A study was conducted of 300 patients with chronic sensorineural hearing loss (SNHL) in four age groups, allocated according to the age classification of the World Health Organization (WHO). For patients of the older age group, a high comorbidity index is noted, while among concomitant diseases, chronic non-infectious diseases that are likely to affect hearing (arterial hypertension, cardiovascular disease (CVDs), diabetes mellitus) are more often observed with age. A direct correlation was found between diseases that probably affect the auditory function and quality of life (QoL) of patients. It was noted that the proportion of people with moderate and severe hearing impairment increases with age, while the total QoL indicator correlated with age (inverse correlation in the elderly, direct correlation in senile people and long-livers) and the degree of SNHL (inverse correlation). Self-assessment of QOL level by the physical component in patients of the older age group corresponded to the pre-critical level.
Objectives to assess the efficiency of using a comprehensive hearing test, including a questionnaire survey and determination of hearing thresholds using the "Automated system of primary hearing assessment" web application, in comparison with tone threshold audiometry in elderly people. Material and methods. We examined 138 patients of the Samara Regional Clinical Hospital for War Veterans who were over 60 years old. The group included 67 women and 71 men with the average age of 71.6 6.4 years. The patients underwent ENT endoscopy, an online survey on hearing self-assessment, hearing thresholds study using the Automated Primary Hearing Assessment web application, and tone threshold audiometry. Results. The prevalence of hearing impairment in the group was 76.1% according to the online questionnaire on hearing self-assessment. When comparing the general results of the on-line test questionnaire and the study of hearing thresholds, the on-line test data were confirmed when conducting tonal threshold audiometry in 75.0% of people with normal test indicators, in 25.0% of people an in-depth study showed some hearing loss. According to an online survey of patients with hearing complaints, 89.1% had a certain degree of hearing loss. Hearing parameters according to the web application were comparable in terms of both hearing threshold values and the degree of hearing loss with the data of tonal threshold audiometry. The maximum difference was 3.9 and 3.5 dB at 1 and 2 kHz for the right ear and 7.2 dB at 4 kHz for the left ear. Low agreement of mean hearing thresholds was observed in patients at frequencies of 1 and 4 kHz on the right ( = 0.24 and = 0.3, respectively) and at a frequency of 4 kHz - on the left ( = 0.14), which may be due to high-frequency hearing loss in this group of patients and more significant fluctuations of indicators. The discrepancies in the data of the web application and in the values of the hearing thresholds when taking into account the comorbid status were minimal in persons with diabetes mellitus and amounted to 2 dB at a frequency of 8 kHz, the maximum deviations were observed in patients with occupational risk factors of 7.2 dB at a frequency of 4 kHz. Conclusion. The comprehensive study that includes an online survey on hearing self-assessment and the hearing function evaluation in the Automated System for Primary Hearing Assessment web application is a convenient and simple tool for screening hearing impairment in outpatients and clinical examination, as well as at the stage of monitoring, treatment, and rehabilitation of patients with various degrees and types of hearing loss, especially in the elderly people.
Introduction. The article discusses methods of screening for hearing impairments in patients of the older age group in the frame-work of primary health care.Aim of the study. Conduct a comparative analysis of the effectiveness of different hearing assessment protocols in primary health care.Materials and methods. Сlinical and demographic data were collected in 585 elderly and senile patients (mean age 76.43 ± 9.83), tonal threshold audiometry was performed in the frequency range from 250 Hz to 12000 Hz, hearing was studied using the web application “Automated primary hearing assessment” (patent No. 2019664671) and analyzed the self-assessment of hearing with the HHIE questionnaire.Results. Most of the patients were elderly people (57.44%) with a high percentage of concomitant diseases (up to 89.23%). When interviewing a geriatrician about a complaint of hearing loss, a sensitivity of 91.5% and a specificity of 82.2% for detecting mild hearing loss, a sensitivity of 95.5% and a specificity of 71.8% for screening for moderate to severe hearing loss were obtained. When assessing the total score of the HHIE questionnaire (>17 points) and moderate hearing loss, the sensitivity was 84.7% and the specificity was 88.7%. The sensitivity index of the web application «Automated primary hearing assessment» for detecting moderate hearing impairment was 90.6% for the left ear and 88.5% for the right ear, and specificity – 88.5% for the left ear and 97.5% for the right ear.Discussion. Raising awareness of hearing problems through the introduction of feasible methods of assessing hearing function should lead to an increase in the number of older adults receiving adequate hearing rehabilitation.Conclusions. The authors conclude that it is important to take preliminary account of data on the sensitivity and specificity of assessment protocols for detecting hearing impairments of varying severity at the stage of examination of an older patient by a geriatrician and an otorhinolaryngologist.
The significance of asymmetric sensorineural hearing loss (ASNHL) is due to a special approach to diagnosis, followed by the process of hearing aids and auditory rehabilitation. Currently, there is no standard audiometric criterion for determining the forms of asymmetry, which significantly affects the assessment of the prevalence of ASNHL. The study aimed to assess the prevalence and classification of ASNHL forms in the older age group using two methods of calculation: 1) the difference in the average hearing threshold at speech frequencies (in the range of 0,5–4 kHz) ≥15 dB was detected in 14,14% of cases; 2) the different degree of hearing loss, according to the International classification, in the right and left ear was 35,98%. In most cases, asymmetry was manifested by bilateral sensorineural hearing loss of varying severity, prevailing in the group of long-livers – 82,6%. Given the potentially high prevalence of asymmetry depending on the audiological criterion, the results of the work are a reason for further research in the development of a unified method for verifying a clinically significant form of ASNHL.
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