CSD 3000DEAFNESS IN SOCIETY

Topic 6The Deaf Adult

Older Adults

Changes in acuity usually begin around the third decade of life

Incidence increases sharply as we age

25%-40% of people over 65 have significant hearing loss

The figure changes to 90% by the time we reach our 80s

Hearing Loss and Aging

Presbycusis No clear etiology (cause) Possible sources include:

Noise exposure Genetics Vascular disease Systemic disease Diet Pollution Other

The Types of Presbycusis

Sensory PresbycusisSensory Presbycusiso Involves the

degeneration of hair cells and supporting cells at the base of the cochlea

o Hearing tests show abruptly sloping progressive high frequency hearing loss

The Types of Presbycusis

n Neural Presbycusis

o Involves the loss of cochlear neurons

o Hearing tests show high frequency hearing loss with very poor speech discrimination ability

The Types of Presbycusis

Strial or Metabolic Presbycusis

o Involves the degeneration of the stria vascularis which disrupts the nutrient supply of the Organ of Corti

o Hearing tests show a flat hearing loss across frequency

The Types of Presbycusis

Mechanical Presbycusis

o Involves alterations to cochlear mechanics produced by stiffness changes within the basilar membrane

o Hearing tests show a sloping hearing loss across frequency

Audiologic Characteristics Associated with Aging

Acuity:Changes in pure

tone sensitivity among older adults emerges gradually as age increases.

Average Hearing Thresholds as a Function of

Age and Gender

n Two trends are clear from these data:1) Both males and females exhibit loss in sensitivity at age

60 and older, especially in the higher frequencies2) Threshold values for males are poorer, overall, than for

females

Audiologic Characteristics Associated with Aging

Loudness:

Recruitment Abnormal growth of

loudness commonly associated with damage to the cochlea

Due directly to the reduced dynamic range

Makes the ear more sensitive to loud sounds

Audiologic Characteristics Associated with Aging

Speech Perception:

Speech perception suffers as we age, even if we control for the change in sensitivity associated with aging

Average Speech Identification Performance as a Function of Age and Degree of Hearing Loss

n This figure makes clear that even when we control for the degree of hearing loss, older people have generally poorer speech understanding performance

Psychosocial Aspects of Acquired Hearing Loss

Characteristics of acquired hearing loss: Gradual and progressive A problem of comprehension rather than acuity Listening in noise Can no longer listen passively Following and remembering details of conversation

DenialStress

Response to the Initial Diagnosis

Most times, the results are expected, but the person can still feel: Sad Worried Fear Disappointment Anger

Psychological Effects

Reactive vs proactive Denial Uncertainty Frustration Anger Stress

Other Issues

Effect of hearing loss on the transmission of the message

Reactions from listeners

Other Issues

Effect of hearing loss on the family Sociological effects

Interference of social efficiency Stigma

Reasons Why Adults Don’t Seek Help for Their

Hearing Loss1. Association with aging

Reasons Why Adults Don’t Seek Help for Their

Hearing Loss1. Association with aging2. Association with a new challenge

Reasons Why Adults Don’t Seek Help for Their

Hearing Loss1. Association with aging2. Association with a new challenge3. Association with disability

Reasons Why Adults Don’t Seek Help for Their

Hearing Loss1. Association with aging2. Association with a new challenge3. Association with disability4. Cosmetic focus

Reasons Why Adults Don’t Seek Help for Their

Hearing Loss1. Association with aging2. Association with a new challenge3. Association with disability4. Cosmetic focus5. High cost

Reasons Why Adults Don’t Seek Help for Their

Hearing Loss1. Association with aging2. Association with a new challenge3. Association with Disability4. Cosmetic Focus5. High Cost6. Unrealistic expectations

Aural Rehabilitation The first step is the fitting of proper

amplification These devices can minimize

conversational difficulty and maximize the use of residual hearing

Their objective is to make speech audible without introducing further distortion and to restore a range of loudness experience

• Selecting the Hearing Aid Candidate

1. Degree of hearing loss

• Selecting the Hearing Aid Candidate

1. Degree of hearing loss2. Motivation

• Selecting the Hearing Aid Candidate

1. Degree of hearing loss2. Motivation3. Acceptance of hearing loss

• Selecting the Hearing Aid Candidate

1. Degree of hearing loss2. Motivation3. Acceptance of hearing loss4. Cosmetic concerns

Initial Adjustment to Amplification

Importance of realistic expectations Hearing will not be returned to normal Liking hearing aids to eyeglasses is

not appropriate

Learning to listen again

Initial Adjustment to Amplification

Getting maximum benefit from amplification requires motivation, perseverance, and patience

Coming to terms with negative feelingsWorking through some of the initial

problemsBackground noise is very disturbingyour own voice sounds different the hearing aid sounds tinny or metallic the presence of something foreign in your earsonly understanding parts of words or phrases

Initial Adjustment to Amplification

Suggestions to make the initial adjustment easier:

1. Begin with a comfortable volume2. Begin with easier listening settings and

activities3. Don’t become overly tired4. Relearn the art of active listening5. Be realistic about how long the adjustment

will take

The Aural Rehabilitation Program Beyond

AmplificationThe program must address the specific

problems related to hearing loss and offer suggestions to how to minimize them

Participants must learn to modify the four major factors in communication settings that affect understanding

The talkerThe messageThe environmentThemselves

The Aural Rehabilitation Program Beyond

AmplificationModel for training

1. Formal instruction2. Guided learning3. Real-world practice

Inclusion of the “significant other”1. Foster empathy for the difficulty of

speechreading2. Encourage the use of appropriate speaking

behaviors3. Learn how to tailor messages so they are easy

to recognize4. Learn how to repair communication

breakdowns effectively

The Class

General content areas: Information about the causes and treatment of

hearing loss Information about the implications of their own

hearing loss--especially within the family Opportunity to review and share experiences

with the group Ways to develop realistic expectations Information regarding hearing aid management Information on the importance and benefit of

speechreading

Speechreading

Salient factors affecting speechreading performance

Visibility of speech sounds1. Visibility of the articulators needed to

make the sound2. Degree to which the sound is

distinguishable from another

Articulatory Classification System

Speechreading

Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech

Speechreading

Salient factors affecting speechreading performance:Visibility of speech soundsRate of speechSpeaker characteristics

How much do the articulators move? How expressive is the speaker? Does the speaker use a lot of gestures? How familiar is the speaker to the “listener”?

Speechreading

Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech Speaker characteristics Environmental characteristics

Speechreading

Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech Speaker characteristics Environmental characteristics Characteristics of the speechreader

IQ? Ability to synthesize and willingness to guess Hearing status? age

Assertiveness Training Situations where assertive

behavior can enhance understanding

Characteristics of assertive behavior

What Hearing People Can Do Clear Speech Visual Contact Auditory Contact Get the person’s attention Reducing cross-talk