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Presbiakuzi: Patofizyoloji, Değerlendirme ve Güncel Yaklaşımlar

Yıl 2021, Sayı: 15, 657 - 668, 31.12.2021
https://doi.org/10.38079/igusabder.971019

Öz

Dünya nüfusu içinde yaşlı nüfusu giderek artmaktadır ve yaşa bağlı işitme kaybı daha yaygın hale gelmektedir. Yaşlanmaya bağlı olarak zamanla gelişen işitme kaybı presbiakuzi olarak tanımlanmaktadır. Presbiakuzinin yeterince teşhis edilmediği ve yeterince rehabilite edilmediği bilinmektedir. Bu derlemenin amacı, yaşlılarda yaygın olarak görünen presbiakuzinin prevelansı, patofizyolojisi, değerlendirme yöntemleri, tedavi ve rehabilitasyonu hakkında literatürde yer alan önemli kaynaklardan bilgileri sunmaktır. Presbiakuzide en çok tercih edilen rehabilitasyon şekli işitme cihazlarıdır. Erken teşhis ve erken cihazlandırmanın önemi konusunda farkındalık oluşturmak amaçlanmıştır. Ayrıca hastalığın patofizyolojisini anlamak; yaklaşımlar geliştirmek, işitme cihazları, yardımcı dinleme sistemleri ve işitsel terapi için sağlanan kaynakları genişletmek için büyük önem taşıyacaktır. İşitme bozukluğu olan kişiler için etkili cihazlarının kullanımı ve eğitim stratejileri, yaşlıların yaşam kalitesi üzerinde olumlu etkiyi ortaya çıkartmaktadır.

Kaynakça

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  • Gates GA, Mills JH. Presbycusis. Lancet. 2005;366(9491):1111-1120. doi:10.1016/S0140-6736(05)67423-5.
  • Pearlman RC. Presbycusis: the need for a clinical definition. The American journal of otology. 1982;3:183–186.
  • Zahnert T. The differential diagnosis of hearing loss. Dtsch Arztebl Int. 2011;108(25):433-444. doi:10.3238/arztebl.2011.0433.
  • Arvin B, Prepageran N, Raman R. "High frequency presbycusis"-is there an earlier onset? Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 3):480-484. doi:10.1007/s12070-011-0356-x.
  • World Health Organization. Age-related factors. World Health Organization. https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/highlighting-priorities-for-ear-and-hearing-care. Yayınlanma tarihi Mart 2021. Erişim tarihi 03 Ağustos 2021.
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  • T.C. Aile, Çalışma ve Sosyal Hizmetler Bakanlığı. Engelli Nufüs. https://www.ailevecalisma.gov.tr/media/42250/istatistik-bulteni-2020-mart.pdf. Yayınlanma tarihi Mart 2020. Erişim tarihi 12 Haziran 2021.
  • Ma A, Jufas N, Patel N. Hearing loss in the elderly. Australian Doctor News. https://www.ausdoc.com.au/. Yayınlanma tarihi Mayıs 2020. Erişim tarihi 03 Ağustos 2021.
  • Wang J, Puel J-L. Presbycusis: an update on cochlear mechanisms and therapies. Journal of Clinical Medicine. 2020;9(1):218. https://doi.org/10.3390/jcm9010218.
  • Goycoolea MV, Goycoolea HG, Farfan CR, Rodriguez LG, Martinez GC, Vidal R. Effect of life in industrialized societies on hearing in natives of Easter Island. Laryngoscope. 1986;96(12):1391-1396. doi:10.1288/00005537-198612000-00015.
  • Kurata N, Schachern PA, Paparella MM, Cureoglu S. Histopathologic evaluation of vascular findings in the cochlea in patients with presbycusis. JAMA Otolaryngol Head Neck Surg. 2016;142(2):173-178. doi:10.1001/jamaoto.2015.3163.
  • Schuknecht HF, Gacek MR. Cochlear pathology in presbycusis. Ann Otol Rhinol Laryngol. 1993;102(1 Pt 2):1-16. doi:10.1177/00034894931020S101.
  • Suzuki T, Nomoto Y, Nakagawa T, et al. Age-dependent degeneration of the stria vascularis in human cochleae. Laryngoscope. 2006;116(10):1846-1850. doi:10.1097/01.mlg.0000234940.33569.39.
  • Gratton MA, Smyth BJ, Lam CF, Boettcher FA, Schmiedt RA. Decline in the endocochlear potential corresponds to decreased Na,K-ATPase activity in the lateral wall of quiet-aged gerbils. Hear Res. 1997;108(1-2):9-16. doi:10.1016/s0378-5955(97)00034-8.
  • Le T, Keithley EM. Effects of antioxidants on the aging inner ear. Hear Res. 2007;226(1-2):194-202. doi:10.1016/j.heares.2006.04.003.
  • Spicer SS, Schulte BA. Spiral ligament pathology in quiet-aged gerbils. Hear Res. 2002;172(1-2):172-185. doi:10.1016/s0378-5955(02)00581-6.
  • Hao X, Xing Y, Moore MW, et al. Sox10 expressing cells in the lateral wall of the aged mouse and human cochlea. PLoS One. 2014;9(6):e97389. doi:10.1371/journal.pone.0097389.
  • Gordon‐Salant S, Frisina RD, Popper AN, Fay RR. The aging auditory system. 1st ed. New York, NY: Springer; 2010:9-38.
  • Wangemann P. Supporting sensory transduction: cochlear fluid homeostasis and the endocochlear potential. J Physiol. 2006;576(Pt 1):11-21. doi:10.1113/jphysiol.2006.112888.
  • Lang H, Jyothi V, Smythe NM, Dubno JR, Schulte BA, Schmiedt RA. Chronic reduction of endocochlear potential reduces auditory nerve activity: further confirmation of an animal model of metabolic presbyacusis. J Assoc Res Otolaryngol. 2010;11(3):419-434. doi:10.1007/s10162-010-0214-7.
  • Dubno JR, Eckert MA, Lee FS, Matthews LJ, Schmiedt RA. Classifying human audiometric phenotypes of age-related hearing loss from animal models. J Assoc Res Otolaryngol. 2013 ;14(5):687-701. doi: 10.1007/s10162-013-0396-x.
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  • Nakazawa K, Spicer SS, Schulte BA. Ultrastructural localization of Na,K-ATPase in the gerbil cochlea. J Histochem Cytochem. 1995;43(10):981-991. doi:10.1177/43.10.7560888.
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  • Ryan AF, Watts AG. Expression of mRNAs encoding alpha and beta subunit isoforms of the Na,K-ATPase in the rat cochlea. Mol Cell Neurosci. 1991;2(2):179-187. doi:10.1016/1044-7431(91)90011-c.
  • Schulte BA, Adams JC. Distribution of immunoreactive Na+,K+-ATPase in gerbil cochlea. J Histochem Cytochem. 1989;37(2):127-134. doi:10.1177/37.2.2536055.
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Presbycusis: Pathophysiology, Evaluation and Current Approaches

Yıl 2021, Sayı: 15, 657 - 668, 31.12.2021
https://doi.org/10.38079/igusabder.971019

Öz

The elderly population is increasing in the world population, and age-related hearing loss is becoming more common. Hearing loss that develops over time due to aging is defined as presbycusis. It is known that presbycusis is underdiagnosed and not adequately rehabilitated. The aim of this review is to present information from important sources in the literature about the prevalence, pathophysiology, evaluation methods, treatment and rehabilitation of presbycusis, which is common in the elderly. The most preferred form of rehabilitation for presbycusis is hearing aids. It is aimed to raise awareness about the importance of early diagnosis and early instrumentation. Also, understanding the pathophysiology of the disease will be crucial for developing approaches and expanding the resources available for hearing aids, assistive listening systems and auditory therapy. The use of effective devices and educational strategies for people with hearing impairment can have a positive impact on the quality of life of the elderly.

Kaynakça

  • Roosa D. Presbykousis. Trans Am Otol Soc. 1885;449–460.
  • Gates GA, Mills JH. Presbycusis. Lancet. 2005;366(9491):1111-1120. doi:10.1016/S0140-6736(05)67423-5.
  • Pearlman RC. Presbycusis: the need for a clinical definition. The American journal of otology. 1982;3:183–186.
  • Zahnert T. The differential diagnosis of hearing loss. Dtsch Arztebl Int. 2011;108(25):433-444. doi:10.3238/arztebl.2011.0433.
  • Arvin B, Prepageran N, Raman R. "High frequency presbycusis"-is there an earlier onset? Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 3):480-484. doi:10.1007/s12070-011-0356-x.
  • World Health Organization. Age-related factors. World Health Organization. https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/highlighting-priorities-for-ear-and-hearing-care. Yayınlanma tarihi Mart 2021. Erişim tarihi 03 Ağustos 2021.
  • Wattamwar K, Qian ZJ, Otter J, et al. Increases in the rate of age-related hearing loss in the older old. JAMA Otolaryngol Head Neck Surg. 2017;143(1):41-45. doi:10.1001/jamaoto.2016.2661.
  • T.C. Aile, Çalışma ve Sosyal Hizmetler Bakanlığı. Engelli Nufüs. https://www.ailevecalisma.gov.tr/media/42250/istatistik-bulteni-2020-mart.pdf. Yayınlanma tarihi Mart 2020. Erişim tarihi 12 Haziran 2021.
  • Ma A, Jufas N, Patel N. Hearing loss in the elderly. Australian Doctor News. https://www.ausdoc.com.au/. Yayınlanma tarihi Mayıs 2020. Erişim tarihi 03 Ağustos 2021.
  • Wang J, Puel J-L. Presbycusis: an update on cochlear mechanisms and therapies. Journal of Clinical Medicine. 2020;9(1):218. https://doi.org/10.3390/jcm9010218.
  • Goycoolea MV, Goycoolea HG, Farfan CR, Rodriguez LG, Martinez GC, Vidal R. Effect of life in industrialized societies on hearing in natives of Easter Island. Laryngoscope. 1986;96(12):1391-1396. doi:10.1288/00005537-198612000-00015.
  • Kurata N, Schachern PA, Paparella MM, Cureoglu S. Histopathologic evaluation of vascular findings in the cochlea in patients with presbycusis. JAMA Otolaryngol Head Neck Surg. 2016;142(2):173-178. doi:10.1001/jamaoto.2015.3163.
  • Schuknecht HF, Gacek MR. Cochlear pathology in presbycusis. Ann Otol Rhinol Laryngol. 1993;102(1 Pt 2):1-16. doi:10.1177/00034894931020S101.
  • Suzuki T, Nomoto Y, Nakagawa T, et al. Age-dependent degeneration of the stria vascularis in human cochleae. Laryngoscope. 2006;116(10):1846-1850. doi:10.1097/01.mlg.0000234940.33569.39.
  • Gratton MA, Smyth BJ, Lam CF, Boettcher FA, Schmiedt RA. Decline in the endocochlear potential corresponds to decreased Na,K-ATPase activity in the lateral wall of quiet-aged gerbils. Hear Res. 1997;108(1-2):9-16. doi:10.1016/s0378-5955(97)00034-8.
  • Le T, Keithley EM. Effects of antioxidants on the aging inner ear. Hear Res. 2007;226(1-2):194-202. doi:10.1016/j.heares.2006.04.003.
  • Spicer SS, Schulte BA. Spiral ligament pathology in quiet-aged gerbils. Hear Res. 2002;172(1-2):172-185. doi:10.1016/s0378-5955(02)00581-6.
  • Hao X, Xing Y, Moore MW, et al. Sox10 expressing cells in the lateral wall of the aged mouse and human cochlea. PLoS One. 2014;9(6):e97389. doi:10.1371/journal.pone.0097389.
  • Gordon‐Salant S, Frisina RD, Popper AN, Fay RR. The aging auditory system. 1st ed. New York, NY: Springer; 2010:9-38.
  • Wangemann P. Supporting sensory transduction: cochlear fluid homeostasis and the endocochlear potential. J Physiol. 2006;576(Pt 1):11-21. doi:10.1113/jphysiol.2006.112888.
  • Lang H, Jyothi V, Smythe NM, Dubno JR, Schulte BA, Schmiedt RA. Chronic reduction of endocochlear potential reduces auditory nerve activity: further confirmation of an animal model of metabolic presbyacusis. J Assoc Res Otolaryngol. 2010;11(3):419-434. doi:10.1007/s10162-010-0214-7.
  • Dubno JR, Eckert MA, Lee FS, Matthews LJ, Schmiedt RA. Classifying human audiometric phenotypes of age-related hearing loss from animal models. J Assoc Res Otolaryngol. 2013 ;14(5):687-701. doi: 10.1007/s10162-013-0396-x.
  • Bredberg G. Cellular pattern and nerve supply of the human organ of corti: a preliminary report. Arch Otolaryngol. 1965;82(5):462–469. doi:10.1001/archotol.1965.00760010464003.
  • Liberman MC, Kiang NY. Acoustic trauma in cats: Cochlear pathology and auditory-nerve activity. Acta Otolaryngol Suppl. 1978;358:1-63.
  • Wu PZ, Liberman LD, Bennett K, et al. Primary neural degeneration in the human cochlea: Evidence for hidden hearing loss in the aging ear. Neuroscience. 2019;407:8-20. doi:10.1016/j.neuroscience.2018.07.053.
  • Makary CA, Shin J, Kujawa SG, Liberman MC, Merchant SN. Age-related primary cochlear neuronal degeneration in human temporal bones. J Assoc Res Otolaryngol. 2011;12(6):711-717. doi:10.1007/s10162-011-0283-2.
  • Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after "temporary" noise-induced hearing loss. J Neurosci. 2009;29(45):14077-14085. doi:10.1523/JNEUROSCI.2845-09.2009.
  • Fransen E, Bonneux S, Corneveaux JJ, et al. Genome-wide association analysis demonstrates the highly polygenic character of age-related hearing impairment. Eur J Hum Genet. 2015;23(1):110-115. doi:10.1038/ejhg.2014.56.
  • Vuckovic D, Mezzavilla M, Cocca M, et al. Whole-genome sequencing reveals new insights into age-related hearing loss: cumulative effects, pleiotropy and the role of selection. Eur J Hum Genet. 2018;26(8):1167-1179. doi:10.1038/s41431-018-0126-2.
  • Nakazawa K, Spicer SS, Schulte BA. Ultrastructural localization of Na,K-ATPase in the gerbil cochlea. J Histochem Cytochem. 1995;43(10):981-991. doi:10.1177/43.10.7560888.
  • Ding B, Walton JP, Zhu X, Frisina RD. Age-related changes in Na, K-ATPase expression, subunit isoform selection and assembly in the stria vascularis lateral wall of mouse cochlea. Hear Res. 2018;367:59-73. doi:10.1016/j.heares.2018.07.006.
  • Ryan AF, Watts AG. Expression of mRNAs encoding alpha and beta subunit isoforms of the Na,K-ATPase in the rat cochlea. Mol Cell Neurosci. 1991;2(2):179-187. doi:10.1016/1044-7431(91)90011-c.
  • Schulte BA, Adams JC. Distribution of immunoreactive Na+,K+-ATPase in gerbil cochlea. J Histochem Cytochem. 1989;37(2):127-134. doi:10.1177/37.2.2536055.
  • Madreiter-Sokolowski CT, Sokolowski AA, Waldeck-Weiermair M, Malli R, Graier WF. Targeting mitochondria to counteract age-related cellular dysfunction. Genes. 2018; 9(3):165. doi.org/10.3390/genes9030165.
  • Pickles JO. Mutation in mitochondrial DNA as a cause of presbyacusis. Audiol Neurootol. 2004;9(1):23-33. doi:10.1159/000074184.
  • Gates GA, Schmid P, Kujawa SG, Nam B, D'Agostino R. Longitudinal threshold changes in older men with audiometric notches. Hear Res. 2000;141(1-2):220-228. doi:10.1016/s0378-5955(99)00223-3.
  • Kujawa SG, Liberman MC. Acceleration of age-related hearing loss by early noise exposure: Evidence of a misspent youth. J Neurosci. 2006;26(7):2115-2123. doi:10.1523/JNEUROSCI.4985-05.2006.
  • Lin HW, Furman AC, Kujawa SG, Liberman MC. Primary neural degeneration in the guinea pig cochlea after reversible noise-induced threshold shift. J Assoc Res Otolaryngol. 2011;12(5):605-616. doi:10.1007/s10162-011-0277-0.
  • Johnsson LG, Hawkins JE Jr. Degeneration patterns in human ears exposed to noise. Ann Otol Rhinol Laryngol. 1976;85(6 PT. 1):725-739. doi:10.1177/000348947608500603.
  • Mills JH, Schmiedt RA, Kulish LF. Age-related changes in auditory potentials of mongolian gerbil. Hear Res. 1990;46(3):201-210. doi:10.1016/0378-5955(90)90002-7.
  • Brien JA. Ototoxicity associated with salicylates: A brief review. Drug Saf. 1993;9(2):143-148. doi:10.2165/00002018-199309020-00006.
  • Hoffman DW, Whitworth CA, Jones KL, Rybak LP. Nutritional status, glutathione levels, and ototoxicity of loop diuretics and aminoglycoside antibiotics. Hear Res. 1987;31(3):217-222. doi:10.1016/0378-5955(87)90190-0.
  • Rybak LP, Whitworth C, Somani S. Application of antioxidants and other agents to prevent cisplatin ototoxicity. Laryngoscope. 1999;109(11):1740-1744. doi:10.1097/00005537-199911000-00003.
  • Nies E. Ototoxic substances at the workplace: a brief update. Arh Hig Rada Toksikol. 2012;63(2):147-152. doi:10.2478/10004-1254-63-2012-2199.
  • Bielefeld EC, Tanaka C, Chen GD, Henderson D. Age-related hearing loss: is it a preventable condition?. Hear Res. 2010;264(1-2):98-107. doi:10.1016/j.heares.2009.09.001.
  • Jiang M, Karasawa T, Steyger PS. Aminoglycoside-induced cochleotoxicity: a review. Front Cell Neurosci. 2017;11:308. doi:10.3389/fncel.2017.00308.
  • Steyger PS, Cunningham LL, Esquivel CR, Watts KL, Zuo J. Editorial: cellular mechanisms of ototoxicity. Front Cell Neurosci. 2018;12:75. doi:10.3389/fncel.2018.00075.
  • Watson N, Ding B, Zhu X, Frisina RD. Chronic inflammation - inflammaging - in the ageing cochlea: A novel target for future presbycusis therapy. Ageing Res Rev. 2017;40:142-148. doi:10.1016/j.arr.2017.10.002.
  • Guerra J, Devesa J. Hormone therapy: Challenges for treating hearing impairments. SN Compr Clin Med. 2019:603-615. https://doi.org/10.1007/s42399-019-00089-y.
  • Kidd Iii AR, Bao J. Recent advances in the study of age-related hearing loss: a mini-review. Gerontology. 2012;58(6):490-496. doi:10.1159/000338588.
  • Shen H, Lin Z, Lei D, Han J, Ohlemiller KK, Bao J. Old mice lacking high-affinity nicotine receptors resist acoustic trauma. Hear Res. 2011;277(1-2):184-191. doi:10.1016/j.heares.2011.01.009.
  • Lang H, Schulte BA, Zhou D, Smythe N, Spicer SS, Schmiedt RA. Nuclear factor kappaB deficiency is associated with auditory nerve degeneration and increased noise-induced hearing loss. J Neurosci. 2006;26(13):3541-3550. doi:10.1523/JNEUROSCI.2488-05.2006.
  • Charitidi K, Meltser I, Canlon B. Estradiol treatment and hormonal fluctuations during the estrous cycle modulate the expression of estrogen receptors in the auditory system and the prepulse inhibition of acoustic startle response. Endocrinology. 2012;153(9):4412-4421. doi:10.1210/en.2012-1416.
  • Kim TS, Chung JW. Evaluation of age-related hearing loss. Korean J Audiol. 2013;17(2):50-53. doi:10.7874/kja.2013.17.2.50.
  • Schubert K. A new audiometer and results obtained with its use. Z Laryngol Rhinol Otol. 1951;30(1):11-26. doi: 10.7162/S1809-97772013000300005.
  • American Academy of Otolaryngology and the American Council of Otolaryngology. Guide for the evaluation of hearing handicap. JAMA. 1979;241(19):2055–2059. doi:10.1001/jama.1979.03290450053025.
  • Çekiç S. Gürültüde Konuşmayı Anlama Testi [yüksek lisans tezi]. Ankara, Türkiye: Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü; 2006.
  • Pyykkö I, Zou J, Schrott-Fischer A, Glueckert R, Kinnunen P. An overview of nanoparticle based delivery for treatment of inner ear disorders. Methods Mol Biol. 2016;1427:363-415. doi:10.1007/978-1-4939-3615-1_21.
  • Miller RA. Evaluating evidence for aging. Science. 2005;310(5747):441-443. doi:10.1126/science.310.5747.441.
  • Ren H, Chen J, Wang Y, Zhang S, Zhang B. Intracerebral neural stem cell transplantation improved the auditory of mice with presbycusis. Int J Clin Exp Pathol. 2013;6(2):230.
  • Löhler J, Cebulla M, Shehata Dieler W, Volkenstein S, Völter C, Walther LE. Hearing impairment in old age. Dtsch Arztebl Int. 2019;116(17):301-310. doi:10.3238/arztebl.2019.0301.
  • Ko J. Presbycusis and its management. Br J Nurs. 2010;19(3):160-165. doi:10.12968/bjon.2010.19.3.46536.
  • Nilsson P, Vesterager V, Sibelle P, Sieck L, Christensen B. A double-blind cross-over study of a non-linear hearing aid. Audiology. 1997;36(6):325-338. doi:10.3109/00206099709071983.
  • Yueh B, Souza PE, McDowell JA, et al. Randomized trial of amplification strategies. Arch Otolaryngol Head Neck Surg. 2001;127(10):1197-1204. doi:10.1001/archotol.127.10.1197.
  • Contrera KJ, Wallhagen MI, Mamo SK, Oh ES, Lin FR. Hearing Loss Health Care for Older Adults. J Am Board Fam Med. 2016;29(3):394-403. doi:10.3122/jabfm.2016.03.150235.
  • Han JH, Lee HJ, Jung J, Park EC. Effects of self-reported hearing or vision impairment on depressive symptoms: a population-based longitudinal study. Epidemiol Psychiatr Sci. 2019;28(3):343-355. doi:10.1017/S2045796018000045.
  • Baraldi Gdos S, de Almeida LC, Borges AC. Hearing loss in aging. Braz J Otorhinolaryngol. 2007;73(1):58-64. doi:10.1016/s1808-8694(15)31123-x.
  • Most T, Aviner C. Auditory, visual, and auditory-visual perception of emotions by individuals with cochlear implants, hearing AIDS, and normal hearing. J Deaf Stud Deaf Educ. 2009;14(4):449-464. doi:10.1093/deafed/enp007.
  • Better Hearing Institute. Hearing Healthcare Professionals. Obtido de Better Hearing, Institute. Better Hearing. https://betterhearing.org/hearingpedia/hearing-care-professionals/. Yayınlanma tarihi 2015. Erişim tarihi 11 Ağustos 2021.
  • Linssen AM, Joore MA, Theunissen EJ, Anteunis LJ. The effects and costs of a hearing screening and rehabilitation program in residential care homes for the elderly in the Netherlands. Am J Audiol. 2013;22(1):186-189. doi:10.1044/1059-0889(2013/12-0058).
  • Bernabei V, Morini V, Moretti F, et al. Vision and hearing impairments are associated with depressive anxiety syndrome in Italian elderly. Aging Ment Health. 2011;15(4):467-474. doi:10.1080/13607863.2011.562483.
Toplam 71 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Betül Özdemir 0000-0002-2184-9818

Yayımlanma Tarihi 31 Aralık 2021
Kabul Tarihi 8 Aralık 2021
Yayımlandığı Sayı Yıl 2021 Sayı: 15

Kaynak Göster

APA Özdemir, B. (2021). Presbiakuzi: Patofizyoloji, Değerlendirme ve Güncel Yaklaşımlar. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi(15), 657-668. https://doi.org/10.38079/igusabder.971019
AMA Özdemir B. Presbiakuzi: Patofizyoloji, Değerlendirme ve Güncel Yaklaşımlar. IGUSABDER. Aralık 2021;(15):657-668. doi:10.38079/igusabder.971019
Chicago Özdemir, Betül. “Presbiakuzi: Patofizyoloji, Değerlendirme Ve Güncel Yaklaşımlar”. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi, sy. 15 (Aralık 2021): 657-68. https://doi.org/10.38079/igusabder.971019.
EndNote Özdemir B (01 Aralık 2021) Presbiakuzi: Patofizyoloji, Değerlendirme ve Güncel Yaklaşımlar. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi 15 657–668.
IEEE B. Özdemir, “Presbiakuzi: Patofizyoloji, Değerlendirme ve Güncel Yaklaşımlar”, IGUSABDER, sy. 15, ss. 657–668, Aralık 2021, doi: 10.38079/igusabder.971019.
ISNAD Özdemir, Betül. “Presbiakuzi: Patofizyoloji, Değerlendirme Ve Güncel Yaklaşımlar”. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi 15 (Aralık 2021), 657-668. https://doi.org/10.38079/igusabder.971019.
JAMA Özdemir B. Presbiakuzi: Patofizyoloji, Değerlendirme ve Güncel Yaklaşımlar. IGUSABDER. 2021;:657–668.
MLA Özdemir, Betül. “Presbiakuzi: Patofizyoloji, Değerlendirme Ve Güncel Yaklaşımlar”. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi, sy. 15, 2021, ss. 657-68, doi:10.38079/igusabder.971019.
Vancouver Özdemir B. Presbiakuzi: Patofizyoloji, Değerlendirme ve Güncel Yaklaşımlar. IGUSABDER. 2021(15):657-68.

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