Supporting Patients with Age-Related Hearing Loss

Shannon Stocks, MS, CCC-SLP

Speech-Language Pathologist

You walk up to your patient’s front door and knock. You pause, waiting to hear the familiar scrape of a rolling walker against the tiled floor, the creak of turning wheels, the satisfying lock of breaks as your patient remembers the safety precautions you covered just days ago. You wait for a beat or two. You knock again, glancing down at your watch: 11:06 am. You knock louder, and call out, “Hey George, can you come to the door?” But you have a sinking feeling. He can’t hear you.

Many of our patients have presbycusis or age-related hearing loss. Identifying age-related hearing loss issues and knowing the warning signs are important for any clinician. And now, as we don our N95s, our patients with hearing loss may have further difficulty discerning our verbal instructions. It is imperative to consider the most practical, advantageous supports for this patient population to deliver a productive therapy session.

Defining Age-Related Hearing Loss

Presbycusis is a bilateral sensorineural hearing loss that occurs gradually due to aging and repeated exposure to sound. In fact, this age-related hearing loss affects one in three people from 65 to 74 years, and nearly half of individuals 75 years and older.

Throughout one’s life, repeated exposure to loud noises like construction, music, and even traffic can result in the gradual loss of inner ear sensory receptors called cilia. The loss of cilia, typically in both ears, can cause mild to severe hearing loss, depending on the level of exposure and possible comorbidities such as high blood pressure or diabetes (Cheslock, 2020). Presbycusis is considered to be a sensorineural hearing loss because of the degeneration of sensory hair cells and supporting cells towards the basal turn of the cochlea, as well as the degeneration of the auditory neurons.

While the prevalence is clear, the question remains: how can we, as clinicians, identify a hearing loss and optimally support our patients with this diagnosis?

Warning Signs of Age-Related Hearing Loss

There are several indicators of presbycusis. The primary symptom is apparent trouble hearing higher-pitched sounds. For example, words containing the “s” and “th” phonemes would be difficult to hear. If you were to say, “let’s sit,” your patient may have more difficulty hearing you than if you were to say, “grab a chair.”

If your patient complains of difficulty hearing the female physical therapist’s voice, yet there are no communication breakdowns during sessions with the male speech pathologist, this can be another indication that your patient struggles with detecting higher pitches. Your patient may also express that conversational partners sound mumbled or slurred, or that certain sounds are cause for annoyance. The reason some sounds may seem irritating to your patient is due to both the shortened dynamic range and the hypersensitivity to loud sounds that often comes with inner ear hearing loss.

Other signs of presbycusis can include complaints of tinnitus (a ringing tone in the ear) and increased difficulty distinguishing messages with background noise present.

Supportive Gestures for Patients with Age-Related Hearing Loss

Throughout the pandemic, it is arduous enough for clinicians to be understood behind our face shields and surgical masks. Adding the complication of patient hearing loss seems like a cruel trick. Without the proper supports in place, miscommunications and frustrations can arise, leading to less productive sessions. Our goal is to overcome these hindrances by considering the following actions:

• Refer to an audiologist: First and foremost, when you suspect a hearing loss, refer your patient to an audiologist. An audiologist can determine the presence, type, and severity of a hearing loss and provide hearing aid options. The audiologist can additionally remove any middle ear occlusions such as wax or refer to an ENT, as necessary.
• Learn simple hearing aid management strategies: If your patient has been fitted with hearing aids, you can play an instrumental role in carrying over considerations for everyday use. Talk to your patient about storing the hearing aid in a consistent location to avoid misplacement. Check the charge on your patient’s hearing aids or assist your patient with replacing a hearing aid battery before diving into your session.
• Provide additional amplification: To avoid breakdowns in communication throughout your therapy session, you can utilize a pocket-talker as a personal sound amplifier. This device reduces background noise and has individual volume and tone controls.
• Suggest assistive listening devices (ALDs): Many ALDs can reduce the impact of presbycusis on your patient’s everyday activities. Let’s use George from earlier as an example. When you call George to remind him of his appointment, he can use a captioning corded telephone to improve phone communication. When you arrive at his door, George can have a doorbell with a flashing strobe light to add a visual alert and compensate for lack of auditory input.
• Use visual supports: Once you are inside working with George on therapy activities, ensure he is processing your directions throughout the session by providing visual supports. These can include written step-by-step instructions, the use of printed pictures, or video demonstrations. A whiteboard can also be implemented for ongoing clarification of conversational speech.

While hearing loss is often a factor with many of our patients, it should not prevent us from having a productive therapy session. Now that we understand the warning signs of hearing loss and have identified ways to support this patient population, we can continue to put our best foot forward with every patient.