Working with Elders Who Have Hearing Impairments

A. Etiology
Hearing impairments may also be associated with the reduced ability to hear
warning signals, ambulation difficulties, and difficulties with instrumental activities of
daily living (IADL), balance problems, and increased incidence of falls. Hearing
impairments can contribute to social isolation. Hearing loss can have a profound
effect on engagement in occupations and activities of daily living (ADL). presbycusis
is the gradual loss of hearing as an individual grows older. One-third of elders
between ages 65 and 74 years have hearing loss. This percentage increases to 47% for
those older than 75 years. In addition, some studies indicate that 85% to 90% of
nursing home residents have hearing impairments that limit function. hearing losses
are divided into the three following areas: sensorineural, conductive, and mixed.
These conditions can affect one or both ears. The most common type of presbycusis
or hearing loss in elders is due to sensorineural damage to the hearing organ itself, the
peripheral, central nervous system or both, and the type of loss is caused by hair cell
damage or loss of the sensory hair cells of the cochlea.

B. Case Classification, Sign and Symptoms

1. Sensorineural losses
Sensorineural loss is caused by atrophy and degeneration of the hair cells at the base
of the basilar membrane. It produces a loss of high frequency sounds but does not
interfere with the discrimination of speech.

2. Neutral loss
Neutral loss is caused by the loss of auditory nerve fibers. It affects the ability to
distinguish speech sounds in higher frequencies but does not affect the ability to hear
pure tones.

3. Mechanical loss
mechanical loss is caused by the degeneration of the vibrating membrane within the
cochlea. This type of loss leads to the gradual loss of hearing in all frequencies.

4. Conductive hearing loss

Conductive hearing loss results in an inability of the external ear to conduct sound
waves to the inner ear, maybe related to the buildup of cerumen (earwax), fluid
accumulation in the middle ear or upper respiratory infection.

5. Tinnitus
Tinnitus is a subjective auditory problem consisting of a ringing, whistling, buzzing or
roaring noise in the ears. Tinnitus may occur as part of a conductive or sensorineural
hearing loss, may also be related to;
 Meniere’s disease
 Otosclerosis
 Sensorineural loss
 Accumulation of cerumen pressing on the eardrum
  Tympanic membrane lesions
 Fluid in the middle ear.
 Medications such as the doses of aspirin can be additional contributing factor
Tinnitus is often most noticeable at night when other noises or reduced.

C. Level of Severity & Prognosis

Older people who live in areas with less exposure to loud noise or high-
intensity noise may have less sensorineural hearing loss than those who live in noisy
industrial areas. Although people in better health seem to be less susceptible to these
disorders, some sensory nerve disorders will eventually affect older people, regardless
of environmental conditions. However, continuous exposure to loud noise over a long
period of time can cause permanent damage. For example, current research shows that
15% of college graduates have the same or greater hearing loss than their parents due
to exposure to high-volume MP3 players.
Three types of sensorineural hearing loss have been identified: sensory, neural,
and mechanical. Sensory loss is caused by atrophy and degeneration of the hair cells
at the base of the basilar membrane. It produces a loss of high-frequency sounds but
does not interfere with the discrimination of speech. Neural loss is caused by the loss
of auditory nerve fibers. It affects the ability to distinguish speech sounds, especially
in the higher frequencies, but does not affect the ability to hear pure tones.
Mechanical loss is characterized by the degeneration of the vibrating membrane
within the cochlea. This type of loss leads to the gradual impairment of hearing in all
frequencies. In situations where several sounds in various frequencies are present at
the same time, the ability to distinguish between the sounds becomes increasingly
difficult.
A sensorineural hearing loss may be unnoticed in the early stages because the
high-frequency tones that are initially lost are above the functional range used in most
environments. As the condition progresses, elders may notice that they cannot hear
the ringing of the telephone, the buzz of the doorbell, the ticking of a clock, or the
water dripping from a faucet. With further progression, the sounds of certain
consonants such as s, z, t, f, and g become increasingly difficult to distinguish.
Eventually, elders may strain to hear and understand conversations and one-syllable
words.
A second hearing condition, conductive hearing loss, results in an inability of the
external ear to conduct sound waves to the inner ear. Conductive hearing losses may
be related to the buildup of cerumen (earwax), fluid accumulation in the middle ear
from eustachian tube dysfunction, or an upper respiratory infection. These conductive
problems often can be corrected by cleaning the ear, administering medications, or
performing surgery. Hearing aids may be effective for persons who have an
untreatable or residual conductive hearing loss.

D. Occupational Therapy Intervention or strategies in dealing with the barriers and

Challenges
COTA and registered occupational therapist (OTR) teams may work together
along with others on the treatment team to identify elders who have hearing
impairments through an observation of behaviors. The Self-Rating Hearing Inventory
also can be an effective tool for assessing the effects of a hearing impairment on
perceived occupational performance. The American Academy of Otolaryngology-
Head and Neck Surgery has developed a 5-minute hearing test to determine the need
for a referral to a hearing specialist. Beyond the scope of therapy practice for more
profound hearing losses, a consultation and referral to a hearing specialist regarding
the use of a hearing aid, individual or computerized training in speech reading (lip
reading), and instruction regarding the use of an ALD may be needed. In addition,
referrals for accessing both formal and informal support services through public and
community agencies may be beneficial. Individuals for whom none of these
interventions are effective may be candidates for cochlear implants.