Hearing Journal:
doi: 10.1097/01.HJ.0000399915.85142.e5
Nuts & Bolts

Show and Tell

Martin, Robert L. PhD

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Robert L. Martin, PhD, has been a Dispensing Audiologist in private practice in the San Diego area for more than 30 years. He has been writing Nuts & Bolts since 1989.

They say, “Seeing is believing.” Our profession deals with sound, not sight, but to be successful, we must use visual information that elicits powerful, memorable emotions. We must avoid too much talk. Think of the doctor sliding the X-ray into a light box, then telling you to look at the X-ray. At that point the doctor has your full, undivided attention. It is difficult not to believe what he is saying.

Figure. Robert L. Ma...
Figure. Robert L. Ma...
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Our teaching tools must be as powerful as the X-ray example. When used properly, teaching tools produce wonderment, awe, and surprise. You want the patient's full attention, especially if the patient needs to change his behavior, such as doing a better job of cleaning his ears or repairing/replacing his hearing aids.

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USING EQUIPMENT FOR EXAMPLES

The distortion bars on my old hearing aid test box were large, red, ugly looking things: brightly colored, very powerful, and attention grabbing. I used to use the visual display of large distortion bars to show patients they needed new hearing aids. Now I have to resort to other graphics.

For example, Figure 1 is a feedback peak produced by a defective hearing aid. It is an excellent visual display, made more powerful by over-scoring the frequency response curve with a bright red highlighter. A normal response curve is smooth and flat; the ugly peak in the feedback study is just the opposite—the distorted line is attention grabbing.

Figure 1
Figure 1
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We all agree that patient education and counseling are important parts of the business. What we sometimes fail to recognize is our ability to create teaching moments, situations that empower us to change the patient's behavior.

We schedule patients for periodic ear clearing; some keep their appointments, others don't. I like to exploit the fact that people tend to react emotionally to the sight of wax and ear debris. I remove the debris, spread it on a clean, ultra white tissue, and show it to the patient. It is ugly stuff! People groan, gasp, and say, “Oh my God, look at that!” These emotions create a teaching opportunity.

“This stuff plugs the hearing aid,” I say, “We need to keep it out.” The “show and tell” aspect of cleaning ears helps to motivate patients to keep their appointments. It also helps patients understand that the problem is the wax in the ears, not the hearing aid.

Many people have the bad habit of cleaning their ears with cotton tipped applicators. Telling a patient, “Don't use Q-Tips to clean your ears,” carries little weight. Some people don't respond well to words. It is more productive to use your video otoscope and show them the blood blister in their ear that they created using cotton swabs.

Reinforce this idea by showing them pictures of bloodied ears and nasty perforations made by people using cotton swabs. Words do not carry much impact. A photo can be powerful education. When patients see the results of their behavior—and the results of other people's behavior—you have captured a golden opportunity to help the patient. When I show people photographs of traumatized ears I warn them that the pictures are unpleasant and I ask them if they want to see them.

Video otoscopes are very useful educational devices:

* People, unhappy with the feedback in the hearing aid, often have wax or dead skin impactions in their ear canals. Telling them about this is not effective. Showing them the impaction in their ear, and saying, “The canal is plugged; sound cannot go through this debris,” is far more effective.

* We often see a sore in an ear. Some are managed easily; others need to be referred to a doctor. Showing the patient and the family the sore gets everyone's cooperation quickly when they see the magnitude of the problem.

* You can also use the video otoscope to show the patient the plug in the sound tube.

I thought patients would listen to me because I was a “doctor.” I was wrong. My degrees are in the field of communication, but I did not know how to communicate effectively. Words do not communicate well with many patients. Demonstrations, visual graphics, or examples, are far more effective forms of communication.

Telling a patient who is complaining of itchy ears to keep the water out of his ears is not as effective as showing photographs of infected or inflamed ears. Also, I make water plugs for these patients and instruct them on how to keep their ears dry permanently.

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DIY: DO IT YOURSELF

Years ago, I made an electronic audiogram display using old fashioned Christmas tree lights. I wiped the paint off with fingernail polish remover and put the bulbs through holes drilled in a plywood board. The face of the box was about 2x2 feet and was covered with deep red Plexiglas. The lights were attached to a ten-position rotary switch for each frequency. The audiogram was displayed by turning on the appropriate lights.

Having a large, colorful, display helps the patient see the results of his hearing test. If you don't have a large display, just use large sized paper and colorful marking pens. Make the test results large, easy to see, and colorful. Shade the area the patient cannot hear. Write the AI scores for speech information above each frequency on the graph (6%, 14%, 22%, 33%, 23%). When the patient has poor hearing in the higher frequency, circle the 33% and 23% values and say something like, “Your hearing is weak in the zone most important to word understanding. You are missing a lot of speech information.”

Some patients have difficulty inserting the hearing aids properly. When this happens, I have the patient use a little baby oil (on the ear and on the hearing aid) and I train a family member to be an inspector. I first show the family member how the instrument is placed improperly, then we play a game, having the patient or myself inserting the hearing aid. We next ask the inspector (family member) if the aid is in properly. By working with the family member, it takes the pressure off of the patient so he can feel better about the task.

Occasionally, I will see a patient who needs to “dry” his ears because of chronic moisture problems. People who swim several times a week fall into this category, as do those who try to “wash” their ears in the shower. This condition, if not changed, will eventually result in a bacterial or fungal infection.

Talking to a patient about this problem is helpful, but calm words lack the power needed to effect change in behavior. If I want the patient to use an alcohol and vinegar wash (equal parts of rubbing alcohol and white vinegar), I write this recommendation on one of my prescription pads. I sign my name on the pad and I clearly write Ph.D. after my name. Again, I am attempting to provide strong, clean, visually affecting information. Remember the impact of the X-ray example and use technology, pictures, and illustrations to create teaching situations.

© 2011 Lippincott Williams & Wilkins, Inc.

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