Download CSD 3000 DEAFNESS IN SOCIETY

CSD 3000
DEAFNESS IN SOCIETY
Topic 6
The Deaf Adult
Older Adults
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Changes in acuity
usually begin around the
third decade of life
Incidence increases
sharply as we age
25%-40% of people over
65 have significant
hearing loss
The figure changes to
90% by the time we
reach our 80s
Hearing Loss and Aging
Presbycusis
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No clear etiology (cause)
Possible sources include:
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Noise exposure
Genetics
Vascular disease
Systemic disease
Diet
Pollution
Other
The Types of Presbycusis
Sensory Presbycusis
o Involves the
degeneration of hair cells
and supporting cells at
the base of the cochlea
o Hearing tests show
abruptly sloping
progressive high
frequency hearing loss
The Types of Presbycusis
n
Neural Presbycusis
o
Involves the loss of
cochlear neurons
Hearing tests show high
frequency hearing loss
with very poor speech
discrimination ability
o
The Types of Presbycusis
Strial or Metabolic
Presbycusis
o
o
Involves the degeneration of
the stria vascularis which
disrupts the nutrient supply
of the Organ of Corti
Hearing tests show a flat
hearing loss across
frequency
The Types of Presbycusis
Mechanical Presbycusis
o
o
Involves alterations to
cochlear mechanics
produced by stiffness
changes within the basilar
membrane
Hearing tests show a sloping
hearing loss across
frequency
Audiologic Characteristics
Associated with Aging
Acuity:
Changes in pure tone
sensitivity among
older adults
emerges gradually
as age increases.
Average Hearing Thresholds
as a Function of Age and
Gender
n
1)
2)
Two trends are clear from these data:
Both males and females exhibit loss in sensitivity at age 60 and
older, especially in the higher frequencies
Threshold values for males are poorer, overall, than for females
Audiologic Characteristics
Associated with Aging
Loudness:
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Recruitment
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Abnormal growth of
loudness commonly
associated with damage to
the cochlea
Due directly to the reduced
dynamic range
Makes the ear more
sensitive to loud sounds
Audiologic Characteristics
Associated with Aging
Speech Perception:
Speech perception suffers
as we age, even if we
control for the change in
sensitivity associated
with aging
Average Speech Identification
Performance as a Function of
Age and Degree of Hearing Loss
n
This figure makes clear that even when we control for
the degree of hearing loss, older people have generally
poorer speech understanding performance
Psychosocial Aspects of
Acquired Hearing Loss
Characteristics of acquired hearing loss:
 Gradual and progressive
 A problem of comprehension rather than acuity
 Listening in noise
 Can no longer listen passively
 Following and remembering details of conversation
Denial
Stress
Response to the Initial
Diagnosis
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Most times, the results are expected,
but the person can still feel:
 Sad
 Worried
 Fear
 Disappointment
 Anger
Psychological Effects
 Reactive vs proactive
 Denial
 Uncertainty
 Frustration
 Anger
 Stress
Other Issues
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Effect of hearing loss on the
transmission of the message
Reactions from listeners
Other Issues
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Effect of hearing loss on the family
Sociological effects
 Interference
 Stigma
of social efficiency
Reasons Why Adults
Don’t Seek Help for Their
Hearing Loss
1.
Association with aging
Reasons Why Adults
Don’t Seek Help for Their
Hearing Loss
1. Association with aging
2. Association with a new challenge
Reasons Why Adults
Don’t Seek Help for Their
Hearing Loss
1. Association with aging
2. Association with a new challenge
3. Association with disability
Reasons Why Adults
Don’t Seek Help for Their
Hearing Loss
1. Association with aging
2. Association with a new challenge
3. Association with disability
4. Cosmetic focus
Reasons Why Adults
Don’t Seek Help for Their
Hearing Loss
1. Association with aging
2. Association with a new challenge
3. Association with disability
4. Cosmetic focus
5. High cost
Reasons Why Adults
Don’t Seek Help for Their
Hearing Loss
1. Association with aging
2. Association with a new challenge
3. Association with Disability
4. Cosmetic Focus
5. High Cost
6. Unrealistic expectations
Aural Rehabilitation
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The first step is the fitting of proper
amplification
These devices can minimize conversational
difficulty and maximize the use of residual
hearing
Their objective is to make speech audible
without introducing further distortion and to
restore a range of loudness experience
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Selecting the Hearing
Aid Candidate
1. Degree of hearing loss
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Selecting the Hearing
Aid Candidate
1. Degree of hearing loss
2. Motivation
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Selecting the Hearing
Aid Candidate
1. Degree of hearing loss
2. Motivation
3. Acceptance of hearing loss
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Selecting the Hearing
Aid Candidate
1. Degree of hearing loss
2. Motivation
3. Acceptance of hearing loss
4. Cosmetic concerns
Initial Adjustment to
Amplification
Importance of realistic expectations
 Hearing will not be returned to normal
 Liking hearing aids to eyeglasses is not
appropriate
Learning to listen again
Initial Adjustment to
Amplification
Getting maximum benefit from amplification
requires motivation, perseverance, and patience
Coming to terms with negative feelings
Working through some of the initial problems
 Background noise is very disturbing
 your own voice sounds different
 the hearing aid sounds tinny or metallic
 the presence of something foreign in your ears
 only understanding parts of words or phrases
Initial Adjustment to
Amplification
Suggestions to make the initial adjustment
easier:
1. Begin with a comfortable volume
2. Begin with easier listening settings and activities
3. Don’t become overly tired
4. Relearn the art of active listening
5. Be realistic about how long the adjustment will
take
The Aural Rehabilitation
Program Beyond Amplification
The program must address the specific problems
related to hearing loss and offer suggestions to
how to minimize them
Participants must learn to modify the four major
factors in communication settings that affect
understanding
 The talker
 The message
 The environment
 Themselves
The Aural Rehabilitation
Program Beyond Amplification
Model for training
1. Formal instruction
2. Guided learning
3. Real-world practice
Inclusion of the “significant other”
1. Foster empathy for the difficulty of speechreading
2. Encourage the use of appropriate speaking
behaviors
3. Learn how to tailor messages so they are easy to
recognize
4. Learn how to repair communication breakdowns
effectively
The Class
General content areas:
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Information about the causes and treatment of
hearing loss
Information about the implications of their own
hearing loss--especially within the family
Opportunity to review and share experiences with
the group
Ways to develop realistic expectations
Information regarding hearing aid management
Information on the importance and benefit of
speechreading
Speechreading
Salient factors affecting speechreading
performance
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Visibility of speech sounds
1. Visibility of the articulators needed to make
the sound
2. Degree to which the sound is distinguishable
from another
Articulatory
Classification System
Speechreading
Salient factors affecting speechreading
performance:
 Visibility of speech sounds
 Rate of speech
Speechreading
Salient factors affecting speechreading
performance:
 Visibility of speech sounds
 Rate of speech
 Speaker characteristics
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How much do the articulators move?
How expressive is the speaker?
Does the speaker use a lot of gestures?
How familiar is the speaker to the “listener”?
Speechreading
Salient factors affecting speechreading
performance:
 Visibility of speech sounds
 Rate of speech
 Speaker characteristics
 Environmental characteristics
Speechreading
Salient factors affecting speechreading performance:
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Visibility of speech sounds
Rate of speech
Speaker characteristics
Environmental characteristics
Characteristics of the speechreader
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IQ?
Ability to synthesize and willingness to guess
Hearing status?
age
Assertiveness Training
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Situations where assertive behavior can
enhance understanding
Characteristics of assertive behavior
What Hearing People Can Do
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Clear Speech
Visual Contact
Auditory Contact
Get the person’s attention
Reducing cross-talk