What Does a Person with Hearing Loss Know About Hearing Loss?


Recently I was sent an email from an audiologist (really nice recent grad) asking how to help a patient with hearing loss hear better in the noisy workplace.

When the issue of using an FM system came up, apparently the person with hearing loss stated “No, that would not work in my situation because it is too noisy”.  So I was asked to come up with some other suggestions.

Ummm, ok,  I have a whole bunch of problems with this.

First, I think we need to clarify when we need to listen to our patients and follow the patients lead.  At other times we, as audiologists, SLP’s, hearing instrument practitioners or hearing resource teachers need to provide leadership and guidance to our clients with hearing loss. As an Audiologist with hearing loss, I have walked in both sets of shoes, so I would like to offer some suggestions.

First, here is a list of things where the person with hearing loss knows best:

  1. Ask and find our all the different situations in which the person with hearing loss is having difficulty.  List them all and seriously look at how we are going to help overcome those challenges.
  2. The patient knows and can tell you how it feels to be in a given situation.  Don’t be afraid to ask about this.  When a patient says ‘I could not hear at my daughter’s wedding” find out how they felt about that.  It is good to just let the patient explore their feelings and frustrations.
  3. Discuss past experiences both good and bad to see what you are up against.  For example, find out if the client ever tried an FM system or ever used directional microphones in the past.  Likely if something was a failure in the past, find out how much coaching the patient had in how to use the equipment.

In short the patient knows, better than you the clinician, the situations they are having the most difficulty in, and what it feels like to have a hearing loss.  But here is what the patient does not necessarily know and where the expertise of the professional is required.

List of Things a Patient with Hearing Loss Does NOT Know;

  1. Whether or not a hearing aid is even needed.
  2. What electroacoustic characteristics are needed in the hearing instrument
  3. What style of hearing instrument is most appropriate.  A patient can wish all they want for a tiny hearing aid, but if the loss is too severe, it can’t be done.  Period.  Yes, many patients have lots of choices of the form factor, but some do not.  We need to lead here, not follow.
  4. What technology for managing noise is needed?  For example, if a client has a moderate severe loss and a speech in noise test such as the LiSN-S PGA indicates that an FM system is needed, the hearing health professional NEEDS to communicate this to the client.  The client does not know what technology is required.  They just know the situations they find challenging.
  5. How to effectively use the equipment.  You cannot simply toss the equipment at the client and hope they figure out how to use it in the difficult listening situations that were identified.  Patients need our counseling and coaching here.

Now back to the patient who can’t hear at work.  The specific situations at work need to be fully explored.  Ideally, you can do this formally with the COSI.  Again, the patient understands this so much better and he needs to tell us as much as he can about his challenges if we are going to have any chance of finding solutions.  Next we need to explore why he feels that an FM system would not work.  He likely does not know how the technology works or how to use it effectively.  There are excellent FM counseling tools available for this purpose.

But we have to stop letting patients dictate the wrong things.  I have seen in my 20+ years of professional experience numerous patients who are wearing “dirty little secret” tiny aids and are not getting the correct amplification.  We need to provide leadership here and work the client towards more appropriate amplification.

Similarly, we must always consider not just the amplification needs but also the hearing in noise needs as they relate to the client’s own personal situation.  Will the client need directional microphone technology?  Should it be fixed or adaptive directional microphones? Will directional microphone technology be enough or will FM technology be needed?  Most patients with moderate severe loss and greater will likely find themselves in situations in which a hearing aid or cochlear implant is not enough.

I agree that we cannot force anyone to take our professional advice.  But patients do have a right to make an informed decision.  In my opinion, we are obligated as Hearing Health Care Professionals to give the patient all the facts.  Too often, when I give talks about directional microphones, FM systems, and other assistive devices,  a patient will ask me “How come this is the first time I am hearing about this stuff?”

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World’s Best Travelled Hearing Ear Dog


Amie loved her long walks.

 

Last weeks blog posting was a bit heavy. Its time for a lighter blog post…and a fan favorite in the blogosphere.  Amie the Hearing Ear Wunderdog.

I guess I am getting sentimental again because Amie is having a tough time these days.    Due to the Transitional Cell Carcinoma in her bladder, she is having suffering from urinary incontinence.  We need to keep her diapered at all times or in the crate with an incontinence liner.  Its stressful for all of us…

Hence the need to reflect upon better days when Amie and I travelled the world together.  We came up with a list of all the places Amie and I have been together.  I must say, it’s pretty impressive for a dog.  Here’s what we came up with:

  • San Diego, California
  • Salt Lake City Utah
  • Chicago, Illinois
  • Atlanta, Georgia
  • Vancouver, Victoria, Whistler, and Kelowna in BC
  • Calgary and Edmonton in Alberta.
  • Hiking in the Alberta Rockies
  • Saskatoon and Regina Saskatchewan
  • Winnipeg and other parts of Manitoba
  • Pretty much every city in Ontario
  • Quebec City and Montreal, Quebec
  • Halifax, NS
  • Charlottetown, PEI
  • Moncton, NB
  • Whitehorse, Yukon
  • Zurich, Stafa, Bern, Kandersteg, Murton, and other places in Switzerland.
  • Plus more, but cannot recall

It is during these trips that I have had some of my funniest stories with Amie.  One time we were doing a training session at the Westin in Ottawa.  Normally Amie just sits in the room while I present, or maybe greets some guests.  But this time she we suddenly realized she was gone.  Turns out she sniffed out that some bankers in the next seminar room had a way better buffet of cheeses and meats (we had veggies and dip…boring!).  Little monkey.

Amie sitting nicely, hoping for treats.

Another time I was in a Montana’s Steak House.  We were seated in a booth and I took Amie’s leash off while she sat beneath the table.  She couldn’t go anywhere…we were in a booth.  Right?  Wrong!  Turns out the walls to the booth did not extend all the way to the floor.  She snuck out and was seated in front on a table of a nice old couple who were sharing their Prime Rib with her.

Another favorite is during a trip to Kandersteg, a village high up in the Swiss Alps.  The Inn owner was terrified of dogs her entire life…until she met Amie.  Amie’s sweet and kind disposition essentially cured this woman’s lifelong fear of dogs.  By the end of our trip, the Inn owner was taking Amie by the leash and introducing her to all the other guests in the Pub.

For years I have done what I like to call “Kids Days” at Phonak. Here we bring kids to the Phonak office and give them a factory tour, followed by a pizza lunch and an Amie Hearing Ear Dog Demonstration.  But for the longest time, I kept getting the same kids returning year after year.  The teacher’s explained that the kids could go wherever they wanted for their trip, but they all wanted to come to Phonak.  Well, it really turns out that they all wanted to come see Amie again. “Forget the Zoo, forget Rock Climbing, we want Amie”.  And here I thought they wanted to come see me.  Nope.

Going to Bass Pro Shops looking for matching outfits.

As we get closer to the difficult day, I want to make sure we always remember Amie in her glory years…as one of the most well travelled and loved Hearing Ear Dogs in the whole world.

Everybody loves Amie, especially her mom.

Seeing the Forest for the Trees…What’s Wrong with Audiology


I love my Audiology colleagues.  But I do not always love my Audiology profession.  For the most part, Audiologists are very skilled and knowledgable professionals.  We do an excellent job of assessing hearing levels, and identifying the site of lesion of the hearing loss.  We have incredible diagnostic tools at our disposal ranging from basic pure tone audiometry (we still mask better than anyone else), to ABR, to Otoacoustic emissions.  We understand how hearing aids work, how to fit them, and how to verify performance using real ear measurement techniques.  In short, we are very well trained at performing assessments.

So whats my beef?  Let me illustrate from a few examples.

  1. When I started working as an educational audiologist in the 90’s, I was asked to report on the progress of child with hearing loss.  I did the usual…hearing assessment, hearing aid selection and verification.  I was an early adopter of the RECD, and I proudly showed how well the hearing aids were meeting DSL targets.  But the parents kept asking me why their kid couldn’t hear well, and I just kept thinking “Beats me, but I did a great job of hitting targets, so there”.  This started to make me realize I needed to look at things differently.
  2. I have had numerous times where I have been asked to assist with an FM fitting on an adults who essentially who have no hearing left.  As recently as just a few months ago, an Audiologist, who was a recent graduate from a Doctor of Audiology (AuD) Program, asked me to help with a client who only have hearing at 250 Hz and 500 Hz.  In other words- deafened.  I thought, “Now you want to try an FM system on this client?  You should have introduced this 10 years ago when the client had a moderate-severe loss.”
  3. The percentage of people with moderate severe losses or greater who use FM systems is disappointingly low.  Yes, I can hear my colleagues protesting saying “Adults won’t use FM”.  Well, if you polled the patients with hearing loss and asked them why they don’t use an FM, their likely answer will be “What’s an FM system?”, or “I was never told about these devices”.
  4. People with hearing loss routinely complain of hearing in noise yet we rarely assess this.  We cannot just do a pure tone audiogram in quiet.  We need to assess the problem that is vexing our patients the most and then find equipment and strategies to deal with that.
  5. How often are the limited number of rehabilitative lectures at Audiology conferences pushed back to Saturday morning.
  6. How many patients know about other assistive devices such as vibrating alarm clocks and fire alarms that are also needed for daily living with a hearing loss?
  7. I frequently am asked situational based rehabilitative questions.  For example, “Peter, how do you help a client hear in meetings” or “How can I help my client who works in a call centre?” etc.  Audiology seems poorly equipped at finding solutions to these situational problems.

What we need is to change Audiology practice from one that is almost exclusively diagnostically-driven to one that is also rehabilitative in nature. We have daily opportunities to do both in parallel:  to complete exemplary testing and then guide the rehabilitation of the patient based on test results.

Frankly the AuD has not helped expand the scope of our interventions, in fact, it has made us even more diagnostically focused.  This bias reduces our practice habits to those of technicians rather than professionals who practice to the full scope of our expertise.

In 2002, the World Health Organization introduced a classification of functioning, disability and health (ICF) to measure health and disability at both individual and population levels. The ICF “takes into account the social aspects of disability and does not see disability only as a medical or biological dysfunction. By including contextual factors, in which environmental factors are listed, ICF records the impact of the environment on the person’s functioning.” (www.who.com). The ICF can help identify: What is the patients level of functioning? What treatments or interventions can maximize functioning? What are the needs of persons with various levels of disability- impairments, activity limitations and participation restrictions?

How do we apply this framework to Audiology?  We view hearing loss as medical/biological dysfunction and our practice culture encourages us to focus on this.  We cannot stop at this – we must go further to examine patient’s functional capacities.

Without question, every patient should have their hearing levels fully and accurately assessed. In addition, we need to accurately determine, to the best of of ability with our non-invasive procedures, the site of lesion. The hearing loss is the genesis of the problem and we cannot proceed we fully understand what we are dealing with.  This is where Audiology shines.

Next we need to look at function.  At a minimum, we should perform a Hearing in Noise Test such as the LiSN-S PGA an all of our clients.  The world is a noisy place and we need to know in what situations our patients will have difficulty.

Functional capacities can also be assessed by asking our patients directly how they function in the context of their own daily lives using a tool such as the COSI.

Once we identify functional concerns, we need to then determne how to maximize function.  Here we need to consider all of the equipment needed.  For example, consider a client with a moderate severe hearing loss that performed poorly on the LiSN-S PGA and has identified several hearing in noise problems on the COSI.  Such a client will likely need a hearing aid with directional microphones, an FM system, and perhaps some alerting devices.  Then this client will need to be counselled how to use these devices properly.  This is a wholistic treatment plan.  But too often, a hearing aid is selected solely based on cosmetic concerns.  Nothing else is recommended, equipment such as FM systems are not discussed.  This is unacceptable.  We owe it to our clients to counsel them properly on the pros and cons of different equipment choices and on how to best navigate the world at-large with a hearing loss . In the absence of this collective practice change, our clients will succeed or fail only through trial and error. I believe that we are capable of delivering more.

These fundamental changes need to occur at the University level.  Audiologists are intelligent and compassionate people; they are fully capable of practicing in this model.  They are simply not taught to think in this way.

Once we shift our focus to maximizing client function, we will be able to see not only the trees but the forest as well.

Putting an End to the Chubby Deaf Guy


Greetings readers from South Beach, Miami Florida.

I have not been the healthiest guy. I eat too much and don’t exercise enough. Very bad.

I am on blood pressure medication as well as cholesterol reducing drugs.

Frankly I have had enough of this crappy lifestyle. I am 47 years old and if I don’t get my shit together, I am going to be faced with a future of even more disabling conditions. And that is not Living Life to the Max with Hearing Loss.

In the past 21 days, I have made some major changes.

First, I have stopped chewing Nicorette. Yes, I quit smoking quite a while ago, but I have been using Nicorette for about 10 years. It has now been 21 days since I have had a piece of Nicorette. So as far as I am concerned, nicotine addiction is over. Check one.

Second, I have stopped eating crap. I have drastically reduced my portion size and I have reduced my consumption of fatty foods. Funny thing is that I now get a feeling of being full and satisfied with much smaller portion sizes. Its great!

Third, I do cardio-vascular exercises at least 5 out of 7 days a week. I slap on the heart monitor and keep my heart rate at about 140 bpm for 30 minutes.

Fourth change is I do weight training at least 3 times per week. I have learned that muscles burn more calories, even at rest. That’s why really fit people can eat more food and stay slim. Their resting basal metabolic rate is higher.

So far, after 21 days I have noticed the following changes.

1. I have lost about 10 lbs.

2. I sleep like a bear at night.

3. My mouth is feeling better now that I don’t chew Nicorette.

4. I already look a bit better.

5. My self esteem has improved.

Starting to get slimmer...10 lbs down, 40 to go.

We have a $400 bet going on at work. The winner will be the person who loses the most percentage weight. I fully intend to win.

This is a gift I am giving to myself, and one that you can give to yourself too. I am convinced that to do this successfully, it must come from a combination of reduced portion size, improved quality of food, cardio exercise, and weight training.

Not only that, but there are some studies have shown that there is a correlation between hypertension and hearing loss. So getting fit might preserve residual hearing.

Wish me luck!!