Hearing Loss Counseling (Auditory Rehabilitation)
Patricia McCarthy, Ph.D. Professor, Rush University Medical Center, Chicago, IL.
Ross J. Roeser, Ph.D. Professor and Executive Director
Once your hearing loss has been identified, it is essential that you become informed of all of the options available to help improve your communication. There is a common misconception that hearing aids are the "cure all" for hearing loss. In reality, improving communication involves a long term rehabilitative process in which the hearing aid is only part. As such, you should enter into this rehabilitative process with realistic goals and knowing what to expect from the hearing aid and your hearing health provider. If you are to be successful in improving communication with amplification, you must be committed, motivated and educated about your role in this process. You should be sure that each of the following facets of the rehabilitation process are offered by your hearing health provider before proceeding.
The first step in the rehabilitative process is insuring that you are an informed consumer. All aspects of your hearing loss should be explained to you in detail including type and degree of hearing loss, implications for communication, preventative and rehabilitative recommendations and need for referrals to other professionals including physicians. Being knowledgeable about your hearing loss will assist you in making rehabilitative decisions.
If amplification is recommended, your hearing health provider should provide you with written information and should give you a step-by-step explanation of the hearing aid fitting and rehabilitation process. Before engaging in this process, you must be knowledgeable of hearing aid options, the adjustment process, and the use of communication repair strategies necessary for success with amplification. You should be made aware of all your amplification options as well as the level of support that you will be provided after being fit with hearing aids.
Including family members or significant others in this discussion is highly recommended. It will allow your communications partners to understand better the hearing difficulties you are encountering and the rehabilitative options that are available to you.
Expectations and Goals
Successful use of amplification is predicated on realistic expectations. Everyone's expectations for amplification are different so it is important that your hearing health provider assess your unique expectations about amplification. There is a fine line between expecting too much out of your hearing aids and having appropriate expectations. For example, expecting that your hearing will return to "normal" is not a realistic expectation for any hearing aids, but expecting to have increased ease of communication with hearing aids is realistic. Unrealistic expectations often lead to frustration, disappointment and often failure. Including your family and/or significant others in your discussion of goals and expectations also will contribute to successful use of amplification and improved communication.
Establishing your goals for improving your communication will assist you and the hearing health provider in choosing the best rehabilitative option for you. For example, if telephone communication is problematic, you should be provided information about telecoils and other options to improve your ability to use the telephone effectively. Your occupation, your social life and your pastimes will help in the decision making process regarding hearing aid features.
Some hearing health providers will have you complete questionnaires to assist them in determining your needs and expectations. These questionnaires often ask about how the hearing loss has influenced various aspects of your life and can be helpful in determining rehabilitative options. Be sure your hearing health provider takes the times to assess your individual needs, goals and expectations so that they are achievable given your hearing loss.
Hearing aid Follow-Up
Once you have been fit with hearing aids, the rehabilitation process begins. Because the audiologic rehabilitation process involves more than just purchasing hearing aids, it is imperative that you be provided with post-fitting orientation, counseling and rehabilitation. You should be offered several sessions that include verification of the hearing aid fitting, adjustment counseling and communication training.
Verification of the hearing aid fitting can be done in several ways. Your hearing health provider will conduct objective tests to verify that the hearing aids are working optimally while at the same providing you comfortable, effective amplification. In addition to this objective testing, your provider should be assessing your subjective benefit from hearing aids. You may be asked to complete questionnaires that assess the level of benefit you receive in various listening environments. Or you might be asked about your level of satisfaction with the hearing aid fitting process. All of this information helps the hearing health provider to make adjustments in the rehabilitative plan to insure that you are successful.
Adjustment to amplification and learning to hear again can be challenging. People are often surprised when they first hear foot steps, refrigerator noise and distant laughter that they had not heard in years. Because the brain has not received this type of stimulation for the duration of your hearing loss, it may take a while for you to adjust to the new sounds you are hearing. Different listening environments present different challenges.
Initially, your new ability to hear may be overwhelming to you. But as your brain relearns to hear, particularly in noisy situations, you will find communication will become increasingly easier. Adjusting to amplification is an individual issue. Some people adjust immediately while others take weeks or months to adjust to their new world of sound. Your hearing health provider should be willing to counsel you through this period in addition to making adjustments to your hearing aids.
Hearing aids are powerful, effective tools for increasing your ability to hear. But hearing aids will not automatically make you a better listener. That takes work! Listening requires attention, concentration and interest. Often times, people with hearing losses develop poor listening skills. This occurs because hearing becomes so difficult that they give up and just "turn off" the speaker. Once you are fit with hearing aids, it is imperative that your listening skills be resharpened. Your hearing health provider should work with you to improve these skills.
Just because you get hearing aids does not mean that you no longer need to rely on your vision. Using visual cues while communicating is essential. People often will say, "I can't lipread" but, in truth, we all lipread to some degree. The eyes are powerful in taking in visual speech information. The brain then masterfully combines the visual speech cues with the hearing cues so that your understanding of the speaker increases dramatically. While very few hearing health providers will offer lipreading lessons per se, they should be able to provide you tips on how to improve your use of visual cues in communication in combination with your hearing aids.
Communication also can be improved with the use of communication strategies such as environmental manipulation and repair strategies. Learning where to position in different listening situations (i.e. at a party, in a restaurant, in a place of worship) can enhance your ability to benefit from your hearing aids. Learning how to keep the conversation alive in a noisy environment by using communication strategies is another rehabilitative strategy. Your hearing health professional can provide you with a wealth of information on how to incorporate these strategies into your everyday communication patterns.
Group Hearing aid Orientation
Many hearing health providers are beginning to recognize the benefits of offering group hearing aid orientation sessions. Rather than providing education and rehabilitative services on an individual basis, these sessions are open to groups of individuals recently fit with hearing aids and their family and/or significant others.
Hearing aid groups vary from setting to setting. Some hearing aid providers will offer a specific number of sessions following the hearing aid fitting while others allow people to attend as many sessions as they need. The focus of these sessions is typically on use, care and repair of the hearing aids, adjusting to amplification, listening and communication strategies. Many people find that the primary advantage of the group environment is that it can provide peer support for adjusting to amplification.
The Role of Your Family
As mentioned previously, including family members and/or significant others throughout the rehabilitation process is strongly advised. In addition to learning about your hearing problems and how they can be remediated, family members can learn how to improve their communication skills to facilitate easier communication. It is important that family members understand their roles in communication breakdowns and how they help avoid and/or repair these breakdowns.
One example of a rehabilitative strategy taught to family members is the use of Clear Speech. With this method, family members are taught to use an appropriate rate (speed) and volume of speech to improve communication with people with hearing loss. Clear Speech is easily taught and quite effective. Family members also can be taught how to use communication repair strategies to facilitate smoother conversations without constantly hearing "huh?". Family members can be taught good communication practices such as limiting background noise when conversing, getting the attention of the listener and not communicating from room to room.
When choosing a hearing health provider, be sure to determine if he/she will be able to offer you the variety of services discussed above. Simply purchasing hearing aids will not insure improved communication. It is important to remember: hearing aids are not a quick-fix purchase. They are simply the tools that provide the amplification you need to become a better listener and communicator. If you are motivated to improve your communication by obtaining amplification, relearning to listen and engaging in an active rehabilitation process, then your chances for improved communication are excellent.