Caregiver Guide: Hearing Problems

Understanding the Problem

Fifty percent of Americans over 65 suffer from hearing loss, although it is more common in older men than in older women.

Problems can be small (missing certain sounds) or large (not hearing at all). Unfortunately, many older people with hearing problems do not visit a hearing specialist or wear a hearing aid. The result is that many older people cannot understand what others are saying.

Hearing loss occurs gradually. One of the first signs to watch for is that the older person turns up the volume on the television. In addition, they do not clearly understand what you have said or frequently request that you repeat yourself. However, when you do repeat yourself in a louder tone, the older person may ask you to stop shouting. This is because the problem is not that you are speaking too quietly but that the older person is having trouble hearing and understanding certain sounds. High-pitched tones may sound fuzzy and certain consonants such as “s,” “f,” and “t” are not clearly understood.

Infections, certain medicines, and exposure to very loud noises over a long time can lead to hearing loss. However, for the most part, hearing loss in older people is the result of age-related changes in the ear.
 
If the older person is asking “What?” frequently, or cupping their ear after everything you say, you should urge them to have their hearing checked by a healthcare provider. They may make a referral to an otologist or otolaryngologist (doctors who specialize in hearing disorders).
 
While hearing loss may be permanent, there is help available to help make up for the loss, such as devices to make the telephone and radio louder, hearing aids, and certain techniques like lip reading.
 
It is important to let the healthcare provider know about hearing problems so the older person can be helped.

Your goals are to:

  • Be aware of the symptoms of hearing loss
  • Make an appointment with a healthcare provider for an evaluation
  • Help to make the loss easier to deal with
  • Encourage using a hearing aid or other assistive device

Click the topics below to read more.

When to Get Professional Help

Hearing loss in itself is not an emergency. However, sudden hearing loss or hearing loss in combination with other symptoms may be serious.

Call the healthcare provider immediately or go to the emergency room if any of the following symptoms occur

Sudden and complete hearing loss in either one or both ears

This could be due to a serious infection, a tumor, or stroke.

Sudden hearing loss in combination with nausea, vomiting, dizziness, or unsteadiness

This combination of symptoms could be due to an inner ear disturbance or a condition called Meniere's disease.

Call the healthcare provider during office hours to discuss the following problems

The person displays one or more of the following common signs of hearing problems:

  • Misunderstands words
  • Has trouble following a conversation
  • Turns up the volume on the TV so loud that others complain
  • Avoids parties or restaurants because of hearing problems
  • Does not answer the door or phone
  • Does not respond to conversation

Something to note is that wax in an older person’s ears can cause muffled hearing. The removal of wax may help a person hear things more clearly. When making an office visit with the healthcare provider, ask them to examine the ears of the older person.

Ways to check hearing at home include the following:

  • Ask the older person if they can hear the sound of a ticking watch.
  • Sit in a quiet room and rub two shoes together or rub a shoe on the carpet. Check to see if the older person hears the sound.
  • Ask the older person to close their eyes while having a conversation. Check to see if they are able to understand what the other person is saying.

Know the answers to the following questions before calling the healthcare provider

  • When is hearing a problem? During ordinary conversation? In a noisy room? While listening to the radio?
  • When did the hearing loss begin? Was it sudden or gradual?
  • In which ear is the hearing problem worse?
  • Is there ringing in the ears, dizziness, or vomiting?
  • Has there been repeated exposure to noisy environments?

What You Can Do to Help

There are many things that you can do, on your own, to help an older person with hearing problems

Don't shout

Shouting or speaking too slowly will distort the sound and make it harder for the older person to understand you. Speak at a normal speed (or slightly slower) in a normal tone of voice with a little amplification (a little louder) and try to use a lower (deeper) pitch to your voice.

Turn off the TV, radio, or running water when you are talking

Background noise makes it harder for the older person to hear what is being said.

Talk face-to-face

The older person needs to see your face when you talk. Seeing your mouth move and facial expressions helps them understand what you are saying. (We all informally read lips for clues to what is being said, but this becomes even more important for someone with a hearing problem.)

Be sure not to cover your mouth when speaking

Point or nod to make your message clearer and be sure you are in an area with good lighting.

Speak clearly

Don't mumble or talk with your mouth full. Use simple sentences or use different words if asked to repeat what you just said. Pronounce the words clearly, but don't exaggerate, because this can make it difficult to read lips.

Encourage the older person to ask for help

People with hearing problems should be open about having difficulty hearing and should tell others what they can do to help. For example, "I need you to look at me so I can hear you better" or "Let's go into a more quiet room."

Hearing Aids

Choose a hearing aid specialist carefully

When the older person is ready for a hearing aid, you must find someone to recommend the right type and to properly fit it. An otolaryngologist (ear, nose, and throat doctor), an otologist (ear specialist), a certified audiologist (who has a graduate degree in hearing impairment), or a licensed hearing aid dealer are all good choices to fit a hearing aid.

When purchasing a hearing aid, ask about follow-up after the sale, help, warranties, and service. (There is often a 30-day trial period where you can return the aid for a full refund minus a small fee.) Make sure the person selling the aid is reputable and experienced.

Make sure the hearing aid fits properly

Hearing aids must be fitted snugly into the ear canal. If the hearing aid doesn’t fit, it will not function properly and will probably whistle. Also, if it is uncomfortable, the older person won’t wear it. The hearing aid specialist should carefully fit the hearing aid, train the wearer in how to use it, and be available to make adjustments.

If the hearing aid does not seem to be working, try a different one

It may take several weeks for the older person to receive the full benefit from the aid. Wearing an aid makes the world seem louder and this takes getting used to.

However, if the aid is not working satisfactorily after several weeks (within the trial period), take it back to the person who sold it, explain the problem, and ask if a different model would be better.

There are many makes and models, from small aids that fit snugly inside the ear to larger ones that are visible on the outside of the ear. Sometimes people have to try several different types before they find the one that will work for them.

Other Devices

Ask about amplifiers

Amplifiers (devices that make a sound louder) have earphones and can be held or placed in a shirt pocket. They can be used for television so the hearing impaired person can hear normally without turning up the volume for the other listeners.

Amplifiers can be purchased inexpensively in electronic stores. They are often available in theatres or churches for patrons to use while in attendance. Ask the theatre manager or church staff how they are used and how to obtain one for the program or service.

Ask about assistive listening devices

These include telephone amplifiers, alerting devices (telephones and doorbells that blink instead of ring), and vibrating alarm clocks.  There are also microphone and headphone systems that make conversation in small groups easier to hear.

Carrying Out Your Plan

Problems you might have carrying out your plan

"Mom refuses to wear her hearing aid."

Sometimes people are ashamed or embarrassed when they have to wear a hearing aid. Some people think it makes them seem old. You can be encouraging, give lots of support, and suggest that your mother try the hearing aid at home to get used to it.

Be sure to encourage family members and friends to comment on how much communication has improved when your mother is wearing the hearing aid.

If your mother is concerned about the appearance of a hearing aid, consider that most women can style their hair to cover the hearing aids.

"My aunt keeps losing her hearing aid."

Make a routine of taking the hearing aid off and putting it in the same place every night.

"Dad won't tell people about his hearing problem."

Women tend to be more aware of health problems and seek help more readily than men do. Gentle but firm persuasion by family members may help direct your dad to the healthcare provider.

"My hearing is fine. You just have to speak up."

If the older person says this, reply with “Let’s work on this together. I’ll try to speak more clearly, but I’ve noticed that you have trouble hearing other people, too. So let’s make an appointment to have your hearing checked. Then the healthcare provider can tell both of us what we can do to help you hear better.”

Think of other problems you might have carrying out your plan

What other problems could get in the way of doing the things suggested in this presentation? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?

You need to make plans for solving these problems.

Checking on Progress

It usually takes at least several weeks and sometimes longer for a person to learn to use and be comfortable with a hearing aid. The older person first has to get used to having the aid in the ear and has to learn how to use the controls.

Hearing aids do not produce normal hearing since they make all sounds louder - background noise as well as speaking. Therefore, it takes some time to learn to focus on key sounds.
 
During the trial period, it is a good idea to return to the hearing specialist for fine adjustment of the aid and for counseling. It is also a good idea to use the aid along with lip reading and avoiding noisy places. The older person should feel comfortable with the audiologist or other hearing specialist and feel free to explain any problems related to the hearing aid that are upsetting. The more information the audiologist or other specialist has, the better they can fit and adjust the hearing aid.

What to do if your plan isn't working

You can't force someone to wear a hearing aid. Gentle persuasion in a cooperative, supportive manner usually works. Don't give up. If, after a fair trial, the hearing aid is not satisfactory, go back to the hearing specialist and ask for suggestions. Hearing aids are not suitable for everyone. A remote microphone or headset may be better.