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Vision and Hearing Comorbidities
Ernest H. Rosenbaum, MD

Hearing Loss And Quality Of Life

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Get your eyes checked frequently. Use glasses or contact lenses as needed so that adjustments can be made in your vision prescription as our vision may continue to deteriorate.

Eye problems from cancer treatment such as: chemotherapy, radiation, hormonal, and bisphosphonate therapy may include; cataracts, blurry vision, impaired night vision, light sensitivity, dry or watery eyes, and pain.1,2,3 Drugs such as Prednisone and Dexamethasone may also cause cataracts.4

The use of light: Use adequate lighting at all times. This should especially include areas of greater difficulty like stairways. A night-light should be used in the bathroom and darkened areas.

The use of color: Use contrasting colors when designing a home or room for an older adult. This is helpful to make a clear delineation between the floor, the carpet and the wall. This assists with depth perception.

Pastel colors appear to have a calming affect, and bright colors appear to promote agitation.

Patterns: Smaller patterns on the carpet and furniture tend to cause more visual dizziness while larger patterns appear to be more protective. Well thought out placement of furniture can help prevent accidents

Hearing Loss And Quality Of Life
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It is not uncommon to lose some of the ability to hear, especially high-pitched tones of speech, as a sign of age-related hearing impairment. The official term is presbycusis, and this is one of the most common conditions of older adults. It can have a major effect on quality of life, as it affects social interactions. It affects about 31% of adults over age 65 and 75% over age 85.

The cause is often due to changes in the inner ear (cochlea), where tiny hairs pick up sound waves and transform them into nerve impulses that the brain interprets as speech, a car horn, or a ringing bell. These tiny cells can die with age or are damaged by excessive positive sound waves, such as loud music or sounds.

There is a relationship to family history and cardiovascular health, where blood flow to the inner ear can become deficient. Often, medications - antibiotics and chemotherapy drugs (Platinol)- can damage inner ear sound perception.

The result is social isolation, as people are often unaware of happenings around them or conversations. Certain high-pitched consonants, such as s or f, are more difficult to hear, often causing word confusion.

Frequently, small adjustments can be of help by standing closer to people or asking them to speak louder and trying not to be embarrassed because of hearing inability.

Losing your hearing can affect your social relationships with family and friends, in business, and in your social life. It has the potential to be an isolating experience.

Hearing loss is commonly accompanied by the loss of balance. The loss of balance jeopardizes the affected person because it increases the risk of falls and injuries.

In the United States, both loss of hearing and loss of balance among the elderly are two common problems. Imbalance, vertigo, and dizziness affect quality of life because they impair personal mobility. This can lead to a diminished sense of well-being and also increases the risk of falls and bone fracture which will limit daily activities.

It is important to get an appropriate analysis with an audiologist to confirm if there is a true hearing loss and what can be done to help reverse this with treatments compensating for hearing loss.

Hearing aids can make a big difference in quality of life; although, according to the NIH, only one in five people who could benefit from a hearing aid actually use it. They do work, but they must be personally selected, adjusted for each person's hearing and fitted for each person and situation. Cost is also a problem.

Hearing aids make speech louder and clearer but will not restore hearing to normal. Expectations are often too great and are not realized. Some find hearing aids uncomfortable, and, even if they have one, they often do not use it.

Exercise improves blood flow and may be helpful, but it is not curative. Physical activity is a priority to help keep one active and moving.

It is important to protect your ears from loud noises, especially after age 50. It is amazing how beneficial hearing aids can be, if used, and one often gains an appreciation of how much hearing and conversations were lost.

Hearing loss is often preventable if detected and treated early. It is important to remember that medications frequently affect hearing, as seen with chemotherapy and head radiation. Although hearing aids are commonly prescribed, only about one in five people use them consistently. With hearing aid recent technological advances with the reduction of size, hearing aids offer a convenient way to improve the hearing of many people.

1. Avoid large damaging noises, often seen in everyday activities, such as use of a hair dryer or lawnmower.
2. Avoid loud music, such as with MP3 players, which can cause hearing loss. Noise is a major problem, especially with advances in our society, and can be a cause of major hearing loss.
3. Check for excess earwax, which can block sound waves and diminish hearing.

Surgical cochlear implants have been able to restore hearing to many who have not benefited from a hearing aid.

Audiologists determine how and what you hear and can determine the need for specific therapy to help maintain or improve your hearing.

By preventing dizziness (vertigo), you can improve both your mobility and balance. Preserving your hearing and balance will help you enjoy life better. People often don't recognize hearing and balance loss because its gradual onset. Treatments can be very helpful, but if untreated, hearing loss can lead to isolation and depression.

Bernard Fisher, Joseph P. Costantino, D. Lawrence Wickerham, Reena S. Cecchini, Walter M. Cronin, Andre Robidoux, Therese B. Bevers, Maureen T. Kavanah, James N. Atkins, Richard G. Margolese, Carolyn D. Runowicz, Joan M. James, Leslie G. Ford, Norman Wolmark, Tamoxifen for the Prevention of Breast Cancer: Current Status of the National Surgical Adjuvant Breast and Bowel Project P-1 Study JNCI Journal of the National Cancer Institute 2005 97(22):1652-1662
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Neil S. Sharma, MB, BS, MPH, Ju-Lee Ooi, MB, BS, MPH, Katherine Masselos, MB, BS, Michael J. Hooper, MD, Ian C. Francis, MB, BS, PhD, Zoledronic Acid Infusion and Orbital Inflammatory Disease, NEJM, Volume 359:1410-1411, September 25, 2008
Hazin, Ribhi; Abuzetun, Jamil Y; Daoud, Yassine J; Abu-Khalaf, Maysa M, Ocular complications of cancer therapy: a primer for the ophthalmologist treating cancer patients, Current Opinion in Ophthalmology: July 2009 - Volume 20 - Issue 4 - p 308-317
Ying J. Hitchcock MD, Jonathan D. Tward MD, PhD, Aniko Szabo PhD, Brandon G. Bentz MD, and Dennis C. Shrieve MD, PhD, Relative Contributions of Radiation and Cisplatin-Based Chemotherapy to Sensorineural Hearing Loss in Head-and-Neck Cancer Patients, International Journal of Radiation Oncology Biology Physics Volume 73, Issue 3, 1 March 2009, Pages 779-788

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First appeared September 21, 2009