Interview with Ruth Bentler Ph.D., Professor of Audiology, University of Iowa
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Topic: Aural Rehab and Hearing Aid Technology
AO/Beck: Hi Ruth. Thanks for joining me today. Your research work in hearing aids has always been exciting and revealing. Before we get to those issues, would you please give me a thumb nail sketch regarding your own education?
Bentler: Sure, the thumbnail sketch is easy. All my degrees are from Iowa. My Ph.D. was finished near the end of 1987. My master's was earned in 1973.
AO/Beck: What was your dissertation on?
Bentler: My dissertation challenged whether we were setting the maximum output of hearing aids appropriately. It was titled Comparison of Discomfort Levels Obtained with Pure Tone and Multi-Tone Complexes .
AO/Beck: Talk about perfect timing, that was certainly the right topic at the right time! I'd like to focus today's chat on many of the same topics you covered at the ARA* meeting in Kerrville, Texas.
Bentler: Sure, that would be great. The bottom line was technology can't do it alone. Barbara Parker asked me to talk about how hearing aids are only one piece of the aural rehabilitation pie, and that's what I've always preached. In many of my research projects we have tried to figure out limits of the hearing aid processor; after that, any increase in benefit must come from our aural rehab efforts.
AO/Beck: What is the most important component of aural rehabilitation?
Bentler: The most important thing we do in the evaluation and follow-up process is to listen to the patient. If we don't know what they're thinking, expecting, wanting, or having problems with, then we don't know where to go with them.
AO/Beck: Ruth, can you explain that a little?
Bentler: Sure. Virtually every patient who comes to our clinic says, I have hearing loss, so that's a given. But I need to know more specifics before I can plan a management scheme. The more specific the patient and their problems are, the better prepared I am to begin the rehab process.If the patient says, I can't hear my grandchildren and my wife says the TV is too loud, we can deal with those specifics quite effectively. But if we try to manage hearing loss with one broad brush stroke, we will be less successful. The way I approach it is sort of as an informal, modified COSI. Once I have a pretty good understanding of what their problems are, and what the solutions might be, then we can establish reasonable expectations. However, I can't establish reasonable expectations until I know specifically what they're having trouble with.
If somebody says to me, The only problem I am having is in large groups, that's a good opportunity to discuss expectations. I will say to them, Nearly everyone with hearing loss has trouble in groups or crowds. So, one of the first steps is to establish a credible relationship, and that has to be based on listening to their specific auditory problems. The technology you choose will help the two of you reach the defined reasonable expectations.
AO/Beck: Very good. I wonder if you can tell me, what are the hearing aid features you find most beneficial?
Bentler: Directional microphones, digital noise reduction and feedback management are all important. Volume controls seem to be important for about half the people. Relative to directional mics. I'm from the David Hawkins' school of thought on this, since he was my first mentor at Iowa. Sometimes I wonder why all hearing aids don't have directional microphones (style permitting)? That is not to say directional microphones are beneficial all the time; they aren't. Brian Walden has reported that if you train a person to use it right and if they use it in the right environment they'll get benefit about 25% of their wearing hours. However, it does add cost and that's a factor too
AO/Beck: What about noise reduction?
Bentler: In terms of noise reduction, most of the hearing aids these days have some version of noise reduction. When you use noise reduction you may be reducing the speech cues at the same time, but doing so has also been shown to improve listening ease. If you can take away the noise without reducing the message too much, it's a good thing. Frankly, I am not convinced I know how to deal with noise reduction. But since most of the hi-tech hearing aids have it, I am trying to understand the function and outcome for the hearing aid user.
AO/Beck: One thing I'd like to get your opinion on is the Etymotic Link-It. I think this offers a really neat solution for people with BTEs and T-coils, when they need help in specific noisy situations. The directionality seems pretty impressive.
Bentler: When we were studying microphones, we studied the Link-It, which is an array microphone, and I, too, was impressed with it. I've had some experience listening with it in the anechoic chamber and in real life situations.
AO/Beck: I suppose we're getting close to the point where ITEs and BTEs have similar directionality characteristics?
Bentler: Well, yes, generally speaking, you can get as much directionality in an ITE as you can in a BTE. One of my doctoral students, spent four years studying directional microphones and some of that time was spent assessing the difference between BTE and ITE mounted microphones, in terms of directivity and user benefit. We know from lots of different research efforts that directional mics can improve the listening success for the hearing aid user.
AO/Beck: Thanks Ruth. It's a pleasure to spend time with you, I know you have to run. Thanks for your time and I hope we can catch up again soon.
Bentler: Thank you too Doug. I appreciate the chance to talk about these topics.
* ARA - The Academy of Rehabilitative Audiology was founded in 1966 to promote excellence in hearing care through the provision of comprehensive rehabilitative and habilitative services. Each year the ARA hosts the ARA Summer Institute which provides a forum for discussion on the latest developments in auditory rehabilitation research and therapy. ARA membership is open to anyone conducting research or providing services in the area of audiologic rehabilitation. For more information visit www.audrehab.org or call the national office at 952-920-0484.
Bentler: Sure, the thumbnail sketch is easy. All my degrees are from Iowa. My Ph.D. was finished near the end of 1987. My master's was earned in 1973.
AO/Beck: What was your dissertation on?
Bentler: My dissertation challenged whether we were setting the maximum output of hearing aids appropriately. It was titled Comparison of Discomfort Levels Obtained with Pure Tone and Multi-Tone Complexes .
AO/Beck: Talk about perfect timing, that was certainly the right topic at the right time! I'd like to focus today's chat on many of the same topics you covered at the ARA* meeting in Kerrville, Texas.
Bentler: Sure, that would be great. The bottom line was technology can't do it alone. Barbara Parker asked me to talk about how hearing aids are only one piece of the aural rehabilitation pie, and that's what I've always preached. In many of my research projects we have tried to figure out limits of the hearing aid processor; after that, any increase in benefit must come from our aural rehab efforts.
AO/Beck: What is the most important component of aural rehabilitation?
Bentler: The most important thing we do in the evaluation and follow-up process is to listen to the patient. If we don't know what they're thinking, expecting, wanting, or having problems with, then we don't know where to go with them.
AO/Beck: Ruth, can you explain that a little?
Bentler: Sure. Virtually every patient who comes to our clinic says, I have hearing loss, so that's a given. But I need to know more specifics before I can plan a management scheme. The more specific the patient and their problems are, the better prepared I am to begin the rehab process.If the patient says, I can't hear my grandchildren and my wife says the TV is too loud, we can deal with those specifics quite effectively. But if we try to manage hearing loss with one broad brush stroke, we will be less successful. The way I approach it is sort of as an informal, modified COSI. Once I have a pretty good understanding of what their problems are, and what the solutions might be, then we can establish reasonable expectations. However, I can't establish reasonable expectations until I know specifically what they're having trouble with.
If somebody says to me, The only problem I am having is in large groups, that's a good opportunity to discuss expectations. I will say to them, Nearly everyone with hearing loss has trouble in groups or crowds. So, one of the first steps is to establish a credible relationship, and that has to be based on listening to their specific auditory problems. The technology you choose will help the two of you reach the defined reasonable expectations.
AO/Beck: Very good. I wonder if you can tell me, what are the hearing aid features you find most beneficial?
Bentler: Directional microphones, digital noise reduction and feedback management are all important. Volume controls seem to be important for about half the people. Relative to directional mics. I'm from the David Hawkins' school of thought on this, since he was my first mentor at Iowa. Sometimes I wonder why all hearing aids don't have directional microphones (style permitting)? That is not to say directional microphones are beneficial all the time; they aren't. Brian Walden has reported that if you train a person to use it right and if they use it in the right environment they'll get benefit about 25% of their wearing hours. However, it does add cost and that's a factor too
AO/Beck: What about noise reduction?
Bentler: In terms of noise reduction, most of the hearing aids these days have some version of noise reduction. When you use noise reduction you may be reducing the speech cues at the same time, but doing so has also been shown to improve listening ease. If you can take away the noise without reducing the message too much, it's a good thing. Frankly, I am not convinced I know how to deal with noise reduction. But since most of the hi-tech hearing aids have it, I am trying to understand the function and outcome for the hearing aid user.
AO/Beck: One thing I'd like to get your opinion on is the Etymotic Link-It. I think this offers a really neat solution for people with BTEs and T-coils, when they need help in specific noisy situations. The directionality seems pretty impressive.
Bentler: When we were studying microphones, we studied the Link-It, which is an array microphone, and I, too, was impressed with it. I've had some experience listening with it in the anechoic chamber and in real life situations.
AO/Beck: I suppose we're getting close to the point where ITEs and BTEs have similar directionality characteristics?
Bentler: Well, yes, generally speaking, you can get as much directionality in an ITE as you can in a BTE. One of my doctoral students, spent four years studying directional microphones and some of that time was spent assessing the difference between BTE and ITE mounted microphones, in terms of directivity and user benefit. We know from lots of different research efforts that directional mics can improve the listening success for the hearing aid user.
AO/Beck: Thanks Ruth. It's a pleasure to spend time with you, I know you have to run. Thanks for your time and I hope we can catch up again soon.
Bentler: Thank you too Doug. I appreciate the chance to talk about these topics.
* ARA - The Academy of Rehabilitative Audiology was founded in 1966 to promote excellence in hearing care through the provision of comprehensive rehabilitative and habilitative services. Each year the ARA hosts the ARA Summer Institute which provides a forum for discussion on the latest developments in auditory rehabilitation research and therapy. ARA membership is open to anyone conducting research or providing services in the area of audiologic rehabilitation. For more information visit www.audrehab.org or call the national office at 952-920-0484.
Ruth Bentler, PhD
Professor in the Department of Speech Pathology and Audiology at The University of Iowa
Ruth Bentler, Ph.D. Professor Department of Speech Pathology & Audiology The University of Iowa
Iowa City, Iowa 52246
319.335.8723
FAX 319.335.8851
Ruth-bentler@uiowa.edu
Bio: Ruth Bentler is a Professor in the Department of Speech Pathology and Audiology at The University of Iowa. After spending 15 years in clinical audiology, she joined the faculty there in 1987. She teaches coursework related to hearing aids and adult rehab, as well as assembly and repair of hearing aids. Her research involves evaluating new signal processing and/or fitting strategies in an effort to optimize user benefit.