Patient client counseling & aural rehab

PATIENT/CLIENT COUNSELING & AURAL REHABILITATION

It has always been difficult to describe an audiogram to a patient/client using the relative terms of mild, moderate, severe, and profound hearing loss.

These are all relative terms, as they would relate to deafness.


No one can actually simulate total deafness, so why should we be using these relative terms when describing a patient/client’s audiogram to them?

Most patient/clients are in their denial stage of hearing loss when they first have their audiogram explained to them.

They can easily perceive the terms mild and moderate as “not that bad”, and continue suffering hearing loss!


As Hearing Instrument Specialists, we must present to our patient/clients a more accurate portrayal of their hearing condition.

After all, electro acoustic stimulation via hearing instruments simply does not “correct” the hearing loss. It only stimulates the remaining ability of their damaged auditory system.

Their hearing loss is permanently gone!


Patient/client counseling exercise:1. Draw a “normal” undamaged dynamic range

“hearing ability” box onto an audiogram. 2. Mark horizontal lines at 0db and 100dbHL,

attach the horizontal lines with vertical lines at 250hz and 6Khz.

3. Plot the patient/client’s thresholds within this box.

4. “Shadow” or “X”-out the area of the box where no hearing ability could be measured.


The non-shadowed area within the box represents the patient/client’s remaining hearing ability (the hearing the patient/client has left).

The shadowed area is permanent hearing loss—gone forever—cannot be “restored”!


This information can be presented as a bad news—good news type of scenario:

Bad news as finding permanent hearing damage.

Good news being the amount of residual hearing ability which can successfully be electroacoustically stimulated.


Counseling the patient/client regarding the permanency of the hearing loss, results in the patient/client taking “ownership” and becoming more proactive in “taking care” of their residual hearing ability.

The patient/client will become more willing to move over to your side, and listen to your professional suggestions regarding appropriate methods for each ear’s care.


Our goal for the hearing impaired is “normal” hearing ability.

However, realistic expectations based on the patient/client’s defined residual hearing ability, should be our basis for counseling and aural rehabilitation--not their permanent hearing loss or, even worse, a ridiculous comparison to a normal hearing person’s abilities.


Realistic expectations of electro acoustic stimulation as applied to each patient/client’s residual auditory ability result in more satisfied patient/clients.

To achieve this goal of realistic patient/client expectations, Hearing Instrument Specialists must recognize the following:


First: recognize the digital hearing instrument paradigm in custom electro acoustic fitting methodology. Due to the implementation of new

digital hearing instrument technology, new assessment tools and methodologies should be integrated/implemented.


Second: Fitting digital hearing instruments using analog fitting methods and rules, equals “digitized analog” fittings. This failure to fully implement new

digital algorithms results in less than optimum hearing instrument performance for the patient/client.


Third: Consistent methodology in the custom electro acoustic fitting of digital technology.This will result in greater

patient/client satisfaction, reduced return rates, and greater market penetration. Ref. Kochkin Feb. ’03 Hearing Review


Fourth: With the appropriate use of digital hearing instrument technology, the patient/client’s UCL should never be exceeded! Loudness discomfort levels can now be

measured in-situ with many digital hearing instruments. This test should always be performed.

Assuring output response limits are appropriately established by frequency is absolutely essential.


Fifth: Patient/clients reject fittings based upon the output of their hearing instrument(s).The old standard electroacoustic

amplifier rules (input plus gain equals output), still apply to digital hearing instrument fittings.


Sixth: Reduced stimulation of the patient/client’s residual auditory ability can result in: 1) poorly perceived sound quality, 2) poor ability to understand words clearly, 3) continued auditory deprivation. When at all possible, it is very important

that the dynamic range of speech information be preserved within the residual auditory capacity of each ear.


Seventh: Kneepoints & compression ratios should not be based upon an audiogram using arbitrary normative data. Kneepoints & compression ratios should

be determined based upon supra-threshold test results for each ear--for each patient/client.

You have then achieved a true custom electro acoustic fitting and a satisfied patient/client!


Identifying and Stimulating the Auditory Residual Area (ISARA), is the custom fitting technique for maximizing the remaining capabilities of the auditory system to both 'hear' and 'understand'.

The ISARA technique may involve, 'warble tones' at frequency, speech noise, or in situ measures to assist in defining the threshold, as well as, the supra-threshold levels of each ear’s dynamic range.


The concept of fitting the residual auditory area accurately, requires that we begin with a method termed: Residual Auditory Area Mapping (R.A.A.M.).

This map is unique to each individual ear, and incorporates each facet of the “diamond like” surface that is sound.


If the full benefit of the hearing instrument is to be embraced by the patient/client, the R.A.A.M. methodology requires accurate--individual measurement.

Residual auditory area mapping can be accomplished using either pure tones under headphones, insert earphones, in situ audiometry (to include both threshold and supra threshold data).


The residual auditory area mapping (RAAM) method permits us to create a 'full' and complete sound without exceeding the individual's loudness discomfort level.

Further, the sound 'floor' is the patient/client's own MCL, below which, the sound has only limited utility.


PLEASE NOTE: Patient/client counseling is not the time to 'dazzle' with 'techno-babble' or recite a pedantic mantra about the mysteries of the 'treasured' audiogram, for all of its 'magic'.


Patient/client counseling should involve realistic hearing/communication expectations based upon tests which reveal the residual hearing ability of each ear!


With today’s digital hearing instrument technology, we can approach 'filling' that residual auditory area and we can approximate the perception of "fullness".

This adds character to 'spoken voices' and 'richness to music'.

And results in a “realistic” and satisfied patient/client.

Education

Patient client counseling & aural rehab