Making Sense! Spotlight On Hearing
Hearing connects us to the world, helping us communicate, work, socialize and be alert to potential danger. Hearing impairment, likely affecting over 30% of seniors, touches all aspects of daily living. It contributes to depression, loneliness, poor job performance, and in the long run, may lead to Dementia. It is thought by some, that untreated hearing loss could be responsible for 9% of Dementia worldwide. The good news is that healthy lifestyle choices that include correction of hearing loss, might possibly delay or prevent one-third of Dementia cases.
Here is a guide to understanding hearing loss and what to do about it:
What causes hearing loss?
- Age
- Genetics (family history)
- Chronic illness (type-2 diabetes, hypertension, cardiovascular, autoimmune and infectious diseases)
- Medication (diuretics, antibiotics, chemotherapy, others)
- Environment (noise, pollution, industrial chemicals)
- Head trauma
- Smoking
- And more ...
We can’t change our genetics, but we can take steps to affect the other factors.
What are the types of hearing loss? Peripheral hearing loss occurs in the ear, while central loss involves parts of the brain that process auditory signals. Hearing loss is often a mix of both types.
How does hearing loss cause Dementia? It increases social isolation, reduces stimulation to the brain, and/or it may arise from the same brain changes that cause dementia.
What does testing involve?
To be thorough, take three tests:
- Ear testing: wear headphones while identifying short sounds played at different volumes and pitches.
- Central auditory processing (CAP) evaluation: checks speech reception and word recognition using the Staggered Spondaic Word Test (SSW) and the Synthetic Sentence Identification with Ipsilateral Competing Message test (SSI-ICM).
- Cognition: The Montreal Cognitive Assessment (MOCA), available online, for free, in multiple languages and dialects, is one page and takes ten minutes. MOCA detects mild cognitive impairment and early dementia.
What treatment is available?
- Hearing aids make sounds louder and easier to pick up.
- Middle or inner (cochlear) ear implants boost signals that go to the brain.
Treatment slows mental decline and improves cognitive test scores, so sooner is better.
What lifestyle strategies support hearing? :
- Moderate alcohol consumption
- Bone-strengthening exercise
- Antioxidant (Mediterranean, DASH) diets
- Stop smoking
Correcting hearing loss improves life enjoyment, daily function, and brain health. Take action today to help counter this modifiable risk for Dementia.
Contributing Blogger: Jennie Ann Freiman, MD, author of The SEEDS Plan.
The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.
References:
www.ncbi.nlm.nih.gov/pubmed/29964378
www.ncbi.nlm.nih.gov/pubmed/29735277
www.ncbi.nlm.nih.gov/pubmed/29212633
www.thelancet.com/commissions/dementia2017?code=lancet-site
www.ncbi.nlm.nih.gov/pubmed/29937713
www.ncbi.nlm.nih.gov/pubmed/30011159
www.ncbi.nlm.nih.gov/pubmed/29430246
www.ncbi.nlm.nih.gov/pubmed/28894825
www.ncbi.nlm.nih.gov/pubmed/27806352
www.ncbi.nlm.nih.gov/pubmed/29937713
For most of us, we are busy with our daily lives engulfed with family activities, work, education, and all the things that consume our time. We never give it a thought and often take it for granted how our senses keep us connected with our world.
As we age there are changes confronting us in the realm of our health and quality of life. These changes are age-related and present a disability to be addressed and remedied. Most of these are hearing, vision, speaking, various motor skills, and cognition. Hearing loss is estimated to affect some 39 to 50 million Americans.
Research has indicated that almost three out of every four individuals age 80 and above will have at least one disability to deal with. Most often, hearing loss is most common. Dr. Frank R. Lin, MD of Johns Hopkins University has been one of the leading researchers over the past ten years to make the connection with untreated hearing loss being a provocateur in the area of Dementia.
Our loved ones and senior friends impacted with hearing loss and some type of Dementia are especially at risk for decreased quality of life. Often these people require special care in a licensed facility with a professional medical staff 24/7.
Ideally, I recommend to every one of my patients to have a complete audiological evaluation on an annual basis. Following this guideline as an associated part of having an annual physical by their family physician, enables the audiologist to detect and monitor adverse changes in hearing acuity, abnormalities, and other medical issues to be addressed.
This evaluation provides the baseline and documentation on future tests that help the patient later in life. The protocol includes, but is not limited to: case history, otoscopic inspection, pure tone (air & bone) audiometry, speech audiometry, tone decay, tympanometry, acoustic stapedial reflexes, and distortion product otoacoustic emissions testing.
One avenue where this documentation will be critical is in handling hearing health care for those requiring amplification and knowing what the previous status was for Dementia-affected patients.
For the reader of this article, you would undoubtedly be able to participate in and complete an audiological evaluation administered by an audiologist. For a person with advancing Dementia, in a facility such as a nursing home or special care unit, it may that up to 95% cannot complete or tolerate the standard evaluation. Even though Congress in 1987 mandated a Minimum Data Set for a required evaluation of incoming residents to a facility, it does not guarantee a successful finding, in hearing, comprehending speech, and producing language.
For those people with mid to later stages of Dementia, alterations in testing protocol could be required. Behavioral tests are mostly eliminated from the battery.
There are many considerations in handling hearing loss, amplification, and proper examination and assessment for the person with Dementia. Since much of the protocol below is rather scientific-sounding and not easily expressed in lay terms, please print out this blog post and/or bring the information to your doctor to get the process underway.
A suggested protocol may include:
- Case history – Since the patient may not be able to provide complete and accurate information, a family member or friend should be queried. This step will require a review of previous audiologic studies.
- Otoscopic inspection – The audiologist will utilize an otoscope to examine the outer ear canals and visually assess for any apparent abnormalities.
- Audiometry for pure tone and speech stimuli – This component requires participation by the patient and test reliability in subjective responses. There will be some that may not tolerate the headset or canal inserts nor provide reliable information. Research has shown that only 5% may be able to complete this step.
- Tympanometry and acoustic stapedial reflexes; impedence testing – This assessment will show whether a perforation, abnormal middle ear pressure, or fluid is present and requiring otologic intervention.
- Distortion product otoacoustic emissions (DPOAE) testing – This is a truly objective test to determine the status of the outer hair cells of the cochlea. Normal responses are seen in threshold level up to 35 dBHL. The frequency range of DPOAE is 1500 to 6000 Hz.
- Amplification check – The doctor of audiology will clean, check, repair as needed, readjust, and refit the patient’s amplification if they are a current wearer. If replacement is indicated, this will be noted. As for a new fitting to a patient who has not previously been fitted, it will not be advised due to issues involving reliability of the assessment and tolerance of fitting.
If you wish to explore this subject further, please contact a board certified & licensed private practice doctor of audiology today.
Hearing loss, once addressed, may result in a much richer and more meaningful quality of life for all those affected!
Contributing Author:
Dr. Patrick M. Murphy, Au.D., M.Ed., CCC-A, FAAA
http://www.murphyhearingservices.com/
The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org
