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PATIENT/CLIENT COUNSELING &AURAL REHABILITATION It has always been difficult to describe anaudiogram to a patient/client using therelative terms of mild, moderate, severe, andprofound hearing loss. These are all relative terms, as they wouldrelate to deafness.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION No one can actually simulate total deafness,so why should we be using these relativeterms when describing a patient/client’saudiogram to them? Most patient/clients are in their denial stageof hearing loss when they first have theiraudiogram explained to them. They can easily perceive the terms mild andmoderate as “not that bad”, and continuesuffering hearing loss!
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION As Hearing Instrument Specialists, we mustpresent to our patient/clients a moreaccurate portrayal of their hearingcondition. After all, electro acoustic stimulation viahearing instruments simply does not“correct” the hearing loss. It only stimulatesthe remaining ability of their damagedauditory system. Their hearing loss is permanently gone!
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONPatient/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 linesat 250hz and 6Khz.3. Plot the patient/client’s thresholds within thisbox.4. “Shadow” or “X”-out the area of the box whereno hearing ability could be measured.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION The non-shadowed area within the boxrepresents the patient/client’s remaininghearing ability (the hearing thepatient/client has left). The shadowed area is permanent hearingloss—gone forever—cannot be “restored”!
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION This information can be presented as a badnews—good news type of scenario: Bad news as finding permanent hearingdamage. Good news being the amount of residualhearing ability which can successfully beelectroacoustically stimulated.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION Counseling the patient/client regarding thepermanency of the hearing loss, results inthe patient/client taking “ownership” andbecoming more proactive in “taking care” oftheir residual hearing ability. The patient/client will become more willingto move over to your side, and listen to yourprofessional suggestions regardingappropriate methods for each ear’s care.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION Our goal for the hearing impaired is“normal” hearing ability. However, realistic expectations based on thepatient/client’s defined residual hearingability, should be our basis for counselingand aural rehabilitation--not theirpermanent hearing loss or, even worse, aridiculous comparison to a normal hearingperson’s abilities.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION Realistic expectations of electro acousticstimulation as applied to eachpatient/client’s residual auditory abilityresult in more satisfied patient/clients. To achieve this goal of realisticpatient/client expectations, HearingInstrument Specialists must recognize thefollowing:
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONFirst: recognize the digital hearinginstrument paradigm in custom electroacoustic fitting methodology. Due to the implementation of new digitalhearing instrument technology, newassessment tools and methodologies shouldbe integrated/implemented.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONSecond: Fitting digital hearing instrumentsusing analog fitting methods and rules, equals“digitized analog” fittings. This failure to fully implement new digitalalgorithms results in less than optimumhearing instrument performance for thepatient/client.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONThird: Consistent methodology in the customelectro acoustic fitting of digital technology. This will result in greater patient/clientsatisfaction, reduced return rates, andgreater market penetration. Ref. KochkinFeb. ’03 Hearing Review
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONFourth: With the appropriate use of digitalhearing instrument technology, thepatient/client’s UCL should never be exceeded! Loudness discomfort levels can now bemeasured in-situ with many digital hearinginstruments. This test should always beperformed. Assuring output response limits areappropriately established by frequency isabsolutely essential.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONFifth: Patient/clients reject fittings basedupon the output of their hearinginstrument(s). The old standard electroacoustic amplifierrules (input plus gain equals output), stillapply to digital hearing instrument fittings.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONSixth: Reduced stimulation of thepatient/client’s residual auditory ability canresult in: 1) poorly perceived sound quality,2) poor ability to understand words clearly,3) continued auditory deprivation. When at all possible, it is very importantthat the dynamic range of speechinformation be preserved within the residualauditory capacity of each ear.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONSeventh: Kneepoints & compression ratiosshould not be based upon an audiogram usingarbitrary normative data. Kneepoints & compression ratios should bedetermined based upon supra-threshold testresults for each ear--for each patient/client. You have then achieved a true customelectro acoustic fitting and a satisfiedpatient/client!
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION Identifying and Stimulating the AuditoryResidual Area (ISARA), is the customfitting technique for maximizing theremaining capabilities of the auditorysystem to both hear and understand. The ISARA technique may involve, warbletones at frequency, speech noise, or in situmeasures to assist in defining the threshold,as well as, the supra-threshold levels of eachear’s dynamic range.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION The concept of fitting the residual auditoryarea accurately, requires that we begin witha method termed: Residual Auditory AreaMapping (R.A.A.M.). This map is unique to each individual ear,and incorporates each facet of the “diamondlike” surface that is sound.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION If the full benefit of the hearing instrumentis to be embraced by the patient/client, theR.A.A.M. methodology requires accurate--individual measurement. Residual auditory area mapping can beaccomplished using either pure tones underheadphones, insert earphones, in situaudiometry (to include both threshold andsupra threshold data).
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION The residual auditory area mapping(RAAM) method permits us to create a fulland complete sound without exceeding theindividuals loudness discomfort level. Further, the sound floor is thepatient/clients own MCL, below which, thesound has only limited utility.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONPLEASE NOTE: Patient/clientcounseling is not the time to dazzle withtechno-babble or recite a pedanticmantra about the mysteries of thetreasured audiogram, for all of itsmagic.
PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONPatient/client counseling should involverealistic hearing/communicationexpectations based upon tests whichreveal the residual hearing ability of eachear!
PATIENT/CLIENT COUNSELING &AURAL REHABILITATION With today’s digital hearing instrumenttechnology, we can approach filling thatresidual auditory area and we canapproximate the perception of "fullness". This adds character to spoken voices andrichness to music. And results in a “realistic” and satisfiedpatient/client.