Dauman René
Unité médicale d'audiologie, université Victor-Segalen Bordeaux 2, groupe hospitalier Pellegrin, CHU de Bordeaux, 33076 Bordeaux cedex.
Rev Prat. 2009 May 20;59(5):625-9.
Auditory perception or hearing can be defined as the interpretation of sensory evidence, produced by the ears in response to sound, in terms of the events that caused the sound. We do not hear a window but we may hear a window closing. We do not hear a dog but we may hear a dog barking. And we do not hear a person but we may hear a person talking. Hearing impairment can result in anxiety or stress in everyday life. Pure-tone hearing loss (or threshold shift) is a measure of hearing impairment. Aging and excessive noise are the main causes of hearing impairment. Speech perception is another concept. The difference with the former is best illustrated by the disabled individual declaring "I can hear that someone is talking to me, but I don't understand what she says". Being unable to understand easily and clearly significant others, especially in understanding speech in a noisy environment, can give rise to considerable psychosocial and professional consequences (disability). Presbycusis is the decline in hearing sensitivity caused by the aging process at different levels of the auditory system. However, it is difficult to isolate age effects from other contributors to age-related hearing loss such as noise damage, genetic susceptibility, inflammatory otologic disorders, and ototoxic agents. Therefore, presbycusis and age-related hearing loss are often used synonymously. In this report pathophysiology is mostly described with regard to presbycusis, and the main peripheral types of presbycusis (sensory or Corti organ-related, strial, and neural) are summarized. An original experimental model of strial presbycusis, based on chronic application of furosemide at the round window, is further described. Central presbycusis is mainly determined by degeneration secondary to peripheral impairment (concept of deafferentation). Central auditory changes typically affect speed of processing and result in poorer speech understanding in noise or with rapid or degraded speech. Last, age-related cognitive factors can be associated to peripheral hearing impairment and increase disability in speech understanding in noise.
听觉感知或听力可被定义为耳朵对声音做出反应所产生的感官证据，依据引发声音的事件进行的解读。我们听不到一扇窗户，但我们可能听到窗户关闭的声音。我们听不到一只狗，但我们可能听到狗叫。我们听不到一个人，但我们可能听到一个人在说话。听力障碍会导致日常生活中的焦虑或压力。纯音听力损失（或听阈偏移）是衡量听力障碍的指标。衰老和过度噪音是听力障碍的主要原因。言语感知是另一个概念。与前者的差异最好通过残疾个体宣称“我能听到有人在跟我说话，但我不明白她说什么”来说明。无法轻松、清晰地理解重要他人，尤其是在嘈杂环境中理解言语，会引发相当大的心理社会和职业后果（残疾）。老年性聋是指在听觉系统不同层面由衰老过程导致的听力敏感度下降。然而，很难将年龄效应与其他导致年龄相关性听力损失的因素区分开来，如噪音损伤、遗传易感性、炎性耳科疾病和耳毒性药物。因此，老年性聋和年龄相关性听力损失常被同义使用。在本报告中，病理生理学主要针对老年性聋进行描述，并总结了老年性聋主要的外周类型（感觉性或与柯蒂氏器相关型、血管纹型和神经型）。进一步描述了一种基于在圆窗长期应用速尿的血管纹型老年性聋的原始实验模型。中枢性老年性聋主要由外周损伤继发的退化所决定（去传入概念）。中枢听觉变化通常会影响处理速度，导致在嘈杂环境中或言语快速或退化时言语理解能力变差。最后，与年龄相关的认知因素可能与外周听力障碍相关，并增加在嘈杂环境中言语理解的残疾程度。
