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the best of Audiology Literature

The Best of 2008: Audiologic Rehabilitation

Wark, David J.

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doi: 10.1097/01.HJ.0000356809.90125.04
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Beginning with my very early introduction to our profession, I was taught, and continue to believe, “Rehabilitation is audiology.” With this perspective in mind, I've attempted this year to expand the envelope of topics and readings with the intent of challenging the more narrow focus of audiologic rehabilitation (AR) that I see in the literature today. Therefore, in addition to traditional research papers on such familiar topics as counseling and auditory training, this year's selections include articles that provide us with the perceptions of persons with hearing impairment and/or tinnitus and of parents whose infants have undergone newborn screening.

My selections also reflect a growing trend in AR research of using a qualitative methodology for gathering data. I hope these selections will challenge the reader to view AR from a broader perspective and understand how it interfaces with most of what we do as audiologists.


This year I've added a new category for selected papers, one that allows for summary or review papers in AR. This category may be especially attractive to clinicians and students who want to brush up on a particular area or look for up-to-date summaries of current practice. Both these selections were published in Contemporary Issues in Communication Sciences and Disorders ( CICSD), a student journal. The first, by Patricia McCarthy and Nathan Schau, reviews current practices in AR, including such topics as clear speech, group hearing aid follow-up, the inclusion of significant others in AR practice, innovative (computer-assisted) auditory training, lipreading, and the use of self-report instruments for program planning and as outcome measures. The authors discuss the future challenges facing providers of AR services.

My other selection, by Kristina English, begins by emphasizing the integral role that counseling plays in the AR process. In particular, the article focuses on two aspects of counseling: (1) understanding the adjustment to change experienced by clients and (2) the strategies that may be employed in counseling clients as they journey through rehabilitation. The author goes on to discuss how hearing impairment and a hearing aid may affect patients' self-concept and their reaction to change and ways of evaluating and improving one's counseling skills.


My two choices in this category are consistent with the broader view of AR that I mentioned. Both articles demonstrate the inter-relationship between the diagnostic and rehabilitative roles in our discipline.

David Hawkins, in the Journal of the American Academy of Audiology ( JAAA), describes a very interesting case in which the patient exhibited a sudden sensorineural hearing loss in his only hearing ear. Hawkins describes the importance of immediate otological and audiological intervention and stresses the potentially devastating impact of this psychosocial-vocational event. Of particular interest to the clinician, the paper provides the details of the AR course followed and stresses the necessity of active counseling in the form of emotional support throughout the process.

My Best of 2008 in the Great for the Clinician category was published by James Henry and colleagues in Trends in Amplification. It emphasizes the importance of the audiologic evaluation in the appropriate management of patients with tinnitus. The authors point out that tinnitus is often considered a minor condition not requiring intervention. However, patients who do require intervention vary significantly along several dimensions, including their emotional state, personality, degree of hearing loss, and general life circumstances. Henry et al. suggest several written questionnaires to assess self-perceived hearing versus tinnitus problems and provide a useful and detailed protocol for your patients, depending on the level of intervention required.


As the focus in hearing care broadens to include all domains of auditory dysfunction, it is logical to include psychosocial and personality factors that may affect patients' communication problems. The articles I've selected as the year's Best Quick Reads demonstrate the importance of considering these domains for patients with vestibular and tinnitus problems.

An article by Piker and colleagues in JAAA describes the extent to which comorbid conditions such as depression, anxiety, somatization, and autonomic symptoms were found in patients who volunteered for a vestibular system assessment. The authors report the results of electrodiagnostic and psychosocial assessments on 63 adult patients who were subsequently grouped according to their balance testing function. Each patient then completed a series of standardized questionnaires designed to reveal the presence of self-reported psychological comorbid conditions accompanying their balance problems. The results section, which includes an informative discussion of the effects of psychological conditions as they relate to the intensity of dizziness, emphasizes the usefulness of self-assessment measures in treating dizzy patients.

My Best of 2008 in the Best Quick Read category was written by David Welch and Patrick Dawes and appeared in Ear and Hearing. The authors sought to understand how personality influences one's perception of tinnitus by interviewing 970 adults (mean 32 years of age) regarding their perceived experience with tinnitus. Subjects were categorized as not having tinnitus, having occasional tinnitus, or regularly experiencing tinnitus. All subjects were asked about the annoyance and distressing aspects of their experience with tinnitus and they completed the Multidimensional Personality Questionnaire. The data analysis provides a better understanding of the relationship between personality traits and the degree of tinnitus as well as of the limitations of counseling as a treatment for tinnitus.


The personal experiences/stories that clients share with us often provide insights that we might not have considered otherwise. This is especially true when the patient is also a prominent professional and a lifetime champion of audiologic rehabilitation. Therefore I've selected an article by Mark Ross in Hearing Loss Magazine for inclusion in this year's papers. Here Ross provides his unique insights and suggestions regarding the different expectations and perceptions about hearing aids and communication problems held by persons with hearing impairment and their significant communication partners. The author advocates making AR assessment procedures that employ both objective and subjective measures an integral part of the hearing aid selection process.

Nancy Tye-Murray and colleagues published a qualitative study in The ASHA Leader for which they conducted focus groups with individuals who were either still working or recently retired. The participants discussed their opinions and their feelings about hearing loss in the workplace and answered questions about their work-related hearing problems. Transcriptions of the sessions were sorted into four areas related to the effects of hearing loss on job performance, accommodations and acceptance in the workplace, psychological and emotional reactions, and self-identified AR needs. The authors provide a rich and informative discussion of the participants' responses, and conclude with advice for clinicians who see patients who are challenged by hearing impairment in the workplace.

Two other Not Ready for PubMed selections are companion papers written by the research group at Communication Disorders Technology (CDT) in Bloomington, IN, and published in The Hearing Journal ( HJ). The first paper, by Charles Watson, James Miller, and colleagues, builds a rationale from previous research for training listeners to hear and identify the spectral-temporal details of simple and complex speech sounds. This literature review includes topics related to how infants develop speech perception, second-language learning, the identification of non-speech sounds, auditory perceptual learning, and the magnitude of changes accomplished by auditory training. Based on this review the authors present five requirements of effective speech-recognition training: (1) immediate performance feedback, (2) a sufficiently large corpus of speech material with talkers of differing gender and age, (3) training on the code of syllable constituents and recognition of meaning sentences, (4) a method of focusing on specific areas of difficulty, and (5) a curriculum that informs listeners of their progress and fosters a willingness to continue training and achieve their highest potential.

Based on these principles, Miller, Watson, and colleagues (including myself) describe in the next issue of HJ the development of a computer-based auditory training program, the Speech Perception Assessment and Training System (SPATS). SPATS is designed to train listeners to improve their perception of natural everyday speech. The authors conclude with a description of preliminary performance training results from hearing aid and cochlear implant wearers and a brief discussion of the differences between SPATS and the LACE program, which was reviewed in this section last year.


William Noble in Trends in Amplification introduces us to new terminology as it relates to self-assessment of hearing. “Auditory Reality” represents the totality of a person's auditory experience, including the circumstances and environments to which people have been exposed and their awareness of their auditory world and their judgment about their hearing abilities. Self-assessment instruments can provide useful information for clinical or research purposes as long as the instrument is part of an individual's auditory reality. But changes in a patient's hearing levels or social circumstances may make previously appropriate self-assessment less relevant than it was because it does not map the individual's current auditory reality. I suspect we will hear more about this concept of auditory reality.

My selection for Best of 2008 in the Most Thought Provoking category is an article by Wendy McCracken, Alys Young, and Helen Tattersall that ran in Ear & Hearing. It describes a study designed to understand very early audiologic management of infants identified with hearing loss from a parental perspective. The study used a qualitative approach based on narratives from 45 parents and caregivers. Parents were invited to relate their experiences with the screening, diagnostic follow-up and referral, and early intervention and professional support. Their narratives were recorded at home and transcribed in their entirety. The authors present the results in broad categories such as Time and Timing Issues, Parental Conceptualization of Early Amplification, Information and Support, and Challenges Related to Moderate Hearing Loss. The excerpts from these narratives provided for each category provide wonderful, often-poignant insights for pediatric audiologists and educators in training programs.


I selected two articles as my All-Around Favorites for 2008. The first selection, by Carolyn Richie and Diane Kewley-Port, appeared in the Journal of Speech, Language, and Hearing Research. It provides a fresh look at the potential benefit of incorporating both auditory and visual cues in a computer-based training program for vowel identification under difficult listening conditions. It contains an excellent review of past and current research that assists readers in understanding the rationale and relevance of this research. Technology has not yet resolved the difficulties of understanding speech in a background of noise and thus the potential for benefit of a computer-based training program for individuals with hearing impairment is a viable alternative for audiologists in a busy practice setting. The article addresses the effects of auditory-visual training on vowel identification, as well as word- and sentence-recognition performance. The authors present an encouraging discussion regarding the inclusion of a training program as described in the article as part of a successful approach to improve speech understanding for clients with hearing impairment.

My Best of 2008 in the All-Around Favorite category is “The effect of hearing impairment in older people on the spouse,” by Nerina Scarinci, Linda Worrall, and Louise Hickson, which appeared in the International Journal of Audiology. The impact on the spouse of a hearing-impaired person is a topic many of us have discussed with our students for years. Our comments have been based on anecdotal reports from our own clinical experience. The present study fills a void in our literature. Its qualitative methodology identified four categories for describing the subjects' experiences being married to a person with hearing impairment. These categories include: (1) the effects of hearing impairment on a spouse's daily life, (2) the spouse's need to adapt to the partner's hearing impairment, (3) the effect of the partner's acceptance of the spouse's impairment, and (4) the effects of aging and retirement. Rich and informative excerpts from the participant interviews are provided to enhance our understanding of each category. The data presented will be of great value to clinicians who serve older couples.

Audiologic rehabilitation is getting greater exposure in the literature as more attention is being paid to the consequences of auditory dysfunction. As more people are using hearing aids and cochlear implants, they and their spouses are demanding greater understanding from their service providers of how these technologies address their daily communication needs. In a sense, AR has turned the corner in recognizing (back to our roots) the importance of considering the whole person as well as his/her family members in their adjustment to hearing impairment. This is a good thing, yes?


English KM: Counseling issues in audiologic rehabilitation. CICSD 35:93–101.
    Hawkins DB: Hearing rehabilitation in a patient with sudden sensorineural hearing loss in the only hearing ear. JAAA 19:267–274.
      Henry JA, Zaugg TL, Meyers PJ, Schechter MA: The role of audiologic evaluation in progressive tinnitus management. Trends Amplif 12(3):170–187.
        McCarthy P, Schau N: Adult audiologic rehabilitation: A review of contemporary practices CICSD 35:168–177.
          McCracken W, Young A, Tattersall H: Universal newborn hearing screening: Parental reflections on very early audiological management. Ear Hear 29(1):54–64.
            Miller JD, Watson CS, Kistler DJ, Preminger JE, Wark DJ: Training listeners to identify the sounds of speech: II. Using SPATS software. Hear J 61(10):29–33.
              Noble W: Auditory reality and self-assessment of hearing. Trends Amplif 12(2):133–120.
                Piker EG, Jacobson GP, McCaslin DL, Grantham SL: Psychological comorbidities and their relationship to self-reported handicap in samples of dizzy patients, JAAA 19:337–347.
                  Richie C, Kewley-Port D: The effects of auditory-visual vowel identification training on speech recognition under difficult listening conditions. J Sp Lang Hear Res 51:1607–1619.
                    Ross M: What did you expect, hearing aids? Expectations and aural rehabilitation. Hear Loss 29(1):20–24.
                      Scarinci N, Worrall L, Hickson L: The effect of hearing impairment in older people on the spouse, IJA 47:141–151.
                        Tye-Murray N, Spry JL, Mauze E: Aural rehabilitation for the workplace: Listening in our offices helps clients listen in theirs. ASHA Leader 13(16):14–17.
                          Watson CS, Miller JD, Kewley-Port D, Humes LE, Wightman FL: Training listeners to identify the sounds of speech: I. A review of past studies, Hear J 61(9):26–31.
                            Welch D, Dawes PJD: Personality and perception of tinnitus. Ear Hear 29(5):684–692.
                              © 2009 Lippincott Williams & Wilkins, Inc.