CSD 3000 DEAFNESS IN SOCIETY Topic 6 The Deaf Adult.
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Transcript of CSD 3000 DEAFNESS IN SOCIETY Topic 6 The Deaf Adult.
CSD 3000DEAFNESS IN SOCIETY
Topic 6The Deaf Adult
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
Hearing Loss and Aging
Presbycusis No clear etiology (cause) Possible sources include:
Noise exposure Genetics Vascular disease Systemic disease Diet Pollution Other
The Types of Presbycusis
Sensory PresbycusisSensory Presbycusiso 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
o Hearing tests show high frequency hearing loss with very poor speech discrimination ability
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
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
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 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 frequencies2) Threshold values for males are poorer, overall, than for
females
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
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
DenialStress
Response to the Initial Diagnosis
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
Effect of hearing loss on the transmission of the message
Reactions from listeners
Other Issues
Effect of hearing loss on the family Sociological effects
Interference of social efficiency Stigma
Reasons Why Adults Don’t Seek Help for Their
Hearing Loss1. Association with aging
Reasons Why Adults Don’t Seek Help for Their
Hearing Loss1. Association with aging2. Association with a new challenge
Reasons Why Adults Don’t Seek Help for Their
Hearing Loss1. Association with aging2. Association with a new challenge3. Association with disability
Reasons Why Adults Don’t Seek Help for Their
Hearing Loss1. Association with aging2. Association with a new challenge3. Association with disability4. Cosmetic focus
Reasons Why Adults Don’t Seek Help for Their
Hearing Loss1. Association with aging2. Association with a new challenge3. Association with disability4. Cosmetic focus5. High cost
Reasons Why Adults Don’t Seek Help for Their
Hearing Loss1. Association with aging2. Association with a new challenge3. Association with Disability4. Cosmetic Focus5. High Cost6. Unrealistic expectations
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
• Selecting the Hearing Aid Candidate
1. Degree of hearing loss
• Selecting the Hearing Aid Candidate
1. Degree of hearing loss2. Motivation
• Selecting the Hearing Aid Candidate
1. Degree of hearing loss2. Motivation3. Acceptance of hearing loss
• Selecting the Hearing Aid Candidate
1. Degree of hearing loss2. Motivation3. Acceptance of hearing loss4. 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 feelingsWorking through some of the initial
problemsBackground noise is very disturbingyour own voice sounds different the hearing aid sounds tinny or metallic the presence of something foreign in your earsonly understanding parts of words or phrases
Initial Adjustment to Amplification
Suggestions to make the initial adjustment easier:
1. Begin with a comfortable volume2. Begin with easier listening settings and
activities3. Don’t become overly tired4. Relearn the art of active listening5. Be realistic about how long the adjustment
will take
The Aural Rehabilitation Program Beyond
AmplificationThe 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 talkerThe messageThe environmentThemselves
The Aural Rehabilitation Program Beyond
AmplificationModel for training
1. Formal instruction2. Guided learning3. Real-world practice
Inclusion of the “significant other”1. Foster empathy for the difficulty of
speechreading2. Encourage the use of appropriate speaking
behaviors3. Learn how to tailor messages so they are easy
to recognize4. Learn how to repair communication
breakdowns effectively
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
Speechreading
Salient factors affecting speechreading performance
Visibility of speech sounds1. Visibility of the articulators needed to
make the sound2. 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 soundsRate of speechSpeaker 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”?
Speechreading
Salient factors affecting speechreading performance: Visibility of speech sounds Rate of speech Speaker characteristics Environmental characteristics
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
Assertiveness Training Situations where assertive
behavior can enhance understanding
Characteristics of assertive behavior
What Hearing People Can Do Clear Speech Visual Contact Auditory Contact Get the person’s attention Reducing cross-talk