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Chapter 12

Hearing

Hearing Impairment

Third most prevalent chronic condition and the foremost communicative disorder

Under recognized public health issue

Men are more likely than women to be hearing impaired

65% of persons over the age of 70 are affected

Factors affecting hearing impairment are complex and include age-related changes, genetics, lifestyle, and environmental factors

Consequences of Hearing Impairment

Loss of self-esteem

Safety risks

Cognitive decline

Increases feelings of isolation

May be diagnosed with dementia inappropriately

Diminishes quality of life

Decline in function

Increased hospitalizations

Miscommunication

Depression

Falls

Types of Hearing Loss

Sensorineural

Damage to inner ear or neural pathways

Presbycusis (age related):

Most common form of hearing loss, worsens with age

First sign is difficulty hearing in noisy environments

Affects high frequency

Noise induced:

Second most common cause

Mechanical injury to the sensory hair cells of cochlea

Continuous noise exposure, expected to rise

Consider better ear protection devices

Types of Hearing Loss

Conductive

Abnormalities of external and middle ear that reduce transmission of sound

Causes include

Cerumen impaction occurs in 33% of nursing home residents

Otosclerosis

Infection

Perforated eardrum

Fluid in middle ear

Tumor

Cerumen accumulation

First image is of a healthy inner ear. Second image is of impacted cerumen in the ear canal.

Interventions to Enhance Hearing

Hearing aids

Personal amplifying system

Numerous types: digital, analog, vary in size, appearance, effectiveness

Type of device depends on type of hearing impairment and what the person can afford

Not usually covered by insurance or Medicare

Hearing aid care and use

Interventions to Enhance Hearing

Cochlear implants

Increased use for sensorineural hearing loss where hearing aids aren’t effective

Bypasses damaged portions of the ear and directly stimulates auditory nerve

Two parts: one piece surgically implanted under the skin and external portion that sits behind the ear

Surgery destroys residual hearing

Avoid magnetic resonance imaging

Image of cochlear implant with transmitter behind the ear, microphone over the ear, and the processor.

Interventions to Enhance Hearing

Assistive listening and adaptive devices

Personal listening systems

Adjunct to hearing aids or used in place of

Enhance face-to-face communication

Text messaging devices

Closed-caption

Special service dogs

Use of computers and email

Pocket-sized amplifiers

Promoting Healthy Aging: Hearing

Screening for hearing impairment is essential primary care for older adults

Assessment includes focused history and physical examination and screening assessment

Self-assessment instruments may be helpful (Box 12-3)

May require referral to an audiologist

Removal of cerumen impaction (Box 12-2)

Follow best practices for communicating with older adults (Box 12-5)

Question 1

Which are best practices for communicating with older adults?

Never assume hearing loss is from age until other causes are ruled out

Lower your tone of voice, articulate clearly, use a moderate rate of speech

Inappropriate responses, inattentiveness, and apathy may be signs of hearing loss

All of the above

ANS: D

Question 2

What is the most common type of hearing loss in the older adult ?

Conductive

Noise induced

Otosclerosis

Presbycusis

ANS: D