Indian Journal of Otology

ORIGINAL ARTICLE
Year
: 2015  |  Volume : 21  |  Issue : 1  |  Page : 29--32

The impact of hearing loss in the life of adults: A comparison between congenital versus late onset hearing loss


Swapna Sebastian1, Anne Varghese2, Mahasampath Gowri3,  
1 Department of ENT, Audio Vestibular Unit, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Psychology, National Institute of Speech and Hearing, Trivandrum, Kerala, India
3 Department of Bio Statistics, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Swapna Sebastian
Department of ENT, Audio Vestibular Unit, Christian Medical College, Vellore - 632 004, Tamil Nadu
India

Abstract

Aim of the Study: The aim of our study was to compare the impact of hearing loss in the life of adults who had congenital hearing loss with that of adults with acquired adult onset hearing loss (auditory neuropathy). Methodology: The quality of life scale questionnaire was administered on two groups. One group consisted of 10 adults with prelingual bilateral severe to profound hearing loss identified before the age of 3 years and who were using hearing aids and had received regular intervention for speech and language development by a qualified speech language pathologist. Second group consisted of 10 adults with auditory neuropathy. Results and Discussion: Wilcoxon rank sum test was used to compare the domains across the groups and the gender distributions between two groups were analyzed using Fisher«SQ»s exact test. The results revealed that differences between the adults with early-onset hearing loss and late onset hearing loss was statistically significant for most of the domains. The results indicated the fact that accepting a hearing loss during adulthood leads to more psychological trauma than adjusting and living with the hearing loss from the early years of life. Loss of hearing is quite traumatic to adults. Psychological trauma that they undergo is as important as their physiological problem and psychological referral to a clinical psychologist may be beneficial to many of them.



How to cite this article:
Sebastian S, Varghese A, Gowri M. The impact of hearing loss in the life of adults: A comparison between congenital versus late onset hearing loss.Indian J Otol 2015;21:29-32


How to cite this URL:
Sebastian S, Varghese A, Gowri M. The impact of hearing loss in the life of adults: A comparison between congenital versus late onset hearing loss. Indian J Otol [serial online] 2015 [cited 2021 Dec 3 ];21:29-32
Available from: https://www.indianjotol.org/text.asp?2015/21/1/29/152857


Full Text

 Introduction



Normal hearing sense is important in the social, emotional, psychological, and communicative realms. It is essential for safety and also to have more meaningful life. In children normal hearing is critical to speech and language development in children. The impact of hearing loss in developing communication is less if the problem is identified earlier and intervention done.

The causes of hearing loss in adults can either be genetic, or due to immune disease, infections such as meningitis, mumps, scarlet fever, Meniere's disease, exposure to loud noise, tumors, head injury, or due to aging (presbyacusis). Acquired hearing loss due to problems in the conductive pathway or inner ear problem can be managed medically, surgically or by using a hearing aid. Auditory neuropathy/dys-synchrony is a form of hearing impairment in which cochlear amplification (outer hair cell) function is normal, but afferent neural conduction in the auditory pathway is disordered. [1],[2] The diagnosis of auditory neuropathy/dys-synchrony is based on the clinical findings of normal outer hair cell integrity as revealed by the presence of the cochlear-microphonics (CM) and/or oto-acoustic emission, absence or severe abnormality of the auditory brainstem response, absence or marked elevation of acoustic middle ear reflexes and Speech perception (reception) that is impaired. The prevalence of auditory neuropathy in adults is reported to be 1.6% by Lotfi and Mehrkian, [3] 2.5% by Lee et al. [4] and 4% by Duman et al. [5] There are varying views regarding the usefulness of hearing aids and cochlear implants in patients with auditory neuropathy. Use of hearing aids in patients with auditory neuropathy/dys-synchrony is currently a controversial issue due to the risk of potential damage to hair cells in the cochlea and the usefulness of cochlear implantation is not convincing since the inherent auditory pathway is atypical. [6],[7],[8],[9],[10],[11],[12],[13]

People with hearing loss exhibit psychosocial problems such as isolation, rejection by others, withdrawal and restricted social life, poor career growth, overall job effectiveness, constricted lifestyle etc., The way it affects an adult who had a congenital hearing loss identified before the critical age and rehabilitated with a hearing aid or cochlear implant will be different from an adult who loses the hearing sense at adulthood and when the options for rehabilitation are limited. Adults with early-onset hearing loss would have grown up accepting the hearing loss whereas an adult who loses his hearing later in his life has already developed a personality and lifestyle, which does not assimilate the hearing loss. The purpose of this study was to look into the quality of life (QOL) in adults with auditory neuropathy compared with adults with early-onset hearing loss.

Aim of the study

The aim of our study was to compare the impact of hearing loss in the life of adults who had congenital hearing loss with that of adults with acquired adult onset hearing loss (auditory neuropathy).

 Methodology



Subjects for this study consisted of two groups. First group consisted of 10 adults between the age range of 16 and 40 diagnosed as prelingual bilateral severe to profound hearing loss identified before the age of 3 years based on behavioral observation audiometry, auditory brainstem evoked response audiometry, tympanometry and acoustic middle ear reflexes. All of them were using hearing aids and had received regular intervention for speech and language development by a qualified speech language pathologist. They studied in an integrated school.

Second group consisted of 10 adults between the age group of 16 and 40 years with adult onset auditory neuropathy. The diagnosis of auditory neuropathy was done based on the clinical findings of presence of the CM and/or oto-acoustic emission, absence or severe abnormality of the auditory brainstem evoked response audiometry, absence or marked elevation of acoustic middle ear reflexes and poor speech discrimination scores. The average thresholds obtained at 500 Hz, 1 kHz and 2 kHz were considered for defining the degree of hearing loss. Tympanograms and acoustic reflex thresholds were measured using a Grason-Stadler tympstar. A 226 Hz probe tone was used for tympanometry, with a sweep pressure from + 200 to − 400 daPa. Ipsilateral and contralateral acoustic reflexes were assessed bilaterally for 500 Hz, 1 kHz, 2 kHz, and 4 kHz. Distortion product evoked oto-acoustic emissions were recorded using intelligent hearing system (IHS systems) and at a particular frequency region when the signal-to-noise ratio was ≥ 6 dB, DOAE was considered to be present. Auditory brainstem evoked responses were recorded using IHS. The stimulus used was rarefaction and condensation clicks presented at the rates of 11.1/s. The filter setting was from 100 to 3000 Hz. The responses were recorded in a 10 ms time window with 2000 averages and was considered absent if there was no repeatable peaks obtained to click stimulus at 99 dB nHL, the maximum intensity of the equipment, and normal if a response was present at lower than 30 dB nHL. CM was obtained by comparing the responses obtained using rarefaction polarity stimuli with those obtained using condensation stimuli as described by Berlin et al. [14] Speech recognition was assessed with phonetically balanced words in Malayalam by Kapur in 1971 (as cited in Nagaraja 1990) [15] using Grason-Stadler, GSI 61 double channel audiometer in a soundproof room.

Exclusion criteria included the presence of (1) psychiatric illness (2) neurological disorders, (3) cognitive delay.

The QOL scale (QOLS) questionnaire [16] was administered on all the patients after taking a written informed consent. The QOLS [Table 1], was developed originally by Flanagan and has been adapted for use in chronic illness groups. [17],[18] Patients were asked to read each item of the questionnaire and circle the number that best describes how satisfied they were. The questionnaire was scored by summing the items to make a total score. QOLS contains 15 items representing 16 conceptual domains of QOL: Material well-being, health, relationship with relatives, having and raising children, relationship with spouse or significant other, having close friends, helping others, civic activities, intellectual development, understanding of self, occupational role, creativity/personal expression, socializing, passive recreation, active recreation, independence.{Table 1}

 Results and Discussion



Wilcoxon rank sum test was used to compare the domains across the groups and the gender distribution between two groups were analyzed using Fisher's exact test. The results are given in [Table 2].{Table 2}

The study reveals that adults with auditory neuropathy are deprived of not only the auditory sense; they also face psycho social problems. The P values suggest that differences between the adults with early-onset hearing loss and late onset hearing loss was statistically significant for most of the domains other than having and raising children and having close friends. The results reveal the fact that accepting a hearing loss later in life leads to more psychological trauma than adjusting and living with the hearing loss from the early years of life, mainly because they have developed a personality and lifestyle, which makes it difficult for them to accept the deprived sense at a later stage. There was no gender difference noticed.

Loss of hearing is quite traumatic to adults, and it was found to affect the material well-being, health and relationship with relatives and spouse. It limits the extent to which they can help others, their civic activities, occupational role and socialization. Their independence as well as quantity of recreation is also restricted, followed by the deprivation of hearing sense.

 Conclusion



Professionals need to be aware of the emotional problems that the patients with auditory neuropathy are undergoing. Psychological trauma that they undergo is as important as their physiological problem and psychological referral to a clinical psychologist may be beneficial to many of them.

References

1Starr A, Picton TW, Sininger Y, Hood LJ, Berlin CI. Auditory neuropathy. Brain 1996;119 (Pt 3):741-53.
2Berlin CI, Hood LJ, Rose K. On renaming auditory neuropathy as auditory dys-synchrony. Audiol Today 2001;13:15-7.
3Lotfi Y, Mehrkian S. The prevalence of auditory neuropathy in students with hearing impairment in Tehran, Iran. Arch Iran Med 2007;10:233-5.
4Lee JS, McPherson B, Yuen KC, Wong LL. Screening for auditory neuropathy in a school for hearing impaired children. Int J Pediatr Otorhinolaryngol 2001;61:39-46.
5Duman K, Ayçiçek A, Sargin R, Kenar F, Yilmaz MD, Dereköy FS. Incidence of auditory neuropathy among the deaf school students. Int J Pediatr Otorhinolaryngol 2008;72:1091-5.
6Rance G. Auditory neuropathy/dys-synchrony and its perceptual consequences. Trends Amplif 2005;9:1-43.
7Roche JP, Huang BY, Castillo M, Bassim MK, Adunka OF, Buchman CA. Imaging characteristics of children with auditory neuropathy spectrum disorder. Otol Neurotol 2010;31:780-8.
8Roush PA. Children with auditory neuropathy spectrum disorder. In: Seewald R, Tharpe AM, editors. Comprehensive Handbook of Pediatric Audiology. San Diego, CA: Plural Publishing; 2011. p. 734-50.
9Roush P, Frymark T, Venediktov R, Wang B. Audiologic management of auditory neuropathy spectrum disorder in children: A systematic review of the literature. Am J Audiol 2011;20:159-70.
10Spirakis S. Auditory Neuropathy Spectrum Disorder and Hearing Aids: Rethinking Fitting Strategies Hearing Review. 2011;18:28-33.
11Teagle HF, Roush PA, Woodard JS, Hatch DR, Zdanski CJ, Buss E, et al. Cochlear implantation in children with auditory neuropathy spectrum disorder. Ear Hear 2010;31:325-35.
12Miyamoto RT, Kirk KI, Renshaw J, Hussain D. Cochlear implantation in auditory neuropathy. Laryngoscope 1999;109:181-5.
13Rance G, Beer DE, Cone-Wesson B, Shepherd RK, Dowell RC, King AM, et al. Clinical findings for a group of infants and young children with auditory neuropathy. Ear Hear 1999;20:238-52.
14Berlin CI, Bordelon J, St John P, Wilensky D, Hurley A, Kluka E, et al. Reversing click polarity may uncover auditory neuropathy in infants. Ear Hear 1998;19:37-47.
15Nagaraja MN. Testing, interpreting and reporting procedures in speech audiometric tests. In: Kacker SV, Basavaraj V, editors. Indian Speech, Language and Hearing Tests-The ISHA Battery. Mysore: Indian Speech and Hearing Association; 1990. p. 79-108.
16Flanagan JC. A research approach to improving our quality of life. Am Psychol 1978;33:138-47.
17Flanagan JC. Measurement of quality of life: Current state of the art. Arch Phys Med Rehabil 1982;63:56-9.
18Burckhardt CS, Woods SL, Schultz AA, Ziebarth DM. Quality of life of adults with chronic illness: a psychometric study. Res Nurs Health 1989;12:347-54.