All About Hearing and Hearing Loss

The ability to hear becomes increasingly important as vision begins to decrease. Contrary to popular belief, hearing does not become more acute to compensate for vision loss; instead, the individual who is blind or has low vision learns to pay closer attention to sounds and the information they provide about the environment.

Facts About Hearing Loss

Here are some facts about hearing loss in the United States:

• 30% of Americans who are 65+ have hearing impairments
• 45% of Americans who are 85+ have hearing impairments
• Persons who are 65+ represent 43% of the hearing impaired population in the United States, but only 24% of audiology caseloads

These statistics very closely resemble the demographic profiles of people with vision loss.

Types of Hearing Loss

There are several different types of hearing loss, each with its own auditory characteristics:

Central Hearing Loss:

• Results from damage to the nerves in the pathway to the brain or to the brain itself.
• Sound levels are generally not affected, but speech discrimination is difficult.
• It usually occurs secondary to a stroke, head injury, or vascular problems.

Sensorineural Hearing Loss:

• This type of hearing loss is also called presbycusis.
• It is caused by irreversible damage to the nerve endings in the inner ear. It is also commonly referred to as "nerve deafness."
• It causes a reduction in the quality of sound.
• Tinnitus frequently accompanies presbycusis. Tinnitus is described as a ringing or buzzing in the ears that occurs in the absence of any external cause or stimulus.

Conductive Hearing Loss:

• This type of hearing loss is caused by an impairment or blockage that prevents sound waves from traveling through the outer or middle ear to the inner ear.
• It causes a reduction in the quantity of sound.
• Amplification (a hearing aid) may sometimes help persons with conductive hearing loss.

Mixed Hearing Loss:

• This describes combined sensorineural and conductive hearing loss.

More About Presbycusis

Presbycusis describes hearing loss that occurs later in life and is often used to describe sensorineural hearing loss in older adults:

• Initially, high-pitched sounds are the most severely affected, with lower- and middle-pitched sounds following.
• It is usually bilateral and progressive.
• Hearing loss is usually greater for consonants than for vowels - S, Z, T, F, and G are especially difficult.

There are several causes of presbycusis:

• Family tendency
• Exposure to excessive amounts of noise at any time of life
• Medications, such as diuretics for hypertension; and non-steroidal anti-inflammatories (such as Ibuprofen)

Complaints of adults with presbycusis may include:

• Difficulty understanding some words and not others
• More trouble in noisy places and group conversations
• Feeling that people now speak less clearly and more quickly
• Less ability to understand unfamiliar voices and/or accents
• Less ability to understand children/women with higher-pitched voices
• Can hear sounds but not understand words

Psychological aspects of presbycusis can include the following:

• Depression can be common and can compound other life changes
• Fear of dependency
• Social withdrawal
• The family may misinterpret these changes as signs of cognitive or psychological deterioration and may institutionalize an individual prematurely or inappropriately.

What can be done for presbycusis?

Insist upon a diagnosis by an audiologist, an audiological evaluation, and proper evaluation and training, if hearing aids are recommended. Temper this with realistic expectations about what a hearing aid can and cannot improve.

Communicating with a Person with a Hearing Loss

• Speak in a normal tone of voice. Do not shout; shouting distorts the sound of your voice.
• Speak clearly and slowly. Don't clip word endings or mumble, and don't over-articulate your words. Stress key words and pause between statements.
• Use natural gestures and natural facial expressions. Avoid moving around while you talk.
• Speak at a distance of between three and six feet. Don't make the person who is hearing impaired speech-read over excessive distances.
• Stand in clear light facing the person with whom you are speaking. This will make your lip movements, facial expressions, and gestures easier to see.
• Make sure you have the hearing-impaired person's attention and are clearly visible to him or her before you start speaking. Tapping the person on the shoulder or waving from a distance can be acceptable methods for getting the person's attention.
• Move away from background noise.
• Rephrase what you have said when you think the person who is hearing impaired has misunderstood you. Look for clues, such as facial expressions and inappropriate responses.
• Do not obscure your mouth and do not chew food while speaking.
• Include the person who is hearing impaired in the conversation. Tell the person the topic of conversation; don't force him or her to guess. Speak directly to, not about, the person who is hearing impaired.
• In meetings or group activities where there is a speaker, strongly suggest that the speaker use the public address system.
• Arrange the room where communication will take place so that all participants are completely visible to one another. Try to eliminate or diminish background noise as much as possible.
• Ask the person who is hearing impaired what you can do to make conversation easier.

Additional resources for vision and hearing loss

• Deafblind Manual Alphabet [1]
• Information about Deafblindness [2] provides links to deaf-blind services throughout the world and examples of deaf-blind communication techniques.
• Self-Help for Hard-of-Hearing People: Hearing Aid Performance [3]