Page 12 - Winter2018

Samira Anderson
Address:
Department of Hearing and Speech Sciences University of Maryland 7251 Preinkert Drive College Park, Maryland 20742 USA
Email:
sander22@umd.edu
Sandra Gordon-Salant
Address:
Department of Hearing and Speech Sciences University of Maryland 7251 Preinkert Drive College Park, Maryland 20742 USA
Email:
sgsalant@umd.edu
Judy R. Dubno
Address:
Department of Otolaryngology Head and Neck Surgery Medical University of South Carolina 135 Rutledge Avenue, MSC 550 Charleston, South Carolina 29425 USA
Email:
dubnojr@musc.edu
10 | Acoustics Today | Winter 2018
Hearing and Aging Effects on Speech Understanding: Challenges and Solutions
Development of effective, evidence-based solutions to overcoming communication barriers imposed by hearing loss is critical in our rapidly aging population.
Why Does Grandma Seem So Withdrawn Lately?
The scene is your annual Thanksgiving dinner. Your grandmother has been smil- ing throughout the dinner, but you can tell that she is not following the conversa- tion. She often interjects the conversation with an off-topic comment, and when asked a question, she may respond with an answer that does not relate to the con- versation. When someone asks, “Have you heard from Faith recently?” she might respond irritably, “Yes, I washed my face this morning.” She is 85 years old, and you are concerned she may be losing cognitive function.
But is it her cognitive status, her hearing ability, or a combination of the two that prevents her from fully engaging in the conversation? The answers to these ques- tions can be difficult to sort out. A hearing loss of just a mild-to-moderate degree can have a significant impact on one’s ability to understand speech in background noise, even if communication in quiet, one-to-one settings remains unimpaired (Dubno et al., 1984).
However, cognitive processes such as working memory or speed of processing may also interfere with communication in background noise (Pichora-Fuller, 2003). Previous studies have shown that hearing loss is associated with cognitive decline (Lin et al., 2013). Clearly, this link between cognitive decline and hearing loss sup- ports the importance of older adults, such as your grandmother, receiving a com- prehensive audiological evaluation and suggestions for managing a hearing loss, if identified. Yet, older adults are often reluctant to pursue help for their hearing difficulties because of assumptions regarding the high cost of hearing aids or how the use of hearing aids may appear to others. Their friends may have shared nega- tive experiences regarding hearing aid discomfort or inadequate performance in background noise. And, when an individual finally makes a decision to seek help, he or she may find that the communication barriers resulting from hearing loss can be difficult to overcome, even with appropriate diagnosis and management, for the reasons described in this article.
The Audiological Evaluation
What can the audiological evaluation reveal about your grandmother’s ability to participate in a conversation at a crowded dinner table? The typical evaluation assesses peripheral hearing function in each ear by measuring detection of pure tones at a wide range of frequencies (0.25-8 kHz) and plotting these thresholds as an “audiogram” and by measuring the ability to understand one-syllable words presented in quiet at conversational levels (“speech recognition”). Figure 1 dis- plays pure-tone thresholds at a range of frequencies for a typical younger adult
| volume 14, issue 4 ©2018 Acoustical Society of America. All rights reserved. https://doi.org/10.1121/AT.2018.14.4.12