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Silence is not golden
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By Dr. Phillip S. Wade
Room-to-room conversations are common in most household, right? Mom's in the kitchen and calls to her son to please set the table for dinner. Dad is in the bathroom and asks for someone to please bring him a clean towel.
So what happens when a family member is hearing-impaired? One person makes a statement. The hearing-impaired person doesn't understand and asks, "What did you say?" if he answers at all. The statement is repeated, but the television is on, the kettle is whistling, and the person still doesn't understand. So Mom marches into her son's room and spits, "I said come set the table for dinner!" Grrrrrr. Dad finally snarls, "Never mind! I'll use a wet one!" Grrrrrr. Mom and Dad are suddenly exasperated and angry.
For adults, hearing loss is usually a gradual process. And often, the one with the hearing loss is the last one to recognize it. Family members, co-workers, and close friends are often the first to perceive difficulty with understanding, because they are the ones who must repeat themselves. This starts with an occasional
"what". As time goes on, it becomes necessary to repeat more and more as the hearing loss becomes worse. This usually occurs over a few years, but the impact is felt as quite sudden.
Types of Hearing Loss
There are two types of hearing loss: conductive hearing loss and sensori-neural hearing loss.
Only 5 per cent of the population suffers from conductive hearing loss due to impacted cerumen (ear wax), punctured eardrum, birth defects, otitis media, or heredity. Severe head trauma and otosclerosis cause conductive hearing loss. Otosclerosis is often a hereditary condition in which the tiny bones of the middle ear no longer transmit sound properly. Surgery may be an appropriate therapy for conductive hearing loss.
Sensori-neural can be caused by prenatal and birth-related problems, viral and bacterial infections (respiratory infections, measles, meningitis, etc.), heredity, trauma, excessive exposure to loud noises, use of ototoxic drugs, or a benign tumor in the inner ear. But sensori-neural hearing loss (also called "nerve deafness") is most often simply a natural phenomenon of aging. This condition is called presbycusis, and it results in the inability to understand what is being said more than a perceived loss in volume. It is caused by degeneration or damage to the microscopic hair cell receptors or cilia in the cochlea, causing irreversible hearing loss. In the vast majority of patients, these hair cells will function well if stimulated more vigorously with amplified sounds. Approximately 95 percent of those who can no longer hear well suffer from sensori-neural hearing loss. It is most commonly treated by the use of a hearing aid, and generally cannot be corrected through surgery or medicine.
Psychological Effects of Hearing Loss
Hearing loss is an invisible disability. People whose hearing is impaired live in a world where others, including their families, expect them to hear normally. Patients with hearing loss may find themselves ridiculed, ignored, or the constant target of anger from family and friends as well as from strangers.
The detrimental psychological impact over time of such treatment is obvious. They may even deny the existence of the problem, all the while becoming more and more confounded by the inability to understand conversation. Trying to cope as if nothing were wrong and" to keep up appearances" places them under a great deal of stress. Their nerves and energy are taxed because they must constantly monitor whether they are speaking too softly or too loudly. They must strain to hear conversation and frequently depend upon speech reading. It is no wonder that people with hearing loss eventually decide that they can no longer tolerate social activities. They may withdraw, first from friends and later from their families.
If you suspect a hearing loss, see your doctor and ask him/her to refer you to the appropriate hearing/health professionals.
For more information, please contact the Canadian Hearing Society Foundation at
(416) 364-4060 voice/TTY or visit their website at www.chsf.ca.
Dr. Phillip S. Wade is director of ENT services at the Canadian Hearing Society, active staff at Markham Stouffville Hospital and Toronto General Hospital.
SCREENING
Today's improved technology makes hearing screening in the physician's office easy and convenient. In a matter of seconds, a screening audiometer can identify patients who need to be referred for more extensive review by a specialist.
Ideally, all consumers should be screened periodically. Certainly, screening is important for the following:
• Every patient who answers "yes" to any question on the Self-Hearing Test
• Others who may be at high risk (e.g. all patients over 50 years of age or those with heart disease, excessive exposure to noise, AIDS, kidney aliments, diabetes mellitus and ototoxic drug use)
• Each year for children functioning at a developmental level of three years through Grade 3 and for any high- risk children including those above Grade 3
• Individuals who manifest symptoms during their visit to your office.
(American Speech-Language-Hearing Association. 1997. Guidelines for Audiologic Screening.)
What is the Self-Hearing Test?
Although the Self-Hearing Test was designed for those who are 65 years or older, it can be an effective tool for screening adults of all ages.
This screening tool can be useful in corroborating information obtained through audiometric screening or observation. A "yes" response to an item is awarded 4 points; "sometimes" 2 points, and a "no" 0 points. Scores range from 0 - 40 with higher scores indicating greater perceived handicap. A score in excess of 10 suggests a need for referral to a hearing care provider.
1.Does a hearing problem cause you to feel embarrassed when meeting new people?
2.Does a hearing problem cause you to feel frustrated when talking to members of your family?
3.Do you have difficulty hearing when someone speaks in a whisper?
4.Do you feel handicapped by a hearing problem?
5.Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?
6.Does a hearing problem cause you difficulty at movies, the theatre, or religious services?
7.Does a hearing problem cause you to have arguments with family members?
8.Does a hearing problem cause you difficulty when listening to TV or radio?
9.Do you feel that any difficulty with your hearing limits or hampers your personal or social life?
10.Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?
(Journal of the American Academy of Audiology 2: 70-75, 1991)
Screening audiometers: What do they do?
Screening audiometers produce a restricted range of pure tones of varying frequency and intensity. Frequency is measured in Hertz (Hz) and is perceived as pitch. Intensity is measured in decibels (dB) and is perceived as loudness.
Screening audiometers typically provide for a sweep across the frequencies important for speech (500 Hz to 4000 Hz) at a fixed intensity, usually 25 dB HL. Typically, the patient who hears all the tones has normal hearing, and a miss constitutes a fail. In other words, it's a "yes"/"no" type of test.
For testing patients over age 65, a screener that can also test at the 40 dB HL level is advised.
Another alternative is the use of a full "threshold" test. A threshold is the faintest sound which the average listener can just hear in a quiet environment. A threshold test is used to obtain more information about hearing at each of about four to eight frequencies.
How do I use the screening audiometer?
First, select a quiet, non-public area of the office. Make sure that a person with known normal hearing can hear all of the sounds used for the test. If not, the background noise is probably too high, and another location should be selected.
Be sure to check your patient's ear canals for excessive cerumen prior to the screening and, if necessary, arrange for cerumen removal.
Depending on the type of screening equipment, the tester will either place the ear speculum snugly in the ear canal or the earphone(s) over the ears.
Screening is as simple as pressing a button to produce the desired tones.
If hearing is normal, the patient should signal that a sound is heard each time a tone is produced. This may be done verbally or by raising the index finger each time a tone is heard.
Symptoms of Hearing Loss
For most people, hearing loss is so gradual that it is hardly noticed — and is usually detected first by family, friends, or a hearing test. You should suspect a hearing loss if you…
• have been exposed to high noise levels, such as tractors, machinery, firearms or power tools, without adequate ear protection
• feel growing nervous tension, irritability or fatigue from the effort to hear
• are inclined to believe that "every body mumbles" or "people don't speak as clearly as they used to"
• find yourself straining to understand conversations in social settings or at work
• frequently misunderstand or need to have things repeated
• find yourself watching people's faces
intently when you are listening
• increase the television or radio volume to a point that others complain of the loudness
• have a family history of hearing loss
• have diabetes, heart, thyroid or circulation problems
• have been exposed to ototoxic drugs or medications
• have reoccurring ear infections, constant ringing in the ears, or dizziness
• 80% of deaf Canadians are unemployed or underemployed
• Half a million Canadians work in noise hazardous enough to permanently damage their hearing
• 1 in 1000 babies is born with severe hearing loss
• 60% of people over 65 have hearing loss requiring assistance - Canada's elderly population will almost triple within the next 25 years
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