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Help Patients ‘Connect the Dots’

Curtin, Judy AuD

doi: 10.1097/01.HJ.0000515658.34988.6c
Hearing Loss Counseling

Dr. Curtin is a rehabilitative audiologist with over 40 years of experience. She is a faculty member at the West Chester University, and the owner of ABC Hearing in West Chester, PA.



Mothers know when something is wrong with their babies. They just don't connect the dots or describe it accurately. Similarly, many people with hearing loss know when they no longer understand conversations. The issue is not in knowing that they have a problem; rather, it's in identifying and describing the problem—how they connect the dots instead of resigning to conclusions like, “People mumble,” or “I just wasn't paying attention.”



For audiology professionals, the challenge is to enable a paradigm shift by helping patients accept their “perception” of their hearing loss as real because it is real. It is important to guide your patients through the discovery process so that they can connect the dots and make informed choices to solve the problem.

To illustrate, consider this: I'm holding up a beach ball with four quadrants. I see red and white. My client, Joe, sees blue and yellow. Both perceptions are equally valid. There is no right or wrong perception. Joe just sees a greater picture. As professionals, it is our job to help patients gain a deeper understanding of their hearing.

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Let's play this out. You have just finished doing a hearing test on Joe and ask, “So what do you want to know, Joe?”

Joe: “How's my hearing? I think I always hear my wife say it's terrible. Some of it is great. Some of it is terrible.” (Here, Joe is acknowledging both sides of the ball.)

Professional: “Very accurate, Joe. Your ears always hear; you just don't always understand (redefining vocabulary). Your ears always hear mumbling. Your ears cannot access many of the consonants such as s, th, f, and t. If you only hear vowels or environmental sounds, you are safe, but conversation will always sound mumbled.”

Joe: “Well, I hear you just fine.”

Professional: “You should, Joe. The great news is that most of the consonant sounds you cannot hear are so easy to see on the lips. We call it speechreading.”

Joe: “I don't read lips.”

Professional: “We all do, Joe. Watch me. Pretend I just stubbed my toe. (I mouth) ‘Oh sh_t’.”

You both laugh. You reiterate that he did not hear a thing, yet he understood.

“You don't have to hear all the details, do you? So you see, everybody speechreads. The problem is you can only speechread one person at a time. On a one-to-one basis, Joe, life is great, especially if no one moves. That's the problem when someone turns around and walks out the door. You can't speechread anymore. It's only your hearing.

“Repeat what I say, Joe (speaks clearly and accurately with visual cues): ‘I don't feel very well, I'm going to go upstairs and rada, rada, rad (swipes hand over mouth and mumbles words with a normal intonation pattern).

“Now, what did I say, Joe?”

Joe: “You said you're going to go upstairs and go to bed.”

Professional: “Actually, Joe, I said ‘Rada, rada, rad.’ Your brain worked so fast and so quick that you filled in the rest because it made sense. That's great.

“Here's the big problem, though, Joe. Sometimes you fill it in wrong. You have a terrible time telling the difference between the words ‘kiss’ and ‘kick’ or ‘love’ and ‘loath.’ This could be quite embarrassing.

“Okay, here you are in the doctor's office with me and I say, ‘I'm going to the bitch.’ What happens? Brain alert! Now you are thinking to yourself, ‘Something is totally wrong with this message. This is not the proper environment for this type of language.’ So, Joe, you have to make a decision. Would you ask, ‘What?’ and hope for a clarification, or would you sit and pretend that you understand and try to figure it out? This is what I refer to as brain chatter. Your brain is quickly talking to itself.

“This problem solving takes a lot of energy. If you have to do this all the time, you are going to be very tired and grumpy. What's worse is that while you are ‘trying to figure it out,’ the conversation is still going on. Now you missed more information.

“Here's the problem. You think you were just not paying attention. Actually, you were paying attention! You were working very hard to sort out the misinformation. You might think that this is a problem with your memory. It's not. Your working memory, where learning takes place, was just busy sorting information out. You always need to work overtime if there's background noise or more than one person talking. That takes a lot of energy and effort. It takes the fun out of being with others.”

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Professional (speaking at a low, 40 dBHL tone): “Let's try something. Joe, listen to me talking to you at soft conversational levels. Close your eyes. We already know you are a good lipreader, so just listen. Feel how your body feels. It's hard to keep your eyes closed. Now, feel how relaxed your body feels when I make it more comfortable for you (voice goes to the most comfortable listening [MCL] level and changes the topic). Now let's try it again (voice goes back to 40dBHL and talks about something low probability, i.e., the author of a book). Feel how your concentration had to shift. You have to use your brain to sort out information. You have to be more vigilant to understand. (Speaking again at MCL level) Feel how more relaxed you feel when your ears are doing the work that they should be doing. You have to work hard all the time. This causes stress. We all know that stress is toxic to the body.

“So here's the good news: Hearing aids can relieve the stress. They make you more comfortable and confident, and less tired. If this will not be the case, you give them back. So what do you want to know now? Do you want to see your audiogram (patients usually say no)?

“Let me ask you, on a one to 10 scale, how much do you want hearing aids? Do you want to try listening with hearing aids on?”

At this point, patients are usually a lot more curious about hearing aids. Now, they start to “connect the dots” with more accuracy, showing that counseling and learning are ongoing.

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