CSD 3000 DEAFNESS IN SOCIETY

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CSD 3000DEAFNESS IN SOCIETY

• Topic 6
• The Deaf Adult

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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

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Hearing Loss and Aging

• Presbycusis
• No clear etiology (cause)
• Possible sources include
• Noise exposure
• Genetics
• Vascular disease
• Systemic disease
• Diet
• Pollution
• Other

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The Types of Presbycusis

• Sensory Presbycusis
• Involves the degeneration of hair cells and
  supporting cells at the base of the cochlea
• Hearing tests show abruptly sloping progressive
  high frequency hearing loss

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The Types of Presbycusis

• Neural Presbycusis
• Involves the loss of cochlear neurons
• Hearing tests show high frequency hearing loss
  with very poor speech discrimination ability

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The Types of Presbycusis

• Strial or Metabolic Presbycusis
• Involves the degeneration of the stria vascularis
  which disrupts the nutrient supply of the Organ
  of Corti
• Hearing tests show a flat hearing loss across
  frequency

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The Types of Presbycusis

• Mechanical Presbycusis
• Involves alterations to cochlear mechanics
  produced by stiffness changes within the basilar
  membrane
• Hearing tests show a sloping hearing loss across
  frequency

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Audiologic Characteristics Associated with Aging

• Acuity
• Changes in pure tone sensitivity among older
  adults emerges gradually as age increases.

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Average Hearing Thresholds as a Function of Age
and Gender

• Two trends are clear from these data
• Both males and females exhibit loss in
  sensitivity at age 60 and older, especially in
  the higher frequencies
• Threshold values for males are poorer, overall,
  than for females

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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

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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

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

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

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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
• Denial
• Stress

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Response to the Initial Diagnosis

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

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Psychological Effects

• Reactive vs proactive
• Denial
• Uncertainty
• Frustration
• Anger
• Stress

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Other Issues

• Effect of hearing loss on the transmission of the
  message
• Reactions from listeners

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Other Issues

• Effect of hearing loss on the family
• Sociological effects
• Interference of social efficiency
• Stigma

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Reasons Why Adults Dont Seek Help for Their
Hearing Loss

• Association with aging

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Reasons Why Adults Dont Seek Help for Their
Hearing Loss

• Association with aging
• Association with a new challenge

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Reasons Why Adults Dont Seek Help for Their
Hearing Loss

• Association with aging
• Association with a new challenge
• Association with disability

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Reasons Why Adults Dont Seek Help for Their
Hearing Loss

• Association with aging
• Association with a new challenge
• Association with disability
• Cosmetic focus

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Reasons Why Adults Dont Seek Help for Their
Hearing Loss

• Association with aging
• Association with a new challenge
• Association with disability
• Cosmetic focus
• High cost

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Reasons Why Adults Dont Seek Help for Their
Hearing Loss

• Association with aging
• Association with a new challenge
• Association with Disability
• Cosmetic Focus
• High Cost
• Unrealistic expectations

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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

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Selecting the Hearing Aid Candidate

• Degree of hearing loss

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Selecting the Hearing Aid Candidate

• Degree of hearing loss
• Motivation

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Selecting the Hearing Aid Candidate

• Degree of hearing loss
• Motivation
• Acceptance of hearing loss

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Selecting the Hearing Aid Candidate

• Degree of hearing loss
• Motivation
• Acceptance of hearing loss
• Cosmetic concerns

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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

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Initial Adjustment to Amplification

• Getting maximum benefit from amplification
  requires motivation, perseverance, and patience
• Coming to terms with negative feelings
• Working through some of the initial problems
• Background noise is very disturbing
• your own voice sounds different
• the hearing aid sounds tinny or metallic
• the presence of something foreign in your ears
• only understanding parts of words or phrases

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Initial Adjustment to Amplification

• Suggestions to make the initial adjustment
  easier
• Begin with a comfortable volume
• Begin with easier listening settings and
  activities
• Dont become overly tired
• Relearn the art of active listening
• Be realistic about how long the adjustment will
  take

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The Aural Rehabilitation Program Beyond
Amplification

• The 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 talker
• The message
• The environment
• Themselves

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The Aural Rehabilitation Program Beyond
Amplification

• Model for training
• Formal instruction
• Guided learning
• Real-world practice
• Inclusion of the significant other
• Foster empathy for the difficulty of
  speechreading
• Encourage the use of appropriate speaking
  behaviors
• Learn how to tailor messages so they are easy to
  recognize
• Learn how to repair communication breakdowns
  effectively

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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

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Speechreading

• Salient factors affecting speechreading
  performance
• Visibility of speech sounds
• Visibility of the articulators needed to make the
  sound
• Degree to which the sound is distinguishable from
  another

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Articulatory Classification System
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Speechreading

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

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Speechreading

• Salient factors affecting speechreading
  performance
• Visibility of speech sounds
• Rate of speech
• Speaker 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?

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Speechreading

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

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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

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Assertiveness Training

• Situations where assertive behavior can enhance
  understanding
• Characteristics of assertive behavior

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What Hearing People Can Do

• Clear Speech
• Visual Contact
• Auditory Contact
• Get the persons attention
• Reducing cross-talk