Hearing impairment: special needs of the elderly

Investigating conversational dynamics in triads: Effects of noise, hearing impairment, and hearing aids

Communication is an important part of everyday life and requires a rapid and coordinated interplay between interlocutors to ensure a successful conversation. Here, we investigate whether increased communication difficulty caused by additional background noise, hearing impairment, and not providing adequate hearing-aid (HA) processing affected the dynamics of a group conversation between one hearing-impaired (HI) and two normal-hearing (NH) interlocutors. Free conversations were recorded from 25 triads communicating at low (50 dBC SPL) or high (75 dBC SPL) levels of canteen noise. In conversations at low noise levels, the HI interlocutor was either unaided or aided. In conversations at high noise levels, the HI interlocutor either experienced omnidirectional or directional sound processing. Results showed that HI interlocutors generally spoke more and initiated their turn faster, but with more variability, than the NH interlocutors. Increasing the noise level resulted in generally higher speech levels, but more so for the NH than for the HI interlocutors. Higher background noise also affected the HI interlocutors' ability to speak in longer turns. When the HI interlocutors were unaided at low noise levels, both HI and NH interlocutors spoke louder, while receiving directional sound processing at high levels of noise only reduced the speech level of the HI interlocutor. In conclusion, noise, hearing impairment, and hearing-aid processing mainly affected speech levels, while the remaining measures of conversational dynamics (FTO median, FTO IQR, turn duration, and speaking time) were unaffected. Hence, although experiencing large changes in communication difficulty, the conversational dynamics of the free triadic conversations remain relatively stable.

The Effects of Hearing-Aid Amplification and Noise on Conversational Dynamics Between Normal-Hearing and Hearing-Impaired Talkers

There is a long-standing tradition to assess hearing-aid benefits using lab-based speech intelligibility tests. Towards a more everyday-like scenario, the current study investigated the effects of hearing-aid amplification and noise on face-to-face communication between two conversational partners. Eleven pairs, consisting of a younger normal-hearing (NH) and an older hearing-impaired (HI) participant, solved spot-the-difference tasks while their conversations were recorded. In a two-block randomized design, the tasks were solved in quiet or noise, both with and without the HI participant receiving hearing-aid amplification with active occlusion cancellation. In the presence of 70 dB SPL babble noise, participants had fewer, slower, and less well-timed turn-starts, while speaking louder with longer inter-pausal units (IPUs, stretches of continuous speech surrounded by silence) and reducing their articulation rates. All these changes are indicative of increased communication effort. The timing of turn-starts by the HI participants exhibited more variability than that of their NH conversational partners. In the presence of background noise, the timing of turn-starts by the HI participants became even more variable, and their NH partners spoke louder. When the HI participants were provided with hearing-aid amplification, their timing of turn-starts became faster, they increased their articulation rate, and they produced shorter IPUs, all indicating reduced communication effort. In conclusion, measures of the conversational dynamics showed that background noise increased the communication effort, especially for the HI participants, and that providing hearing-aid amplification caused the HI participant to behave more like their NH conversational partner, especially in quiet situations.

Self-reported hearing difficulties, communication strategies and psychological general well-being (quality of life) in patients with acquired hearing impairment

PURPOSE

The aims were to (i) translate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Swedish and evalute its usefulness, (ii) describe hearing difficulties and psychological well-being (quality of life) and (iii) explore variables related to psychological well-being in a Swedish population.

METHOD

Seventy-nine consecutive patients, referred to the hearing clinic for hearing examination and audiological rehabilitation, formed the study sample. Along with pure-tone audiometry, the AIADH, the Psychological General Well-being index and the Communication Strategies Scale were used.

RESULTS

Men had significantly worse hearing on the high frequencies (2, 3, 4 and 6 kHz) than women but their quality of life was significantly higher than for women. Men scored significantly lower on 'auditory localization' and adopted non-verbal communication strategies less often than women. A stepwise regression analysis showed that 'maladaptive behaviours' and 'intelligibility in quiet' explained 48% of the variance in quality of life.

CONCLUSION

Psychosocial consequences of hearing loss, such as lowered quality of life, cannot be predicted from audiometric data alone. The adverse relationship between maladaptive behaviour and quality of life emphasizes the relevance of developing training programs aiming to improve coping with the consequences of a hearing impairment. The AIADH may be useful in assessing self-reported difficulties among patients with hearing problems, but needs to be further developed in terms of psychometric evaluations and reliability testings based on a larger representative sample.

The use of outcome measures to formulate intervention strategies

OBJECTIVE

To investigate the relative value of the use of open-ended and structured questionnaires in the determination of the most appropriate management of patients in a busy audiological rehabilitation clinic.

DESIGN

An open set questionnaire was sent to 56 consecutive patients before clinic attendance, and they were asked to rate the severity of the problems listed on arrival at the clinic. They subsequently were administered the Hearing Disability and Handicap Scale (HDHS), which was not scored until after management decisions had been made. The implications of the results of both questionnaires separately and together for patient management were compared.

RESULTS

The Problem Questionnaire highlighted a number of areas in terms of Activity Limitation (Disability) not covered in the HDHS, some of which, such as employment effects, were considered to be of considerable importance to the patients. However, in the field of more general Participation Restriction (Handicap), the structured questionnaire highlighted a number of important areas not volunteered by the patient.

CONCLUSION

Although the open-set Problem Questionnaire approach is valid in the domain of Activity Limitation, it needs to be supplemented by an additional measure of Participation Restriction, either open-set or structured, to ensure optimal patient management.

Use of patient-specific estimates in patient evaluation and rehabilitation

For a number of years we have been using open-ended questionnaires in the assessment of hearing disability and handicap, tinnitus complaint behaviour together with shortcomings and benefits of various rehabilitative interventions. More recently we have applied this approach to positive experiences reported by adults who have developed a hearing impairment and to the use of silence or social withdrawal as a communication tactic. In addition, we have asked individuals to rate the magnitude of each of their listed disabilities, handicaps, shortcomings, etc., on a scale to provide a qualitative assessment of each of these elements important to the individual. Such a procedure can be repeated after the intervention to measure changes in such estimates. This approach can thus highlight for the therapist, those elements of the patients' problems which are being well or poorly addressed and hence help them to concentrate their effort on the latter. Results obtained using this technique are presented and discussed.

An analysis of the communication tactics used by hearing-impaired adults

The aim of this study was to establish whether and to what degree certain types of communication strategies (hearing tactics) used by hearing-impaired adults could be shown to co-occur, and to find out which strategies were more likely to be used in which type of communicative situations. A consecutive series of 100 patients attending an audiological rehabilitation clinic was given a questionnaire asking how often they used each of five different hearing tactics in 11 different situations. 'Avoidance' and 'request for repetition' were the tactics used most commonly. 'Pretending to hear/understand' and 'positioning self to improve hearing' were used less frequently, with 'interruption' the least commonly used. There was some association between tactics and situations but no clear picture emerged. In a reassessment of our methodology and results, we suggest that the future research of communication strategies would benefit from a sociolinguistic approach based on the qualitative analysis of naturally occurring discourse (conversation) of hard-of-hearing people, focusing on the use of different strategies in relation to communicators' goals in interaction.

Aural rehabilitation in the elderly: supply of hearing aids related to measured need and self-assessed hearing problems

Three age cohorts of elderly persons in Göteborg (70, 75 and 88 years of age) were studied regarding hearing aid (HA) rehabilitation, on the one hand, and measured and self-assessed hearing, on the other. The participants, 615 in number, were representative of their ages and were selected from a geriatric population study. At age 70, 12% of the participants had been equipped with HAs. At age 75, the corresponding figure was 14% and at age 88, 32%. The correlations between self-assessed and audiometrically measured hearing were reasonably high (r = 0.5-0.7). According to the result for the self-assessed measure, we estimate that elderly persons with pure-tone averages (PTAs) at 30 dB HL (0.5-4 kHz, better ear) are in need of aural rehabilitation. Nevertheless, few subjects with PTAs between 30 and 49 dB HL have been equipped with HAs. At age 88, almost 20% of those with pronounced problems had no HA. Very few participants with no documented hearing problems for aural rehabilitation had been equipped with HAs.