Hearing Loss Understanding Where We Stand Today
Partial or Total Inability to Perceive Sound
Hearing loss, the partial or total inability to perceive sound, is the third leading chronic condition in older adults, exceeded only by hypertension and arthritis (Bance, 2007). The prevalence of hearing loss is staggering in nursing homes, with reports between 82%-90% (Hannula, 2011). Hearing loss has many etiologies, it can be present at birth (congenital), develop post-speech, be genetic in nature, due to an illness (like meningitis or rheumatic heart disease), due to noise exposure, due to age (presbycusis) or a combination of insults. Most nursing home residents with hearing loss have not purchased hearing aids (77%) or any other amplification device (Cohen-Mansfield & Taylor, 2004). Hearing loss greatly interferes with communication, impeding the ability to impart health information (Cohen-Mansfield & Taylor, 2004; Pryce & Gooberman-Hill, 2012). Untreated hearing loss detracts from interactions with family, cognitive status, functional status, and social integration (Gopinath et al., 2012; Lin, 2011; Solheim, Kvaerner, & Falkenberg, 2011).
Hearing loss is most frequently treated with hearing aids. Hearing aids provide amplification and improve audiometry scores by 15-20 decibels (dB), a measure of sound intensity. Aids improve hearing handicap scores by an average of 55 %,(Kochkin, 2011) and improve speech understanding, especially in one-on-one situations (Lewis, 2006). People who hear better and communicate more effectively experience less depression, anxiety, fear, isolation, and cognitive decline (Kiebling & Kreikemeier, 2013). Those who adopt hearing aids participate more in leisure activities than those with uncorrected hearing loss (Gonsalves & Pichora-Fuller, 2008). Those who wear hearing aids show improved cognition scores over those with uncorrected hearing loss (Cruz-Oliver, 2014).
Many methods exist to assist in communication and speech understanding. These include amplifiers (such as hearing aids, frequency modulator (FM) systems or pocket talkers), dry erase boards, electronic boards, sign language, and writing notes (Lancioni et al., 2012; Shinohara, 2012; Shinohara & Wobbrock, 2011). Sign language is typically not an option for persons who are hard of hearing, and it most commonly utilized by the Deaf community. Writing notes or using dry erase boards and electronic boards can be cumbersome and time consuming.
Assistive technology has been defined to include any items or equipment used to improve the functional capabilities of an individual with a disability. In this paper assistive technology is limited to FM systems, a system which assists individuals with auditory receptive communication. FM systems are particularly helpful for persons with moderate, severe, or profound hearing losses. They can be used with or without hearing aids, within a particular environment or for specific tasks. FM systems are not meant to be used in place of hearing aids, but in the case where an individual has never purchased hearing aids they may help in providing amplification in certain situations (Kiebling & Kreikemeier, 2013).
Types of Hearing Aids
Listening in Noise & FM Systems
Listening in noise, at a distance and in rooms with significant reverberation present challenges for any person, however, those with a hearing loss, particular the elderly experience significant difficulty. FM systems are the most effective way to improve the speech-to-noise ratio. FM systems work by decreasing background noise and show speech-to-noise ratio improvements of 15-20 decibels (Killion, 1997). For every 1 decibel increase in speech-to-noise ratio word recognition scores improved by 7-10% (Hawkins, 1984; Picard & LeFrancois, 1986; Thibodeau, 2010, 2014).
FM systems can also help overcome problems of listening at a distance. When the source of sound is more than 10 feet from a listener, the speech-to-noise ratio becomes too significant to compensate for, especially for those with moderate to severe hearing loss (Lewis, 2006). Rooms with significant reverberation also results in poor speech understanding, especially for older persons. The degree to which reverberation impacts speech understanding depends on reverberation time, distance between talker and listener, and the speech-to-noise ratio in the room (ANSI, 2010; Klatte, Lachmann, & Meis, 2011; Zannin et al., 2011).
Benefits of using FM systems for older persons has been documented. Erber conducted a 2-week trial with a portable FM system and found fewer misunderstandings and less disruption to communication (Erber, 1994). Much more recently Chisolm, Noe, McArdle, and Abrams found positive results when using FM systems with a group of hearing impaired veterans (Chisolm, Noe, McArdle, & Abrams, 2007). In addition Hickson et al found conducted environmental assessments of the long term care environment and found that the long term are environment was not conducive to communication. Long term care environments have significant numbers of residents with communication disabilities and their environment inhibits effective communication. They recommend that wide spread use of assistive listening devices, facility wide (Hickson, Worrall, Wilson, Tilse, & Setterlund, 2005). This study aimed to explore the acceptability and use of FM systems among long-term care residents who had not purchased hearing aids.
Have you heard of using FM systems before to better understand speech?
How an FM System Works?
How a FM System may help you
Hearing Aids and FM Systems
Hearing loss can be very disabling, however there are ways to improve speech understanding in many, not all, situations.
- See your audiologist to be tested
- Try hearing aids and other amplification
- Practice good communication and listening tips
- Add FM Systems when possible to further improve speech understanding
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