Communication disorders are the primary disability among old age people, especially hearing impairment. Nearly half of the population who needs assistance with hearing disorders are of 65 years or older. This article will explain the various types of hearing loss that are prone to old age people.

Conductive loss occurs in the outer and middle ear and impairs the sound being conducted from the outer ear to the inner ear. It is caused by certain conditions which are interfering with the conduction of air such as cerumen impaction, middle ear diseases and otosclerosis. Antibiotic treatment, tubes in the eardrum and surgery usually corrects these problems. This loss shows atleast 15dB air-bone gap in the audiogram.

An air-bone gap occurs when hearing sensitivity by bone conduction is significantly better than by air conduction. Clients may speak softly because they will hear their voice which is conducted by bone as loud. These clients hear better in the noisy environment. A hearing aid is quite helpful for a client with a 40 to 50 dB loss or more, although the device is not often necessary because of the excellent results of treatment. At least 15dB air-bone gap is demonstrated in the audiogram.

Sensorineural hearing loss is caused by impairment of function of the inner ear or its central connections. There are certain congenital, hereditary factors and noise trauma over a period of time, ageing, meniere’s disease and ototoxicity can also cause Sensorineural hearing loss. There are two main problems associated with sensorineural hearing loss. One is the ability to hear sound but not understand speech and other is the neural loss involving the hearing nerve. The ability to hear high pitched sound also diminishes gradually.

Mixed hearing loss is caused by a combination of conductive and sensorineurol losses. Careful evaluation is needed before corrective surgery for conductive loss, because the cause of the sensorineural loss will still remain.

Central hearing loss is caused by problems in the central nervous system from the auditory nucleus to the cortex. The client will not be able to understand or to put meaning to the incoming sound.

Functional hearing loss may be due to an emotional or psychological factor. The client does not seem to hear or respond to pure-tone audiometry test, but no organic cause can be identified. Psychological counseling may help in this situation.

Manifestation of Hearing loss:

If the hearing loss is congenital or profound, difficulty in learning speech and conceptual thinking is quite evident. Rehabilitation should be started as early as possible.

Deafness is often called as the “Unseen Handicap” because it is not until the conversation is initiated with a deaf adult that the difficulty in communication is realized. The health care professional should be aware of the need for thorough validation of the deaf person’s understanding of health teaching. Descriptive visual aids can be helpful.

Interference in communication and interaction with others can be the source of many problems for the client and family. Irritability is common because of the intentness with which the client must listen to understand speech.

The loss of clarity in speech is the most frustrating symptom. Withdrawal, suspicion, loss of self-esteem and insecurity are also common manifestations of hearing loss.

Rehabilitation of the client with impaired hearing:

If we suspect a client with a hearing loss, a hearing assessment should be done by a qualified audiologist. If a hearing aid is indicated, it should be fitted by an audiologist or a speech and hearing specialist. Initially the use of hearing aids should be restricted to quiet situations in the house. The client needs to first adjust to voices and household sounds. The client should also experiment by increasing and decreasing the volume as situations require. When the hearing aid is not being worn it should be placed in a dry cool area. The battery should be disconnected or removed when not in use. Speech reading can be helpful in increasing communication. The cochlear implant can be used as a hearing device for the profoundly deaf.

Communication with the client with Impaired Hearing:
  • Draw attention by hand movements
  • Have the light on face
  • Avoid covering mouth or face with hands
  • Avoid chewing, eating, smoking while talking
  • Maintain eye contact
  • Avoid distracting environment
  • Avoid careless expression that the client may misinterpret
  • Use touch
  • Move close to better ear
  • Avoid light behind speaker
  • Speak normally, slowly
  • Do not over exaggerate facial expression
  • Do not over enunciate
  • Use simple sentences
  • Rephrase sentence; use different words
  • Write down names or difficult words
  • Avoid shouting


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