On 08 March 2025, Seniors Today hosted their weekly Health Live Webinar with a Senior ENT Surgeon, Dr Shama Kovale who spoke on and answered questions about ENT Care for Healthy Ageing.
About Dr Shama Kovale
Dr Shama Kovale is Consultant, ENT Surgeon and Voice and Swallowing Consultant at the Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai
ENT care for healthy ageing includes how to take care of your ear, nose and throat when you’re ageing.
The first thing that we notice among the ear, nose and throat are the changes we experience as we age are in the ear.
Nose does not have a lot of changes as we age other than drying of nose or allergies.
In the throat, as we age, one can experience difficulty in swallowing, change in voice.
Normally, in the process of hearing, when the sound waves travel, they enter and are collected by the external ear canal and it hits the eardrum. Once the sound waves hit the eardrum, there are 3 bones behind the eardrum, in the middle. The sounds hitting the eardrum move the eardrum which in turn moves the bones in the middle ear. From here, these sound waves are transmitted into the inner ear. In the inner ear, the sound waves are converted into electric waves and stimulus. These are then transmitted to the brain and that is how you hear/ sound is perceived.
As you age, the cochlea in the inner ear and the nerve becomes weak, resulting in hearing loss. This loss of ageing because of age is called presbycusis.
Presbycusis is a gradual loss of hearing over a period of time.
One in three adults suffer from presbycusis.
Presbycusis mostly affects the high pitched sounds such as phone ringing.
Causes can also include:
- Inner ear injuries
- Damage to the nerve to the brain
- Continuous exposure to loud sounds
- Hereditary
- Associated co morbid conditions such as diabetes, hypertension
- Side effects of certain medications
- Chemo drugs
Symptoms of hearing loss:
- loss of clarity of sound
- High pitched sounds are hard to distinguish
- Difficulty in hearing in places with a background noise
- You hear mens voice better than women’s sound s
- Loud sounds become annoying
- Ringing/ buzzing/ hissing sound may also be heard
Investigations done for a patient complaining of hearing loss includes:
- Ear and ear drum is checked externally
- Pure tone audiometry- tells us about the extent of hearing loss
Treatment includes hearing aids. You can also go for a cochlear implant, however that also depends on the general condition of the patient.
Prevention of hearing loss can include:
- If the hearing loss is hereditary, it cannot be prevented
- It is preventable in case you’re taking drugs that are causing the hearing loss. These medications can be substituted or changed
- Avoid exposure to loud noises
- Do not use earbuds
- Protection from loud noises. This is also why head phones/ earphones are discouraged. Try using it for no longer than 60 minutes per day and at a volume that is 60% less than the total volume of the system
As we age, the voice becomes very feeble, the volume becomes less. This is because the vocal folds become thin because of muscle atrophy. When the muscle mass is lost, the vocal fold cannot come close together completely, resulting in a change in the quality of the voice.
The neck muscles also become stiff and atrophied, thereby affecting the voice quality.
The loss in the quality of speech as a result of ageing is called prebyphonia.
Symptoms include:
- Men can have a high pitched voice and low pitched in women
- Loss of projection
- Loss of volume to the voice, making it feeble
- Your endurance for taking for longer durations reduces
- Tremors in the voice can be heard
- Breathy voice
Management of a patient suffering from voice changes include:
- Examining the voice box
- Voice analysis
Treatment depends on the symptoms. Depending on whether your voice is too pitchy, or if you have a weak voice or a breathy voice, the treatment changes.
In case of a breathy voice, the treatment includes giving fillers in the vocal folds.
For tremors in the voice, there are medications, botox and fat injections
These can be followed up with voice therapy.
Fillers are not a permanent treatment. If fillers do not work, the patient can be given fat injections. If that fails, there is a surgery which is the Thyroplasty.
Voice therapy is done for all patients with voice problems.
Swallowing can also be a problem, mostly seen in patients with neurological problems such as Parkinsonism or Myasthenia Gravis.
