No significance was found
between 80 + and 90 + age groups at 250 Hz, 2 kHz, 4
kHz, and 8 kHz(Figure 2).
Concerning the audiometric configuration, 12
Figure 2 Averaged Pure Tone Audiogram in Different Age Groups
Figure 3 Distribution of hearing loss severity
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Journal of Otology 2011 Vol.6 No.1
Figure 4 Proportions of different Audiometric Configurations
(5.45%)ears showed conductive hearing loss with obvi⁃
ous air-bone gap(Figure 1A). For the other ears, the
configuration was gradually sloping(Figure 1B)in 99
ears (45%), sharply sloping (Figure 1C) in 34 ears
(15.45% ), flat(Figure 1D) in 45 ears(20.45% ),
notch-shaped(Figure 1E)in 5 ears(2.27%), trough
and rising(Figure 1F)in 2 ears(0.91%), total deaf⁃
ness in 2 ears (0.91% ) and normal hearing in 21 ears
(9.55%)(Figure 4).
Discussion
Survey data have showed that there are about 130 mil⁃
lion elderly people in China, 11% of the total popula⁃
tion. It is expected that the elderly population will in⁃
crease to more than 400 million around the year of
2040. Hearing impairment is a major issue the elderly
are faced with. Calculated from the results of second Na⁃
tional Sample Survey on Disability, there are more than
13 million elderly patients suffering from presbycusis.
In people between 65 and 75 years of age, about 30%
have hearing loss, while in people older than 75 years
this proportion is higher than 50%.
1
The main clinical
manifestations of presbycusis include symmetrical and
g4 Discussion Survey data have showed that there are
about 130 million elderly people in China, 11% of the to⁃
tal population. It is expected that the elderly population
will increase to more than 400 million around the year of
2040. Hearing impairment is a major issue the elderly
are faced with. Calculated from the results of second Na⁃
tional Sample Survey on Disability, there are more than
13 million elderly patients suffering from presbycusis.
In people between 65 and 75 years of age, about 30%
have hearing loss, while in people older than 75 years
this proportion is higher than 50%.
1
The main clinical
manifestations of presbycusis include symmetrical and
gradually increasing sensorineural hearing loss, high fre⁃
quency tinnitus and speech recognition disorders. These
will bring a series of psychological and emotional dis⁃
tress to the elderly, such as depression, loneliness, anxi⁃
ety, irritability, etc., thereby affecting quality of life in
older persons.
5, 6
Two major factors affect the incidence
control group
60+ group
70+ group
80+ group
90+ group
Mean±SD
250 Hz
17.5 ± 11.4
20.4 ± 12.0
30.4 ± 20.3
39.1 ± 16.6
49.6 ± 14.6
30.9 ± 18.7
500 Hz
18.3 ± 10.1
22.2 ± 14.1
37.0 ± 22.4
46.3 ± 17.5
58.4 ± 13.0
36.0 ± 21.2
1000 Hz
20.7 ± 11.7
27.3 ± 18.3
40.8 ± 23.1
51.3 ± 17.5
60.9 ± 9.6
40.1 ± 22.0
2000 Hz
25.3 ± 17.7
38.4 ± 22.2
46.9 ± 22.0
59.6 ± 16.9
65.0 ± 13.1
47.6 ± 22.9
4000 Hz
42.0 ± 27.8
52.2 ± 23.2
58.4 ± 16.6
71.0 ± 16.4
76.8 ± 11.3
60.3 ± 22.5
8000 Hz
32.7 ± 23.4
58.8 ± 17.8
66.1 ± 14.6
76.9 ± 11.1
80.5 ± 7.6
62.9 ± 21.8
Table 2 Mean air conduction thresholds in different age groups(dB HL)
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Journal of Otology 2011 Vol.6 No.1
of presbycusis. First, industrialization and urbanization
bring about high level environmental noises which can
do chronic harm to hearing. Second, with the increase of
people's life expectancy, the impact of aging on the audi⁃
tory system becomes increasingly prominent. There is a
strong need to investigate the status of elder people with
hearing loss in China. We have investigated into hearing
loss among Chinese elder adults who are over 50 years
old and complain of hearing impairment, in order to un⁃
derstand general characteristics of this population. In
this paper, the preliminary results are reported.
The mechanism and inducement of presbycusis is
complex. In 1988 a work group of the Committee on
Hearing and Bioacoustics and Biomechanics(CHABA)
of the National Research Council published a report on
speech-understanding problems in the elderly. In this
report, the etiology and risk factors of presbycusis were
comprehensively summarized: Understanding of presby⁃
cusis may be flawed because physiological, pathological,
and environmental factors all undoubtedly contribute to
age-related hearing loss. Presbycusis is the sum of vari⁃
ous types of hearing loss that result from several variet⁃
ies of physiological degeneration. The degeneration can
result from noise exposure, exposure to ototoxic materi⁃
als, systemic medical disorders(such as arteriosclerosis,
hypertension, renal disease, diabetes mellitus), and
treatment of these disorders. Potential sites of disorders
have been identified as peripheral-auditory, central-au⁃
ditory, or cognitive systems.
7
The complexity in mecha⁃
nisms and causes of hearing loss in elderly patients
leads to a wide variety of audiometric configurations.
8
Such complexity can be seen from the results of this pa⁃
per. In addition to conductive hearing loss with air-bone
gap, other configurations included gradually sloping,
sharply sloping, flat, notch, trough and rising curves, to⁃
tal deafness and normal hearing. Variability in hearing
loss profiles reflects effects by various impacting factors
in different individuals.
In this paper, elderly subjects of different ages were
investigated. It can be seen from Table 2 and Figure 1
that hearing loss in elder adults generally shows a gradu⁃
al deterioration especially in high frequencies., Hearing
loss is mild in the mid and low frequency area, but mod⁃
erate to severe in high frequency area. Pure tone thresh⁃
olds increase gradually along with age at a rate of about
10 dB/10year. Lee et al
9
analyzed pure-tone thresholds
in 188 elder adult human subjects to study longitudinal
changes in thresholds over a period of 3 to 11.5 years.
Subject initial ages ranged from 60 to 81 years, and
pure-tone thresholds at 0.25 to 8 kHz were measured. It
was concluded that on average, hearing threshold in⁃
creased approximately 1 dB per year for subjects aged
60 and over, which was similar to our results. Lee et al
suggested that the rate of change in thresholds could be
affected by age, gender, and initial threshold levels.
Pure tone thresholds at 0.25 to 3, 10, and 11 kHz in fe⁃
male subjects over 70 years changed faster than in fe⁃
male subjects aged 60 to 69 years, while those in older
male subjects changed faster at 6 kHz than in younger
male subjects., Females had a slower rate of threshold
change at 1 kHz and faster at 6 to 12 kHz than males.
Subjects with higher initial thresholds at low and mid
frequencies tended to have faster changing rate at 0.25
to 2 kHz, and those with higher initial thresholds at mid
and higher frequencies tended to have slower changing
rate at 6 to 8 kHz in the following years.
9
From the current investigation, some preliminary con⁃
clusions can be drawn. (1) Thresholds remain stable
from 50 to 70 years of age, except a significant deteriora⁃
tion along with age at 8 kHz. (2) Thresholds increase dra⁃
matically at all frequencies after 70 years of age. (3) Be⁃
tween the 80 + and 90 + age groups, most threshold
changes are at only 500 Hz and 1 kHz but not at high
frequencies, indicating stable high-frequency hearing
sensitivity in patients over 80 years of age. The decline
in mid and low frequencies may lead to a significant de⁃
cline in perception of loudness.
Acknowledgement
This work has been supported by the grants from
Hi-Tech Research and Development Program of China
(973)(#2011CBA01000), National Natural Science
Foundation of China(NSFC)(#30871398, 30730040).
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(Received May 27, 2011)
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