1. CSD 3000 DEAFNESS IN SOCIETY Topic 6 The Deaf Adult

2. Older Adults 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

3. Hearing Loss and Aging Presbycusis No clear etiology (cause) Possible sources include: Noise exposure Genetics Vascular disease Systemic disease Diet Pollution Other

4. 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

5. The Types of Presbycusis n Neural Presbycusis o Involves the loss of cochlear neurons o Hearing tests show high frequency hearing loss with very poor speech discrimination ability

6. The Types of Presbycusis Strial or Metabolic Presbycusis o Involves the degeneration of the stria vascularis which disrupts the nutrient supply of the Organ of Corti o Hearing tests show a flat hearing loss across frequency

7. The Types of Presbycusis Mechanical Presbycusis o Involves alterations to cochlear mechanics produced by stiffness changes within the basilar membrane o Hearing tests show a sloping hearing loss across frequency

8. Audiologic Characteristics Associated with Aging Acuity: Changes in pure tone sensitivity among older adults emerges gradually as age increases.

9. Average Hearing Thresholds as a Function of Age and Gender n Two trends are clear from these data: 1) Both males and females exhibit loss in sensitivity at age 60 and older, especially in the higher frequencies 2) Threshold values for males are poorer, overall, than for females

10. Audiologic Characteristics Associated with Aging Loudness: Recruitment 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

11. 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

12. 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

13. 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

14. Response to the Initial Diagnosis Most times, the results are expected, but the person can still feel: Sad Worried Fear Disappointment Anger

15. Psychological Effects Reactive vs proactive Denial Uncertainty Frustration Anger Stress

16. Other Issues Effect of hearing loss on the transmission of the message Reactions from listeners

17. Other Issues Effect of hearing loss on the family Sociological effects Interference of social efficiency Stigma

18. Reasons Why Adults Don’t Seek Help for Their Hearing Loss 1. Association with aging

19. Reasons Why Adults Don’t Seek Help for Their Hearing Loss 1. Association with aging 2. Association with a new challenge

20. 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

21. 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

22. 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

23. 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

24. Aural Rehabilitation 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

25. Selecting the Hearing Aid Candidate 1. Degree of hearing loss

26. Selecting the Hearing Aid Candidate 1. Degree of hearing loss 2. Motivation

27. Selecting the Hearing Aid Candidate 1. Degree of hearing loss 2. Motivation 3. Acceptance of hearing loss

28. Selecting the Hearing Aid Candidate 1. Degree of hearing loss 2. Motivation 3. Acceptance of hearing loss 4. Cosmetic concerns

29. 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

30. 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

31. 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

32. 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

33. 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

34. The Class General content areas: 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

35. Speechreading Salient factors affecting speechreading performance Visibility of speech sounds 1. Visibility of the articulators needed to make the sound 2. Degree to which the sound is distinguishable from another

36. Articulatory Classification System

37. Speechreading Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech

38. Speechreading Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech Speaker characteristics 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”?

39. Speechreading Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech Speaker characteristics Environmental characteristics

40. Speechreading Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech Speaker characteristics Environmental characteristics Characteristics of the speechreader IQ? Ability to synthesize and willingness to guess Hearing status? age

41. Assertiveness Training Situations where assertive behavior can enhance understanding Characteristics of assertive behavior

42. What Hearing People Can Do Clear Speech Visual Contact Auditory Contact Get the person’s attention Reducing cross-talk