The current divide between researchers and clinicians means that fewer study results find their way into the clinic to help clients with hearing loss. The direct application of research results to patient care has always been an issue for clinicians.
This problem appears to be more pervasive in audiology, as researchers in disciplines tangential to ours outnumber audiology researchers. Fields such as experimental and cognitive psychology, electrical engineering, experimental electrical engineering, medical research, geriatrics, and psychiatry are increasingly producing research that may be applied clinically.
With the advent of the AuD, advanced degrees in audiology are becoming more clinically oriented, rather than research oriented. The graduating PhDs tend to go in the direction of neuroscience, cognitive hearing science, or electrical engineering, as opposed to pursuing classical audiology and psychoacoustics. Manufacturers produce a significant amount of research focused mainly on hearing instruments and cochlear implants, with little new advances in clinical counseling.
Therefore, the old U.S. model of PhD researchers and clinicians working in the same department occurs less often. When they do work together, new insights are possible. These insights can generate novel ideas for clinical practice, as seen at the University of Iowa, Northwestern University, and Vanderbilt University.
The Hidden Effect of Hearing Acuity on Speech Recall, and Compensatory Effects of Self-Paced Listening
Piquado T, Benichov JI, Brownell H, Wingfield A Int J Audiol 2012;51(8):576-583
The paper by Tepring Piquado and colleagues is a good research article that points the way for clinicians to help their patients. In the study, 12 normal hearing adults were compared with 12 adults who had mild to moderate hearing loss.
Participants from both groups listened to a recording presented at an average rate of 150 words per minute in two different ways: continuously (without interruption) and self-paced. In the latter approach, the passage was interrupted at predetermined critical idea points, where listeners could choose to pause for as long as they wanted before starting the next segment.
After each presentation, participants were asked to identify the critical ideas in the passage.
Overall, both the listeners with normal hearing and those with hearing loss missed main ideas less often than minor ideas. In the uninterrupted condition, the normal hearing participants were, on average, 10 percent to 16 percent more accurate than the listeners with hearing loss were. The best score any normal hearing participant obtained was 54 percent, compared with 44 percent for patients with hearing loss.
When the passage was listened to without interruption, the hearing loss group not only recalled significantly fewer main ideas but also significantly fewer elements from the other two story categories—middle-level information and details—compared with the normal hearing group.
Since the participants with hearing loss were able to understand the critical words individually, the hearing loss itself was not considered to be the point of interference.
The difference between the groups disappeared when participants were allowed to self-pace the story. Those with hearing loss were able to remember both the main ideas of a story and the lesser details as well as the normal hearing subjects were.
FROM THE LAB TO THE CLINIC
How does this research translate to clinical practice? Decide what is important. The cognitive cause of the reduced comprehension is not a factor in applying this article's conclusions. Rather, how the problem was overcome is the clinically important application.
Not only can the listener self-pace but, we believe, so can the speaker when talking to someone with hearing loss, by pausing at critical ideas in the conversation.
Even though our approach varies from the design of this research, we have applied the technique successfully in communicating with patients who have hearing loss and teaching family members to use the technique.
Pausing at the end of important elements is now added to the list of recommended methods for listening as a hearing aid user and speaking to people with hearing loss. Patients are also still told to use their hearing aids and ask for help when the meaning of the conversation is lost, and speakers are still advised to help those with hearing loss get back into the conversation by updating the topic periodically and dovetailing each part of the conversation back to another by repeating part of what the other said.
When translating research into practice, discover not only what the communication or fundamental issues are, but also how to overcome these issues, as we have in this article.
This clinical application occurred even though the researchers do not work closely with clinicians or in the field of audiology. More research can be applied clinically if both sides keep the final object in mind.
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