When an individual with Parkinson’s or age-related voice changes is referred to my practice, they undergo a comprehensive clinical assessment prior to the initiation of treatment, and this includes a medical history review, medications the patient is taking, and vison and hearing status, usually as reported by the patient.
Once patients are enrolled in treatment, we set about addressing their symptoms, which can include low volume, voice quality changes such as a hoarse voice, or vocal endurance. If indicated, referral to an ENT (Ear, nose and throat) doctor might be recommended prior to commencement of voice treatment.
THE GREAT DEBATE
At the time of the initial visit with a patient referred for speech and voice changes due to Parkinson’s disease (PD), the person with PD often reports that their spouse “can’t hear,” and the spouse often reports that the person with PD “mumbles or speaks to softly”. Could BOTH be true?
A problem of low speaking volume for the person with Parkinson’s is often real, and while this may not be the only motor speech disturbance, it is certainly the most characteristic change in speaking that is reported in clinical practice and in the literature, consequently, a primary target of speech therapy treatment is often to improve vocal intensity.
But, what impact does hearing loss have on perception of speech, by the person speaking or their communication partner, and is this a missing component of voice treatment that is frequently overlooked?
Should Patients and Carepartners Undergo a Hearing Test Prior to Speech Therapy?
Age-related hearing loss, also known as presbycusis, typically begins to become noticeable after the age of 60, and by the age of 75, nearly half of adults experience presbycusis, the same age range when Parkinson’s is often diagnosed. So, just as the loss of dopamine for the person with Parkinson’s is causing changes in the motor speech mechanism, including a reduction in vocal intensity (hypophonia) and less accurate perception of ones own voice, they or their primary communication partner (spouse), may also be experiencing hearing loss.
Hearing loss causes many of the same communication difficulties as a motor speech problem including:
- Difficulty monitoring one’s own voice: When you can’t hear yourself clearly, it becomes harder to regulate volume and pronunciation.
- Altered voice quality: Some individuals with hearing loss may develop a flat, monotone voice with little inflection because they cannot properly hear and monitor their own vocal pitch and intensity.
- Difficulty understanding others especially in noisy environments.
- Due to changes in speech clarity and difficulty following conversations, individuals with hearing loss may feel frustrated and misunderstood during interactions.
- Reduced confidence in conversations: Concerns about speaking clearly and understanding others can lead to anxiety and avoidance of social situations.
- Fatigue during conversations: Concentrating on hearing and understanding can be mentally and physically exhausting for people with hearing loss.
If you are someone with Parkinson’s’ reading the list above, it may sound very familiar, because these are often the concerns I hear from patients. If you are a spouse of someone with PD you may not have realized that hearing could be a factor in your communication interactions, and untreated hearing loss may negatively impact the desired outcome from speech therapy treatment.
Would you be surprised to know that hearing loss is considered the largest modifiable risk factor for dementia? And, we know that Parkinson’s disease is also associated with dementia with estimates suggesting that around 50-80% of people with Parkinson’s will eventually develop dementia. So, why not reduce your risk by being evaluated by an audiologist and if testing indicates, address any hearing loss through interventions like hearing aids.
Why an Audiologist?
I have to admit that this next recommendation is a pet peeve of mine, and that is to PLEASE SEE AN AUDIOLOGIST for your hearing testing. Why is that important? Because of the obviously close connection between hearing and speech and language production Audiologist receive their undergraduate and graduate training along side Speech-language pathologists . Presently, audiologist are required to have a clinical doctorate in their field, meaning they are not technicians, but rather, highly skilled clinicians. Dissatisfaction with hearing aids often comes about because the hearing aid selected did not match the user’s type of hearing loss, the hearing aid was not programmed optimally, or an unrealistic expectation regarding the benefit hearing amplification will provide. An audiologist is th emost qualified person to address those concerns.
Telehealth Bring Therapy as Close as Your Computer
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My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * Voice Aerobics® A Whole Body Approach to Voice Practice* Certified End of Life Specialist Training (CEOLS) * FiTOUR® Group Exercise Instructor