Dedicated to Professor Petar Guberina on the occasion of his seventy-fifth birthday

The purpose of the present report is to offer a somewhat different perspective on the frequency with which otolaryngological and communication disorders were seen in patients age 65 years and above within a six-month period in a modern otolaryngology practice in a large medical clinic setting.Autori proučavaju probleme sluha i govora kod starijih osoba u SAD. Iznose najprije brojne statistike objavljene u SAD o gubitku sluha i smetnjama u govoru kod starijih osoba u SAD, ali ističu da još ni jedan istraživač nije sistematski obradio te probleme u cjelini otorinolaringološkog aspekta. Toga su se rada prihvatili dr. Joseph H. Oyer, predstojnik u Odjelu za Otorinolaringologiju na Harvardu i dr. Herbert J. Oyer, Profesor znanosti o govoru i sluhu na Ohio State University, Columbus, Ohio.

 Broj pacijenata: 216, koje su podijelili u dvije grupe: 1) »Mladi-stari« (65-74) g. i 2) »Stari-stari« (preko 75 godina). Ispitivali su područja: lica, vrata, uha, nosa i grla. Najviše je problema bilo s uhom: 48,7%. Onda su problemi slijedili ovim redom: nos, 19,8%, grlo: 13,8%, lice: 12,9%, glava i vrat: 4,7%. Nije bilo razlike između spolova. Zaključci su bili sljedeći: prvo, najviše je problema s uhom, te je presbiakuzija najčešća od svih problema ORL. Drugo: potrebno bi bilo napraviti u istom smislu komparativne studije da se vidi status ORL problema u SAD i drugdje u svijetu

H.J. Oyer

J. H. Oyer

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FIWLOGIJA, KNJ/GA 17, ZAGREB 1989 YU ISSN 0449-363 X UDK: 001.891 :801.4-056.236 Izvorni znanstveni clanak Primljeno 10/1989 J. H. OYER, HARVARD, CAMBRIDGE, MASS. ­H. J. OYER, OHIO STATE UNIVERSITY, COLUMBUS HEARING AND SPEECH DISORDERS AND THE ELDERL Y Dedicated to Professor Petar Guberina on the occasion of his seventy-fifth birthday The purpose of the present report is to offer a somewhat different perspective on the frequency with which otolaryngological and com­munication disorders were seen in patients age 65 years and above within a six-month period in a modem otolaryngology practice in a large medical dinic setting. INTRODUCTION Some of the health prob:lems of the elderly are associated with the nor­mal aging process and others with pathological conditions that are more pre­valent in the Iater years. Disorders of human communication provide no exception to this. The efficiency of the speech, oral receptive and expressive language, and hearing systems frequently suffer as a function of diminished integrity of the peripheral and/or central nervous systems. Of great impor­tance as weIl are pathologies of other kinds. Extant data on the prevalence of speech, language, and hearing problems among the eldel'ly inthe United States provide only limited information. The U. S. National HeaJlth SlUiI'Veyl, fbr eXaJIDU)le, estimated ,thM Ithe rnmnber of per­SOIlJS aged. 65 years and 'Over havting 'two-ear :impairmel1!tlS wa;s 2 226,00 and 715,000 Wlith one-ear impaiwnen<t!s. HaTIPiJs2 states that Jrrnpab:ment of hearing ranJk Isecond OIIlIlyto arthrritrlis ~s one of t'he five .IDOSt preva:lent CO!lldIDtions affeot:i.ng the heai~th of older aldU1l:ts. Acc0l1Cl!mgto the U. S. Admhüstration on Agjmg, 01der ilndiMidJUal:sare o.nly twice as lÜ!kely rto wear eyeglasses as younger persOl1!S but thiJroteen ·timesas llikely '10 own a hearr.ing aid3• SbiM aJIlo"therVliew by GentHe and Reis4 suggests that over one-half of the persons in the U.S.A. with 1 Glorig, A., Roberts, J., Hearing Levels of Adults By Age And Sex: Uni ted States 1960---62, Vital Health Statistics Series 11, No. 11. Table 11, p. 28, Washing­ton, D. C., U. S. Department of Health, Education and Welfare, 1965. 2 HaITis, C. S., Fact Book On Aging: A Profile of America's Older Population, Washington, D. C.: National Council On Aging, p. 100, 110, 1978. J U. S. Administration On Aging, New Facts About Older Americans, Washing­ton, D. C.: USDHEW Publication (SRS) 73-20006, p. 1, 1973. • Gentile, A., Reis, P., Population Estimates of the Number of DcaE Persons 65 Years oE Age and Over for the Next 15 Years, Services for Elderly Persons, Deafness Research and Training Center, New York Unive rsity, p. 15-18, 1971. 27 · J. H. Oyer - H. J. Oyer: Hearing and speech disorders ... ; FILOLOGIJA 17 (1989) str. 27-37 bilatera,l hearing loss are sixty,five years of age and older. RUpp5 states that from ages 45-46 years the hearing impaimnent rate per 1000 population in the U.S.A. is 52.2; from 65-74 years it is 129.2 per 1000; and from age 75 years and above it is 256.4 per 1000 people. Thete appears to be a difference in the prevalence of hearih·g 10ss between institutionalized and noninstitu­tionalJized elderly persaniS wHh <the mstirtJut10naHzed showrlrng subst<l!ntiaUy poorer hearing levels than those not so confirned.6 One hospital survey for example indicated that hearing impairment among senior 'patients could exceed seventy per cent. With greater longevity it can be expected that hear­ing problems will increase innumber as weIl as the many problems that are associated with hearing 10ss.7 Estimates of speech and 'language problems of older people are some­what more difficult to obtain. Monograph 10 of the then National Institute öf Neurological Disease and Stroke (NINDS) gives gross figures of 10,000,000 people with speech disorders and 2,100,000 with disorders of communication of central ürigin for the entire population of the U.S.A.8 Bollinger9 estimates that between 40-50 percent of the patients in extended care facilities have speech,language handicaps. In view of these rather incomplete and somewhat unrelated data, it becomes obvious that there is need for a comprehensive epidemiological study that would give a dear picture of, among other things, the incidence and prevalence of di,sorders of communication by age groupings. PURPOSE The purpose of the present report is to oUer a somewhat different per­spective on the frequency with which otolaryngological and communication disorder.s were seen in patients age 65 years and above within a six-month period in a modern otolaryngology practice in a large medical dinic setting. Thedata gathered indude a>l1 patients 65 years and over in order that the problems of communication might be viewed aga'inst a backdrop of the case­load in this practice. Analysis of caseloads is an approach that has been employed by various specialities for various reasons. Within otolaryngology for example Brod­, Rupp, R. R., Understanding the Problems of Presbyeusis, Geriatrics, 25, p. 100-107, 1970. , Maurer, James F., Rupp, R. R., Hearing And Aging, New York: Grone and Stratton, Ine., p. 24, 1979. 7 Oyer, Herbert J., Kapur Y. P., Deal, Leo V., Hearing Disorders And Aging: Effects Upon Communication, In Oyer, H. J., & Oyer, E. J., (ed.), Communication And Aging, Baltimore: University Park Press, p. 175, 1976. 8 Human Communication And Its Disorders, NINDS, Monograph 10, USDHEW, 1970. • BoIIinger, R. L., Geriatrie Speech Pathology, Gerontolgoist, 14, p. 217-220, 1974. 28 J. H. Oyer - H. J. Oyer: Hearing and speech disorders ... ; FILOLOGIJA 17 (1989) str. 27-37 nitzlO and Batzal1 studied thcir patient loads with particular reference to vocal disorders. The present investigators are not aware of any previous study made of an otolaryngological patient load of elderly within the categories employed in this study, ll1amely medical/surgical and comnmnication. CATEGORIES The medical/surgical categories inc1uded (1) head and neck,(2) facial plastic, (3) ear, (4) nose, and (5) throat. The communication categories included (1) s'peech, and (2) hearing. PATIENTS There were 216 patients examined that were placed within two age groups as follows: Group 1 - »Young-Old« (65-74 year.s) and Group 2 ­»Old-Old« (75 years and above). In Group 1 - (Y-O) there were 76 males and 66 females,and ,in Group 2 - (0-0) there were 36 males and 38 females. The age range for both spanned 24 years (65-89 years). The median ages for Group - (Y-O) were 69 for males and 66 for females, and, 79 years for both males and females within Group 2 - (0-0). Patients visits totaled 250. RESULTS AND DISCUSSION The rank order of medical/surgical problems seen was: Ear - (113 ­48.7%); Nose - (46 - 19.8%); Throat - (32 - 13.8%); Facial Plastic - (30 - 12.9%); Head & Neck - (11 - 4.7%). Upon inspection of these data the question was raised as to whether or not there were sex and age differences. Null hypotheses were generated namely that there were no .statistically sig­nificant differences with ,reference to each of the fi.ve medical/surgical sub­-categories (1) between Group 1 - (Y-O) and Group 2 - (0-0); (2) between male and female patients within Group 1 - (Y-O); (3) between male and female patients of Group 2 - (0"0); (4) between sexes for combined groups; (5) for female patients of Group 1 - (Y-O) and Group 2 - (0-0); (6) for malepatients of Group 1 - (Y-O) and Group 2 - (0-0), and; (7) in the frequency of OCCUTrencc of each medical problem in relation to the frequency of occurrence of each of the other four medical problems. . Results of Chi Square analysis showed that at the .05 .level the null hypo­theses could not bc rejected for age or sex differences relative to the medical problems, howevcr the seventh hypothesis was rejected for frequency of occurrence of the ear problem when compared to each of the other four 10 Brodnitz, F. S., Vocal Rehabilitation, (3rd ed,), Rochester: American Aca­demy of Ophthalmology and Otolaryngology, 1965. 11 Batza, E. M., Adventures in Vocal Rehabilitation, In Cooper, M. & CooperM. H., (ed), Approaches To Vocal Rehabilitation, Springfield: Charles C. Thomas Publishers, 1977. 29 J. H. Oyer - H. J. Oyer: Hearing and speech disorders ... ; FILOLOGIJA 17 (1989) str. 27-37 medical problems: Head and Neck - (.01 level); FaciaI Plastic (.001 level); Nose - (.001 level); and Throat - (.001 .level). Ear problems appeared sig­nificantly more frequently than any others. In all other corn,parisons the Chi Square values were less than the critical vaolue at the .05 level of con­fidence. With respect to the problems of communication, it was found that there were considerably more hearing impairments than speech .impairments obser­ved. Of the speech impa1rments observed, all were disorders of voice. Hear­ing .problems were diagnosed principally as a type of presbycusis. Null hypo­theses were formtilated stating that there were no significant differences in the occurrence of either speech or hearing problems (1) between Group 1 ­(Y-O) and Group 2 - (0-0); (2) between males of the two age groups and females of the two groups; (3) between sexes within each age group; (4) between sexes for .speech and hearing problems combined; (5) between Group 1 - (Y-O) and Group 2 - (0-0) for speech and hearing problems combined, and; (6) when coHapsed over age and sex. Chi Square analysis showed that there was a significant difference in the frequency of occurrence of speech (voice) problems between Group 1 ­(Y-O) and Group 2 - (0-0) with greater occurrence among the »young-old« patients. Thus, null hypothesis one was rejected in relation to speech. As for the differences between the age groups with respect to hearing impairment, the Chi Square value computed was 3.83 with the critical value of Chi Square:;;::: 3.84 at the .05 lev.el of confidence. We chose for »practical« purposes to reject null hypothesis one as related to hearing. It is of interest to note at this point that there were 15 percent more hearing problems among the »o'ld-old« patients than among the »young-old«. In no other instan­ces did the statistical analyses yield significant sexoofferences, thus the null hy.potheses two, three, and four concerning sex differences and communi­cation problems could not be rejected. A significant difference (at .01) was found between age groups when speech and hearing problems were com­bined, thus a ,rejection of hypothesis five . Group 1 - (Y-O) had significantly more speech and hearing problems than did Group 2 - (0-0). A significant difference (at .001) was also found betwecn the frequency of occurrence of the problems of speech and hearing with hearing problems occurring more frequently. It is of some interest to note that no problems of language (dyspha­sia or aphasia) or of speech (dysarthria, apraXlia, functional articulatory or ala.ryngeal) except for voice were manifested in this sampie of elderly patients. We believe that it would be of considerable interest to determine whether or not a similar distribution of patient problems would be observed in a study of older persons consulting otolaoryngologists in countries other the U.S.A. Such a comparative study might be useful in further understanding and theory development concerning communication problems associated with the aging process.12 12 Oyer, Herbert J., Importance of an International Perspective, In Oyer, Her­bert J., (ed.), Communication For The Hearing Handicapped- -An International Perspective, Baltimore: University Park Press, p. 8, 1976. 30 J. H. Oyer - H. J. Oyer: Hearing and speech disorders ... ; FILOLOGIJA 17 (1989) str. 27-37 For the medicalj.surgical problems seen, the necessary rnedical and or surgical interventions were invoked. And for the patients with communication problems, steps were taken [or exarnple with the voice cases to identify the etiologies and to ipravtide the necessary medical, surgical, or other rehabi­litation procedures. For hearing problems, most of which were sensorineural impairments, full otological and audiological workups were provided which frequently resu:lted in recommending amplification WLith a hearing aid. Perhaps the most strikirng feature of this study of elderly patients seen w.ithin a ,large medical clinic was that approximately Olle-half (48.7%) of aU the medical problems seen were inv.oh1ed with the ear (52.3% of the patients). Well over threefourths (85.2%) of the communication problems were those of hearing impail1ll1ent; 40.3% of all patients seen. These facts highlight the irnportance of integrating the functions of oto­logy and audiology in providirng care for the elderly who have prohlems of communication, particularly those associated with impairments of audition. Through informed diagnostic, treatment, testing, and lI'ehabilitativ.e procedures the stresses and handicaps that accompany impaired communication can be alleviated and hopefully, by so doing, improve the quality of the Jives of the elderly. Sazetak PROBLEM I SLUHA I GOVORA KOD STARIJIH OSOBA Autori prouCavaju probleme sluha i govora kod starijih osoba u SAD. Iz­nase najprije brojne statistike objavljene u SAD 0 gubitku sluha i smetnjama u govoru kod starij·ih osoba u SAD, ali isticu da jos ni jedan istraZivac nije siste­matski obradio te probleme u cjelini otorinolaringoloskog aspekta. Toga su se rada prihvatili dr. Joseph H. Oyer, predstojnik u Odjelu za Otorinolaringologiju na Harvardu i dr. Herbert J. Oyer, P.rofesor znanosti 0 govoru i sluhu na Omo State University, Columbus, Ohio. Broj pacijenata: 216, koje su podijelili u dvije grupe: 1) »Mladi-stari« (65-74) g. i 2) »Stari-stari« (preko 75 godina). Ispitivali su podrucja: lica, vrata, uha, nosa i grla. Najvise je problema bilo s uhom: 48,7%. Onda su prob1emi slijedili ovim redom: Nos, 19,8%, grlo: 13,8%, lice: 12,9%, glava i vrat: 4,7%. Nije bilo razlike izmedu spolova. Zakljucci su bili slijedeci:Prvo, najviSe je problema s uhom, te je presbiakuzija najcesca od svih problema ORL. Drugo: potrebno bi bilo napra­viti u istom smislu komparativne studije da se vidi status ORL problema u SAD i drugdje u svijetu. 31 

Problem i sluha i govora kod starijih osoba

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