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Sensory Impairment - Treatment Options PowerPoint Presentation

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Description : Check out this medical presentation on Hearing Disorders, which is titled "Sensory Impairment - Treatment Options", to know about the treatment options for common vision and hearing disorders.

Tags : Hearing Disorders, Sensory Impairment, Treatment Options, vision

Published on : Jul 10, 2021 | Views : 2483 | Downloads : 2

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Sensory Impairment Treatment Options Module 3 Brenda K. Keller, MD Geriatrics and Gerontology University of Nebraska Medical Center
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Objectives Module 3 Review treatment options for common vision and hearing disorders Understand techniques to improve function for older people with low vision and hearing loss.
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Treatments for Visual Disorders
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Cataracts Treatment: Surgical Extraction 90% of patients achieve vision ≥ 20/40 Cataract extraction is one of the leading operations performed on persons over 65 yrs of age- 1.5 million surgeries are performed annually in US. Local or topical anesthesia, small incision sonographic breakdown and aspiration of the lens, placement of an artificial lens
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Age Related Macular Degeneration Treatment Vitamins, antioxidants, zinc AREDS study showed vitamins decrease risk of advanced ARMD by 25% ( Dry) 500mg Vit C, 400 Vit E, 15 mg Beta Carotene, 80 mg zinc oxide, 2 mg cupric oxide Laser or intraocular pharmacotherapy (wet)
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Glaucoma Management: Intraocular pressure-lowering medications Local (eg, Xalatan, timolol, Alphagan) Systemic (eg, Diamox) Argon laser trabeculoplasty Intraocular surgery ± antimetabolites (mitomycin-C) Drainage devices Ciliary body destructive procedures
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Diabetic Retinopathy Treatment/prevention Prevention: Tight glucose control (A1C < 7 %) and BP control (≤140/80) Treatment: laser photocoagulation to decrease macular edema and inhibit growth stimulus for neovascularization
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Vision Rehabilitation Available to those with vision worse than 20/60
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Prosthesis: hearing aides Assistive listening devices Environmental changes Cochlear implant Hearing Loss: Options for Treatment
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Hearing Rehabilitation Hearing Aides Behind the ear In the ear In the canal Programmable
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Hearing Aids Two are better than one Not everyone benefits, ie, those with: Central auditory processing problems Poor speech discrimination Dementia Two types: Analog (less expensive) Digital (smaller, customizable) Many available styles
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Assistive Listening Devices Pocket-sized, personal amplifiers Telephone equipment: amplifiers, vibrating and flashing ringer alert devices, text telephones (TTY) Television listening devices Vibrating and flashing devices for alarm clocks, smoke alarms, doorbells, and motion sensors
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Cochlear Implant Electronic device that bypasses the function of damaged or absent cochlear hair cells by providing electrical stimulation to cochlear nerve fibers Implantation requires extensive pre-implant testing, post-implant training, and general anesthesia Costs are partially covered by most Medicare carriers and insurance companies; may require authorization Outcomes for adults >65 years are comparable to those of younger adults, with excellent audiologic and quality-of-life measures
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Improving Communication with hearing impaired elderly Be certain to have the person’s attention Speak face-to-face Repeat by paraphrasing Speak at normal level to slightly louder Speak a little more slowly Stand within 2 - 3 feet
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Improving Communication with hearing impaired elderly Reduce background noise Pause at end of sentences Avoid appearing frustrated Write down key words if the person can read Have the person repeat to be certain message was understood
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Summary
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Acknowledgments Slides adapted with permission from the American Geriatrics Society, Geriatric Review Syllabus teaching slide set. Permission granted 1-10-07
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Post-test question 1 An elderly couple is seen in outpatient geriatric assessment at the prompting of the wife. The 78-year-old husband was diagnosed as having occupational hearing loss following his retirement as a printing press operator 10 years ago, at which time he purchased by mail a left-side in-the-ear hearing aid. Initially he used the aide regularly; after he lost the unit, however, he did not get a replacement. Since then his wife feels that he has become more reclusive, refusing to accompany her to social gatherings. He declined an offer from his children to purchase a new aid as a holiday gift, saying that the last one "didn't seem to help that much." The wife feels both angry with his recalcitrance to obtain another hearing aid and concerned about his possible depression. Which of the following would be most appropriate to stress in advising the patient about going for formal hearing evaluation? Used with permission from: Murphy JB, et. Al. Case Based Geriatrics Review: 500 Questions and Critiques from the Geriatric Review Syllabus. AGS 2002 New York, NY.
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Which of the following would be most appropriate to stress in advising the patient about going for formal hearing evaluation? A. Bilateral hearing aids may significantly help with speech recognition. B. Newer, "hidden" in-the-canal hearing-aid models provide the loudest amplification. C. His prior experience with the older hearing aid means he will do well with another one. D. His wife should repeat misunderstood phrases more loudly
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Correct Answer: A. Bilateral hearing aids may significantly help with speech recognition. Use of hearing aids remains an underutilized rehabilitative strategy for many elderly persons who otherwise might gain important health benefits from some form of amplification. Men typically underestimate both the degree and the consequences of their hearing impairment. Reinforcement by the physician of the need to improve poor hearing is an important step. Speech discrimination is one of the most important benefits than can result from binaural amplification. While doubling the cost, two aides may jointly allow a lower, more tolerable level of amplification with better overall speech perception due to an improved signal-to-noise ratio.
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The most appropriate type of hearing aid for a patient is best determined after audiologic assessment. The latest technology features very small units placed inside the auditory canal with only a small "tail" used for retrieval. Such units are appealing cosmetically; however, they require considerable manual dexterity to operate and are easily lost, a recurring problem for this patient. In addition, a person's prior successful use of one type of hearing aid may not predict how well he will tolerate new types of amplification devices.
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Altered speech is rarely an effective way to improve overall speech recognition in a hearing-impaired person because it distorts the facial expressions, intonations, and nonverbal cues. Most meaningful portions of speech are contained in higher-pitch consonant sounds. As these higher frequencies are often missed with the common causes of hearing loss in older age (eg, presbycusis), repeating the exact phrases initially missed by the hearing-impaired person is often not effective. A better strategy is to attempt to rephrase the statement using words that sound different but convey the same meaning.
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Post-test question 2 Which of the following is the most appropriate device for an older patient who is primarily homebound and has a severe bilateral, symmetric sensorineural hearing loss; moderately severe rheumatoid arthritis of the hands; and a strong desire to minimize health care costs? A. Body-worn hearing aid B. Behind-the-ear hearing aid C. Hard-wired system such as a Pocket Talker D. Completely in-the-canal hearing aid E. In-the-ear hearing aid
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Correct Answer: C. Hard-wired system such as a Pocket Talker Feedback: The major complaints of persons with presbycusis are difficulty hearing in noisy environments and when the speaker is at a distance. Hearing assistive devices, rehabilitative technologies, or assistive technologies are devices that improve communication efficiency in quiet, noisy, and reverberating environments when hearing aids are not appropriate or are not sufficient. To explain, the intensity of the desired signal relative to the intensity of background noise is referred to as the signal-to-noise ratio. The more favorable the ratio, the better speech understanding. A well-recognized strategy for improving speech recognition in rooms is the use of personal room amplification systems or hearing assistive devices.
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A hard-wired system is a device wherein a wire connects the microphone of the speaker to the amplifier and the amplifier to the receiver used by the listener. Thus, there is a direct physical connection or hard wiring between the sound source and the individual. These devices have proven beneficial for persons who cannot manage hearing aids because of manual dexterity problems or dementia. Some advantages include their inexpensiveness, their helpfulness for patients who cannot use hearing aids, their utility in physicians' offices to ease communication with hard-of-hearing patients, and their ease of connection, use, and purchase. A body-worn hearing aid would be a poor choice for this patient. These devices are presently limited in their availability; in addition, they are bulky and too costly for the person described in the case.
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Behind-the-ear hearing aids (analog, programmable, or digital) are excellent for active older adults with severe sensorineural hearing loss who have significant communication demands and who can afford the device. This patient is unlikely to be able to manipulate such a hearing aid comfortably and would likely find such a choice too expensive. Completely in-the-canal and in-the-ear hearing aids are excellent for persons with significant communication demands or severe hearing loss, but they, too, are too costly for persons on a limited income and too difficult for persons with manual dexterity problems to manipulate independently. Medicare does not pay for hearing aids. The average price of traditional units in 1999 ranged from $782 for an analog nonprogrammable behind-the-ear unit (the most simple) to $1270 for an analog nonprogrammable completely in-the-canal unit to $2673 for a completely in-the-canal unit that is digital signal-processing programmable. The clinician must consider a host of factors, both audiologic and nonaudiologic, when recommending hearing aids for a particular patient. End
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Vision Acknowledgments Co-Editors: Karen Blackstone, MD Elizabeth L. Cobbs, MD GRS6 Chapter Authors: David Sarraf, MD Anne L. Coleman, MD, PhD GRS6 Question Writer: Gwen K. Sterns, MD Medical Writer: Barbara B. Reitt, PhD, ELS (D) Managing Editor: Andrea N. Sherman, MS © American Geriatrics Society
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Hearing Acknowledgments Co-Editors: Karen Blackstone, MD Elizabeth L. Cobbs, MD GRS6 Chapter Author: Priscilla Faith Bade, MD, MS GRS6 Question Writer: Barbara E. Weinstein, PhD Medical Writer: Barbara B. Reitt, PhD, ELS (D) Managing Editor: Andrea N. Sherman, MS © American Geriatrics Society