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Chapter 14
Hearing Loss in Adults

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Focus Questions

What is adult hearing loss?

How is adult hearing loss classified?

What are the defining characteristics of prevalent types of adult hearing losses?

How is adult hearing loss identified?

How is adult hearing loss treated in evidence-based practice?

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Introduction

Invisible Disability
Hearing loss in adults often emerges gradually with age.
Can be mistaken for cognitive decline or psychological issues.
Untreated hearing loss can have detrimental effects on an social-emotional, psychological, and physical wellbeing.
May resist seeking intervention for hearing loss:
A perception that the hearing loss is not severe enough
Concerns about the costs associated with treatment
Negative images associated with hearing aids

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Case Study 14.1: Mr. Johnson

Mr. Johnson is 58 years old and has been exposed to noise throughout his life, both in the military and on his job. He has a mild to moderate sensorineural hearing loss. His audiologist suggested counseling, fitting and maintenance of hearing aids, some assistive listening devices for home and office, and aural rehabilitation. He was fitted with bilateral hearing aids. His quality of life improved with the improvement in his hearing.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Brainstorm and Discussion

What are some activities that Mr. Johnson and his family could practice to promote better communication?

What are some approaches husbands or wives might use to support their spouses as they seek intervention?

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Is Hearing Loss?

Definition
Deviation or change for the worse in either auditory structure or auditory function that differs significantly from normal.
If loss impacts person negatively, it is considered a hearing handicap or a hearing impairment.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Definitions

Three classifications of adult hearing loss
Sensorineural Loss
Conductive Loss
Mixed Loss
Terms
Recruitment
Tinnitus
Signal-to-noise ratio (SNR) loss

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Social-Emotional, Psychological, and Physical Impact

Hearing loss goes undetected or untreated in more than 75% of adults with hearing loss.
Left untreated, it can impact hearing acuity and clarity.
Can have devastating effects on
Social-emotional well-being
Psychological well-being
Physical health
Lifestyle
Educational choices
Vocational choices

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Terminology

Hearing loss
Objective; refers specifically to a decrease in hearing acuity or clarity as a malfunction of the hearing mechanisms.
Handicap, disability, and impairment
References the impact of hearing loss on daily living activities.
Presbycusis
Hearing loss that occurs as a result of aging
Acquired from exposure to noise

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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How Is Hearing Loss Identified?

Hearing loss in the adult population is classified in terms of:
Etiology
Severity

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Etiology

Definition
Identifies the area of the auditory pathway or brain that is affected.
Conductive loss is in the outer or middle ear.
Sensorineural loss is in either the outer ear, the cochlea or the auditory nerve.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Severity

Severity of hearing loss ranges from mild to profound.
Typically defined using decibels (dB):
-10 dB to 15 dB: Normal hearing
16–25 dB: Slight loss
26–40 dB: Mild loss
41–55 dB: Moderate loss
56–70 dB: Moderately severe loss
71–90 dB: Severe loss
>91 dB: Profound loss

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Are the Defining Characteristics of Prevalent Types of Adult Hearing Loss?

Conductive
Sensorineural
Mixed

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Conductive Hearing Loss

Defining characteristics
Less common among adults than among children.
Occurs when sound is not conducted efficiently through the outer and/or middle ear.
Results in an attenuation of the sound.
Creates a sense of fullness or plugged ears.
Causes a slight to moderate loss of hearing in one or both ears.
Amenable to medical or surgical intervention.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Causes and Risk Factors

Causes
Cerumen blockage
Foreign objects
Otitis media
Damage to outer- or middle-ear
Otosclerosis

Risk Factors
Accidents and trauma
Reduced mental capacity (e.g. dementia and Alzheimer’s disease)
Terms
Myringoplasty
Stapedectomy

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Sensorineural Hearing Loss

Defining characteristic
Most common type of hearing loss in adulthood.
Results most often from damage to the outer or inner hair cells of the cochlea.
Outer hair cell damage often results in difficulty with hearing acuity.
Inner hair cell damage results SNR loss.
Results in both a decrease in acuity and a loss of clarity, especially in noise.
Person may experience recruitment and/or tinnitus
Treated with amplification or other types of intervention.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Causes and Risk Factors

Causes
Presbycusis - a degeneration of the inner ear and other auditory structures as a result of the normal aging process
Noise exposure
Factors which influence impact of noise exposure:
The intensity of the noise
The length of exposure
The use of hearing protection
The recovery time between exposures
Other forms of damage to the cochlea

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Causes and Risk Factors, Cont.

Ototoxicity
Common cause of inner-ear damage
Meniere’s Disease
Long term disorder caused by overproduction or underabsorption of endolymph, a fluid that circulates in the inner ear
Labyrinthitis
Short-term infection that is treated medically
Vertigo
Dizziness
Acoustic Neuromas
Tumors on the auditory nerve

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Mixed Hearing Loss

Definition
A combination of a permanent reduction of sound and a temporary loss of hearing from a conductive component.
Can be the results of otitis media or a buildup of cerumen with a sensorineural loss.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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How is Hearing Loss Identified?

The assessment process
Audiometric screening
Complete hearing evaluation
Assessment for hearing aids
Aural habilitation assessment
Three categories of assessment tools:
Observation and self-assessment
Conventional audiometry
Objective measurement

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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The Importance of Accurate Diagnosis

Negative consequences of mismanaged hearing loss can affect
General well-being
Lifestyle
Interpersonal relationships
Economic livelihood

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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How Is Adult Hearing Loss Treated in Evidence-based Practice?

Human auditory system remains plastic throughout life.
Most effective treatment approach for adult hearing loss is an individualized and comprehensive plan.
Counseling
Fitting of amplification devices
Aural rehabilitation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Limitations of Current Approaches

Most hearing aid recipients received information focused on:
Audiogram results (78%)
Reasons for the specific hearing aid selection (79%)
Care of the hearing aid (79%)
Care of the hearing aid battery (67%)
Hygiene for the hearing aid and earmold (60%)
Other types of information was neglected:
Involving spouses and family (21%)
Consumer resources and self-help groups (195)
Strategies to improve communication (17%)
Strategies to deal with hearing loss at work (13%)

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Assistive Technology

Hearing aids

Digital
Behind-the-ear (BTE)
In-the-ear (ITE)
Directional microphones

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Assistive Listening Devices (ALDs)

Telephone amplifiers
Strobe-light doorbells
Amplified or lighted fire alarms
TV ears
Vibrating alarm clocks
FM systems

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Cochlear Implant

Surgically implanted device
Cochlear implants
Middle-ear or mastoid implants
Brain-stem implants
Optimal candidates
Postlingual deaf with moderately severe to profound, bilateral SNR
Marginal or no speech-perception benefit from aids
Good health with no physical abnormalities of head and neck
Access to optimal education and rehabilitation services following implantation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Aural Rehabilitation

Living Well with Hearing Loss
Examine communication breakdowns
Goals of Aural Rehabilitation
Evaluating communication partners’ roles in conversation
Determining whether social rules are broken
Teaching strategies to facilitate communication and repair breakdowns effectively

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Building Treatment Plans

Five areas of rehabilitation (e.g. FACES)
Family/significant other participation
Auditory skill building
Conversation strategies
Education and counseling
Speech reading and visual cues
Education topics regarding hearing aids
Function, use, and maintenance
Understanding of hearing loss and impact on communication
Realistic expectations for instrumentation
Social, emotional, and psychological underpinnings of hearing loss

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Early Identification and Intervention

Screening for hearing loss
Example questions:
Does a hearing problem cause you to attend religious services less often than you would like?
Does a hearing problem cause you to have arguments with family members?
Does a hearing problem cause you difficulty when listening to the TV or radio?