Hearing Loss In Older Adults

Front 1

Hearing Loss: Why we care

Back 1

Potentially has a significant negative impact on communication and well-being.

Front 2

Primary Complaint

Back 2

Difficulty understanding speech, esp. when in noise.
Partially related to peripheral HL.
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 elderly and in general, genders.

Front 3

Characteristics and causes.

Back 3

Typically gradually progressive.
May be accompanied by tinnitus.
Men tend to have greater loss in the high freq.
Women tend to have lesser degrees of high freq. loss and more low freq loss. (flatter shape. )

Front 4

Aging Auditory System

Back 4

Changes can occur anywhere along pathway from outer ear to cortex.
Great reduction in neuronal population.
Negative effect on processing of complex stimuli (degraded speech and sequential non-speech signals.)

Front 5

Aging Auditory System: Outer ear.

Back 5

Cerumen tends to increase.
Hair growth at opening to canal
Cartilage starts to breakdown.

Front 6

Peripheral: Pinna

Back 6

Loss of elasticity.
Decrease in collagen.
Increase in size of ear and lobes + presence of creases.
Pigmentation spots.
Ulcerations/carcinomas primarily from sun exposure.

Front 7

Chondrodermatitis (Pinna)

Back 7

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.

Front 8

Squamous Cell Carcinoma (Pinna)

Back 8

Appears as a red-brown nodule.
90%+ occur on fair skinned people on face or ears.
Primarily in elderly.

Front 9

Basal Cell Carcinoma (Pinna)

Back 9

Second most common malignant.
Tumor occurring most often in males.
Secondary to sun exposure.

Front 10

Ear Canal (Age Changes.)

Back 10

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.

Front 11

Middle Ear (Age Changes)

Back 11

TM stiffens, thins, and becomes less vascular.
ME muscles and ossicular ligaments atrophy and fiber degeneration.
Thinning and calcification or ossicular joints related to arthritis.
Calcification of ET cartilage and muscle atrophy. (Leads to frequent otitis media.)
Loss of ossicular and TM flexibility may result in air-bone gap, often seen in elderly at 4KHz.
Acoustic reflex amplitude and growth may be diminished (esp. uncrossed motor component).
Weakened muscle and/or neural dysfunction.

Front 12

CANS

Back 12

Afferent signal transmission
Recoding
Binaural correlation
Frequency coding.
Final processing signal.

Front 13

CANS (more)

Back 13

Reduction in neural inhibitory transmitters could produce a reduction in ability to suppress external noise, which could further degrade speech perception in noise.

Front 14

Hearing Thresholds

Back 14

Framingham Cohort.
HL is related to factors other than aging process.
Early monitoring of extended HF in younger adults considered at risk may help with early identification of loss and aggressive management to prevent or reduce HL.

Front 15

Psychoacoustic Measures: Temporal Processing

Back 15

Elder listeners have some limitations in temporal resolutions independent of peripheral HL.
Extent is highly influenced by listening task.
Greater difficulty with discrimination of duration, esp. for speech.

Front 16

Gap detection

Back 16

ability to detect a brief silent interval in the stimulus waveform.

Front 17

Frequency and Intensity discrimination

Back 17

Aging effect on both suggests a common mechanism underlying the age-related deficit.

Front 18

Speech Perception: Speech in Noise.

Back 18

Age related differences observed.
Most likely to occur in 80+ pop.

Front 19

Speech Perception: Temporally distorted speech.

Back 19

Longer reverberation times result in greater detrimental effects on speech recognition.
Poorer performace in recognizing rapid speech.
Even worse if in noise or reverberation.

Front 20

Speech Perception: Cognitive Factors and speech.

Back 20

When linguistic and semantic cues in speech are reduced or enhanced, age-effects are correspondingly enhanced or reduced.
Contextual cues enhance understanding.
Reduced availability of short-term memory functions under adverse listening conditions.

Front 21

Phonemic Regression.

Back 21

Unusually poor word identification in comparison with hearing thresholds.
May exhibit rollover performance-intensity functions.
Occurs more among 80+

Front 22

Presbycusis

Back 22

Hearing loss attributed to aging effects.
Impossible to distinguish from associated issues with heredity, noise exposure, disease, ototoxicity, etc.

Front 23

What old people say about hearing loss.

Back 23

Freq. reports of hearing problems in 65+.
Those with mild to moderate losses report significant impact on communication and emotional reaction to difficulties.
Report less handicap than younger people with 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 HL.

Front 24

Attitudes about Hearing Loss

Back 24

Older women more likely to...
Admit to communication prob.
Assign more importance to effective communication.
Use nonverbal strategies to circumvent communication problems.

Front 25

Hearing Handicap

Back 25

Subjective.
Communication and personal adjustment problems related to HL may not be eliminated by use of a hearing aid.

Front 26

Feelings of...

Back 26

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.

Front 27

Management of Hearing Loss

Back 27

Less than 25% of people who may benefit from hearing aids actually have them.
35 million hearing impaired.

Front 28

Goals of hearing aids

Back 28

To make sounds audible (gain)
Provide widest freq. response possible.
Keep sounds from becoming uncomfortably loud.
Ideally, soft sounds should be soft, etc.

Front 29

Hearing aid Implications and Considerations

Back 29

Stigma
Cost/Benefit
Vision
Dexterity

Front 30

Motivation (4 variables.)

Back 30

Wants
Expectations
Reinforcement
Cost of behavior
If cost is higher than benefits ->unmotivated.

Front 31

Motivation as we age.

Back 31

May require more and different reinforcement.
Respond to more concrete goals that are immediate and affect daily function.
Fulfillment of safety and security needs are strong incentives.
Older adults 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.