Hearing loss is a noted modifiable risk factor for dementia, and is also associated with depression, decreased quality of life and isolation. Hearing aids are the main intervention for presbycusis and a 2017 Cochrane Review showed that they have a large beneficial effect for adults with mild-moderate hearing loss in enabling them to listen to other people and take part in everyday situations. Our Editors’ Choice paper reviews a study evaluating the long-term use of monaurally fitted hearing aids, and the reviewers encourage us to think of the study implications for our patients and ourselves! Many thanks as always to all our reviewers for their hard work and contributions.
Nazia Munir Hannah Cooper
In this Lebanese study, Dunya et al assess what impact aiding versus non-aiding has on the progression of presbycusis. They performed a retrospective analysis of pure tone thresholds (n=77) and word recognition scores (WRS; n=64) of people with presbycusis aged 45 to 94 years at first audiogram, with symmetrical, sensorineural hearing loss and no underlying otologic disorders. Patients self-selected unilateral aiding (due to cost or technology) on their preferred side within two years of noting the initial hearing loss. Initial and last hearing thresholds and WRS, a minimum of three years apart, were compared for each patient for both the aided and the unaided ear. Comparisons of pre- and post-aiding WRS were analysed using the Thornton and Raffin model for significant change – if the post-aiding WRS lay outside the respective band determined by this model, the result was deemed significant. Results demonstrated a significant deterioration in hearing thresholds between first and last audiogram (p<0.001), as would be expected in presbycusis. There was no significant difference in hearing thresholds between aided and non-aided ears at last audiogram, irrespective of length of aiding (3-5 years, 5-10 years, 10-15 years, >15 years). Contrastingly, there was significant worsening of WRS in the non-aided compared to the aided ears (p=0.002). This study highlights three significant points: first, auditory function in presbycusis can be preserved by amplification through aiding; secondly, hearing thresholds in isolation may not adequately quantify deterioration in auditory function; thirdly, for maximum auditory preservation, aiding should be binaural. This is information worth knowing before your own presbycusis (and ‘I don’t need hearing-aids yet’ pride) kick in.