Hearing loss is a common consequence of aging^1-5. It is difficult to distinguish changes of normal aging from those of other contributing factors. Hearing impairment is one of the most important health problems of the elderly above 60 years 1-5. Very often it leads to verbal communication difficulty and without treatment it can cause serious psychological and social complications such as depression and social isolation. Hearing impairment is the most common chronic handicap in the US⁶.

It has been reported that hearing loss ranks as the third-most-prevalent major chronic disability in the elderly and the prevalence of hearing loss has been documented very well by several authors^1-5,7-10. One third of the people aged 70 years and over has hearing loss great enough to require a hearing aid; the proportion is even higher among those aged over 80 years. The loss of hearing associated with the aging process is referred to as "Presbycusis". Presbycusis is the most common auditory disorder in the elderly population. The aging process produces alterations in the cochlea, the end organ of hearing, as well as in many areas of the auditory system.

In U.S¹¹, hearing loss is the third most prevalent chronic condition in older Americans, after hypertension and arthritis. Up to 40% of people over age 65 are hearing impaired and more than 80% of the people over age 85 have hearing loss. It is reported that people with hearing loss have twice as high of rates of depression. They are severely socially isolated and a lot of them have substantial loss of self-esteem.

Although hearing impairment in the elderly is very common, it is often ignored and poorly managed in the primary care setting. Deterioration of hearing with advancing age is well documented¹². It can be substantially improved with hearing aids and sometimes surgery. Although hearing aids are the mainstay of treatment for Presbycusis, they are not used by the majority of elderly sufferers.

Unfortunately, hearing impairments often receive minimal attention and can affect the most common and simple tasks of daily life^13-14. The aim of this study was to find the frequency of patients with hearing loss and the severity of hearing impairment in patients above 60 years and to describe the problems with use of hearing aids.

METHODS

One significant demographic feature of developing countries is the increase in older population. It has been demonstrated that populations of above 65 years form 1.3%, 2.5% and 2.4% of the total population in Qatar in 2002, 2003 and 2004 respectively¹⁵. The apparent decline in the percentage of old population in Qatar is mostly due to the rise in the young population (working expatriates) in the country during recent years due to the fast growing economy.
This study was conducted during the period from January 2001 to Dec 2003. The number of patients seen in the ENT outpatient clinics of the Hamad General Hospital and Rumaillah hospital were 70,406 during the study period. Out of these patients, 1167 elderly patients visited the Audiology outpatient clinic for further investigation of ear complaints. Among them, 207 patients above 60 years of age were diagnosed as having hearing loss and 182 patients were prescribed for hearing aids. Data were collected from patient's records on the socio-demographic characteristics, the severity of hearing impairment and the audiological details of the studied patients. Also, Patients prescribed for hearing aids were studied with regards to their hearing aid performance and problems.

Clinical and hearing evaluation procedures:
All patients were tested by two pre-trained technicians using two clinical digital audiometers. The severity of hearing impairment and configuration in each ear was evaluated according to International Standard Organization (ISO). Garson Stadler GSI 61 and Madsen Orbitar 922 were the two audiometers used to evaluate the hearing loss.

RESULTS

Table 1 shows the socio-demographic characteristics of the studied subjects. 72.5% of the studied subjects were Qataris and 27.5% were non-Qataris. The majority of them (62.8%) were in the age group (60 - 69). The proportion of hearing loss was higher in the female patients (89.4% for the right ear and 86.2% for the left ear) than in the male patients (81.4% for the both ears).

Table 2 presents the severity of hearing impairment according to gender. Hearing loss was more severe (56 - 70 dB) in women (29.8% for RE and 28.7% for LE) than in men (18.6% for RE and 15.1% for LE). Although the hearing loss severity was higher in women, normal hearing was more in male patients (14.2% for RE & LE) than females (7.5% for RE & 9.6% for LE). There were cases of deafness among female patients (1.1% for RE & 2.1% for LE).

Table  2. The severity of hearing impairment according to gender

Table 3 shows the type of audiogram according to gender. Sloping audiometric curves were found to be the most prevalent ones in the elderly patients (69.9% & 67.3% for Males; 66.0% & 61.7% for Females), followed by flat audiogram shape (15.0% & 17.7% for Males; 8.5% &16.0% for Females) and to less extent rising type audiogram (1.8% for both the ears for males; 2.1% & 3.2% for females). Severity of hearing loss between men and women was not statistically significant.

Table 3. Type of Audiogram according to gender

* P value = 0.278
** P value = 0.132
*** P value = 0.974

Table 4 explains the problems encountered with the use of hearing aids. 182 patients (87.9%) were fitted with hearing aids. Improper mould problems were the most common problem found (28.6%), secondly intolerance to loud sound (19.8%), thirdly headache and psychological problems (14.9%) followed by whistle (13.7%).

DISCUSSION

Hearing loss among the elderly population is a prevalent problem that affects their ability to understand speech in quiet, noisy, and reverberation environments. Elderly people also experience difficulty in understanding rapid speech, heavily accented English language, and speech with few contextual cues and/or added memory demands. Hearing impairment is the fifth most prevalent chronic health condition and the second most prevalent impairment in the U.S¹⁶. Hearing problems have a profound influence on the lives of the elderly. Although hearing loss in the elderly may not have a cure, early rehabilitation helps to restore better quality of life, if the problem is detected early.

The present study findings revealed that 85% of the studied patients above 60 years had problems of hearing loss. Cruickshanks K J et al¹⁷ reported a similar proportion over the aged 70 that the prevalence of significant hearing impairment among people over the age of 65 is approximately 45% and among people over age of 70 exceeds 83%. It is reported in a study done by Herbst KG¹⁸ et al that one third of people aged 70 years and over suffer from hearing impairment require a hearing aid. The proportion is even higher among those aged over 80 years.

Both men and women are at risk for age-related hearing loss. The present study showed that the proportion of hearing loss was higher in female patients (89.4% for RE & 86.2% for LE) than in males (81.4% for the both ears). Even the hearing loss was more severe in women. Nearly 30% of the studied women had severe (56-70 dB) hearing loss, while approximately 18% for men. On the contrary, it is reported in the US¹⁹ that women of all ages have better hearing than men at frequencies above 2000Hz.

Overall, around 24% had severe hearing loss and nearly 27% had moderate hearing loss which is much lower than the rate reported in a study done by Sangster J F that 60% of the patients tested at the hearing clinic were found to have severe hearing loss²⁰. But in the UK, 8% of the participants reported a severe hearing loss and 42% moderate hearing.

Presbycusis remains a leading cause of sensorineural deafness in the elderly⁶. Majority of the studied patients with hearing loss were associated with Presbycusis (70.5%). Rosenhall U²¹ and colleagues also found that Presbycusis is the most common type of auditory dysfunction. Aging and noise exposure are the key factors implicated. Earlier studie^s7,22 revealed that the shape of audiogram which is regarded as reflector of the pathology underlying presbyacusis and slope and ski-slope type curves were the most common types of audiogram present in the hearing impairment patients. The present study demonstrated that most of the elderly patients showed sloping (68.1% for RE & 64.7% for LE), followed by flat audiogram shape (12.1% for RE & 16.9% for LE).

The present study revealed that the majority of elderly patients suffering from hearing loss were fitted with hearing aids (87.9%). This finding is not in agreement with that of other researchers who reported a much lower percentage of hearing aid usage ranging from 6% to 14%²³. Another study²⁴ documented about 20% of elderly individuals with significant hearing impairment obtained hearing aids, despite the widespread occurrence of significant hearing loss in the elderly population. Moreover, about 30% of hearing aid users are dissatisfied with their instruments. Factors that may contribute to low hearing aid use include cost and low consumer awareness of the benefits of amplification. In our study, most of them had faced some kind of problem with their hearing aids. Improper mould problems were the most common problem found among our studied patients (28.6%). Many elderly people accept their hearing loss, believing there is no effective treatment; others attribute it to the aging process or even deny its existence.

LIMITATION
As the study was hospital based, the results may not give a true reflection of the situation in the community. The high referral rate from GP to Specialist in this study is clearly not sufficient to solve the problem of hearing impairment in elderly people.

CONCLUSION

The study findings revealed that the proportion of hearing loss was higher in female patients than male patients. Also, hearing loss was severe in women. The majority of the patients were fitted with hearing aids and most of them faced some kind of problem with the hearing aid. There was a high rate of dissatisfaction among hearing aid users.

Acknowledgement

We would like to thank Dr. A.A. Jufairi ENT consultant, and Audiology Unit staff members at the Hamad General Hospital and Rumailah Hospital for help and referring us some patients.

REFERENCES