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35 Cards in this Set
- Front
- Back
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Why should we care?
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Hearing loss potentially has a significant negative impact on communication and well-being
We, therefore, need to be familiar with the prevalence, nature, and consequences or age- related hearing loss NOTE: very chronic problem that will effect majority of population at some point in their lives. The way that we interact and enjoy life is by communicating with other people. (positive emotions). People are reluctant to get hearing assistance- some wait around 5-10 years to get assistance. Cause feuding/bickering between couples- blame each other for not listening or mumbling. Affects relationships. |
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Primary Complaint
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Difficulty understanding speech, especially when in noise
Partially related to peripheral hearing loss Partially related to changes in auditory processing Possibly related to cognitive decline Wide variations in changes in hearing sensitivity, reactions to hearing loss, and speech understanding problems among the elderly, in general, and genders NOTE: Most of the time people notice that they cannot understand speech clearly. Complaints about background noise (configuration and degree of hearing loss). Hearing loss due to aging is gradual. Causes people to not realize that they are losing their hearing. Forget what normal hearing is like. Neural system degrades as we age- may not be enough to be classified as neurological disorder. Too much going on at the same time- cannot process as quickly. Difficulty interpreting multiple things going on at once. Cannot necessarily be fixed with hearing aids. |
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Characteristics and Causes
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Typically gradually progressive
May be accompanied by tinnitus Men tend to have greater loss in high frequencies Women tend to have lesser degrees of HF loss and more LF loss Tends to have a flatter shape NOTE: hear buzzing, humming. Tinnitus: change of the outer hair cells. Men- different blood flow than women, occupational and social differences, ex: hunting, wood working. Women have a tendency to have flatter hearing loss because of blood flow. |
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Outer Ear Changes
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Cerumen tends to increase
Hair growth at opening to canal Cartilage starts to breakdown NOTE: More ear wax and greater tendency to be impacted because of dryness in skin. Hair looks very stiff (tree trunks compared to other hair on body)= makes it hard to fit hearing aids. Cartilage breaks down. Not as much rigidity. If you put an earphone on top of ear canal that is soft/droopy, causes it to collapse. Adds another hearing loss on top of what you have. (insert earphones for that problem) |
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Pinna changes
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Loss of elasticity, decrease of collagen, increase in size of ear and lobes and presence of creases, pigmentation spots, ulcerations/carcinomas primarily from sun exposure
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Chondrodermatitis
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PINNA
Tender pink ulceration on the helix or antihelix Occurs as a result of degeneration of the skin or cartilage from chronic sun exposure, pressure, or trauma |
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Squamous cell carcinoma
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PINNA
Appears as red-brown nodule 90+% occur on fair-skinned people on face or ears Primarily in elderly |
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Basal cell carcinoma
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PINNA
2nd most common malignant Tumor of pinna occurring more often in males Secondary to sun exposure |
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Notes about Peripheral (pinna) changes
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easier to scrape, more painful from loss of fat and neural ends being closer to the skin. Pigmentation spots and skin cancers on edge of ear because of lack of sunscreen and protection from the sun. Chondrodermatitis: people who did a lot of contact sports, wore headphones frequently. Squamous cell carcinoma: fair-cell. Basal cell carcinoma: more often in men because of sun exposure and eats away at the area more than the others. A cavity instead of a bump.
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Ear Canal Changes
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Skin atrophies and thins
More susceptible to cracking and bleeding with manipulation Reduction in Cerumen production= dryness, less protection Excessive amounts of Cerumen may be produced and/or epithelial migration may be inadequate leading to impaction EAM may narrow due to sagging of skin Greater risk of collapsing canals due to changes Use extreme care when doing Cerumen management NOTE: having to be aware of technique when taking ear molds to not manipulate the ear. Have to be careful when removing wax, because of increase of hair |
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Middle Ear Changes
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TM stiffens, thins, and becomes less vascular
ME muscles and ossicular ligaments atrophy and fiber degeneration Thinning and calcification of ossicular joints related to arthritis Calcification of ET cartilage and muscle atrophy Leads to more frequent OM Loss of ossicular and TM flexibility may result in air-bone gap often seen in elderly at 4K Hz Acoustic reflex amplitude and growth may be diminished (especially uncrossed- motor component) Weakened muscle and/or neural dysfunction |
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The Aging auditory system
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Great reduction in neuronal population
Negative effect on processing of complex stimuli (EG: degraded speech and sequential non-speech signals) |
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CANS
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Central Auditory Nervous System
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Central Auditory Nervous System
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Afferent signal transmission, Recoding, Binaural correlation, Frequency coding, Final processing of signal
Taking the information from your left ear and your right ear and putting it back together Reduction in neural inhibitory transmitters could produce a reduction in ability to suppress external noise, which could further degrade speech perception in noise your brain has two buckets, put important info in one, and non-important info in the other. As you get older the ability for your brain to separate the information is reduced. If you have two things going on at the same time, the ability for you to tune out one sound to focus on another. EX: conversation with the TV on. |
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Framingham Cohort
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revealed much of hearing loss is related to factors other than the aging process
had individuals come in for routine health tests every few years. Question them about their health. Documented how the people aged. Lifestyle, occupation, etc. found what is age-related vs. social and environmental. Found that it is not just aging that is causing hearing loss. It is many factors such as lifestyle, disease, occupation, environment. Hearing loss is occurring much earlier. Getting progressively worse with each generation |
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Psychoacoustic Measures
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Temporal processing --> gap detection
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Gap Detection
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ability to detect a brief silent interval in the stimulus waveform
Elder listeners have some limitations in temporal resolutions independent of peripheral hearing loss The extent is highly influenced by the listening task Greater difficulty with discrimination of duration, especially for speech (complex stimuli) |
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Age Related differences observed in Speech Perception
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Most likely to occur in 80+ population
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Temporarily distorted speech
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Longer reverberation times result in greater detrimental effects on speech recognition
Poorer performance in recognizing rapid speech Even worse if in noise or reverberation |
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Cognitive factors and speech
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When linguistic and semantic cues in speech are reduced or enhanced, the age- effects or correspondingly enhanced or reduced
Contextual cues enhance understanding Reduced availability of short-term memory functions under adverse listening conditions NOTE: doesn’t matter how clear it is, if you can’t remember what was being said at the beginning, you will not understand it. Short-term memory problems. Start to see decrease in understanding of speech. Ability to have contextual cues vs. isolation |
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Phonemic regression
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unusually poor word identification in comparison with hearing thresholds
May exhibit rollover in performance-intensity functions Occurs more among80+ |
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Presbycusis
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hearing loss attributed to again effects
“I can hear, but I can’t understand.” Impossible to distinguish it from associated issues with heredity, noise exposure, disease, ototoxicity, etc. NOTE: Presbycusis: age-related change to the middle ear – hair cells, etc. Doesn’t wake up and suddenly have hearing loss. Gradual. Can’t understand because they lose high frequency. Can hear because they hear low frequency. Sounds like Charlie Brown’s teacher. |
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What older people say about their hearing loss
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Frequent reports of hearing problems in those 65+
Those with mild to moderate losses report significant impact on communication and emotional reaction to difficulties Report less handicap than younger people with the same degree of loss May be related to slow progression of loss and fewer demands on hearing Women more often express feelings of frustration, anger, and stress associated with hearing loss |
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Attitudes about hearing loss
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Older women are more likely to
Admit to communication problems Assign more importance to effective communication Use nonverbal strategies to circumvent communication problems NOTE: more like to admit problems, tell spouse to better understanding |
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Hearing Handicap
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Handicap: the disadvantage resulting from impairment
Subjective Communication and personal adjustment problems related to hearing loss may not be eliminated by use of a hearing aid NOTE: very subjective. Impairment is the hearing loss- pure tone thresholds. Handicap- how we feel about the problem and how we are functioning. Hearing aid is not perfect. May not have perfect hearing after hearing aids. |
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Patients report feelings of
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Stress, low self-esteem, frustration, irritation, embarrassment, isolation, stigmatized, penalized at work, loss of self-confidence, loss of personal security, at-risk for misunderstanding, appearing ignorant
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Management of hearing aids
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Less than 25% of individuals who may benefit from hearing aids actually have them
35 million hearing impaired NOTE: a lot of people are suffering from the frustrations because they do not have hearing aids. Hearing aids are not like glasses where you get 20/20 vision back. Sometimes cannot make things as loud or clear as would like. Everyone has a different opinion of what their hearing should be. |
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The general goals of hearing aids
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To make sounds audible (gain)
Provide the widest frequency response possible Keep sounds from becoming uncomfortably loud Ideally… Softest sounds should be soft, average sounds should be average, loud sounds should be loud but not harmful NOTE: try and amplify as much as we can (in Hz)- widest frequency response possible. UCL- uncomfortable loudness levels. Tolerance of loudness tends to increase. Want to hear natural growth of sounds. Dynamic range: difference between where they can just barely hear sound to where it becomes uncomfortable |
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Implications of hearing aids
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Stigma, cost/benefit
Different considerations to make with hearing aids Vision, dexterity It takes time to get used to hearing aids NOTE: Stigma- you’re old, you still can’t hear well, ppl talk slow to you. Cost- $1000-$4000+ (hearing loss in both ears will double that). Benefit- will improve life. Hard to say what improvement of life is worth. Hearing aids need to be replaced every 5-7 years. We want to feel normal and look normal. Vision: have to handle small parts, batteries, etc. Dexterity: how long it takes you to adjust to hearing aids, the longer you have gone without hearing, the longer it will take to adjust. People who do not wear them regularly may never adjust |
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Motivation is key with hearing loss
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Must have family members or a support system that may be able to help out or be supportive
NOTE: if you are not motivated, you will not be successful. If they go in to prove everyone wrong, they will not be as successful as someone who goes in for themselves and wants to improve hearing |
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Motivation
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Having the impetus to seek out opportunities
Important cognitive factor that affects adaptation to chronic disease and resultant disability State of being that produces a tendency toward some type of action 4 Variable; Wants, expectations, reinforcement, cost of behavior Motivation= W x B x R / C Motivation is optimal when the person knows what they want, the person expects or believes it can be obtained, rewards associated with it are meaningful and the costs associated with it are meaningful |
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Motivation = W x B x R / C
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EX: want a new car x I really think I need one x my spouse wants one too / how much it costs. Is it more than what it will actually cost me? I want to be able to hear x I will be able to do this x my family supports me / financial cost, perceived loss of dignity, time consuming appointments. Equation will be the same for people, but the decision will be different. Psychological decision. Value it differently. Important to spend time talking to patients about what will motivate them.
These are all based on the person’s perceptions…not necessarily what others outside the situation perceive The likelihood of success as well as the expectancy factor is critical |
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Beliefs (B)
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Cognitive component of motivation
What a person acts upon Situation and/or task the person is facing, the future as the person sees it, and the person himself/herself A person must be optimistic about their capability to succeed at a task to actually succeed Belief in one’s capabilities will initiate behavior NOTE: before hearing test some people already decide they will fail, and never get test. People who have seen the benefits of hearing devices are more likely to think they will succeed. If you do not provide with praise, they will be less likely to want to work with you. Have to put yourself aside to help your patients do well. You can be the deciding factor to whether they are successful or not |
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Motivatio (M)
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Behavior is associated with some form of reward, reinforcement, positive feedback.
Cost pertains to effort, physical pain, emotional discomfort, threats to self esteem, money and time If costs are higher than the benefits a person will be unmotivated If benefits outweigh the cost, a person will be highly motivated. |
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Motivation as we age
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May require more and different reinforcement.
Older adults respond to more concrete goals that are immediate and affect daily function Fulfillment of safety and security needs are strong incentives Older adult need to be given reason to believe that improvement or success is possible prior to attempting a new technique or intervention Regular corrective feedback present in a nonthreatening, supportive manner will help reduce anxiety about a task, sustaining continued involvement, motivation and sense of success NOTE: make concrete goals to help motivate them |
