Geriatrik Popülasyonda Odyolojik Yaklaşım
Özet
Ömür sürelerinin uzamasıyla birlikte geriatrik popülasyonda anatomik ve fizyolojik değişimlerin anlaşılması kritik hale gelmiştir. Yaşlanma süreci, dış kulaktan işitme korteksine kadar tüm işitsel yolları etkileyerek iletim veya sensörinöral işitme kayıplarına yol açmaktadır. Hücre dejenerasyonu ve mitokondriyal disfonksiyon gibi faktörlerin tetiklediği presbiakuzi, genellikle bilateral yüksek frekanslı işitme kaybı ve konuşulanı anlamama şikayetleriyle belirir. Bu sürece sıklıkla sosyal izolasyon, depresyon ve demans riskini artıran tinnitus (presbitinnitus) eşlik eder. Tanıda saf ses ve konuşma odyometrisi temel alınırken, tedavisinde işitme cihazları ve koklear implantlar ile rehabilitasyon eğitimleri kritik öneme sahiptir. Benzer şekilde, periferik ve santral vestibüler sistemdeki tüy hücresi ile nöron kayıpları, yaşlılarda denge bozukluklarına ve presbivertigo tablosuna zemin hazırlar. Bu durum düşme riskini ciddi ölçüde artırdığından, geriatrik odyolojik yaklaşımda multidisipliner tarama, anket değerlendirmeleri, bilişsel testler ve denge egzersizleri hayati rol oynar. Erken teşhis ve uygun cihazlandırma hem bireysel yaşam kalitesini optimize eder hem de toplumsal mali yükleri azaltır.
With the expansion of life expectancy, understanding the anatomical and physiological transformations within the geriatric population has become paramount. The aging continuum impacts the entire auditory pathway from the outer ear to the auditory cortex, culminating in conductive or sensorineural deficits. Presbycusis, driven by cellular degeneration and mitochondrial dysfunction, primarily manifests as bilateral high-frequency hearing loss accompanied by impaired speech comprehension. This clinical picture is frequently compounded by tinnitus (presbytinnitus), which exacerbates social isolation, depression, and cognitive decline risks. While pure-tone and speech audiometry remain foundational for diagnosis, interventions leverage hearing aids, cochlear implants, and tailored auditory training. Concurrently, hair cell and neuronal attrition within the peripheral and central vestibular frameworks induce equilibrium impairments and presbyvertigo. Because these vestibular deficits substantially elevate fall risks, a holistic geriatric audiological paradigm must synergize multidisiplinary screenings, self-assessment questionnaires, cognitive evaluations, and vestibulospinal rehabilitation. Timely diagnosis and strategic amplification not only restore personal autonomy and communication quality but also mitigate broader socioeconomic healthcare burdens.
Referanslar
Türkiye İstatistik Kurumu, İstatistiklerle Yaşlılar 2021, Haber Bülteni 2022. (20/08/2022 tarihinde https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2021-45636 adresinden ulaşılmıştır).
World Health Organization. World report on ageing and health 2021. (20.08.22 tarihinde https://www.who.int/news-room/fact-sheets/detail/ageing-and-health adresinden ulaşılmıştır).
Tu NC, Friedman RA. Age-related hearing loss: Unraveling the pieces. Laryngoscope Investigative Otolaryngology. 2018;3(2):68-72. doi:10.1002/lio2.134
Howarth A, Shone GR. Ageing and the auditory system. Postgraduate Medicine Journal 2006;82(965):166-171. doi:10.1136/pgmj.2005.039388
Knight J, Wigham C, Nigam Y. Anatomy and physiology of ageing 6: the eyes and ears. Nursing Times Journal. 2017; 113(7): 39-42.
Wang J, Puel JL. Presbycusis: An Update on Cochlear Mechanisms and Therapies. Journal of Clinical Medicine. 2020;9(1):218. doi:10.3390/jcm9010218
Hinojosa R, Nelson EG. Cochlear nucleus neuron analysis in individuals with presbycusis. Laryngoscope. 2011;121(12):2641-2648. doi:10.1002/lary.22383
Someya S, Prolla TA. Mitochondrial oxidative damage and apoptosis in age-related hearing loss. Mechanisms of Ageing and Development. 2010;131(7-8):480-486. doi:10.1016/j.mad.2010.04.006
Jerger J, Chmiel R, Stach B, Spretnjak M. Gender Affects Audiometric Shape in presbyacusis. Journal of the American Academy of Audiology. 1993;4:42-9.
Erdoğan AA. Yaşlılık Döneminde İşitme Kaybı ve İşitme Kaybına Yaklaşım. Turkish Journal of Family Medicine and Primary Care. 2016;10(1):25-33. doi:10.5455/tjfmpc.204524
Chisolm TH, Willott JF, Lister JL. The aging auditory system: anatomic and physiologic changes and implications for rehabilitation. International Journal of Audiology. 2003;42:2S3–10.
Pichora-Fuller MK, Souza PE. Effects of aging on auditory processing of speech. International Journal of Audiology. 2003;42:2S11–16.
Jennings CR, Jones NS. Presbyacusis. Journal of Laryngology & Otology. 2001;115:171–8.
Khan S, Chang R. Anatomy of the vestibular system: a review. NeuroRehabilitation. 2013;32(3):437-443. doi:10.3233/NRE-130866
Jahn K. The Aging Vestibular System: Dizziness and Imbalance in the Elderly. Advances in Oto-Rhino-Laryngology. 2019;82:143-149. doi:10.1159/000490283
Ji L, Zhai S. Aging and the peripheral vestibular system. Journal of Otology. 2018;13(4):138-140. doi:10.1016/j.joto.2018.11.006
Wagner AR, Akinsola O, Chaudhari AMW, et al. Measuring Vestibular Contributions to Age-Related Balance Impairment: A Review. Frontiers in Neurology. 2021;12:635305. doi:10.3389/fneur.2021.635305
Lopez I, Honrubia V, Baloh RW. Aging and the human vestibular nucleus. Journal of Vestibular Research. 1997;7(1):77-85.
Huang Q, Tang J. Age-related hearing loss or presbycusis. European Archives of Oto-Rhino-Laryngology. 2010; 267(8): 1179-1191.
Schuknecht HF, Gacek MR. Cochlear pathology in presbycusis. Annals of Otology, Rhinology, and Laryngology. 1993;102(1 Pt 2):1-16. doi:10.1177/00034894931020S101
Humes LE, Dubno JR, Gordon-Salant S, et al. Central presb¬ycusis: a review and evaluation of the evidence. Journal of the American Academy of Audiology. 2012; 23(8): 635-666.
Lotfi Y, Mehrkian S, Moossavi A, et al. Quality of life improvement in hearing-impaired elderly people after wearing a hearing aid. Archives of Iranian Medicine. 2009; 12(4): 365-370.
Arlinger S. Negative consequences of uncorrected hearing loss--a review. International Journal of Audiology. 2003; 42(Suppl 2): 2S17-20.
Veras RP, Mattos LC. Audiology and aging: literature review and current horizons. Brazilian Journalof Otorhinolaryngology. 2007;73(1):122-128. doi:10.1016/s1808-8694(15)31134-4
Idrizbegovic E. The effects of ageing in the peripheral and central auditory system. Karolinska University Hospital, Stockholm. In: Proceedings of the 1st International Congress on Geriatric/Gerontologic Audiology, 2004, Stockholm, (pp. 6-9).
Brant LJ, Gordon-Salant S, Pearson JD, Klein LL, Morrell CH, Metter EJ, et al. Risk factors related to age-associated hearing loss in the speech frequencies. Journal of the American Academy of Audiology. 1996;7:152–160.
American Speech-Language-Hearing Association. Adult Hearing Screening (22.08.2022 tarihinde http://www.asha.org/practice-portal/professional-issues/adult-hearing-screening adresinden ulaşılmıştır).
Şerbetçioğlu MB, Eser BN. Geriatrik İşitme Taraması Ve İşitmenin Korunması. In: Aksoy S (Ed.) Geriatrik Odyoloji. Ankara: Hipokrat Kitabevi; 2022. p. 125-133.
Akşit AM, Kalcioğlu MT, Dursun E et al. Çok merkezli araştırma: Hafif orta derece işitme kayıplarında işitme cihazı performansı. In: 7. Dünya İşitme Cihazı ve İmplantlar Sempozyumu, 2015, İstanbul, (Yayın No:2673307).
Aksoy S, Kamışlı GİŞ. İşitme Kaybı Ve Bilişsel Fonksiyon. In: Aksoy S (Ed.) Geriatrik Odyoloji. Ankara: Hipokrat Kitabevi; 2022. p. 189-204.
Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngology–Head and Neck Surgery. 2014; 151(2): 1-40.
Baguley D, McFerran D, Hall D. Tinnitus. The Lancet. 2013; 382(9904): 1600-1607.
Zachariah M, Idiculla J, Begum K. Serum Vitamin B12 Levels among Type 2 Diabetic Patients Maintained on Metformin Based Oral Anti-Diabetic Drugs-An Observational Study. The Indian Journal of Nutrition and Dietetics. 2020; 57(2): 154-163.
Salonen J, Johansson R, Joukamaa M. Alexithymia, depression and tinnitus in elderly people. General Hospital Psychiatry. 2007;29(5):431-435. doi:10.1016/j.genhosppsych.2007.05.002
Zagólski O. Management of tinnitus in patients with presbycusis. International Tinnitus Journal 2006;12(2):175-178.
Caspary DM, Llano DA. Auditory thalamic circuits and GABAA receptor function: Putative mechanisms in tinnitus pathology. Hearing Research. 2017;349:197-207. doi:10.1016/j.heares.2016.08.009
Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG. Review of Pharmacotherapy for Tinnitus. Healthcare (Basel). 2021;9(6):779. doi:10.3390/healthcare9060779
Attarha M, Bigelow J, Merzenich MM. Unintended Consequences of White Noise Therapy for Tinnitus-Otolaryngology's Cobra Effect: A Review. JAMA Otolaryngology—Head & Neck Surgery. 2018;144(10):938-943. doi:10.1001/jamaoto.2018.1856
Jun HJ, Park MK. Cognitive behavioral therapy for tinnitus: evidence and efficacy. Korean Journal of Audiology. 2013;17(3):101-104. doi:10.7874/kja.2013.17.3.101
Thomas E, Martines F, Bianco A, et al. Decreased postural control in people with moderate hearing loss. Medicine (Baltimore).2018;97(14):e0244. doi:10.1097/MD.0000000000010244
Duracinsky M, Mosnier I, Bouccara D, et al.Working Group of the Société Française d'Oto-Rhino-Laryngologie (ORL). Literature review of questionnaires assessing vertigo and dizziness, and their impact on patients' quality of life. Value in Health. 2007;10(4):273-284. doi:10.1111/j.1524-4733.2007.00182.x
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975;12(3):189-198. doi:10.1016/0022-3956(75)90026-6
Fernández L, Breinbauer HA, Delano PH. Vertigo and Dizziness in the Elderly. Frontiers in Neurology. 2015;6:144. Published 2015 Jun 26. doi:10.3389/fneur.2015.00144
Yiğit Ö, Avcı NB, Aksoy S. Geriatrik Bireylerde İşitme Kaybı ve Denge Becerilerinin İncelenmesi: Retrospektif Çalışma . Hacettepe University Faculty of Health Sciences Journal. 2022; 9 (2) , 387-402 .
Iwasaki S, Yamasoba T. Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. Aging Disease. 2014;6(1):38-47. doi:10.14336/AD.2014.0128
