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Defining Hearing Loss and its Consequences Dr Vinaya K. C. Manchaiah Senior Lecturer in Audiology Dept. of Vision and Hearing Sciences Anglia Ruskin University Outline • Hearing as a sense • Consequences of hearing loss • Dimensions of hearing loss • How we classify hearing loss currently • Is there a need to classify differently? • Disability models with an emphasis to ICF • Some insights to way forward • Hearing as a sense • Consequences of hearing loss • Dimensions of hearing loss • How we classify hearing loss currently • Is there a need to classify differently? • Disability models with an emphasis to ICF • Some insights to way forward Hearing as a sense • To explore experiences around the world • Change of hearing sense over time • Hearing activities Cognitive domain: Detection, recognition, localisation, understanding Emotional domain: Tolerance and pleasantness • Individual’s priority can change quickly Environmental and social factors play a big role What aspects of hearing are most important? Clarity - Cognitive domain • Pleasantness – Emotional domain Goal of audiological enablement/rehabilitation Hearing expectation = Hearing experience Consequences of hearing loss Negative Increased difficulty communicating Reduced interpersonal interactions Avoidance and withdrawal from social situations Increased loneliness, anxiety, irritability, anger and frustration Psychological problems such as depression Decreased self-esteem and self-efficacy Resultant (or increased) relationship problems Increased risk to personal safety Reduced ability to appreciate music Reduced job performance Reduced activities of daily life Poor health related quality of life Positive Reduced disturbances from unwanted noise Development of communication strategies Affinity to people with hearing impairment and other disabilities Perceived self development Using hearing impairment to self advantage Dimensions of hearing loss Psychoacoustic dimensions Perceptual experiences • Threshold sensitivity • Dynamic range • Frequency resolution • Temporal resolution • Binaural hearing (localisation) • Upward and downward spread of masking • Biological (or pathophysiological) • Social • Environmental (i.e., physical or acoustic) • Individual (also include psychological) Four dimensions of factors which may influence the perceptual experience of hearing loss Biological (or pathophysiological) Type of hearing loss Degree of hearing loss Genetic factors Pathophysiology Cognitive functions (e.g., working memory) Environmental (i.e., mainly referring to physical and/or acoustic domain) Background noise Directions of speech and noise Orientation in the space Number of people in the communication situation Acoustics of the communication situation (particularly reverberation) Social Communication partners Employment Socio-economical status Culture Social norms Individual (also includes psychological) Age Sex Personality Family history Acceptance of hearing loss Mental toughness Life-style • Hearing as a sense • Consequences of hearing loss • Dimensions of hearing loss • How we classify hearing loss currently • Is there a need to classify differently? • Disability models with an emphasis to ICF • Some insights to way forward How do we classify hearing loss? Type of hearing loss: Conductive Vs SNHL Degree/severity of hearing loss Hearing pathologies (e.g., glue ear, ANSD, etc) Audiogram could be misleading Dimensions of hearing loss Psychoacoustic dimensions Perceptual experiences • Threshold sensitivity • Dynamic range • Frequency resolution • Temporal resolution • Binaural hearing (localisation) • Upward and downward spread of masking • Biological (or pathophysiological) • Social • Environmental (i.e., physical or acoustic) • Individual (also include psychological) Disadvantages of Audiogram • Patients with similar audiogram are reporting different communication difficulties (Erdman & Demorest, 1998) – But rehabilitation approaches planned mainly using audiogram • Mild category: “Oh its only a mild loss? I’ll wait until it gets more severe” • Wording ‘normal’ is misleading • dB scale in appropriately converted into % of loss (Manchaiah et al., 2011) • Does not represent all the dimensions of hearing loss Important to treat hearing pathology rather than “audiogram” 4 outcome variables • Help seeking • Hearing aid uptake • Hearing aid use • Satisfaction Number of studies per factor divided over stage (i.e., prefitting, fitting, postfitting) Hearing sensitivity (i.e., PTA) and outcome variables Outcome variable Number of studies Result Help seeking 4 0+++ Hearing aid uptake 3 +++ Hearing aid use 6 00000+ Satisfaction 7 0000+++ Self-reported hearing disability and outcome variables Outcome variable Number of studies Result Help seeking 3 +++ Hearing aid uptake 3 +++ Hearing aid use 3 +++ Satisfaction 5 +++++ Audiological enablement and/or rehabilitation should be based on the perceived Or experienced difficulties of the patient rather than the severity or levels of hearing impairment (Stephens & Kramer, 2009) • Hearing as a sense • Consequences of hearing loss • Dimensions of hearing loss • How we classify hearing loss currently • Is there a need to classify differently? • Disability models with an emphasis to ICF • Some insights to way forward Models of disability • Biomedical • Social • Bio-psycho-social • Cultural Shifting the focus from cause to impact Health condition Body functions/ Body structures Environmental factors Activities Participation Personal factors The ICF provides an universal conceptual framework and an international common language for describing functioning, disability and health Modified WHO-ICF showing interactions between impairment, disability, and quality of life No impairment seen in audiogram but reported significant hearing disability • Auditory neuropathy spectrum disorders (ANSD) • Auditory Processing Disorders (APD) No measurable hearing loss but some hearing pathology found Possible impairment but no reported hearing disability • • • • • Audiogram: Normal hearing OAEs present Fine structure DPOAEs showed some dips Speech in Noise: Good performance No reported problems Panda, 2010 (PhD Thesis) The classification – Structure and Codes Detailed-classification ICF Body Functions Body Structures Activities & Participation Environmental Factors b s d e b1 – b8 s1 – s8 d1 – d9 e1 – e5 d110 – d999 e110 – e599 d1150 – d9309 e1100 – e5959 b110 – b899 b1100 – b7809 b11420 – b54509 s110 – s899 s1100 – s8309 s11000 – s76009 Personal Factors Chapters 2nd level 3rd level 4th level Introduction to the ICF To provide a systematic coding scheme for health care information systems b1 b130 b134 b1801 b • • s299 s710 s730 s7301 • EQ-5D NHP Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions INSTRUCTIONS: This survey asks for Sleep your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities. Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep WHODAS WHOQoL Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep 31 SF-36 INSTRUCTIONS: This survey asks for Answer every question by marking your views about your health. This the answer as indicated. If you ar information will help keep track of how unsure about how to answer a you feel and how well you are able to question, please give the best answer do your usual activities. you can. Answer every question by marking the answer as indicated. If you ar unsure about how to answer a question, please give the best answer you can. d170 d230 d410 d415 • e110 e115 e125 e150 ICF Core Sets for Hearing Loss Consensuses Conference, Denmark May 2012 Brief version - 27 Comprehensive version - 117 Mean number of responses per patient by ICF categories (Stephens et al., 2001) 1.8 1.6 1.4 1.2 1 Problem questionnaire 0.8 Life effect questionnaire 0.6 0.4 0.2 0 BF AL PR EF PF WHO-ICF • Integrative bio-psycho-social model of functioning & disability • An individual’s functioning in a specific domain is an interaction or complex relationship between the health condition and contextual factors BSA: Common principles of rehabilitation for adults with hearingand/or balance-related problems in routine audiology services AAA: Guidelines for the Audiologic Management of Adult Hearing Impairment Way forward • Disability model: WHO-ICF & Self-reported hearing disability • Lessons from other disciplines (e.g., Intellectual disability) Previous Now • Based in intelligence (i.e., mild, moderate, severe) • Persons ability • Person’s skills • Functioning and community participation • Causes of their intellectual disabilities • Epilepsy • Range of mental disorders experiences Ways in which PHI, CPs and Clinicians describe hearing loss Person with Hearing Impairment (PHI) Difficulty understanding speech in group and noisy situations Difficulty in having conversation on the telephone Difficulty following television Communication Partners (CPs) PHI does not hear well in social situations is embarrassing Acting as interpreter to PHI PHI sets the television volume too high which is disturbing Type and degree of hearing loss Audiometric configurations with underlying pathology Speech recognition scores Clinician Four dimensions of factors which may influence the perceptual experience of hearing loss Biological (or pathophysiological) Type of hearing loss Degree of hearing loss Genetic factors Pathophysiology Cognitive functions (e.g., working memory) Environmental (i.e., mainly referring to physical and/or acoustic domain) Background noise Directions of speech and noise Orientation in the space Number of people in the communication situation Acoustics of the communication situation (particularly reverberation) Social Communication partners Employment Socio-economical status Culture Social norms Individual (also includes psychological) Age Sex Personality Family history Acceptance of hearing loss Mental toughness Life-style What we need to considered while planning management of consequences of hearing loss? Conclusions • Defining hearing loss generally drives our management plan • No classification would serve all purpose • Disability measures (i.e., activity limitations and participation restrictions) and measures for hearing impairment cannot replace each other, but are complementary