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The Best of 2002: Aural rehabilitation

Murray, Nancy Tye

doi: 10.1097/01.HJ.0000293889.80142.c2
The Best of Audiology: Eighth Annual Literature Review


This year I had the—and here I must pause to identify the right word—pleasure/burden/challenge/thrill (??) of revising my textbook, Foundations of Aural Rehabilitation: Children, Adults, and Their Family Members, for Delmar Publishing. Regardless of how I describe the experience, and it was more pleasurable than burdensome, I had a greater than usual incentive for keeping up with the literature during 2002 because of it. Perhaps the primary reason that I found revising an introductory textbook about aural rehabilitation pleasurable was that my concentrated reading revealed to me what a healthy phase our profession is currently passing through. We are expanding some newer areas of research, while we are revisiting traditional areas and asking new questions.

Two of the newer topics of research include the baby boom generation and multicultural issues. Both are highly relevant in today's world. Baby boomers comprise the generation born between 1945 and 1965, and demographers estimate that every 7.5 seconds a member of this generation turns 50. The 2002 census revealed that our diversity has increased significantly during the past decade and, if the trend continues, by the year 2050 50% of our population will consist of people who describe themselves as members of an ethnic culture or minority race.

A more traditional topic of research now being revisited from new angles is auditory training. Electrophysiologic measures and case studies are being used to enhance the efficacy of this intervention.

So, with that as a prelude, here are the outstanding articles of the year 2002 in aural rehabilitation, presented by category:

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Do you ever wonder how your audiology service compares to other practices around the country? If so, the article “Aural rehab services: Survey reports who offers which ones and how often” might be of interest to you. Written by Susan Prendergast and Lori Kelley for The Hearing Journal (HJ), it defines a range of aural rehabilitation services, and then presents the results of a survey given to members of the American Academy of Audiology. The survey measured which services are provided frequently (e.g., information on assistive listening devices and counseling) and which services are provided infrequently (e.g., auditory and speechreading training). In addition, the authors examine barriers to service provision.

The tutorial by Deborah von Hapsburg and Elizabeth Pena, “Understanding bilingualism and its impact on speech audiometry,” is a great place to start if you don't know much about bilingualism and its relationship to speech-recognition testing. Writing in Journal of Speech, Language, and Hearing Research (JSLHR), the authors give a very thoughtful overview of what is meant by the term “bilingualism” and present considerations for assessing monolingual and bilingual speakers. They also point interested readers to other relevant investigations.

Another resource on bilingualism that you might want to check out is the ASHA Leader special focus issue published in April 2002. It included articles about the following issues: cultivating cultural competence, socioculture and healthcare delivery, and language interpreters and translators.

Norman Erber has long been a leader in aural rehabilitation research. What Norm is doing today, most of the rest of us will be doing in 10 years. He and his colleagues published two interesting articles for the clinician this year. One (Heine, Erber, Osborn, and Browning) in Disability and Rehabilitation addresses the implications for intervention of communication perceptions of older adults and their communication partners. The other (Erber), on hearing, vision, and communication with regard to older persons, was published in Seminars in Hearing. If you work with older people, add both these to your must-read list.

My pick for best of the year in this category is an IJA article by Ann-Kristin Espmark and colleagues. These investigators examined the “two faces of presbyacusis”: hearing impairment and psychosocial outcome. As the authors discuss, hearing loss may have different psychosocial consequences for older persons than for younger persons, and these consequences cannot always be predicted by the audiogram alone. Researchers in Europe and Canada have led the way in advancing our understanding of the psychosocial effects of hearing loss and in developing intervention plans that deal with the social and emotional issues of hearing loss. This article adds another link to that fine tradition of work and provides new information about older people.

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I'll start off with the best of this category straight away—though if you read it all, it will no longer be a quick read. HJ published a terrific overview monograph in November about aural rehabilitation and infants, entitled, “Beyond infant screening: What comes next?” If you read the eight articles, each not more than a couple of pages and all written in engaging prose, you'll have a surprisingly up-to-date and comprehensive knowledge of service provisions for babies with hearing loss. With the advent of universal newborn screening, this monograph, edited by Anne Marie Tharpe, was indeed a timely issue. The articles include treatments of tone-evoked ABR, OAEs in diagnosing hearing disorder, the use of visual reinforcement audiometry, what parents want to know, and empowering parents.

If you work in the schools, you'll be interested in “School-based services for children with cochlear implants,” an article by Holly Teagle and Jan Moore in Language, Speech, and Hearing Services in Schools (LSHSS). In less than four pages of text, the article provides a nice review of cochlear implant candidacy and school-based services that should follow implantation. These services include establishing routines for wearing and maintaining the cochlear implant, evaluation and modification of the classroom environment, and strategies to improve classroom communication. If you're interested in cochlear implant candidacy, you might also want to check out Donna Sorkin's easy-to-read update on candidacy and outcome measures that ran in Hearing Loss, the SHHH journal.

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With a title like, “Venus, Mars, and aural rehabilitation,” how could I leave out the article by Nicole Klimas in Advance for Speech-Language Pathologists and Audiologists? But I would have included it regardless. Besides a catchy title, the author offers a quick overview of how men and women vary in their aural rehabilitation needs and their reactions to hearing loss. The author suggests several reasons why their needs and reactions might differ and suggests new directions for research about these issues.

The winner in this category could also have been a contender in the Best Quick Read category. Writing in HJ, Richard Carmen and Shelley Uram discuss anxiety in adults who have hearing loss, a condition that many of us in the profession recognize but don't talk a lot about— perhaps because we don't know what to do about it. The authors—an audiologist and a psychiatrist—contrast normal and abnormal anxiety (including phobias and adjustment disorders) and discuss anxiety-provoking situations related to hearing healthcare practice. The latter include entering an unknown office (vulnerability), facing the financial burden of hearing healthcare services, meeting new staff and professionals, being in a small booth (feeling claustrophobic), and dealing with the burden of wearing and caring for hearing aids. Then, very succinctly, the authors outline considerations in rehabilitation, both in terms of providing hearing-related services and treatment options for anxiety disorders generally.

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If you enjoy tickling your intellect, then 2002 was a good year for you. Several articles provided in-depth, thought-provoking discussions on topics pertaining to aural rehabilitation. I've selected three to highlight.

In her LSHSS article, Tova Most compares how children with hearing loss and children with normal hearing use repair strategies. Although much research has focused on how adults with hearing loss use repair strategies, we know comparatively little about their use by children. Based on her findings, Most concludes that strategy-training programs should be tailored to individual needs and take into account the speech intelligibility of the child.

Erik Borg, Berth Danermark, and Brigitta Borg developed a theoretical model for considering the communication between hearing-impaired adults and their communication partners, and then designed a rehabilitation strategy based on this model. This IJA article is worth reading both to learn about the authors' proposed model and strategy as well as to learn a systematic way for developing an aural rehabilitation strategy and a means to implement and evaluate it.

Picking the Best of 2002 in this category was hard, but I tip my hat toward a paper by Neita Israelite, Janet Ower, and Gayle Goldstein because they focus on what is perhaps the most overlooked population in the world of the hard-of-hearing—the adolescent. What's more, they do so in an especially revealing way: They talked to and interviewed their subjects and reported what the teenagers had to say. The authors conducted a qualitative study exploring the identity construction of seven adolescents with hearing loss. The resulting article in Journal of Deaf Studies and Deaf Education is a fascinating consideration of the teenagers' school experiences and of their interactions with teachers and peers. In particular, selected quotes from the youths reveal powerful emotions and reactions pertaining to their loneliness, self-identity, courage, and anger. For instance, a student identified as “Sam” remarked, “My biggest challenge was grade nine. Trying to fit in a school where I had never been… When I was there, people would put me down because I was different. But my challenge was to fit with them, to tell them that I could do the same thing as [they could] or possibly better.” Another student, “Jade,” noted, “I hated that class so much. The teacher was so nervous around me. I'm a normal kid. I have no problems. I don't need special treatment.”

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Even if you're not a history buff, you'll enjoy reading the monograph put out by the American Academy of Audiology entitled, “American Wartime Military Audiology.” As you probably know, audiology blossomed during and after World War II. Audiology then consisted in large part of what we now consider to be traditional components of aural rehabilitation, including auditory training, speechreading training, and counseling. This monograph provides an overview, and then describes several of the larger programs that existed back then.

As I noted at the beginning, some traditional areas of aural rehabilitation received new treatments in 2002, auditory training in particular. My All-Round Favorite award is divided between two articles, which together present a compelling case for auditory training. Kelly Tremblay and Nina Krause show that auditory training induces changes in neural activity at the level of the cortex. Their article in JSLHR continues this team's work demonstrating that after auditory training patients demonstrate both behavioral and corresponding physiologic changes in response to auditory speech stimulation.

My other All-Round Favorite about auditory training was published by David Ertmer, Jeannette Leonard, and Michael Pachuilo in LSHSS. Not only do they demonstrate the effectiveness of auditory training, but they also show how the individual needs of the patient dictate what should be included in the auditory training curriculum. Through the use of a case study design, the article walks readers step by step through the design and implementation of auditory training. If I hadn't saved this article for my All-Round Favorite, I would have placed it in the Great for the Clinician category, as it provides a superb how-to guide on providing services to children who wear cochlear implants.

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I hope I've inspired you to delve into that stack of journals you've been pushing off to the side of your desk. I also hope that if you work with students you'll encourage them to read their journals, too. We have a vibrant and dynamic profession, but it will continue to be only if we stay abreast of our research and encourage young people to enter the field of academic study.

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American Speech-Language-Hearing Association: Focus on multiculturalism. ASHA Leader 2002;7(April).
    Bergman M: American wartime military audiology. Audiol Today 2002; Monograph No. 1.
      Borg E, Danermark B, Borg B: Behavioral awareness, interaction and counseling education in audiological rehabilitation: Development of methods and application in a pilot study. Int J Audiol 2002;41:308–322.
      Carmen R, Uram S: Hearing loss and anxiety in adults. Hear J 2002;55(4):48–54.
      Ertmer DJ, Leonard JS, Pachuilo ML: Communication intervention for children with cochlear implants: Two case studies. Lang Sp Hear Serv Schools 2002;33:205–217.
        Espmark AK, Rosenhall U, Erlandsson S, Steen B: The two faces of presbycusis: Hearing impairment and psychosocial consequences. Int J Audiol 2002;41:125–135.
        Erber N: Hearing, vision, communication, and older people. Sem Hear 2002;23:35–42.
          Heine C, Erber N, Osborn R, Browning C: Communication perceptions of older adults with sensory loss and their communication partners: Implications for intervention. Disability Rehab 2002;25: 356–363.
            Israelite N, Ower J, Goldstein G: Hard-of-hearing adolescents and identity construction: Influences of school experiences, peers, and teachers. J Deaf Studies Deaf Ed 2002;2:134–148.
              Klimas N: Venus, Mars, & aural rehabilitation. Advance Audiol 2002;4(4):6–8.
                Most T: The use of repair strategies by children with and without hearing impairment. Lang Sp Hear Serv Schools 2002;33:112–123.
                  Prendergast S, Kelley LA: Aural rehab services: Survey reports who offers which ones and how often. Hear J 2002;55(9):30–36.
                  Sorkin DL: Cochlear implant candidacy and outcomes: 2002 update. Hear Loss 2002;23(4):12–17.
                    Teagle HFB, Moore JA: School-based services for children with cochlear implants Lang Sp Hear Serv Schools 2002;33:162–171.
                      Tharpe AM, ed.: Beyond infant screening: What comes next? Hear J (special issue) 2002;55(11):13–59.
                        Tremblay KL, Kraus N: Auditory training induces asymmetrical changes in cortical neural activity. J Sp Lang Hear Res 2002;45:564–572.
                          Von Hapsburg D, Pena ED: Understanding bilingualism and its impact on speech audiometry. J Sp Lang Hear Res 2002;45:202–213.
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