Final Word | March 2019 Hearing Review

The community where I practice has a sizeable population of nonagenarians. Many of them find their way into the office and proceed to amaze me with their wisdom, wit, and capabilities. A few months ago, it was a 97-year-old WWII veteran who showed remarkable ability to adapt as a first-time hearing aid user.  More recently, it was a 94-year-old who responded to a marketing piece offering a “get acquainted” consultation. I questioned her about what situations might cause her to have difficulty hearing conversation. She reported that she recognizes no problems one-to-one; no problem in groups or worship services; no problems in a Bible study she leads, or in a prayer group she attends. She did say that she has trouble hearing her daughter-in-law who speaks very quietly. She had been seen in this office by the previous business owner six years ago when a bilateral moderate loss was identified. As I finished up asking history information, she hesitated for a bit and then reported that she has trouble blowing her nose. “I have to plug my ear with my finger or all the pressure blows out my ear.”

This matter-of-fact statement got my attention. I asked questions about ear infections and surgery, but she reported no recollection of any problems or treatment. Otoscopy revealed bilateral inferior perforations with no visible drainage or other abnormality.  Further brief investigation suggested symmetrical moderate mixed hearing loss. She has an upcoming primary care physician visit and I asked her to have a discussion with her physician about a referral for a full audiologic evaluation and ENT care. Further, we talked about the need for help with her hearing, including the use of hearing aids. (I did mention that blowing smoke out of one’s ear was a parlor trick back when there were many smokers and TM perforations were more common, but she allowed that it probably wouldn’t go over well in Bible study.)

With respect to considering hearing aids, she offered that she thought that it would be best if she “waited for a while” before thinking about adding hearing aids to her lifestyle. Thinking about her six-year delay in returning to the office, I pointed out that it is typically much easier for younger individuals to adapt to hearing aids than older individuals. She repeated her preference for waiting, and I settled for a six-month return appointment.

I shouldn’t be surprised that alert and cognitively intact nonagenarians have different priorities and needs than younger individuals with similar hearing loss. Additionally, although they may prove to be cognitively intact, they may not be as flexible and accepting of change in their lives, and more wary of dealing with small and delicate appearing devices. What I cannot get past is the importance of better hearing, especially for those with moderate hearing loss. The moderate loss may give them the impression that they are hearing well enough because they are aware of speech, even if they do not hear the message in its entirety. Further, because they are in their 90s others may give them a pass and accommodate for the hearing loss by SPEAKING.  SLOWLY. AND. IN. A. LOUDER. AND. CLEARER. MANNER.

The Final Word?  We see a wide range of patients who have difficulty hearing. In the interest of efficiency, we try and follow a system of proven successful actions in fulfilling best practices. Of course, every patient needs to be approached as an individual, with individual preferences and needs, and our orderly systems may not match up with everyone’s needs. Patients in their 90s can offer unique challenges as they deal with the typical consequences of the aging process, including their hearing loss. My experience has been that these patients are especially rewarding to work with as they offer good examples of healthy aging and adaptation to the inconveniences of the complications of being lucky enough to outlive many of their peers.

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Citation for this article: Van Vliet D. Hearing loss in the ninth decade of life. Hearing Review. 2019;26(3)[Mar]:50.

Image: © Rido |