Dual sensory impairment

Specialty: Geriatrics.

• combined sensory loss
• acquired deafblindness of the elderly
• multiple sensory deprivation in the elderly

Why it occurs

• Bilateral sensorineural presbycusis associated with chronic age-related macular degeneration (AMD)
• Bilateral dense cataracts concomitant with moderate-severe presbycusis or central auditory neuropathy
• Advanced proliferative diabetic retinopathy combined with hearing loss induced by cumulative pharmacological ototoxicity (high-dose loop diuretics, aminoglycosides)
• Severe bilateral open-angle glaucoma associated with conductive presbycusis due to otosclerosis or chronic earwax impaction
• Late systemic degenerative neurosensory syndromes or sequelae of previous meningitis

Initial workup

Comprehensive ophthalmological evaluation (measurement of visual acuity with adapted optotypes, applanation tonometry to rule out glaucoma, fundus examination under mydriasis to evaluate macula and retina); complete otorhinolaryngological evaluation (bilateral otoscopy to rule out earwax plugs, adapted tonal and verbal audiometry); global cognitive assessment using validated tests free of sensory interference (scales adapted for the blind or hard of hearing); ergonomic evaluation of the home by an occupational therapist.

Standard management

• Withdrawal of all potentially ototoxic medication — furosemide in high doses, acetylsalicylic acid in anti-inflammatory doses, aminoglycosides
• Artificial tears based on sodium hyaluronate without preservatives — application of 1 drop in each eye 3 to 4 times a day to reduce eye irritation that worsens visual quality
• Specific treatment of wet AMD using intravitreal injections of anti-VEGF — ranibizumab or aflibercept, prescribed by ophthalmology if baseline visual acuity and general condition justify the intervention
• Earwax softening ear drops (sodium carbonate solution or mineral oils) to facilitate the atraumatic removal of plugs.