Die Entstehung und Behandlung der Presbyakusis: Heutiger Stand und Perspektiven für die Zukunft

[Possibilities to predict the success of an individual hearing aid fitting using the APHAB]

BACKGROUND

Since 2012, the APHAB is part of the quality agreement for statutory insured patients in hearing aid fitting (HAF). So far, individual results could be interpreted by using percentile curves only, but not for the improvement quotient and the cumulated benefit. The presented study should close this gap. Moreover, it should be clarified if an individual constancy within percentile exists.

METHODS

Using the data of 6861 hearing aid fitted patients from a database, we calculated the benefit by improvement quotient and cumulated benefit for different age-classes and percentile-groups and presented by a heatmap. Individual constancy of percentile would be calculated using Spearman's rank correlation.

RESULTS

The average benefit was 21.41. The average of the improvement quotient was 41.01. It was significantly higher (44.36 %) in subjects younger than the average (27.26 years ± 11.86) than in the elderly (37.66 %). It decreased in cases of lower APHAB-scores before HAF concerning the percentile-group, ranging from 23.22 % to 52.07 %. Spearman's rank coefficient for the APHAB benefit was 0.285, Cohen's effect size was small. The correlation between the APHAB-score before HAF and the cumulated benefit was 0.582 and the improvement quotient was 0.270.

CONCLUSIONS

An individual constancy within percentile before and after HAF was not detectable. Nevertheless, some relationships of the improvement quotient and the age resp. percentile-groups could be demonstrated. The benefit of HAF was less in older subjects with lower APHAB-scores and best in young subjects with higher APHAB-scores before HAF.

Hearing Impairment in Old Age

BACKGROUND

Hearing impairment associated with old age (presbycusis) is becoming more common because the population is aging.

METHODS

This review is based on publications retrieved by a selective search in Medline and Google Scholar, including individual studies, meta-analyses, guidelines, Cochrane reviews, and other reviews.

RESULTS

The cardinal symptom of presbycusis is impaired communication due to bilateral hearing impairment. Patients may be unaware of the problem for a long time because of its insidious progression. Evidence suggests that untreated hearing impair- ment in old age can have extensive adverse effects on the patient's mental, physical, and social well-being. Early detection is possible with the aid of simple diagnostic tests or suitable questionnaires. In most cases, bilateral hearing aids are an effective treatment. Surgery is rarely indicated. For patients with uni- or bilateral deafness, a cochlear implant is the treatment of choice. These treatments can improve many patients' quality of life.

CONCLUSION

The small amount of evidence that is currently available suggests that presbycusis is underdiagnosed and under- treated in Germany. Early detection by physicians of all specialties, followed in each case by a specialized differential diagnostic evaluation, is a desirable goal.

Tinnitus pitch and minimum masking levels in different etiologies

OBJECTIVE

We sought to determine whether the results of audiological tests and tinnitus characteristics, particularly tinnitus pitch and minimum masking level (MML), depend on tinnitus etiology, and what other etiology-specific tinnitus characteristics there are.

DESIGN

The patients answered questions concerning tinnitus laterality, duration, character, aggravation, alleviation, previous treatment, and circumstances of onset. The results of tympanometry, pure-tone audiometry, distortion-product otoacoustic emissions, tinnitus likeness spectrum, MML, and uncomfortable loudness level were evaluated.

STUDY SAMPLE

Patients with several tinnitus etiological factors were excluded. The remaining participants were divided into groups according to medical history: acute acoustic trauma: 67 ears; chronic acoustic trauma: 82; prolonged use of oral estrogen and progesterone contraceptives: 46; Ménière's disease: 25; congenital hearing loss: 19; sensorineural sudden deafness: 40; dull head trauma: 19; viral labyrinthitis: 53; stroke: 6; presbycusis: 152. Data of 509 ears were analysed.

RESULTS

Tinnitus pitch was highest in patients with acute acoustic trauma and lowest in patients receiving estrogen and progesterone. MML was lowest after acute acoustic trauma and in congenital hearing loss, and highest after a stroke and in the case of presbytinnitus.

CONCLUSIONS

Tinnitus pitch and MML are etiology dependent.

Involvement of p-CREB and phase II detoxifying enzyme system in neuroprotection mediated by the flavonoid calycopterin isolated from Dracocephalum kotschyi

PURPOSE

There is an increasing amount of experimental evidence that oxidative stress has a central role in the neuropathology of neurodegenerative diseases. It has been suggested that the loss of cell function results from the increased oxidative damage to proteins and DNA. Herein, we investigated the effect of a natural neuroprotective flavonoid, calycopterin, on H₂O₂-induced disruption of phase II detoxifying enzyme system and cAMP response element binding protein (CREB) phosphorylation.

METHODS

PC12 cells were treated with 25, 50 and 100 μM of calycopterin for 3h, followed by adding H₂O₂ (150 μM) for 24 h. The extent of apoptosis was assessed by comet assay. The level of phosphorylated CREB, nuclear factor erythroid 2-related factor 2 (Nrf2), glutamylcysteine synthetase (γ-GCS) and heme oxygenase 1 (HO-1) were measured by western blot method. The concentration of glutathione (GSH) was determined in whole cell lysate using dithionitrobenzoic acid method. Superoxide dismutase (SOD) activity was measured by colorimetric assay.

RESULT

Morphological analysis of protection induced by calycopterin, determined by comet assay, showed that calycopterin reduced DNA in tail. We found that H₂O₂ decreased mitochondrial membrane potential (MMP), while, calycopterin prevented this decrease in MMP in presence of H₂O₂. In H₂O₂-treated cells, calycopterin also suppressed cytochrome C release to cytosol that is necessary for maintaining mitochondrial homeostasis in survived cells. Moreover, calycopterin, in presence of H₂O₂ inhibited the decrease caused by oxidative stress in stress-sensing transcription factors, CREB and Nrf2, which play an important role in antioxidant capacity of the cell. There was also an increase in γ-GCS and HO-1 levels in calycopterin pretreated cells. In the presence of H₂O₂, calycopterin inhibited decrease in GSH level and SOD activity.

CONCLUSION

We provided documentation of neuroprotective effect of a natural flavone, calycopterin, against H₂O₂-induced oxidative stress in differentiated PC12 cells by modulating the level of CREB phosphorylation and Nrf2 pathway.

[Vertigo and falls in the elderly. Part 1: epidemiology, pathophysiology, vestibular diagnostics and risk of falling]

Disorders of the equilibrium function in the elderly will increase in the coming years due to demographic changes in Germany. In addition to a reduction in the quality of life of affected patients, the risk of suffering from a fall increases with age. At the morphological level age-specific changes of the peripheral vestibular structures, somatosensory pathways and vision can be found, such as degenerative alterations, reduced number of cells and receptors and an accumulation of lipofuscin. Disorders of the equilibrium function in old age are individual-specific, complex procedures which develop from age-related physiological, degenerative alterations in the components of the sensomotor system which maintain equilibrium and can come into being together with vestibular and non-vestibular accompanying diseases as well as psychological factors.