A Speech and language therapist (SLT) is considered an expert in the treatment and management of communication and swallowing concerns across the lifespan. An SLT should have a comprehensive understanding of hearing and the auditory mechanism in order to identify individuals who may have impaired hearing, resulting in communication challenges. This report examines the different categories of hearing loss and the challenges and consequences that may arise for clients in this area.
A mild hearing loss is evident in air conduction thresholds within the 26dB HL to 40dB HL range. A mild hearing loss can result in inaccurate speech production and decreased participation amongst peers, (Stelmachowicz, Pittman, Hoover, Lewis & Moeller, 2004). This type of hearing loss can equate to an individual missing as much as 50% of a spoken conversation, resulting in difficulty developing appropriate language, social-emotional and academic skills, (Yoshinaga-Itano, Johnson, Carpenter & Brown, 2008). Consequences of a mild hearing loss are varying and impact individuals to different extents, however, it is important to note that the term 'mild' does not equate to insignificant or small challenges, (Welling & Ukstins, 2017).
A moderate hearing loss can be observed in an individual whose air conduction thresholds fall within 41dB to 55dB HL. This category of hearing loss can account for individuals missing as much as 80% of speech signals when verbally communicating, (Welling & Ukstins, 2017). It is suggested that full auditory access is integral for the development of appropriate speech and language in children and that this category of hearing loss is likely to result in delayed or incorrect syntax, a smaller vocabulary repertoire, inaccurate speech, and a flat voice, (Anderson & Matkin, 2007). Consequences for an adult with a moderate hearing loss are more concentrated on social effects, as adults are more likely to navigate their auditory challenges by using inference and life experience to fill gaps they encounter. Adults may decide they no longer enjoy participating in activities they once loved, such as going to the cinema, eating out at restaurants and being in settings that are loud and busy, (Dalton, et al, 2003).
A hearing loss evident in the range 71dB HL to 90dB HL is considered to be severe. For children who fall into this categorisation, it is imperative that early intervention takes place in order to improve the likelihood of speech and language acquisition within a relatively appropriate rate, (Tharpe, 2008). Individuals with a severe hearing loss may be unable to access any verbal conversation without supplements, (Welling & Ukstins, 2017). Educational impacts are evident in children with severe hearing loss, as individuals can become withdrawn due to being unable to access learning in the traditional format. Thus, these children don't make the typical gains seen in their normal-hearing peers and can be much slower to reach educational milestones, (Marschark, Shaver, Nagle, & Newman, 2015). Adults can display a rapid decline of participation and are often seen to self-isolate due to feelings of disconnect and insecurity, (Blazer, 2018).
A conductive hearing loss (CHL) is diagnosed when an air-bone gap is evident. This occurs when an individual’s bone conduction thresholds are within normal limits, yet their air conduction thresholds show impairment, (Hsieh, Lin, Ho & Liu, 2009). A conductive hearing loss can result from damage to the outer and middle ear or may be due to abnormality or obstruction in this area. Typically, a conductive hearing loss is characterised by a reduction in sensitivity, rather than a loss of clarity, (Welling & Ukstins, 2017).
If an individual is observed to have air and bone conduction thresholds that are equally abnormal, they are considered to have a sensorineural hearing loss, (SHL). This occurs as a result of damage to the inner ear and auditory nerve and is considered to be permanent. Often a person with SHL can hear low frequency sounds better than sounds in the higher frequencies, (Khan et al, 2019).
An individual with SHL is likely to be more impaired than someone with CHL. This is in part due to the fact that SHL includes a loss of sensitivity similar to CHL but is often times more significant and far-reaching. This loss of sensitivity is in addition to an impaired ability to understand auditory information which is evident even with amplification. Furthermore, individuals with SHL are likely to experience symptoms such as vertigo, tinnitus and an abnormal rising loudness upon the identification of a sound, (Wroblewska-Seniuk, et al. 2018).
An SLT is likely to have an individual with a conductive hearing loss on their caseload at any given time. In this population, an SLT may require collaboration with an audiologist in order to provide the best evidence-based practice. An SLT may provide counselling in the form of emotional support to clients with a conductive hearing loss and their families. This would include addressing hearing loss concerns and the social and emotional consequences of hearing impairment. An SLT's role also encompasses prevention and wellness by observing the quality of life and general wellbeing of clients in this population. Furthermore, advocation and education around hearing loss are paramount. It is the role of an SLT to identify individuals who may be displaying difficulties hearing, yet it is not within their scope of practice to evaluate or diagnose a hearing impairment. Additionally, it is the role of an SLT to maintain audiology instrumentation used for conductive hearing loss. Finally, it is the role of an SLT to ensure clients and their families receive the most beneficial service, therapy, and support in alignment with a client centred practice, (Welling & Ukstins, 2017).
In consideration with the above, it is important for an SLT to consider the implications of a hearing loss on all aspects of a client's life. By doing so an SLT is employing the use of client-centered practice and ensuring a holistic view is being maintained in the management of each client. The following themes are important considerations for this population of clients and should be closely monitored to ensure social-emotional wellbeing.
Social isolation
People with hearing impairment can become withdrawn and avoid instances where they will be required to communicate. Thus, there appears to be a strong relationship between hearing loss and social isolation, (Mick, Kawachi & Lin, 2014). Furthermore, it has been reported that children with hearing loss have greater difficulty forming positive relationships with their typically hearing peers, (Martin, Bat-Chava, Lalwani & Waltzman, 2010). It is often reported that people with hearing loss will exclude themselves from family gatherings to avoid demonstrating difficulty in front of loved ones, (Welling & Ukstins, 2017).
Depression
It has been concluded that individuals with hearing loss are at significant risk for psychiatric symptoms such as anxiety and depression, (Blazer, 2018). The inability to access information in traditional ways can cause feelings of worthlessness and low self-esteem, which result in lowered mental health status, (Weinstein, & Crofts, 2018). Research indicates that hearing loss can double the likelihood of developing depression and anxiety across the lifespan when compared to typically hearing individuals, (Kvam, Loeb, & Tambs, 2007).
Educational achievement
Research by Most (2004) suggested that children with mild hearing loss demonstrate lower performance in the classroom than children identified as having a more severe hearing loss, this is likely a consequence of accessibility to supports being lower for less significant hearing loss. Dalton, (2013) suggested that students presenting a mild hearing loss are likely to exert greater energy expenditure than their peers, impacting their ability to process the information around them. Alternately, children with moderate hearing loss were observed to make adequate academic progress when compared to their peers with typical hearing, (Antia, Jones, Reed & Kreimeyer, 2009). This could be because of the additional supports put in place for these children. Children with severe hearing loss often cannot access any verbal information or instruction within the classroom without additional support. They are often unable to participate and show significantly lowered educational attainment when compared to their typically hearing peers, (Marschark, Shaver, Nagle, & Newman, 2015).
The following reflection is based on my own experience using earplugs to simulate having a moderate hearing loss. I found this experience incredibly challenging. Not only was it difficult to have an impairment of hearing, but I felt I was inconveniencing others. I found it difficult to ask for help and found that the environment played a huge role in my level of understanding. For example, within my own home, I felt I was better able to adjust external influences, i.e., I could turn off the extractor fan and turn up the tv to better my chances of hearing what was being said. Thus, the task where I watched television was the easiest.
When using earplugs to watch television, I had to ask my friends to constantly adjust the volume. My friends also complained that once I found a comfortable volume for myself, it was too loud for them to enjoy the program we were viewing together. The volume was significantly higher than I am used to, with usual ranges being 15-20 and adjusted to approximately 40 during this experiment. The premise of the show we were watching made this task difficult as well due to the fantasy theme that was evident, meaning I could not always infer what was happening or what would come next. Once I took the earplugs out, I had to go back to the beginning as I had not taken in a lot of information.
Following this, we watched a segment of the news. This was much easier to follow, perhaps because I could use my inferencing skills to fill in details that were not heard. The absence of background sound made this part of the task much easier and the ability to see the speakers face allowed me to lip-read to some extent.
In the café setting, I could not control the level of noise happening around me, which made following the conversation challenging. I found that I was constantly asking for clarification on what was being said and asking friends to repeat themselves a number of times. The noise and environment made conversing really difficult and I felt very aware that my own voice was raised more so than others. When ordering my drink, I did not anticipate that the waitress would ask me follow up questions and was unprepared for having to navigate conversing with her. I felt uncomfortable and after explaining to her that I was completing an assignment I took out the earplugs and gave up.
I found the café scenario particularly unpleasant and the most difficult, due to the added component of unfamiliar people. When in the café I felt that I had to advocate for myself so much more, asking the waitress to repeat herself and attempting to clarify what she was saying. This was the most difficult part of the experiment in my opinion.
While wearing earplugs to my paediatric dysphagia lecture on a Monday morning, I found myself losing motivation incredibly quickly. I could not keep up with what the lecturer was saying and found myself reading off of the slides rather than following her verbal language. I found that I was exerting so much effort for minimal return. I tried to rely on my hearing but found that the more I focussed on listening the more irritated I became.
The thing that surprised me most about this experiment was the way in which my hearing impairment impacted other people. I found that in order to accommodate for my disability other people were having to adjust their own way of living. For example, turning up the tv supported my ability to hear but was actually too loud for my friends. Furthermore, when I couldn't understand what was being said they had to slow down their speech, often times choosing keywords and over articulating to further support my receptive input.
With earplugs in I experienced a hearing loss that ranged from mild to moderately severe. Upon consideration of the mean results of my audiogram I mostly experienced a moderate hearing loss. I believe that this reflected the difficulties that I encountered relatively well, however; I do believe I was unprepared for how challenging I would find this experiment. Over the course of the different tasks, I learnt how frustrating and time consuming every-day activities can be for a person with hearing loss.