Hearing loss: Listening to the signs
Seated in a soundproof room, 67-year-old Dale Fowler listened carefully for tones coming through his earphone inserts.
In an adjacent space during this Oct. 25 appointment, audiologist Barbara Peregoy conducted a hearing test for Fowler at the University Hearing and Speech Clinic in Spokane. Helping Peregoy was Washington State University graduate student Megan Moore.
Graduate students, under the supervision of licensed speech-language pathologists and audiologists, offer a range of hearing and speech services at the clinic, which is operated jointly by Eastern Washington University and WSU on the Riverpoint Campus.
“Basically, we’re going to run through various frequencies we use for speech,” said Peregoy, who also is an EWU senior lecturer.
“Vowels are lower in frequency; the consonant sounds are high frequencies. Boomers definitively lose hearing in the high frequencies first, so they start missing the consonant sounds in the words.”
About 37.5 million Americans of all ages have some degree of hearing loss, Peregoy said, and baby boomers make up about 20 to 25 percent of that population. The American Speech-Language Hearing Association recommends that people age 50 and older have a hearing test every three years.
Fowler wanted to know if he needed hearing aids, a check suggested by family members. He has to strain sometimes to hear others speaking, especially in noisy places.
“If I’m in a cafeteria and it’s loud and echoey, I really have to pay attention to make sure I’ve heard someone,” said Fowler, a retired harbormaster.
Peregoy gave directions to Fowler through a microphone as she controlled an audiometer, which has a control panel with multiple knobs and distributes a range of frequencies. Peregoy and Moore could see Fowler’s face through a small window in the wall of the adjoining rooms.
Fowler responded with a “yes” when he heard different frequencies, first in the left ear, then the right.
“We work hard to find the lowest-intensity level per frequency,” Peregoy said.
After about 30 minutes, she found in Fowler’s hearing range what she says is common among baby boomers: he had some minor hearing loss at high frequencies in one ear, but it wasn’t enough to warrant a hearing aid.
Peregoy also checked both of his ears for any physical problems, and she asked common screening questions such as past noise exposure. She ended Fowler’s session with tips for improving communication skills, from requesting face-to-face dialogue to turning off the TV.
Baby boomers tend to fall into that gray area of minor hearing loss, Peregoy said. “As an audiologist, I’d say they have enough hearing loss to have some communication difficulties.
“Baby boomers probably have been exposed to noise either from work or recreation, sometimes both, but they’re also getting older, so they have noise-induced hearing loss and the aging of the auditory system.”
For those who have a more severe hearing problem, hearing aids are recommended both for better understanding of verbal speech but also for brain activity, she added.
“Hearing loss can definitely lead to cause a person to be more isolated, which is also a risk factor for dementia. People stop going to restaurants with friends, for example.
“As we age, use of hearing aids can help keep the brain active. Hearing loss is a risk factor for dementia. We think nothing of vision correction, yet people kind of hem and haw about correcting hearing. It’s just as important, both for hearing and to keep the brain active.”
In hearing tests, she checks how well people understand spoken words, screening possible issues with how the brain is processing words. With Fowler, Peregoy used a comfortable tone of voice to recite words loaded with high frequency sounds, and he repeated each one back to her correctly.
At younger ages, people typically can hear a wide range of frequencies, with each frequency measured in a unit called hertz for the frequency of sound waves.
“The range of frequencies we can actually hear are huge,” Peregoy said, from a low 20 hertz up to 20,000 hertz. “When we test for somebody’s hearing, we only test from 250 hertz to 8,000 hertz. That’s because those are the frequencies we need to be able to hear to understand speech.
“People come in and say, ‘I can’t hear my grandchildren, or I can’t hear my spouse.’ ”
A five-year wait is the average length of time in the U.S. between when someone is told they need hearing aids and the point they actually go get them, Peregoy said.
Some reasons for such a delay may be cost, denial, vanity, or even fear.
“It’s called the hearing aid effect,” she said. “They’re afraid they’ll start feeling old, or people will start treating them like they’re old. People are getting better at accepting and getting treated for hearing loss. I think the trend is starting to turn that way.”
Cost for the devices depends on the level of technology and the outcomes a patient desires, she added.
“You can fit someone as inexpensively as $800 per ear,” Peregoy said. “But it’s going to be extremely basic, just a generic amplifier. You can spend as much as $2,000 per ear for a hearing aid.”
Higher-end hearing aids can help people cope with tinnitus, which is ringing in the ears, or filter out background noises so the wearer can focus on individual speakers. Certain hearing aids also can stream cellphone conversations.
Some people ask Peregoy if they can get the smallest hearing aids possible, so they don’t show. She often tells those clients about a favorite quote, “Hearing loss is more obvious than the hearing aid.”
“We want people to come in to hear better and get the best technology, but sometimes people come in and say they’d rather spend money on a hearing aid that doesn’t show; they worry more about that.
“Yes, they are designing hearing aids that are more aesthetically pleasing. It’s been that way for a while.”
The clinic at 310 N. Riverpoint Blvd. handled about 2,050 patient visits for the academic year 2015-16, said Doreen Nicholas, its director. It sets appointments for all ages and can bill insurance, or people can pay on a cash basis.
Examples of the clinic’s speech services include patient support following a stroke, traumatic brain injury, Parkinson’s, concussive disorders, voice disorders, multiple sclerosis and amyotrophic lateral sclerosis.
Other sessions help with child language delay, stuttering and fluency disorders, speech problems from hearing impairment. Hearing-related support includes hearing tests, consultation for assistive listening devices, hearing aid assessments, and dispensing of hearing aid equipment.
A clinic hearing test typically costs $75 to $150, depending on what diagnostic services are provided, Nicholas said. “That should be reimbursed by most insurances.”
Seeing older clients for hearing tests is common, she added. “We know for those over 60, you’re more prone to hearing loss.”
Speech pathology students also are exposed to the clinic’s hearing services. To correct speech, their future clients must be able to hear errors they are making and corrections given to them during therapy sessions, Peregoy said.
“We teach our clinicians to screen for hearing loss, refer when necessary and implement any management strategies recommended by the audiologist,” she said.
Many clinic patients enjoy working with the graduate students, she added.
“We’re using evidence-based practices that we’re teaching graduate students. I think because we are a teaching clinic, we take a lot of time with people, and we’re able to educate the patients and the students.”
Here’s what audiologist Barbara Peregoy hands to patients who have minor hearing loss:
Ten commandments for good communication skills
1. Thou shall not speak from another room.
2. Thou shall not speak with your back toward the person with a hearing impairment (or their back toward you).
3. Thou shall not speak and walk away.
4. Thou shall not start speaking and turn away from the person with a hearing impairment.
5. Thou shall not speak in competition with something else (turn off the water or turn down the radio, TV).
6. Thou shall get the attention of the person with a hearing impairment before speaking.
7. Thou shall try to speak face-to-face at all times.
8. Thou shall try to remove obstructions while speaking (your hand from your face, etc.).
9. Thou shall try to speak distinctly.
10. Thou shall try to be patient.
To learn more
University Hearing and Speech Clinic
310 N. Riverpoint Boulevard, Spokane