1. Jenny Bashiruddin Departemen THT FKUI-RSCM Jakarta

2. Introduction Presbyacusis : sensory neural hearing loss, gradually,in elderly, degeneration disorders, bilateral, symmetric, start in high frequencies Limitation in communication Isolated

3. Epidemiology demography 1990, >65 yr : 6,7 million people 2020 estimation :18,8 million people Prevalence presbyacusis >65 yr : 30 % >75 yr : 50% Presbyacusis in Indonesia : 9,3 million people US census Bureau International Data Base th 2004

4. Epidemiology 1 off 3 American, age 65-75 yr suffer hearing loss The National Institute on Deafness & other Communication Disorders (NIDCD) 8,58 million England suffer hearing loss : 75% age >60 yr The UK National Study of Hearing Disorder 1995 Industrial population >>

5. Prevalence National Academy on an aging society Hearing loss-A Growing Problem that effect quality of life.Des 1999

6. Etiologi Atherosclerosis /cardiovascular diseases Diet and metabolism Accumulation noise induced Drugs/ toxic substances Stress Genetic

7. DIAGNOSIS Screening Anamnesis  Otoscopy  Tuning fork tes  Pure tone Audiometri  Speech Reception Test (SRT)  Speech discrimination scor (SDS)

8. Anamnesis : Aged >60 years Hearing impaired slowly, progressive,& symmetries, Tinnitus Difficulties hearing in noise (Cocktail party deafness) Pain in hearing loud sound(recruitment) Diagnosis

9. Symptom Slowly Impaired in high frequencies Women and children voice difficult to hear Tinnitus Recruitment

10. Sign and Symptom High frequency hearing loss. Gradually, bilateral and symetric Difficulty in differentiated the consonant s, r, n, c, h, ch. Coctail party deafness. Recruitment : over increasing sensitivity

11. Audiology Test Diagnostic Pure tone Audiometry Speech Reception Test (SRT) Speech Discrimination Score (SDS)

12. Physical examination/ Otoscopy normal Audiogram : sensory neural hearing loss in >1000Hz frequency Speech Audiometric test : Speech discrimination score decrease

14. Presbyacusis: sensoris Atrophy epithel, hair cell, organ Corty Basal chochlea High frequency loss. Steeply sloping high frequency hearing loss

15. Presbyacusis Neural Atrophy neuron cell in cochlea Spiral gangglion, in auditory central pathway 2100 neuron loss every decade Speech Discrimination score loss unproporsional Regresi fonem Sloping audiogram

16. Presbyacusis metabolic (strial) Atrophy stria vascular Bioelectrika dan biochemical endolimfa Flat audiogram Speech Discrimination score normal Aged 30-60 yr Genetic influence

17. Presbyacusis mechanic Thickening basal membrane cochlea High frequency loss, slowly progressive Slowly progressive sloping high frequency sensoryneural hearing loss

18. Management: Neurotonic Avoid loud noise, ototoxic Annual hearing test Rehabilitation: Hearing aid, lip reading & auditory training

19. Management Hearing aid Hearing devices Lip reading Implant cochlea Consultation Diet Activities

20. Prognosis Progressive Avoid etiology factors

21. Impact of life Quality of life Social isolated Less activities Depression emotional problem Frustrated others Less Interpersonal relationship Lonely

22. Quality of life Hearing problem could impact function and psichosocial life such as : Daily comunication Phone comunication (social and emergency) Social attitude Family relationship, activity and time leisure Safety Independent living.

23. Summary Changes in Presbyacusis : Changes cochlea structures and audit0ry nerves Atrophy and hair cell degeneration in organ Corty Changes vascularisation and decreasing volume and size of nerves

24. Summary Presbyacusis could managed properly Need early identification Psychosocial impact should be consider Try to identification of etiology and specific problem. Need support from family, friends and surrounding