Presbycusis, name signs and symptoms, etiology and differential diagnosis.

by | Feb 12, 2025 | Analysis

Define presbycusis, name signs and symptoms, etiology and differential diagnosis.
Create 3 interventions-education measures with a patient with Presbycusis.
List, define and elaborate on three different retinal and macular diseases age-related.

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Presbycusis:

  • Definition: Presbycusis is age-related hearing loss. It’s a gradual, progressive, usually symmetrical hearing loss that typically affects the high-frequency sounds first. It’s a very common condition in older adults.

  • Signs and Symptoms:

    • Gradual hearing loss, often starting with high-pitched sounds (e.g., difficulty hearing birdsong, the voices of women and children).
    • Difficulty understanding speech, especially in noisy environments. Conversations in restaurants or crowded rooms become challenging.
    • Tinnitus (ringing, buzzing, or hissing in the ears).
    • Difficulty hearing consonants, leading to misinterpretations of words (e.g., “cat” vs. “hat”).
    • Perceived muffled or distorted sounds. Speech may sound unclear even if loud enough.
    • Increased difficulty understanding speech in group settings.
    • Needing to turn up the volume of the television or radio excessively.

  • Etiology: Presbycusis is multifactorial, meaning it has several contributing causes, and the exact mix varies by individual:

    • Changes in the inner ear (Cochlea): This includes degeneration of the hair cells in the cochlea, which are responsible for converting sound waves into electrical signals that the brain can interpret. Supporting cells and structures can also deteriorate.

Presbycusis:

  • Definition: Presbycusis is age-related hearing loss. It’s a gradual, progressive, usually symmetrical hearing loss that typically affects the high-frequency sounds first. It’s a very common condition in older adults.

  • Signs and Symptoms:

    • Gradual hearing loss, often starting with high-pitched sounds (e.g., difficulty hearing birdsong, the voices of women and children).
    • Difficulty understanding speech, especially in noisy environments. Conversations in restaurants or crowded rooms become challenging.
    • Tinnitus (ringing, buzzing, or hissing in the ears).
    • Difficulty hearing consonants, leading to misinterpretations of words (e.g., “cat” vs. “hat”).
    • Perceived muffled or distorted sounds. Speech may sound unclear even if loud enough.
    • Increased difficulty understanding speech in group settings.
    • Needing to turn up the volume of the television or radio excessively.

  • Etiology: Presbycusis is multifactorial, meaning it has several contributing causes, and the exact mix varies by individual:

    • Changes in the inner ear (Cochlea): This includes degeneration of the hair cells in the cochlea, which are responsible for converting sound waves into electrical signals that the brain can interpret. Supporting cells and structures can also deteriorate.
    • Changes in the auditory nerve: The nerve that carries sound information from the inner ear to the brain can also degenerate with age, reducing the fidelity of the signal.
    • Exposure to loud noise: Prolonged or repeated exposure to loud noises throughout life (occupational, recreational, etc.) can damage the hair cells in the cochlea, accelerating or mimicking presbycusis.
    • Genetic predisposition:

      Some people may be genetically more susceptible to age-related hearing loss.

    • Medical conditions: Certain medical conditions, such as diabetes, high blood pressure, heart disease, and thyroid problems, can contribute to presbycusis by affecting blood flow to the inner ear.
    • Medications (Ototoxicity): Certain medications (ototoxic drugs), including some antibiotics, chemotherapy drugs, and even high doses of aspirin, can damage the inner ear and lead to or worsen hearing loss.

  • Differential Diagnosis: It’s important to differentiate presbycusis from other causes of hearing loss:

    • Noise-induced hearing loss: Can occur at any age and often has a characteristic “notch” on the audiogram (hearing test) related to the specific frequencies affected.
    • Ototoxicity: A careful medication history is essential.
    • Impacted cerumen (earwax): A simple examination of the ear canal can reveal this.
    • Meniere’s disease: Characterized by episodes of vertigo (dizziness), tinnitus, fluctuating hearing loss, and a feeling of fullness in the ear.
    • Acoustic neuroma: A benign tumor on the auditory nerve, often causing unilateral (one-sided) hearing loss, tinnitus, and balance problems.
    • Ear infections: Can cause various types of hearing loss, often accompanied by pain, drainage, or fever.

Three Intervention/Education Measures for Presbycusis:

  1. Hearing Aids: A thorough hearing evaluation by an audiologist is crucial. Discuss the benefits and limitations of hearing aids. Explain the different types available (behind-the-ear, in-the-ear, etc.) and help the patient choose the best fit for their needs, lifestyle, and budget. Provide detailed instructions on how to use, clean, and maintain the hearing aids, including battery care and volume adjustment. Emphasize the importance of regular follow-up appointments with the audiologist for adjustments and ongoing support.

  2. Communication Strategies: Educate the patient and their family members on effective communication strategies. This includes:

    • Optimizing the listening environment: Suggest minimizing background noise (turning off the TV during conversations, choosing quieter locations in restaurants).
    • Positioning: Advise the patient to face the speaker directly, as lip reading and facial expressions can provide valuable cues.
    • Clear speech: Encourage family members to speak clearly and at a moderate pace, avoiding shouting (which can distort speech).
    • Rephrasing: Suggest using different words or phrases if the patient doesn’t understand something the first time.
    • Written communication: For complex information or important conversations, consider using written notes or emails.

  3. Hearing Protection and Prevention: Educate the patient about protecting their remaining hearing and preventing further damage. This includes:

    • Noise avoidance: Advise limiting exposure to loud noises (concerts, power tools, etc.).
    • Hearing protection: Recommend using earplugs or earmuffs when exposed to unavoidable loud noises.
    • Regular checkups: Emphasize the importance of regular hearing checkups with an audiologist to monitor hearing levels and make necessary adjustments to hearing aids or treatment plans.

Three Age-Related Retinal and Macular Diseases:

  1. Age-Related Macular Degeneration (AMD): A leading cause of vision loss in older adults. It affects the macula, the central part of the retina responsible for sharp, detailed vision. AMD blurs central vision, making it difficult to read, recognize faces, or drive. There are two main types:  

    • Dry AMD (atrophic): Characterized by the gradual thinning of the macula and the presence of drusen (yellow deposits) beneath the retina. Vision loss is usually slow and progressive.
    • Wet AMD (exudative): Characterized by the growth of abnormal blood vessels beneath the retina, which can leak fluid and blood, causing rapid and severe vision loss.  

  2. Cataracts: Clouding of the natural lens of the eye. Cataracts cause blurred or hazy vision, glare (especially at night), and difficulty seeing in low light. They can also affect color perception. Cataracts are very common with age and are typically treated with surgery to replace the cloudy lens with an artificial lens.

  3. Diabetic Retinopathy: A complication of diabetes that affects the blood vessels in the retina. High blood sugar levels can damage these vessels, causing them to leak fluid or blood, or to grow abnormally. Diabetic retinopathy can lead to blurred vision, floaters, dark spots, and even blindness. It’s crucial for people with diabetes to have regular eye exams to detect and treat diabetic retinopathy early.

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