Estimates of hearing loss in the elderly vary, but at least 25% of people from 65-75 and 35% of those over eighty have some degree of impairment.This month Elder Voice focuses on hearing loss in Seniors and how to help when someone is loosing their hearing.
Hearing loss can have profound physical, emotional, and social impact. At a physical level someone is at risk if they cannot hear an alarm, an intruder, a warning shout, or the honking of a horn. Hearing loss often causes people to isolate themselves from family and friends, withdraw from activities, become depressed. It can be embarrassing and shame producing when one does not hear what is being said to them and frightening to realize that one is slowly losing the ability to participate with others because they cannot hear. Most disturbing, hearing loss can also contribute to a misdiagnosis of dementia, or the degree of dementia when someone answers tests or questions inappropriately and the cause is attributed to cognitive impairment and not understood as hearing loss.
The most common cause of hearing loss is presbycusis, the slow hearing loss that occurs as people age. Presbycusis occurs when the small hairs of the inner ear are damaged or die. When functioning properly, they enable hearing by picking up sound waves and changing them into nerve signals that the brain interprets as sound. They do not regenerate and the hearing loss is permanent. Causes of presbycusis are not known but family history, continued exposure to loud noise over one’s lifetime, smoking, and certain medical conditions correlate with it’s occurrence. Technically, people with presbycusis hear, but have trouble making sense of some sounds, especially higher pitched sounds or voices.
Conductive hearing loss occurs when the processing of sound through the inner ear is impaired. People may hear, but the sound is distorted or muffled, and seems distant There are different causes of conductive hearing loss, many of which are easily treatable. They include medical conditions, fluid or wax build-up inside the ear, colds, allergies,certain medications, and infections.
Two other conditions are often cause for hearing loss and problems. Tinnitus is a condition in which people are hearing sounds which are not coming from outside their head. The sounds may be buzzing, ringing, chirping or others. Tinnitus may be just an annoyance that someone can live with or it can be severe enough to interfere with sleep, cause distractions, and interfere with the ability to hear. A hearing specialist can help with suggestions and equipment for severe tinnitus. These may include Tinnitus Retraining Therapy and hearing aides.
Meniere’s Disease is a condition of the inner ear that causes dizziness, vertigo (loss of balance), tinnitus as well as hearing loss. Meniere’s Disease occurs in episodes or attacks, and is treated symptomatically. Changes in diet, medications, and sometimes surgery have been helpful with symptoms, with treatment including consultation from the family physician or octolaryngologist (a physician who specializes in the ear, nose, and throat ).
For hearing to occur, the brain must be able to make sense of the signals that it is receiving from the ear. This means that although signals may be sent, if there is impairment in the brain, they may not be processed. An individual with Alzheimer’s disease or other dementias may appear to not be hearing, when the problem is that their brain is not processing the soundsthey are hearing.
Hearing loss is frequently undetected and/or untreated in older people.One reason for this is that often, the person does not realize it is occurring, and blames the environment or other people. Behaviours that may indicate hearing loss/worsening hearing include:
- Trouble hearing over the telephone,
- Difficulty following conversations with two or more people
- Need to turn up TV or radio volume so loud that others complain,
- Avoidance of noisy places because of the impact of background noise
- Complaining that people mumble
- Greater difficulty hearing women or children than men.
- Apparent ignoring of people or not responding to environmental stimuli
- Isolation from others or social situations
- Unexplained aggressive behaviour
- Unexplainable confusion
- Cessation of hearing aide usage.
If you suspect someone is having trouble hearing, approach the topic in a way that respects their dignity, knowing that they may feel some embarrassment. Emphasize that your goal is to help them get the most out of life, that their relationship with you is important, and you want to be able to communicate with them. If you believe they may be avoiding you or withdrawing generally, let them know that you miss their input and don’t want to lose it. It may help them to talk with someone who has a hearing aid so that they can learn first hand what they are like and how someone else is benefiting from one.
Ears should be examined on a regular basis by a physician. If hearing loss is suspected, and causes of loss such as wax build-up are eliminated or dealt with, a hearing test by an audiologist or hearing technician should be conducted. Many companies do testing in the seniors home or in a seniors residence.Recommendations from hearing testing may include assistive devices (including, but not limited to hearing aids) and appointment with one’s family doctor who may then make a referral to an otolaryngologist.
For more on hearing loss, please see the links below:
Hearing Aids and Other Assistive Devices
There are many assistive devices available to people with hearing loss. They range in price, accessibility, ease of use, cost, and conditions for which they are effective.
Hearing aids are the most common form of assistive hearing devices. A report from the Canadian Association for the Deaf in 2006 reported that only 1 in 6 people who could benefit from wearing hearing aids actually use one. That means 83% of people with hearing loss are coping with a life impacting problem in ways that they may not need to.
There are many reasons for people not using a hearing aid:
- Shame or embarrassment about the hearing loss or about how it “looks” to be wearing a hearing aide.
- They do not realize they have an impairment and blame hearing difficulties on environmental factors–the TV is broken; people mumble, there is too much noise in the room.
- Lack of knowledge about the quality of today’s hearing aides.
- Previous experience with a hearing aide which did not help, caused buzzing or discomfort.
- Cost
- Disinterest, lack of information, poor/no assessment from caregivers and involved personnel
- Inability to put it on, adjust it, or change batteries.
- They do not realize the batteries have died or it is not adjusted properly and so give up.
- Improper fitting causes discomfort in the ear or lowers the quality or level of sound.
- Lack of assessment
- Dementia
- Depression
Hearing aides have improved considerably and rapidly over the past few years. Not only are they smaller and less intrusive than previously, but the sound quality is much improved and the screening of background noise is more effective so they can be used in public places such as restaurants.
The cost of hearing aids varies, but can range from $1800 up to $3000.00 per hearing aide, depending on the hearing loss and the type of aide needed.
Hearing aids need to monitored and maintained regularly. Batteries should be regularly checked and changed.
When a hearing aid does not compensate for hearing loss, another option may be a cochlear implant Cochlear implants consist of a headpiece, a speech processor, and a receiver. The headpiece includes a microphone and a transmitter worn behind the ear, a processor, which converts the sound into a signal that it relays to a receiver,and the receiver which is surgically inserted under the skin behind one ear. The cochlear implant bypasses the damaged hairs of the inner ear, and directly stimulates the nerves to produce sound. Older people are candidates for cochlear implants but they need to have a consultation with a hearing specialist.
Another assistive device is a hand held amplifiers which consist of an amplifying unit used by the speaker and earphones to be worn by the person who is hearing impaired. They can range in price from $30.00 up to $200.00. For other assistive devices see the online stores of the Canadian Hearing Association website. www.chs.ca or the Western Institute for the Deaf www.widhh.com
When You Talk to Someone who is Hearing Impaired:
- Be patient
- Speak clearly and enunciate
- Make sure your mouth is clearly visible
- Stand in front of them
- Use a lower register
- Use gestures to support your speech
- Make sure lighting is adequate so your mouth can be seen.
- Decrease surrounding or competing noise
- Ask the person if they can hear you
- Use an amplifying device
