Akeem O. Lasisi

Tinnitus in the elderly: profile, correlates, and impact in the Nigerian Study of Ageing.

OBJECTIVE: To determine the prevalence and correlates of tinnitus among community elderly and its impact on their quality of life. STUDY DESIGN: Longitudinal cohort. SETTING: Yoruba-speaking communities in Nigeria. SUBJECTS AND METHODS: Face-to-face interviews of 1302 subjects 65 years or older selected by the use of a multistage stratified sampling of households. Subjects were assessed for subjective tinnitus, chronic health conditions, functional impairment, and quality of life by use of the brief version of the World Health Organization quality of life instrument. RESULTS: Tinnitus was reported in 184 (110 female and 74 male subjects), giving a prevalence of 14.1 percent (SE = 0.49). Gender, age, economic status, educational level, residence, smoking, and alcohol consumption were not significantly associated with tinnitus. Univariate analysis revealed a history of recurrent otitis media (odds ratio [OR] = 4.5, 95% confidence interval [95% CI] 3.1–6.6, P = 0.01), head injury (OR 3.4, 95% CI 2.1–5.6, P = 0.01), rhinosinusitis (OR 2.4, 95% CI 1.5–4.0, P = 0.01), dizziness (OR 2.1, 95% CI 1.4–3.1, P = 0.01), and hypertension (OR 1.7, 95% CI 1.0–2.7, P = 0.05) as significant correlates. However, in multivariate analysis, only a history of otitis media and of head injury remained significant. Compared with those without, persons with tinnitus had a more negative perception of their overall health and a poorer quality of life as well as twofold likelihood to experience impairment in both activities of daily living and instrumental activities of daily living. CONCLUSION: Tinnitus is common among elderly Nigerians and is associated with treatable health conditions, such as otitis media, rhinosinusitis, head injury, and hypertension. Its association with functional impairment and reduced quality of life highlights the need for inclusion in any comprehensive health care for the elderly.

Prevalence of insomnia and impact on quality of life among community elderly subjects with tinnitus.

Objectives: We sought to determine the prevalence of insomnia and its impact on the quality of life (QoL) among community elderly subjects (at least 65 years of age) with subjective tinnitus. Methods: After household selection with multistage stratified area probability sampling, face-to-face interviews were used to obtain self-reports of subjective tinnitus and insomnia, and QoL was assessed with the WHOQoL-Bref instrument. Results: Among 1,302 elderly subjects, there were 183 subjects (109 female and 74 male) with tinnitus. Among those with tinnitus, insomnia was encountered in 95 (51.9%) and was found to be significantly more common among those with tinnitus than among those without (378 of 1,119, or 33.8%; p = 0.002). The insomnia symptoms included difficulty in maintaining sleep in 73.4% of subjects, difficulty in falling asleep in 70.0%, early morning wakefulness in 64.3%, non-restorative sleep in 35.1%, and daytime sleepiness in 34.7%. Univariate analysis revealed difficulty with falling asleep (p = 0.01) and early morning wakefulness (p = 0.05) to be significantly associated with tinnitus among the symptoms. Students t-test and logistic regression analysis revealed significant deterioration in the total QoL and in the physical, psychological, social, and environmental QoL domains among elderly subjects who had tinnitus with insomnia as compared with those without insomnia. Conclusions: We believe that insomnia is significantly more common among elderly subjects with tinnitus than among those without, and that its presence further depreciates the QoL in these elderly individuals.

Disability and quality of life among community elderly with dizziness: report from the Ibadan study of ageing.

BACKGROUND Dizziness is prevalent among the elderly. However, little is known about its impact on quality of life and disability, especially in developing countries, where the number of elderly people is increasing. AIM This study aimed to determine the prevalence of disability, and the quality of life, among elderly persons with dizziness living in the community. SETTING AND DESIGN Longitudinal cohort study of dizziness among elderly persons (i.e. aged 65 years and over) residing in Yoruba-speaking areas of Nigeria. METHOD Face-to-face interviews with respondents selected using a multi-stage, stratified area probability sampling of households. Dizziness was based on self-reporting and health-related quality of life was measured using the brief version of the World Health Organization quality of life assessment. RESULT Dizziness was reported and confirmed in 318/1281 elderly respondents, a prevalence of 24.8 per cent. Respondents comprised 197 (61.9 per cent) women and 121 (38.1 per cent) men. Thirty-nine respondents (12.3 per cent) were aged 65-69 years, 91 (28.6 per cent) 70-74 years, 66 (20.8 per cent) 75-79 years and 122 (38.4 per cent) > or =80 years. The prevalence of disability in activities of daily living was 29.56 per cent, and that of disability in instrumental activities of daily living 10.1 per cent. The influence of gender was not significant. The prevalence of disability in activities of daily living (p = 0.00) and in instrumental activities of daily living (p = 0.00) increased significantly with age. Univariate analysis revealed that disability in activities of daily living (p = 0.00), disability in instrumental activities of daily living (p = 0.01), poor family interaction (p = 0.00), poor community involvement (p = 0.00), overall poor health (p = 0.00), current depression (p = 0.01), and difficulty with sedentary (p = 0.00) and vigorous (p = 0.00) activities were significantly more common among elderly respondents with dizziness, compared with non-dizzy elderly respondents. In contrast, cognitive impairment (p = 0.05) was not significantly correlated. The probabilities of the occurrence of difficulty with vigorous or sedentary mobility in our elderly respondents were 2.6 and 1.9, respectively, compared with non-dizzy elderly respondents. Similarly, the probabilities of the occurrence of disability in activities of daily living, current depression and dementia were 1.6 each. Logistic regression analyses for age, sex, medical conditions and presence of disability confirmed that dizziness was significantly associated with worsened cognition. Similarly, dizziness was significantly associated with reduced total quality of life (p = 0.00), and also with reductions in the physical (p = 0.00), psychological (p = 0.00) and environmental (p = 0.00) domains of the research instrument. CONCLUSION Among elderly people with dizziness, there was a high prevalence of significant disability requiring assistance. In addition, dizziness alone significantly reduced these individuals overall total quality of life, and their quality of life as regards physical, psychological and environmental parameters. This information will assist policy planning for the elderly.

Age-related hearing loss, vitamin B12, and folate in the elderly.

OBJECTIVE: Determine the correlation between the hearing threshold and the serum levels of vitamin B12 (cobalamin) and folic acid among elderly subjects (> 60 years) with age-related hearing loss (ARHL). STUDY DESIGN: Cross-sectional. SETTING: Community. SUBJECTS AND METHODS: Subjects included elderly who were found apparently healthy following repeated examination by physicians. The pure tone average (PTA) for the speech and high frequencies, and the serum folate and cobalamin were determined and the correlation found. RESULTS: The mean ± SD values of serum folate among the subjects with normal PTA in the speech frequencies (0-30 dB) was 412.3 nmol/L ± 17.6 nmol/L, while among those with hearing loss (HL), it was 279.1 nmol/L ± 17.2 nmol/L (P = 0.01). In the high frequencies, the mean ± SD values among the subjects with normal PTA was 426.3 nmol/L ± 17.6 nmol/L, while among those with HL, it was 279.14 nmol/L ± 171.2 nmol/L. The serum cobalamin among the subjects with normal PTA within the speech frequencies was 49.7 pmol/L ± 9.4 pmol/L, while among those with speech-frequency HL, it was 42.6 pmol/L ± 10.2 pmol/L. However, for high frequencies, the mean ± SD values among the subjects with normal PTA was 47.4 pmol/L ± 7.3 pmol/L, while among those with HL, it was 41.3 pmol/L ± 9.2 pmol/L. Spearmans correlation revealed that low folate (correlation coefficient = −0.27, P = 0.01) and cyanocobalamin (correlation coefficient = −0.35, P = 0.02) were significantly associated with increasing hearing threshold in the high frequencies. After adjusting for age, serum folate (correlation coefficient = −0.01, P = 0.01) was significant, while vitamin B12 (correlation coefficient = −0.01, P = 0.74) was not. CONCLUSION: Serum folate was significantly lower among elderly with ARHL. Trials on nutritional supplementation may substantiate the role of serum folate in ARHL.

The prevalence and correlates of self-reported hearing impairment in the Ibadan Study of Ageing

This cohort study of 1302 persons aged ≥65 years, conducted in the Yoruba-speaking regions of Nigeria, determines the prevalence and correlates of hearing impairment (HI) in the elderly population. Self-reports of HI and its putative risk factors among several indices were obtained using face-to-face interviews, and confirmed by observers evaluation. Hearing impairment was found in 79 respondents, giving a prevalence of 6.1%. Gender difference was not significant but increasing age was associated with higher prevalence. Logistic regression analysis, adjusted for age and sex, revealed that history of recurrent suppurative otitis media [odds ratio (OR) = 4.6, 95% CI 2.34–8.99, P = 0.01], head injury (OR = 2.2, 95% CI 1.14–4.26, P = 0.02) and current hypertension (OR = 2.1, 95% CI 1.18–3.57, P = 0.01) were significantly associated with HI. No identifiable risk factors were found in 32 (40.5%) of the 79 respondents with HI. We conclude that the prevalence of HI among the elderly in Nigeria is comparable to reports from other countries. Identified risk factors were preventable or controllable. The large proportion of elderly with no identifiable risk factors, presumably presbyacusis, suggests a need for further study. The strategies for control of these risk factors and hearing aid support should be integrated into health care policy initiatives for elderly persons in sub-Saharan Africa.

Role of elevated immunoglobulin E levels in suppurative otitis media

Abstract Background and Objectives: An association between suppurative otitis media (SOM) and allergy has been reported in about 80% of patients with allergy. However, there is controversy regarding their relationship and the concept of middle-ear allergic response. We test the hypothesis that increased secretion of IgE in the middle ear is higher in chronic than in acute SOM. Methods: Allergy skin testing and enzyme-linked immunoassay of specimens of middle-ear secretions and sera were analysed. Results: Paired sera and middle-ear secretions (MES) from 37 subjects with SOM, 20 chronic (CSOM) and 17 acute (ASOM), and sera of 15 controls selected from children without otitis media were analysed. There were 30 males and 27 females aged between 6 months and 9 years, mean (SD) 6 years (3.26). A history of allergy and skin test positive to one or more of dust, house dust mite, mould, cockroach and poultry feathers were found in 80% of CSOM, 47% ASOM and 33% controls. The mean IgE levels in sera were: controls 52.1 mg/dL, ASOM 63.9 mg/dL and CSOM 79.2 mg/dL; the MES levels were: AOM 60.4 mg/dL and CSOM 102.0 mg/dL. The MES to serum IgE ratios were 0.75 for ASOM and 1.4 for CSOM. The serum IgE ratio of controls to ASOM was 1.22 and to CSOM was 1.5. Multivariate analysis of the mean showed significant correlation between IgE level of MES in ASOM and CSOM (p=0.04) but no correlation between IgE levels in control and ASOM sera (p=0.10), control and CSOM sera (p=0.7) or AOM and CSOM sera (p=0.3). Conclusion: Allergy appears to play a contributory role in CSOM and elevated IgE in the MES suggests a likely mucosal response.

The Inner Ear in Patients with Nasal Allergy

BACKGROUND The endolymphatic sac has been proposed as a target organ responsible for inner-ear symptom in allergic subjects. This is a report of inner-ear symptoms in patients with nasal allergy. METHOD Retrospective review of record charts of patients with known nasal allergy presenting to the otorhinolaryngology out-patient department of the University College Hospital, Ibadan in 5 years. RESULT Ear symptoms were found in 95/144 (66%) subjects with nasal allergy. This comprises of 41 males and 44 females (M: F = 1:1). Of these, itching of the external ear canal, hearing loss and tinnitus accounted for 63 (66%), 55 (58%) and 39 (41%), respectively, while vertigo was found in 12 (13%). Peripheral vestibular signs of imbalance were seen in 11/95. The audiological assessment of 73 subjects revealed normal pure-tone average in 43 (59%), and sensorineural hearing loss (SHL) in 17 (23.3%). The severity of SHL was mild in 6/17, moderate in 7 and moderate-to-severe in 4. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated in 10/15 (67%) and 6/15 (40%), while the skin sensitivity test showed reactions to dust in 32, cold in 25, cockroach in 7, perfume in 11, vegetable oil in 1 and insecticide in 2. The clinical diagnoses were idiopathic tinnitus in 25 (26.3%), Idiopathic SHL in 17 (18%), cochlear hydrop in 6 (6%) and autoimmune inner-ear disease in 6 (6%). CONCLUSION This report suggests some peculiar predisposition to inner-ear pathology in patients with nasal allergy. However a longitudinal assessment of cochleovestibular features of nasal allergy subjects will help in its validation.

Serum and Middle Ear Immunoglobulins in Suppurative Otitis Media

Background and Purpose: Despite the increasing occurrence of suppurative otitis media (SOM), the content of immunoglobulin fractions in the middle ear secretion (MES) has still not been determined. Method: The serum and MESwere analyzed for IgG and M using enzyme-linked immunoassay. Result: The subjects and controls were 30 males and 22 females, between 6 months and 9 years old, with a mean age of 6 years (SD = 3.26). The patient group included 20 chronic SOM (CSOM) and 17 acute SOM (ASOM) cases, and sera of 15 subjects made the control group. The mean serum IgG levels were for controls 1,051 mg/dl, ASOM 666.1 mg/dl and CSOM 1,321.1 mg/dl; the MES levels were for ASOM 203.4 mg/dl and CSOM 511.5 mg/dl. The mean serum IgM levels were for controls 35 mg/dl, ASOM 64.1 mg/dl and CSOM 40 mg/dl; the MES levels were for ASOM 22.59 mg/dl and CSOM 3.44 mg/dl. The mean MES:serum ratios for IgG and IgM were between 0.1 and 0.4 in ASOM and CSOM. The ratio of serum IgG levels of controls to ASOM cases was 0.66 while that of controls to CSOM was 1.3. The corresponding ratios of IgM were 1.6 and 0.88. Multivariate analysis revealed a significant correlation between serum IgG levels of ASOM and CSOM (p = 0.043) and MES IgG (p = 0.02) in ASOM and CSOM but no correlation between serum IgG levels in controls and ASOM (p = 0.25), serum IgM levels in controls and CSOM (p = 0.62) and serum IgM levels in controls and ASOM (p = 0.73), ASOM and CSOM (p = 0.064) and MES IgM levels of ASOM and CSOM (p = 0.06). Conclusions: Monitoring of the serum and MES IgG in ASOM may provide a useful index to assess the possibility of progression to chronicity. This forms a database for the immunological status of SOM patients.

Correlation between Serum Immunoglobulin G and Hearing Threshold among Elderly Subjects with Age-Related Hearing Loss

Background and Purpose: This study was based on the hypothesis that suboptimal immune response and low serum immunoglobulin G (IgG) may predispose to age-related hearing loss (ARHL), and the objective was to determine the serum levels of IgG and hearing thresholds of apparently healthy elderly subjects and assess their correlation. Method: This prospective study involved 126 participants ≧60 years old who were found to be free of any medical conditions. Pure-tone averages for both the speech (500–2,000 Hz) and high frequencies (3,000–8,000 Hz) and serum IgG levels were determined. Using 30 dB as cut-off for hearing loss, the correlation with serum IgG was assessed. Results: There were 59 males and 67 females with a mean age ± SD of 67.0 ± 2.7 years. Speech frequency hearing loss was seen in 30.2%, while high-frequency hearing loss accounted for 74.6%. In the speech frequencies, the mean ± SD of serum IgG among subjects with normal hearing was 11.3 ± 3.9 g/l, while among those with hearing loss it was 8.3 ± 3.3 g/l (p = 0.01). In the high frequencies, the mean ± SD values of serum IgG among the subjects with normal hearing was 11.1 ± 2.3 g/l, while among those with hearing loss it was 8.7 ± 1.9 g/l (p = 0.01). Conclusion: Low serum IgG may be a contributory factor to the development of ARHL among the elderly. However, a longitudinal study involving intervention with immunoglobulin supplementation may further confirm this role.

Correlation between plasma levels of radical scavengers and hearing threshold among elderly subjects with age-related hearing loss

Abstract Conclusion: Low plasma melatonin is significant in the development of high frequency hearing loss (HL) among the elderly. Objective: To determine the correlation between hearing threshold and the plasma melatonin and ascorbic acid (vitamin C). Methods: This was a cross-sectional study involving 126 apparently healthy elderly subjects, 59 males and 67 females, aged >60 years. Subjects underwent pure tone audiometry and plasma melatonin and vitamin C were assayed using high-performance liquid chromatography. Results: The mean ± SD of plasma melatonin among the subjects with normal hearing (NH) (0–30 dB) and those with HL in the speech frequencies was 18.3 ± 3.6 μg/L and 16.4 ± 4.7μg/L, respectively. In the high frequencies the values were 17.7 ± 6.2 μg/L and 13.1 ± 6.4μg/L for NH and HL, respectively. For vitamin C, the mean ± SD among subjects with NH and those with HL in the speech frequencies were 1.2 ± 0.2 μg/L and 1.0 ± 0.1 μg/L, respectively. In the high frequencies, the values were 1.0 ± 0.2 μg/L and 0.9 ± 0.3 μg/L for NH and HL, respectively. Among subjects with high frequency HL, Spearmans correlation revealed significant correlation between increasing hearing threshold and melatonin (correlation coefficient = –0.30, p = 0.01), but not for vitamin C (correlation coefficient = –0.12, p = 0.22). Linear regression, adjusting for age, still revealed significant correlation between the melatonin (correlation coefficient = –0.03, p = 0.00) and hearing threshold in the high frequencies.