The challenge of working with hearing-impaired patients goes beyond selling and fitting hearing aids. We all work with aged patients who have deteriorating social and communication capabilities and no longer feel like part of the family, may not join in conversations, and seem to be in their own world. What can be done to help? Is this a hearing problem? Will hearing aids help?
A strong word of caution: When patients withdraw from society and their mental, social, and emotional skills begin to deteriorate, they need help and support from their families, doctors, and other mental health professionals. Be sure to use a team approach and ensure that your patient is seen by all appropriate professionals.
Most new hearing aids have many specialized listening programs, and the most common ones include an everyday program and a noise-reduction program. Using these guidelines and adding a listening program to your patient's current programs may be beneficial if your patient needs special amplification for auditory rehabilitation. Hearing aids can change a patient's life, but it is best to see this problem from a wider viewpoint — the rehabilitation of all communication skills controlled by the brain. We are, in essence, attempting to retrain the neural pathways needed for speech and hearing.
USE IT OR LOSE IT
It helps to remember the amount of time children need to develop listening and language skills. Babies learn to walk, talk, and interact with their parents in a few short years, and before long they learn to argue using highly developed language skills. Children need thousands of hours of listening and imitating to develop sophisticated language. They cannot develop these skills in one-hour therapy sessions three times a week. Likewise, adults need many hours a day to relearn their listening and speech skills.
Auditory rehabilitation needs to be fun. We want to stress the importance of emotion because it is the lubricant, propellant, and stabilizer for language development. Most childhood learning is suffused with exhilaration, passion, and pleasure, but adults lose early developed skills as they age. Hearing grows weaker and the voice becomes rough, striated, and strained. Articulation becomes less crisp, and the patient's spouse may notice slurred words and mumbling. Memory, especially short-term memory, dims. The old adage, “use it or lose it” is all too true. Social interaction becomes problematic and hearing-impaired people may start to withdraw from social situations, significantly reducing time spent engaging in conversation. Listening and spoken language functions become markedly impaired if withdrawal continues. Said simply, people rust.
MAKE AUDITORY REHABILITATION FUN
Vast amounts of new scientific research have been published on brain development. High-precision imagery provides phenomenal views of brain tissue. Years ago, if you wanted to rehabilitate a specific part of the brain, the process was guesswork. Now, pictures are taken, treatments are given, and additional images are created to see if brain tissue has generated new pathways. It was believed at some point that neural structures in the brain could not regenerate, but this view is changing. The concept of neural plasticity is popular. A dysfunctional section of the brain can be retrained in many cases using effective treatment strategies and optimal training conditions. Similar to the child model, the adult brain can be trained and neural pathways can be reactivated. Auditory rehabilitation strives to help patients achieve the high-level listening and spoken language skills they once had through various guidelines.
* Make the activity fun and exciting.
* Repeat the activity many hours a day.
* Challenge the brain. Do not repeat simplistic tasks.
* Enhance learning by stimulating many different areas of the brain.
* Include the concept of play and body movements, such as dancing.
* Incorporate interactions with groups of people and family members.
* Most importantly, involve professional support to ward off crisis and temporary setbacks.
Ask yourself what tricks or equipment you can use to help patients hear well and have fun. The equipment may be a frequency modulation system to provide noise-free, high-quality speech to the patient.
Use bright, crystal clear, wideband sound when reawakening the brain's language centers. Think about the digital sound in movie theaters that grabs attention, elicits a lot of emotion, and stimulates and engages listeners.
AMPLIFICATION FOR AUDITORY REHABILITATION
Sophisticated hearing aids have multiple listening programs, such as an everyday listening program. The auditory rehabilitation program we are introducing provides optimal listening. The everyday listening and noise reduction programs are designed for listening comfort. Gain and output are noticeably reduced in the lower frequencies, and considerable amounts of compression are used. Substantial amplification is used in the higher frequencies because the goal of these programs is to improve word understanding.
Our auditory rehabilitation program in contrast uses wideband amplification and minimal compression and strives for maximum hearing. Most listening programs have limited amplification in the 100- to 400-Hz zone. Our program uses considerable amplification in these frequencies to pick up all the rhythm and intonation cues contained in this zone. Most hearing aid fittings stress amplification in the high-frequency zone. Most of conversational speech's emotional meaning is stripped off if you present speech through high-frequency, band-pass filter. People need to hear a wider range of speech frequencies as they age so they can discern the speaker's intended emotional meaning.
The amplified speech signal needs to be crystal clear and free of all types of distortion. Compression is seen as a type of distortion for the auditory rehabilitation listening program. The perceived clarity of speech decreases, in our experience, as the amount of compression is increased. Test this concept by listening to amplified sound with the compression turned off and then with the compression turned to maximum. Amplification quickly becomes loud without compression, but it also gets fuzzy with large amounts of compression. We suggest you use the gain and output controls to reduce intensity (loudness) rather than using substantial compression to reduce output. It is important to avoid excessive amplification to evade the upward spread of masking that noticeably degrades the speech's quality.
Working with an auditory rehabilitation program has to be fun and engaging. Present visual and auditory input through all modalities, strive for huge numbers of repetitions per day, and engage the patient in group interaction. The fear of going deaf needs to be reduced with effective demonstrations that show the patient he can hear well in some situations; if necessary use frequency modulation systems to present the patient with easy-to-hear sounds.
* Read Dr. Martin's past columns in a special collection in The Hearing Journal archive at http://bit.ly/HJMartin.
* Visit HJ’s Student Blog at http://bit.ly/HJStudentBlog.
* Check out HJ’s R&D Blog at http://bit.ly/RDBlog.
* Click and Connect! Access the links in The Hearing Journal by reading this issue on our website or in our new iPad app, both available at thehearingjournal.com.
* Follow us on Twitter at twitter.com/hearingjournal and like us on Facebook at www.facebook.com/HearingJournal.