Listening to identify and improve communication in individuals with hearing loss

People with poor hearing may not realize their condition or the impact on their life. They can feel anxious, depressed, isolated, misunderstood or embarrassed, but when this information is not shared, their diagnosis is delayed. About 17% of American adults have some hearing loss, but the incidence increases to 50% over the age of 75.  Having hearing loss affects not only daily interactions, but may also affect a person’s overall wellbeing.

The underlying cause of hearing loss varies.  Sensorineural hearing loss, the most common type, is due to cochlear hair cell damage in the inner ear. This may occur gradually and affect both ears by decreasing the ability to hear high-frequency sounds. Conductive hearing loss affects the middle or outer ear, and treatment may include ear wax removal or surgery. Other causes can be medications or medical conditions including diabetes.

In our current health care system, hearing screenings for adults 50-years or older are not routine, since research has not shown a benefit. Pharmacists, who interact regularly with the general public, are in a unique position to help identify undiagnosed people, who may have poor hearing.  This can be done by knowing a person’s work history or through personal interactions. At risk individuals may include those exposed to loud sounds like heavy trucks and sirens, especially if the person does not routinely wear appropriate ear protection. Not all these people are at risk, since existing laws in the United States do require employers in the manufacturing industry to monitor noise levels and provide hearing protection to help reduce this risk. Pharmacist may also identify potential people through normal communication especially when asking open-ended questions. People, who respond to these questions by needing the question to be repeated, looking to others to respond for them, or relying on family members for help, may also be risk. Other ways a person may show they have poor hearing is through their actions.  Higher risk people may try to read lips, moves their heads to help position themselves to hear better or may not respond appropriately or at all.

An easy way to identify people, who may potentially be at risk for hearing loss, is to recommend and provide a screening test. Several tests are available in written form or on the internet. One example is a written 10 question hearing screening test called the Hearing Handicap Inventory for the Elderly that assesses the social and emotional aspect of hearing loss. This test could be available in a variety of settings were pharmacists or health care workers interact with the general population. After the person completes the test, the pharmacist could review the score and determine if that person should follow up with their health care provider or a hearing specialist.

For individuals who require treatment, hearing aids are an option, but cost and lack of insurance coverage may make it difficult for all who need them to obtain them. Therefore certain communication techniques can be used to improve a person’s comprehension. These include talking in a quiet room, using simple language, providing handouts or written instructions, and ensuring the speaker’s mouth is visible without gum, lozenges, or food in it. When talking, use a low pitch and speak slowly. Also allow for moments of silence when appropriate. At the end of the discussion, have the person repeat what they heard and understood. This allows for areas of misunderstanding to be addressed and clarified.  Finally, determine the communication style the individual prefers to make sure understanding is optimal.

Deborah Zeitlin
College of Pharmacy and Health Sciences
Butler University, USA

 

Publication

Identifying and optimizing communication in patients with hearing loss.
Zeitlin D
Am J Health Syst Pharm. 2016 Aug 15

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