Hearing in advanced age Epidemiological, pathophysiological, and diagnostic perspectives from the Gothenburg H70 Birth Cohort Studies
Abstract
The population aged 80 and above is expected to increase in the future resulting
in an anticipated rise in health care demands. Age-related hearing loss (ARHL)
is described as the third most common health condition associated with ageing.
ARHL often results in communication difficulties and social isolation and is
associated with cognitive decline. Ageing processes affect both the peripheral
and the central auditory systems. Age-related deterioration in the central parts
of the auditory pathways often results in severe communication difficulties. It
is important to study the prevalence of ARHL, including age cohort
differences, in order to assess rehabilitation needs. However, to gain a deeper
understanding of ARHL and its associated care needs, it is essential to conduct
studies that incorporate pathophysiological aspects of ageing in the auditory
system. A limited amount of research has been carried out in this area in
evolving populations 80 years and older. This thesis focuses on
epidemiological, pathophysiological, as well as diagnostic perspectives of
ARHL in 85-year-old men and women. The results are based on a prospective
and epidemiological study, The Gothenburg H70 Birth Cohort Studies. The
specific papers within this thesis explore different aspects of ARHL. Paper I
presents pure-tone audiometry results, which predominantly reflect peripheral
hearing. The findings indicate that men have better hearing at low frequencies
but poorer hearing at high frequencies compared to women. Additionally, the
study examines hearing decline longitudinally between the ages of 75 to 85,
revealing a significant decline at mid-high frequencies for both sexes. Paper
II also focuses on peripheral hearing loss and highlights differences in pure-
tone hearing between two birth cohorts of 85-year-olds, born approximately 30
years apart. The prevalence of ARHL was found to have decreased over
approximately three decades among 85-year-old men but remained unchanged
vi
in women. Paper III describes pathophysiological aspects of ARHL. Test
results describe various validated and clinically utilized auditory measures,
including speech audiometry, and suggest that sensorineural hearing loss,
related to cochlear damage, is the most common subtype of auditory
dysfunction in 85-year-olds. Only a few participants had conductive hearing
loss (~6%), reflecting middle-ear pathologies. Additionally, almost one-fifth
of the 85-year-olds had poor speech recognition in relation to a SII-based
algorithm based on pure-tone thresholds as well as supra-threshold factors.
Based on the criteria used in this study, poor speech recognition was only
occasionally (~2%) attributed to auditory nerve dysfunction. Paper IV
investigates central auditory function, specifically binaural listening skills in
70- and 85-year-olds. Central auditory function was studied using a simplified
dichotic digit test (DDT) with the use of one-pair digits, which imposes a
relatively low cognitive and linguistic load on participants. The results showed
that older age was associated with poorer DDT scores. Furthermore, the
outcome of the DDT was influenced by both peripheral hearing loss, including
high frequency hearing loss, and cognitive abilities. This makes it difficult to
identify isolated central auditory processing disorders using DDT in advanced
age.
Parts of work
I. Göthberg H, Rosenhall U, Tengstrand T, Rydberg Sterner T, Wetterberg H, Zettergren A, Skoog I, Sadeghi A. (2019). Cross- sectional assessment of hearing acuity of an unscreened 85-year-old cohort -Including a 10-year longitudinal study of a sub-sample. Hearing Research 382:107797. https://doi.org/10.1016/j.heares.2019.107797 II. Göthberg H, Rosenhall U, Tengstrand T, Rydén L, Wetterberg H, Skoog I, Sadeghi A. (2020). Prevalence of hearing loss and need for aural rehabilitation in 85-year-olds: a birth cohort comparison, almost three decades apart. International Journal of Audiology 60(7):539-548. https://doi.org/10.1080/14992027.2020.1734878 III. Göthberg H, Skoog I, Tengstrand T, Magnusson L, Hoff M, Rosenhall U, Sadeghi A. (2023). Pathophysiological and Clinical Aspects of Hearing Loss Among 85-Year-Olds. American Journal of Audiology 17:1-13. https://doi.org/10.1044/2023_AJA-22-00214 IV. Göthberg H, Skoog J, Tengstrand T, Hoff M, Hadarsson Bodin, T, Rosenhall U, Skoog I, Sadeghi A. (2023). Results from a simplified dichotic listening test in younger and older olds. Manuscript.
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Neuroscience and Physiology. Department of Health and Rehabilitation
Disputation
Fredagen den 17 november 2023, kl. 9.00, Hörsal Arvid Carlsson, Academicum, Medicinaregatan 3, Göteborg
https://gu-se.zoom.us/j/68844193775?pwd=My80dVdJWHNQdzRCZ3BlWlRlbG5tUT09
Date of defence
2023-11-17
hanna.gothberg@neuro.gu.se
Date
2023-10-16Author
Göthberg, Hanna
Keywords
Age-related hearing loss
Older adult
Hearing decline
Peripheral auditory function
Central auditory function
Audiological research
Publication type
Doctoral thesis
ISBN
978-91-8069-387-5 (PRINT)
978-91-8069-388-2 (PDF)
Language
eng