In audiological circles, when the term "expectations" is
used, it usually refers to the expectations that consumers have regarding
the performance of hearing aids. These expectations can differ considerably.
Some people have an exalted, and completely unrealistic,
idea of how well they’ll be able to hear with hearing aids. After resisting
the notions for years, when they finally do succumb and accept hearing aids,
they want to hear "everything" that "everybody else does.
Anything less is a cause for disappointment.
For other people, expectations are too low. With
some "fine-tuning" of the hearing aid’s electroacoustic characteristics,
assertive communication strategies, and the judicial use of other types of
hearing assistance technologies, they can be helped to communicate much more
effectively than they are.
One important role of the professional audiologist
is to help clients balance their hopes against the limitations imposed by
the nature of their hearing problem. Without realistic expectations, people
may either be sorely disappointed with their hearing aids or "satisfied" with
much less benefit than what is possible. So consumers’ expectations
not only have to be satisfied to a large extent, but they also have to be
realistic. If not, the aids are likely to be returned or discarded; at the
least, we can predict a very unhappy hearing aid user!
The problem is that there is no way that I know
of to determine, in any objective fashion, exactly what can be considered "realistic" aided
performance targets with hearing aids. Can someone do even better with a
different adjustment, or a different set of hearing aids? While we really
don’t know the answer to this ( it is not possible to compare every
possible combination of hearing aid and speech processing strategy), some
estimate has to be made whether "expected" targets have been reached.
Using their training, experience, and various audiological
tools, audiologists do try to arrive at an estimate of whether the aided
performance of a particular client is satisfactory, i.e., whether their "expectations" have
been met. The weakness of this approach is that the client’s role is
essentially passive, that of a recipient of a service and not someone who
is really the main stakeholder in the process. Unfortunately, prospective
hearing aid user usually do not know what they should and should not "expect" from
the audiologist, in terms of service, follow-up appointments, and information.
Expectations, in other words, cut both ways. Not
only is it necessary for audiologists to help people formulate realistic
expectations regarding the hearing aid performance, it is also necessary
that clients know what to expect from their audiologist.
In this article, I will outline the information
and services that I think that new hearing aid users should expect from their
audiologists. I emphasize that this is my personal list, based on my personal
judgment, though it is one that I would gladly debate with those who may
disagree with its scope and details.
At the First Visit
1. Did you learn if you are or are not a hearing
aid candidate? Based on what information?
2. Was the nature of your hearing loss explained
to you? Did it include: a) the implications of you audiogram, particularly
regarding understanding speech in noise and why, sometimes, you can "hear," but
not "understand." B) General amplification goals and how they relate
to your specific audiogram, loudness sensitivity (recruitment), and your
personal communication need.
3. Were you administered some sort of self-report
scale regarding the effect of the hearing loss on your life (social, emotional,
vocational, etc.)? A) Did some "significant other" (spouse, adult
children) have an opportunity to complete a parallel form? B) Did you have
an opportunity to talk about the implications of the specific ratings? C)
Will you be completing a follow-up scale after you’ve work the aids
for several weeks of months?
4. Were the advantages, disadvantages, and function
of various hearing aid options explained to you? A) Binaural (usually, and
appropriately, recommended). B) Telephone coils and direct audio-input (depends
on your communicative needs and the nature of your hearing loss). If not,
why not? C) Directional microphones. D) Other sophisticates signal processing
possibilities (too many to list, but did you, at least, get some kind of
overview?)
During and After the Hearing Aid Selection Process
1. Did the audiologist explain the basis for recommending
one pair of aids over another? A) Were your personal preferences considered?
B) If rejected , do you know why?
2. Do the aids fit comfortably?
3. Were you able to insert the aids in your ears
by yourself?
4. Did the audiologist perform a "real-ear" measure
and explain the results to you?
5. Was the following information concerning batteries
explained to you? A) the purpose of the paper tab on the battery. B) How
to insert them in the aids. C) How to use a battery tester. D) The necessity
of spare batteries and how to keep them handy. E) Factors that affect life
span of batteries (size, type aid, sound inputs, etc.) F) Where you can obtain
batteries and how much they cost.
6. Was the following information regarding the
care of the hearing aids and earmolds explained to you? A) How to keep earwax
out of the sound bore of the hearing aid. B) Keeping the surface of the mold
clean. C) Using a dehumidifier box for night storage. D) Good hygiene for
the ear canal.
7. Did you receive written material that reviews
this information?
Was the Following Information Covered at the Time
of Your First Scheduled Hearing Aids Follow-Up (a week or two after aids
were delivered)?
1. Auditory experiences with aids (in noise, feelings
of loudness discomfort, etc.).
2. Fit of earmolds (comfort, acoustic feedback—squeal).
3. Telephone usage with hearing aid—problems
and solutions.
4. "Real-ear" hearing aid measures checked.
5. Were changes in any of the electroacoustic parameters
explained to you?
Group Hearing Aid Orientation Program
This is a highly recommended service that should
be incorporated into the hearing aid selection process, at no extra charge.
It serves to reinforce and extend information covered in individual sessions,
plus it gives an opportunity for valuable group interactions. The following
is a general outline of the content of such a program.
1. Review nature of hearing loss, basic anatomy
and physiology, audiogram and speech sounds, basic principles of hearing
aid fitting, types of aids, care of aids, hearing aid troubleshooting, review
and discussion of hearing aid problems.
2. Review common communication problems with group.
Opportunity to exchange experiences and possible solutions ro problems.
3. Review implications of hearing loss for normal
hearing with significant other (i.e., play audiotape "unfair hearing
test"). Exchanging experiences (i.e. hearing loss a "family problem").
4. Presentation and discussion of other types of
hearing assistance technologies (e.g., TV devices, aids to telephone communication,
large-area assistive listening devices, personal FM systems, and signaling
and warning devices of all kinds). The need for such devices determined in
respect to social and vocational implications. How such systems can be purchased.
5. Review of communication strategies (conversational
repair strategies, definition and practice of assertiveness, other kinds
of hearing tactics).
6. Speechreading, concept and principles.
At the Conclusion of the Hearing Aid Selection
Process
1. You can decided, within 30 days, whether the
cost/benefit ratio of the aids is sufficiently positive to justify purchase.
But be realistic.
2. Finally, don’t hesitate to call you audiologist
if you have questions or problems (many of these would have been answered
or managed if you participated in the group hearing aid orientation program).
They can’t do their job appropriately unless you give them constructive
feedback.
3. Were your "expectations" met?
This article was reprinted with permission from
the American Academy of Audiology Web site (www.audiology.org). This article
was supported, in part, by grant #RH133E30015 from the U.S. Department
of Education, NIDRR, to the Lexington Center, Jackson Heights, New York.
