Hearing Impairment In Older Adults

Saunders, G.H. and Echt, K.V., An Overview of Dual Sensory Impairment in Older Adults: Perspectives for Rehabilitation; Trends in Amplification: Vol. 11, No. 4, December 2007; pp 243-258.

Deterioration of hearing like other senses begins early and continues as we grow older. The degree of decline differs across individuals, much as the degree of decline for other physical systems. It is related to heredity, genetics, aging and environmental factors. This does not mean that hearing loss should be accepted passively – especially not when it affects one’s quality of life and communication with family and friends. Surprisingly many older adults in particular live with a hearing loss for years – even when help is within easy reach.

Reduction in hearing is often considered a common part of aging. The medical term used to describe this is presbycusis. If your mother or father has hearing loss it is likely that you will also. However, environmental factors may play a role in hearing loss as well. While hereditary/genetic factors, to a large degree cannot be changed, we do have control over environmental factors. The biggest environmental factor involved in hearing decline is noise. Noise particularly affects the sensory (hair) cells within the cochlea. If you have ever attended a concert where loud music was played, you may have experienced a “muffled sensation” upon leaving the concert. This is known as temporary threshold shift. Loud music has the effect of “flattening” the hair cells and causing a temporary loss of hearing. Allowing the ears to rest after the concert will result in a recovery of the threshold shift. If you allow your ears to be exposed to loud sounds repeatedly, permanent threshold shift will ensue leaving you with a permanent loss of hearing. Initially, you may not experience significant problems. You may find yourself misunderstanding certain sounds, making confusions between “s”, “f” and “th” sounds and feeling that you can hear, but not understand. Initial noise exposure results in loss of high frequency (high-pitched) sounds. With repeated exposure, there is a greater range of frequencies that are affected. When an individual notices that he must ask people to repeat things more and more frequently, at this point it may be time to consider amplification.

When Should You Consider a Hearing Aid?

Deciding whether or not to try a hearing aid is an important decision and one which a lot of individuals would like to avoid. After all, hearing aids conjure up images of elderly people like your grandfather, who walked around with a device that had a long wire going from the hearing aid to his ear. Fortunately, we have come a long way with hearing aids since that time. Devices today are more discreet and sophisticated and can provide a tremendous benefit. Additionally, we have come to look at older people in a new light. Individuals are living longer, working longer and have a desire to have full and active lives. Hearing aids can add to the quality of this life. The image we have had of older people with hearing loss is actually an image of individuals who remained unaided, frequently asking for repetitions and blaming others for not speaking clearly. Studies have shown that it is not hearing aids that the public perceives as a sign of old age, but rather individuals choosing to remain unaided that is perceived as “old”. We live in an age of technology that we have never seen before. It is a common occurrence to see individuals walking down the street with iPods, MP3 players, cell phones and blue tooth devices. With all of this technology at the ears of a good portion of the population on a daily basis, the concern over the visibility of a hearing aid, which is much smaller than most of these devices seems illogical. Fortunately, hearing aids have been able to take advantage of this high technology as well. Not only are hearing aids today more discreet, but the sound quality is better than it has ever been before.

What should I expect with hearing aids?

When you have reached the point where you have decided that a hearing aid is an appropriate choice for you, it is important to approach it with realistic expectations. Your hearing loss likely came on very gradually and so too, your orientation to amplification should be gradual. If you are like most people, you have probably had your hearing loss for a while and will have grown accustomed to hearing things at a reduced volume. When you first put your hearing aids on, things will seem much louder than they really are. Part of the orientation process will involve getting used to sounds again. You may be particularly bothered by noise. While the newer digital hearing aids have complex schemes for processing bothersome noise, you too will have to re-learn how to deal with these situations. It may involve something as simple as re-situating yourself in a noisy environment and using visual cues, trying a different program on your hearing aid or having your Audiologist make some fine tuning adjustments within specific programs. The important thing to remember is that amplification is a process. It is not simply a matter of putting on hearing aids and having the hearing ability that you had when you were younger. You are an integral part of the process.

Diminished vision, manual dexterity, and other special considerations.

The presence of combined sensory losses, as in the case of impaired hearing and vision, is very prevalent with age. Studies show between 9% and 21% of adults over the age of 70 years having some degree of dual sensory impairment. (Saunders, G.H. and Echt, K.V., 2007) Given certain medical or physical conditions, you may find the need for certain modifications of your hearing aid to accommodate this. Discuss the style of hearing aid e.g. ITE (in the ear) versus BTE (behind the ear) and its possible accessories with your hearing healthcare professional to determine what is most appropriate for your needs. Know that features such as larger or raised hearing aid controls, reinforced removal lines and larger than typical color indicators for right versus left hearing aid identification can be requested at the time of your hearing aid order. Special engraving such as the user’s name may also be requested.

Small inclusions such as these may afford better tactile information for the user where there is diminished vision and/or manual dexterity. Finally, you may want to discuss assistive technologies that can be used in addition to your hearing aids that can further enhance communication and help improve your quality of life.

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