Results of an extensive research study by Kochkin (2000), regarding the impact of hearing instruments on quality of life, succinctly articulates the compelling social, psychological, cognitive and health effects of hearing loss. Kochkin concludes hearing impairment negatively effects communication, resulting in isolation, withdrawal and separation adversely impacting the individuals with hearing loss as well as those with whom they interact.
The literature also indicates hearing loss is associated with feelings of embarassment, fatigue, irritability, tension and stress, avoidance of social activities, withdrawal from social situations, depression, negativism, danger to personal safety, rejection by others, reduced general health, loneliness, less alertness to the environment, impaired memory, less adaptability to learning new tasks, paranoia, lessened ability to cope and reduced overall psychological health (Kochkin, 1993, 1996 and 2000).
Hearing loss is a serious problem impacting all who come in contact with it. Therefore, it is vitally important to consider the dramatic impact of hearing loss while working with hearing impaired individuals and their significant others. In essence, audiologic rehabilitation equals good hearing health care.
Our self-concept is formed and based upon our social relationships with others. Our social relationships originate with communicative interactions. When communicative interaction is altered by hearing loss, it impacts the very nature of our beings. Because communication is transactional in nature, it is necessary to include communication partners in the audiologic rehabilitation process. Whenever possible, we must extend our services beyond the individual with the hearing loss since his/her hearing impairment is not only his/her problem. It impacts every interaction.
Despite the fact that continued rapid technological advancements in hearing instruments facilitate improved communicative function for those with hearing impairment, the act of simply fitting hearing instruments cannot and does not completely or efficiently remediate affected communication experiences.
Although patients using hearing instruments may demonstrate improved word recognition ability, better speech reception thresholds and improved audibility index scores, is this adequate? Is communication function described by the patient as 'good enough' satisfactory, when we know thoughtful audiologic rehabilitative procedures could assure, and more thoroughly accomplish, optimal communication level?
Such an audiologic rehabilitative approach is not something we 'add-on' to what we do as audiologists. Rather, it is the underlying essential component of compassionate care which we provide our patients and their significant others. It is the 'golden thread' running through all aspects of the hearing improvement treatment plan. In this sense, audiologic rehabilitation is provided from our very first meeting with the patient (and their significant others) through the entire relationship.
The exact content of a rehabilitation program will, by necessity, vary with each individual's needs. In most cases, counseling regarding the dynamics of communication, with focused education and training in effective communication skills can significantly facilitate the individual's management of their hearing impairment to improve communication ability for themselves and significant others.
How does one begin? We have determined it is very useful to have handouts available for the patient. Handouts should include; communication tips and strategies, coping techniques and speechreading strategies. Guidebooks which include appropriate handouts to reinforce your instruction are available for the clinician to copy for distribution to patients. (Wayner, 1990 , Wayner and Abrahamson, 1996). These materials were designed for individuals or groups of hearing aid users and their families. Activities and exercises are included to allow the clinician to select materials appropriate for specific individual needs. An extensive reference section includes resources to aid the clinician in providing quality rehabilitative services for their patients.
Family involvement in the rehabilitation process is essential for optimal benefit and improved communication function. Knowledge of communication strategies and information can enhance the interaction between the patient and their communication partner. Understanding the benefits and limitations of amplification and the acoustic (background noise, reverberation, signal-to-noise ratio, etc.) and related factors (speaker-to-listener distance, lighting, etc.) of the listening environment can have predictable effects on communication performance.
Following the case history and the initial audiologic evaluation, it is critically important to address not only the degree and type of hearing loss, but also;
1) amplification options,
2) the benefits and limitations of amplification,
3) various products available (assistive listening devices) beyond hearing aids,
4) the follow-up fitting and hearing aid checks,
5) training schedules,
6) time commitments, and
7) financial and insurance information.
Providing written 'take-home' material (see 'handouts' above) as a supplement to this first meeting allows patients to easily review the information you have provided. Pre-fitting information sheets were recommended by Denzil Brooks, Ph.D. at the recent Academy of Rehabilitative Audiology Summer Institute 2000. Dr. Brooks suggested the following items should be addressed within the hand-outs.
- It will be necessary to practice getting new hearing aids into and out of one's ears comfortably and adjusting them correctly.
- At first, it may seem like everything (including your own voice) sounds too loud. This is a common reaction. Most people adjust to this slowly.
- Background noise interferes with every person's ability to understand speech, even if their hearing is normal.
- Watching the speaker will help understanding,
- Remembering that hearing loss impacts every one in a communication interaction is important. It doesn't only affect the patient with hearing loss.
- Help others know how to communicate in the best way for you. Review the tips for communication shown on Table 1 titled: 'Help Others Hear You' (see below).
- Many people who experience hearing loss over an extended period of time withdraw from social situations. Therefore, be aware that you may have been affected by your hearing loss. Hearing aids will help make communication easier, but, will not make it perfect.
- Remember, hearing loss is more visible than hearing aids. It is not necessary to hide the hearing instruments. In fact, sometimes it is useful if they are visible, as others will be reminded of one's special hearing needs.
- Do not expect overnight perfection from the hearing instruments. Adjusting to hearing aids and learning how to use them properly takes time, patience and practice.
- With time, patience and practice, your communication skills will improve and interaction with friends and family will be easier and more satisfying.
Help Others Hear You
Get their attention
Face them in good light
Speak slowly and clearly - don't shout
Reword rather than repeat
Guiding your patients and their significant others through 'learning how to hear again' reflects the origin of our profession, and it is what our work is all about. Keep in mind that a thorough hearing health care formula includes the equation:
REFERENCES
Abrahamson, J., Patient Education and Peer Interaction Facilitate Hearing Aid Adjustment, High Performance Hearing Solutions (Supplement to The Hearing Review), 1, 19-22
Brooks, D. Presentation at the Academy of Rehabilitative Audiology Summer Institute, Snowbird, Utah, 2000
Kochkin, S. Marketrax III identifies key factors in determinind customer satisfaction, The Hearing Journal, 46: (8) 39-44, 1993
Kochkin, S. Marketrak IV: 10 years of trends in the hearing aid market: Has anything changed? The Hearing Journal, 49 (1), 23-34, 1996
Kochkin, S. And Rogin, C. (2000) Quantifying the Obvious: The Impact of Hearing Instruments on Quality of Life. The Hearing Review; Vol. 7, No. 1: 6,8,10,12,16,18,22,24,26,30,32,33,34
Northern, JL and Beyer, C. Reducing hearing aid returns through patient education. Presentation at the Academy of Rehabilitative Audiology Summer Institute. Lake Geneva, Wisconsin:1998.
Ross, M. A Retrospective Look at the Future of Aural Rehabilitation,
Journal of the Academy of Rehabilitative Audiology, 30 11-28, 1997
Wayner, DS. The Hearing Aid Handbook: Clinician's Guide. Washington, D.C.: Gallaudet University Press, 1990.
Wayner, DS and Abrahamson, JE. Learning to Hear Again: An Audiologic Rehabilitation Guide: Hear Again. Austin, Texas: 1996.
Wayner, DS. Hear What You've Been Missing: Coping with Hearing Loss. Minneapolis, MN: Chronimed Publishers, 1998.
Wayner, DS Facilitating Improved Communication for Adults with Hearing Impairment, Chapter 41, Handbook of Clinical Audiology, 5th edition, Katz, J., Williams and Wilkins, . In Press, Publication date: 2001.
