Hearing Impairment In The Elderly

Front 1

epidemiology of hearing loss

Back 1

-prevalence increase with age
10% of adults 65-75 yo
-smokers have higher rates of hearing loss

Front 2

older adults with hearing loss

Back 2

-less likely to participate in social or solitary activities
-report more sx of depression

Front 3

hAGE-RELATED CHANGES THAT CAN INTERFERE WITH HEARING

Back 3

External ear canal: walls thin
Cerumen: becomes drier, more tenacious
Eardrum: thickens, appears duller
Cochlea: hair cells are lost (Outer Hair Cells most vulnerable), basilar membrane stiffens, auditory structures calcify, cochlear neurons are lost

Front 4

location of hair cell loss influences threshold

Back 4

-50-75% loss of OHC in apex – mild loss
-50% loss of OHC near base – moderate to severe loss

Front 5

conductive hearing loss

Back 5

1. external ear pathology:
-ceruminosis
-foreign body
2. middle-ear path
-osteosclerosis
-cholesteatoma
-TM perforation
-middle ear effusion
-Air conduction thresholds are greater than bone conduction thresholds, most likely due to middle ear pathology.

Front 6

sensorineural hearing loss

Back 6

-most often from age, noise damagem or ortotoxicity
1. cochlear dz: most common cause
-Air and bone conduction thresholds are the same, most likely due to inner ear damage. The high-frequency pattern of this patient’s hearing loss is typical

Front 7

presbycusis

Back 7

-"older hearing"
-sensorineural hearing loss, usually symmetrical, may have central components
-classified by pathology:
1. sensory
2. neural
3. strial
4. cochlear conductive
5. combined
-amplification often helps

Front 8

contributors to presbycusis

Back 8

cumulative effects of environmental noises
hereditary factors
health
side effects of some medications

Front 9

hallmarks of presbycusis

Back 9

-type: sensorineural
-freq specific: high frequency hearing loss
-speech understanding: loss of freq resolution, temporal discrimination
-earS: bilat
-equality b/t ears: symmetrical
-severity: mild- mod
-gradual
-can hear ppl talk byt cant make out the words!
-misunderstand what others are saying
-appar forgetful

Front 10

presbycusis- presenting features

Back 10

-speech of others sounds mumbled or slurred
-high pitched sounds such as "s" or "th" are hard todistinguish
-conversations are difficult to understand, particularly with background noise
-mens voices easier to hear than womens
-some sounds seem overly loud and annoying
-tinnitus may occur in 1 or both ears

Front 11

diagnosis of hearing loss in primary care

Back 11

-Audioscope: Screens for hearing loss at selected frequencies (0.5, 1, 2, and 4 KHz) and at two loudness levels (25 and 40 dB HL)
-screening questionnaire
-hearing loss screener: 3+ points is a positive score indicating the need for further eval

Front 12

when to refer

Back 12

1. Otolaryngolosit: Consult for asymmetrical hearing loss, which may indicate tumor of posterior pharynx blocking eustachian tube or auditory nerve tumor

2. Audiologist: Consult to determine the presence and type of hearing loss, recommend and fit hearing aids, and provide auditory rehabilitation

Front 13

treatment of hearing loss

Back 13

1. assistive listening devices
-pocket sized personal amplifiers
-telephone equipment
-tv listening devices
-vibrating alarms
2. hearing aids
3. cochlear implants
4. communication strategies

Front 14

assitive listening devices

Back 14

-increase the loudness of a desired sound without increasing the loudness of the background noise
-ALDs are also used ot visually alert the person to sounds from the doorbell, telephone, fire alarm and other sounds that the listener may not consistently hear
-less $$
-ideal for selected pts and settigns

Front 15

hearing aids

Back 15

-2 usually better than 1
-not everyone benefits ie those with
1. central auditory processing problems
2. poor speech discrimination
3. dementia
-2 types: analog, digital
-many styles

Front 16

styles of hearing aids

Back 16

1. completely in the canal
2. in the canal
3. in the ear
4. behind the ear
5. body aid

Front 17

completely in the canal hearing aid

Back 17

-for mild to mod hearing loss
-almost invisible, more natural sound, easier to use with phone
-dexterity may be a problem
-small size may limit features
-may cost more
-shorter battery life

Front 18

in the canal hearing aids

Back 18

-for mild to mod hearing loss
-more appealing, use with headphones
-dexterity a problem
-small size may limit features

Front 19

in the ear hearing aids

Back 19

-for mild to severe loss
-easy, comfortable, more power
-more conspicuous
-may be difficult to use with headphones

Front 20

behind the ear aids

Back 20

-for mild to profound loss
-greatest power, most options, earmold can be changed
-more conspicuous

Front 21

body hearing aids

Back 21

-for severe to profoundloss
-Greatest separation of microphone from receiver reduces feedback
-most conspicuous

Front 22

values of hearing aids

Back 22

-users more socially active
-less tension, and anxiety
-sig others notice improvements in psychosocial function
-improved life satisfaction for successful users!
-functional independence!

Front 23

most common problems reported by new hearing aid users

Back 23

1. Difficulty hearing someone whispering
2. Difficulty hearing the television/radio
3. Difficulty hearing at a party
4. Difficulty hearing in a restaurant
5. Difficulty hearing in a group

Front 24

greatest areas of improvement following 3 months of hearing aid use

Back 24

1. Less frustration felt when talking to family members
2. Less difficulty when listening to television and radio
3. Less difficulty at a party
4. Less difficulty when visiting friends/relatives
5. No longer feel left out of groups

Front 25

benefits of hearing aids

Back 25

-found 3-6 wks post fitting
-benefits demonstrated and sustained throughout 1 yr
-Up to 80% of older adults experience significant reductions associated with hearing aid use

-acclimization takes about 3 months

Front 26

cochlear implant

Back 26

-Electronic device that bypasses the function of damaged or absent cochlear hair cells by providing electrical stimulation to cochlear nerve fibers
-Outcomes for adults > 65 years are comparable to those of younger adults, with excellent audiologic and quality-of-life measures

Front 27

communication strategies

Back 27

1. obtain listeners attention
2. eliminate or reduce background noise
3. be sure the listener can see the speakers lips
4. speak slowly and clearly, but avoid shouting
5. speak toward the better ear
6. use alternate phrasing when not understood
7. spell words out, use gestures or write them
8. have listener repeat what he or she has heard