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Evolution and Future of Aural Rehabilitation

Hull, Raymond H., PhD

doi: 10.1097/01.HJ.0000544485.03386.28

Dr. Hull is a professor of communication sciences and disorders, and the coordinator of the Doctor of Audiology Program at Wichita State University in Wichita, KS. He has published books on rehabilitative audiology and interpersonal communication.

The profession of audiology really began as a hearing rehabilitation service during World War II. Military hearing rehabilitation programs provided the birthplace of the profession in the 1930s. The Veterans Administration (VA) then expanded the role of audiologists and the standards for professional hearing care services and equipment through the 1940s. The first training program for audiologists was developed at Northwestern University in the 1940s, and rapidly expanded—with victories and difficulties—through the next 20 years.

As instrumentation became more elaborate in the 1950s and 1960s and audiology became more sophisticated through research, the emphasis began shifting away from the rehabilitation of patients with hearing impairment toward pure and applied research and diagnosis of auditory disorders (In: Alpiner and McCarthy, eds. LWW, 2000). Results from automated equipment or scientific research were after all more tangible than the emerging signs of improved social communication observed in an adult patient with impaired hearing. Furthermore, helping patients deal with the emotional impact of hearing impairment, along with their frustrations and fears, comes with challenges that often require audiologists to become closely involved with patients and their families.

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The popularity of research and diagnostics was important to the growth of the profession. Amid the array of new courses in areas like differential diagnosis of auditory disorders, speech and hearing science, and experimental audiology, training programs on aural rehabilitation were also offered to students. However, in my experience in the university setting for over 25 years, I found early on that when it came to finding someone to teach these rehabilitation courses, the lowest-ranking faculty member or a doctoral assistant often submitted to the task. Students generally reflected the same passive response to the classroom instruction and the practicum experience of providing hearing rehabilitation to children and adults with impaired hearing.

In many ways, such attitude toward aural rehabilitation does not prevail today. As Schow and Nerbonne have observed, audiologists generally have begun to recognize the opportunities for rehabilitation for both children and adults (In: Schow & Nerbonne, eds. Person Education, 2007). A more humanistic approach to services for people with impaired hearing has become predominant among today's audiology clinicians and professors. Prospective students are searching for graduate programs in audiology that allow them to focus on providing restorative along with diagnostic services. So our field appears to be achieving a healthy balance.

A momentous step taken during the past four decades toward strengthening the professional stature of aural rehabilitation and its providers was the establishment of the Academy of Rehabilitative Audiology in 1966. The academy has done much in promoting greater awareness of the importance of rehabilitative services.

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So, what is aural rehabilitation? It is defined as services for people with impaired hearing that reduce the resulting barriers to communication and facilitate adjustments to the possible psychosocial, educational, and occupational effects (Hull. Plural, 2014). These services are generally geared toward those who previously had normal to near-normal hearing but sustained hearing loss that, if left untreated, can impede social, occupational, and/or educational functioning. Individuals with impaired hearing vary in age, gender, and social status, just as their hearing loss vary greatly in the type, degree, and required audiometric configuration. Each one also has different communicative desires and needs.

Important as these services are, aural rehabilitation remains an unsung hero that is too often neglected or only offered to patients as an add-on. And unfortunately, many patients decline the opportunity to benefit from these services.

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I have come to the conclusion that “hearing rehabilitation,” which is the term that I accept as having greater meaning than aural rehabilitation, should be integrated into audiology services and not be offered as a separate service. We may already be providing these services without realizing it! Those services include, but are not limited to, the following:

  • diagnostic testing in its various forms and discussions during testing, including the pre-diagnostic case and medical history reviews;
  • counseling when discussing the audiogram and other test results, and providing suggestions on resolving difficult daily communicative situations;
  • counseling on the benefits and limitations of hearing aids and assistive listening devices (ALDs);
  • counseling on the use of vision to supplement impaired hearing;
  • counseling with a patient's significant other to discuss ways to provide support in different listening environments;
  • counseling on the importance of hearing protection to help preserve residual hearing;
  • counseling on the optimal use of hearing aids or ALDs in difficult listening situations; and
  • counseling in the forms of persuasion, encouragement, and challenge.

These are all part of the essence of aural or hearing rehabilitation. These services should be an integral part of what audiologists do every day and not be treated as add-ons.

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