Patient client counseling & aural rehab

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  • 1. 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.
  • 2. 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!
  • 3. 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!
  • 4. 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.
  • 5. 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”!
  • 6. 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.
  • 7. 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.
  • 8. 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.
  • 9. 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:
  • 10. 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.
  • 11. 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.
  • 12. 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
  • 13. 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.
  • 14. 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.
  • 15. 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.
  • 16. 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!
  • 17. 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.
  • 18. 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.
  • 19. 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).
  • 20. 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.
  • 21. 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.
  • 22. PATIENT/CLIENT COUNSELING &AURAL REHABILITATIONPatient/client counseling should involverealistic hearing/communicationexpectations based upon tests whichreveal the residual hearing ability of eachear!
  • 23. 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.