Chapter 11AR for Adults

Perry C. Hanavan

Strategies for Planning

• Subjective– Comments, case history, communication partners

comments, questionnaires, etc.

• Objective– Audiologic diagnostic tests, speechreading tests, etc.

• Assessment– Subjective and objective summary

• Plans– Strategies, goals, and objectives based on

assessment

8 AM Appointment• Subjective: 50 yr old white male with noise exposure experiencing increasing

difficulty understanding conversations at work and home, seems to be “saying what” more often and spouse complains the TV is too loud and seems to have selective hearing loss, questionnaires shows he is experiencing difficulty listening in noisy environments

• Objective: Pure tone results show a moderate high frequency hearing loss, SN, WRS are 84% AU, SNR loss is 10, tympanograms are WNL AU, ART are WNL AU, OAEs are abnormal AU, speechreading score is 20%, speechreading enhancement is 100%.

• Assessment: Results indicate a moderate high frequency SNHL, fair WRS, with poor ability for understanding speech in noise, with good speechreading enhancement ability. This degree and type of hearing loss will result in communication difficulties at home, work, recreational and social situations. Spouse interested in AR including hearing aids, however, patient not interested in help for hearing problems

• Plans: The following recommendations are in order:– Refer for medical advisement regarding hearing loss– Hearing aids will provide benefit, therefore, provide counseling regarding benefits of hearing

aids– Counseling family regarding facilitative and repair communication strategies– Counseling regarding use of hearing protection– Counseling regarding ALDS– Speechreading and auditory training will provide benefit

Counseling Benefits

• Enhanced understanding of hearing loss

• Improved self-disclosure and self acceptance

• Improved understanding of hearing loss and resulting in compliance to treatment

• Reduced stress and discouragement

• Increased satisfaction with AR intervention

• Increased motivation with AR

Types of Counseling

• Informational

• Rational Acceptance

• Adjustment Counseling

Informational Counseling

• Goals: patient learns about hearing loss, communication strategies, hearing aids, ALDS, etc.

• Desired Outcomes: patient understands hearing loss, communication strategies, various amplification technologies, etc., and is more willing to participate in AR intervention

Rational Acceptance Counseling

• Goals: patient learns how to manage hearing loss and manage communication difficulties

• Desired Outcomes: patient optimally uses communication strategies and structures listening environments; is more willing to participate in AR

Adjustment Counseling

• Goals: Patient works through negative feelings about hearing loss and decreased sense of self-worth

• Desired Outcomes: Patient begins to view disability as separate from self; begins to regain positive self-image; is more willing to participate in AR

Stats• 28 million Americans have hearing loss• (95%) with hearing loss have their hearing loss

treated with hearing aids • Only 20% purchase a hearing aid• Only 60% are satisfied with hearing aids• 20% who own a hearing aid do not wear• Many do not receive AR following fitting of

hearing aid• Many are not informed about ALDS• Only 30% of hearing aids have telecoils• Only 20-30% fitted with directional hearing aid

Rejection of Hearing Aids

• Cost• Vanity• Fear of aging• Social stigmata• Hearing loss not severe enough to warrant

use• Does not meet expectations• Does not help in noisy listening

environments

Model for Hearing Aids1. Education: provide clear explanation of hearing loss,

loss not reversible, options for managing hearing loss, quality of life issues, value and limitations of HAs

2. Value Change: HA will reduce communication problems, HA will not result in devaluation by others, or been seen as old

3. Attitude Change: Discuss and select styles, monetary and non-monetary costs of HA, hopefully individual will determine benefits are cost effective

4. Action: provide explanation of steps involved in acquiring hearing HA resulting in person undergoing hearing aid evaluation and hearing aid fitting

5. Establishment of Use Pattern: After purchase or acquisition of hearing aid, person continues to wear hearing aid and improve communication interactions

Acquisition of Hearing Aids

1. Hearing evaluation

2. Hearing aid evaluation/selection

3. Hearing aid fitting/orientation

4. Follow-up

HAO

• Parts of HA

• Operation of HA

• Care and Maintenance of HA

• Trouble-shooting techniques

• Return for repair procedures

Maintenance

• Battery

• Cleaning

• Inserting/removing

• Care when not worn

Expectations of HA

• Amplifies all sounds

• Speech understanding

• Comfort issues

• Speechreading

Establishing Use Patterns

• Full time pattern

• Rejection pattern

• Intermittent pattern

AR

• The ear, hearing, hearing loss• Adjusting to hearing aids• Communication strategies• Speechreading• Auditory training• Listening strategies• ALDS• ADA

AR

• Group

• Individual