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Rachel Hii

on 26 May 2014

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Transcript of Management

Effects of hearing loss
Type of hearing loss
Anis Adibah
Muhammad Fadhil
Hii Yu Nga
Type Of Hearing Loss
Murray. T. N. 2009.
Foundation Of Aural Rehabilitation Children, Adults, and Their Family Members.
Delmar Cengage Learning. United State.
Erdman. S. E. t.th.
Older Adults and Hearing Loss.
http://www.asha.org/aud/articles/oldhearingloss/ [15th May 2014]
Loh. K. Y., Elango. S. 2005.
Hearing Impairment in The Elderly.
Med J Malaysia Vol 60 No 4 October 2005.
World Health Organization. t.th.
Definition of an older or elderly person.
http://www.who.int/healthinfo/survey/ageingdefnolder/en/ [15th May 2014]
Hearing Loss In Geriatric Population
Group 3
Conductive Hearing Loss (CHL)
Mixed Hearing Loss (MHL)
Sensorineural Hearing Loss (SNHL)
Sensorineural deafness, bilateral high frequency HL (4k Hz).

Difficulty in:
- Speech discrimination
- Central auditory processing information.
- High pitched tinnitus.

Predisposing factor:
- Arteriosclerosis
- Diabetes Mellitus
- Exposure to noise (longterm)
- Drugs
- Smoking
- Genetic
Meniere's disease

Fluctuating hearing loss associated with low frequency at initial phase, however as it progress it will affect high frequency.
Aural fullness
Episodic vertigo
Ear wax in auditory canal
Fluid in the middle ear
Chronic otitis media
Trauma to the tympanic membrane
Speech hard to understand, slurred or mumbled
Hard to follow and understand conversation.
Less enjoyable daily activities eg. TV show, music and movie.
Difficult to communicate through telephone.
Common sign of hearing loss
Social isolation
Paranoid and suspicious

Labeled as:
demented, confused, uncooperative and unresponsive.
Activity limitations & Participant restrictions
Audiologic Testing &
Otologic examination
Cognitive variables
Hearing aid orientation
(visual deficits elderly)
Use of a magnifying lens during demonstration of proper hearing instrument care.
Use of a suitably large font size on handouts and printed material with high-contrast images.
Demonstrating hearing instrument use and care in well-lighted areas.
Emphasizing strategies that are also sensitive to vision problems (e.g., speaker identification).

- See more at: http://www.asha.org/aud/articles/oldhearingloss/#sthash.bR2wVvKA.dpuf
Other Services
Half of the 65+ age group could benefit from hearings aids actually purchased them.

20% of older adults who actually purchased hearing aids discontinue their use as they relegate their hearing aids to the dresser drawer.
(Kochkin 2000)
Denial of having hearing loss
Did not acknowledge having hearing loss
Management for elderly that not acknowledge
Provide information about HL (others than communication breakdown)
Follow up 3- 6 months time (in the interval: monitor their HL that affect themself & family members)
Family member should persuade the patient (not to nag!!)
Management on elderly who is denial
Need to ask several questions:
What type of situations does the patient find most troubling?
Does the patient have difficulties separating out and attending to voices from multiple talkers?
Administered Hearing handicappe inventory in elderly (HHIE)
1. Ample time for patient instructions
and double-check to ensure that instructions are understood.

2. PTA : Tone stimuli presented for a longer duration time.

3. Stimuli for speech recognition testing may need presented by live voice.

4. Time for rest periods.
Affect the aural rehabilitation plan, evaluation and intervention
Consideration to referred to other professionals (eg. physiotherapist)
Physical variables
Def: Vision loss that can't be corrected through the use of eye glasses/ contact lense alone
Audiological Testing:
The test setting need to be adapted.
(Can't be too bright or too dark)
Communication strategies:
Teach how to enhance the visual communication (come closer)
Visual Impairment
Def: Painful inflammation of joint & surround tissue
Difficult to:
Putting the HA on & taking it off.
Opening the battery compartment & insert batteries.
Removing device earwax/ other cleaning task.
Operating controls.
Prescribed device large control. (eg HA with controller)
Involve the family member in how to handle the listening devices.
Def: Irreversible decline in cognitive functions
Hearing loss increase the cognitive dysfunction & accelerates demetia

(Garahanet al 1992)
Highly recommend HA to reduce consequences of dementia
Elderly experience changes in
attention, slowed processing speed and reduce working memory.
1) Attention : Short attention. Therefore reduce the speed to perform mental task.

2) Slowed processing speed : Unable to understand the whole sentence.

3) Reduce working memory: May forget at the beginning of utterance by the time reach the end.
eg. Complexity + high speed when giving instruction during testing.
Topic of aural rehabilitation program:
Counseling about issues that are important to the elderly
HA, ALD or CI and their functions
Auditory and visual nature of speech
Communication strategies
Through case history :
1) Problem, effect, kind of activity limitations effected

2) To indicate a patient's listening goal,the priority and expectations

3) To know patient's living arrangements,social interactions, vocational status and other.

4) Gather medical data such as strokes, memory loss, vision problems, muscle weaknes, dementia and Alzheimer's.
Residency & living arrangements

a) Private residencies

b) Nursing home
- Requires special attention as patient commonly are multitude of health status
- Their environments are likely to be noisier.

Personal variables

- Socioeconomic status
- Culture
- Emotional
- Self-sufficiency and independence
Family & social contacts

- Frequency of interaction of the patient will influence the hearing awareness of the patient.

- Social contacts allow to feel more a part of life and more involved in the community.

Life - situation factors
Reasons older person do not
wear HA/ALD

1. Fear of technology
2. Believe their hearing loss is not problematic
3. Lack of self confident
4. Fear of stigmatization
5. Secondary health issues eg. reduced fine motor and visual impairment
Landmark events in acquiring
1. Recognition that hearing-related difficulties create participation restriction
2. Awareness that HA/ALDs exist
3. Consultation
4. Adaptation to use HA/ALD and adapting behaviour
Outcome Measure
1. Objective test (Speech test)

2. Client's report
eg. Questionnaire:
Chronological age of 60+ years as cut off to refer as older population.
(WHO 2014)

Elderly population
6.3% of total population in Malaysia is the elderly population (In year 2000).
30% of elderly aged above 60 have some degree
of hearing loss.

Worldwide prevalence of hearing loss in geriatric population ranges from 14-46%.

(Loh. K. Y 2005)
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