Conductive Hearing Loss Stimulation
Have you ever wondered how we are able to hear the world around us? We have the ability to hear the most sensitive sounds like a pin dropping across the room; and those of much higher intensities like a balloon popping. These sounds are only perceptible to us due to our auditory system. As we discussed in 491 last semester, a healthy working auditory system is able to take advantage of the physical qualities of sound (frequency, intensity, and phases), allowing us to hear. The ear itself is known as a transducer; meaning it is able to convert one form of energy to another (e.g. acoustic energy into electrochemical energy). A hearing loss can occur at different points along the auditory pathway. For the particular instance of this paper, I am going to focus on that of a conductive hearing loss. This type of hearing loss occurs when the outer and/ or middle ear(s) are damaged. When an individual experiences a conductive hearing loss, there will be a decrease in the amount of sound intensity reaching the cochlea (Welling & Ukstins, 2019). For this project, I was able to experience what it is like to have a conductive hearing loss. I organized my study across a wide range of environments and experienced a variety of reactions.
What is sound? Why am I having difficulty hearing it? As we have discussed this semester in CSD 402, sound relates greatly to a branch of physics known as acoustics. Sound is identified as a physical phenomenon that can propagate through a medium (e.g. air) without permanently shifting the particles (e.g. air molecules). In order to produce sound, we must have three principles: an energy source, a vibrating object that creates an audible pressure wave, and a medium of transmission. When one of these principals fail, our hearing ability is altered.
Passive Listening Environments
Anxiety during dinner:
My senses seem off. I remember this being my first thought of wearing the ear plug while being out to dinner one evening. It was as if my left side was muffled; everything seemed distant. The longer I wore the earplug, the more my anxiety increased. I could not help but to keep turning my head to the left side to be sure I was not missing something. The restaurant was crowded, which increased my anxiety more. Anxiety ridden thoughts coursed through my head. What if someone sneaks up behind me? What is someone steals my purse? When I began to research my feelings, I found this to be quite common in people with hearing difficulties.
An article published in 2018 caught my eye regarding that of a study known as “The Three City Study”. Researchers developed a prospective population-based study of 3,928 adults aged 65 and older in three different cities located in the French community. The goal of this study was to determine if there is any relationship concerning anxiety and people with hearing loss. The subjects were followed over a twelve-year time frame. Based on the findings, there proved to be an immediate link of heightened anxiety of individuals dealing with a hearing loss. The study also found anxiety was prospectively correlated with a heightened risk of reporting hearing loss. It was perceived that early detection of the hearing loss can be beneficial for quality of life regarding anxiety issues (Cash, Naël, & Carrière, 2018).
Watching Television: Higher MCL
When watching television, I noticed I had to keep turning the volume up past my normal most comfortable listening level or MCL. As we learned last semester in 491, our MCL is the level of which we prefer to listen to sound that is most comfortable to us. I decided to experiment with where I sat when watching. I noticed if I sat directly in front of the tv, I could hear it at a quieter volume (intensity)as compared to sitting towards the left or right side. A sound’s intensity is assessed in acoustic pressure. Pressure is generated when a force is dispersed over an area. When we measure sound intensity, we are measuring the force of that sound wave’s vibration over a given area. This is measured as: the larger the change in air pressure, the greater the intensity of the sound. I could hear the television at all locations, but I could not make out what they were saying. I also want to make note, there were other people in the room while I was testing this experiment. They complained that I was turning it up much louder than it needed to be.
When researching this idea, I found this to be a common issue in those with a hearing loss for both the individual with the impairment, along with the spouse/ family member of the person with the impairment. In the article “Guidelines for Providing Mental Health Services to People Who Are Hard of Hearing”, turning the television/ radio up too loud was at the top of the list of complaints by family members. This article focused on both the emotions of the person with the hearing loss and that of the family member experiencing it on a daily basis. In situations like the one described above, both parties shared similar feelings; the top two being frustration and guilt (e.g. such as when the individuals in my situation was getting frustrated with me turning the tv up too loud). These feelings are driven from lack of knowing how to handle such circumstances. If these situations are not addressed promptly, it could lead to difficulties down the road with relationship difficulties between the two parties (Trychin, 2002).
Active Listening Environments
Difficulty hearing in background noise:
While shopping one afternoon, I noticed it increasingly difficult to hear customer service representatives in the store(s) due to the amount of background noise. As I entered louder stores, the difficulty grew. I discovered it was more difficult in stores playing music and when they strayed a greater distance away from me when assisting me with something. If the environment was not overwhelmingly loud or they happened to be closer to me facing my direction, it was not hardly as difficult. I found this to be a fairly common occurrence in those with hearing difficulties when conducting my research.
In a research article titled “Effects of age and mild hearing loss on speech recognition in noise”, it was confirmed that several individuals with hearing loss suffer from difficulties understanding speech in the presence of background noise. The article suggests that individuals with a hearing loss may have greater difficulty when listening in loud environments than that of those of normal hearing. One probable cause researched was the possibility that this could be due to a distortion factor that results in reduction in function signal-to-noise ratio. The scientists conducting this research used eleven spondaic words to test the ability of understanding in both noise and quiet. These eleven spondees were digitized onto an analog tape as follows: “say the word…”. The background noise was placed on a two-channel tape recorder, interspersed and diluted by a speech audiometer (Dubno, Dirks, & Morgan, 1984). For the speech in noise technique, the primary starting level of the noise was established by modifying the noise in 10 dB steps according to an up-down adaptive process (beginning at 30dB). While a spondee word was presented in one side of a set of earphones, background noise was presented in the opposite ear. Measurements of speech recognition in quiet and in noise were acquired during three one and a half hour sessions. The results were constant with the hypothesis that both attenuation and distortion effects are present at low speech levels, whereas distortion effects persist at elevated levels.
Social Isolation during conversation:
I decided to use my ear plugs during dinner one night for another active listening environment experience. During this time period, I experienced feelings of social isolation from the people around me. I found myself missing bits and pieces of the conversation my family was having. I noticed myself trying hard to keep up with the conversation, while also dealing with loud noise that increased the difficulty. I eventually found myself becoming much less engaging than I typically am. My self-esteem seemed to dwindle. I lost the ability to confidently keep in plays with the conversation going on in front of me.
Research has shown there to be a direct link between social isolation and hearing aid usage (Dawes, Emsley, & Cruickshanks, 2014). It was observed that both social isolation and depressive episodes were linked to cognitive decline. Between the years 2006-2010, the UK National Health Service tested 500,000 UK adults that inclusively represented the general population. The subjects completed a two-hour test session that measured their lifestyle, environment, medical history, cognitive capacity and hearing levels. Hearing aid usage was addressed via questions such as “Do you use a hearing aid most of the time?”. Along with social isolation being addressed via the question “Do you often feel lonely?”. The subjects had the choices of “yes/no/do not prefer to answer”. Depression was also measured via “Over the past two weeks, how often have you felt down, depressed or hopeless?”. The answer choices were “not at all/several days/more than half the days/nearly every day/do not know/ or prefer not answer”. It was discovered that there was a relationship between social isolation with lesser hearing abilities and weaker cognitive function. It was also found that social isolation and mediocre hearing were linked with higher frequency of depression. Surprisingly, hearing aid usage was not associated with depressive episodes, but was associated with higher rates of social isolation. It was speculated that hearing aids can hinder involvement in social gatherings due to the amplification of background noise (e.g. restaurants).
Clarity difficulties while at the nail salon:
Another active environment I decided to test my ear plugs in was the nail salon. While I had no issue hearing her, I did have issues with the clarity of what she was essentially saying (also a topic we learned about last semester during audiology). I could hear her voice fine; I just simply could not understand the words. Her voice sounded muted, almost like I had water in my ears. Based on my knowledge from previously coursework, this seems to be a frequent complaint of hard of hearing patients.
The phenomenon of hearing the speech signal, while not being able to comprehend the content is a common occurrence amongst the hard of hearing populace. This idea brings us back to a concept we learned last semester in 491 regarding auditory pathology. Hearing loss occurs somewhere throughout our auditory pathway. It impairs the loudness of the sound reaching the persons ear and may result in distortion of it as well. Two common elements we learned to be an issue in hearing loss was that of severity and clarity. Severity refers to “how loud sound must be made for a person to just barely be able to hear it” (Welling & Ukstins, 2019). Whereas clarity refers to “how intelligible the signal is once it is presented at a comfortably loud level” (Welling & Ukstins, 2019)- e.g. most comfortable listening level. This principle describes why someone may hear something but could lack the ability to be able to discriminate what they heard.
While stimulating a conductive hearing loss, I learned a great deal of knowledge of how to better prepare myself for my future clientele. It was increasingly interesting to experience each emotion and reaction. Being able to step into another person’s shoes with a hearing loss has provided me with somewhat of a backbone on how it feels to have a hearing loss. As a future speech language pathologist, this experiment has given me more insight on what to look for in my future clients; as well gaining more insight on what my client(s) are experiencing in their daily life. While we cannot always see the hearing loss, we certainly can feel it.