Best of Hearing Health: Two Ways to Show Patients their Hearing Aids are Helping
Originally posted at HHTM On April 20, 2016. Reprinted with permission.
If you are an audiologist, it is easy to delude yourself into thinking that people will listen to you and accept what you are saying. You spent a lot of time and energy going to graduate school, and you have a license to practice Audiology. So, because you are a trusting individual, you believe other people will listen to you, and trust you. Sadly, this is often not the case.
One of the great weaknesses of any profession, including ours, is that our professional training does not give us a “real world” orientation. Audiology students in a typical graduate school do not learn much about the realities of life and business. All too often, new graduates enter practice without a good understanding of the basic human nature of the patients they will be caring for.
People have their own “judgment systems” that are strongly influenced by their age, culture, and individual differences. If you become adept at relating to a wide range of people and if you learn how to sell and fit hearing aids, you will become successful. If you don’t, you won’t. Like a lot of audiologists, my greatest weakness is not in technology, it is in salesmanship.
Some Tips for the Next Generation
Speaking as a veteran Audiologist, let me offer some fatherly advice to young Audiologists.
Every time you see a patient, use some type of demonstration that starkly contrasts the difference between aided and unaided hearing. From the patient’s perspective, this demonstration needs to be black and white. Your demonstration should leave them saying to themselves, “I hear with these hearing aids. I cannot hear without them.”
Here are a couple of ways to make this demonstration successful.
Study the patient’s audiogram. If the speech-reception thresholds (SRTs) are above 40 dB and the thresholds for 1000-6000 Hz are above 50 or 60 dB, patients will have trouble hearing the noise they make when they rub their hands together.
The demonstration goes like this: Fit the aids; adjust the volume to a comfortable level; remove the aids. You should also try the hearing aids on your own ears, or measure their output in a test box to make sure you have substantial amplification. Don’t start the demonstration until you’re sure everything is working correctly.
Then, put a hearing aid on the patient’s ear and tell them to rub their hands together. They should be able to hear this noise easily with their aided ear.
Tell the patient, “Keep rubbing,” and then reach over and remove the hearing aid. If you do this correctly, it will be a dramatic demonstration to the patient that the hearing aid enables them to hear sound that is inaudible to them unaided.
SHOW IMPROVED WORD UNDERSTANDING
Here’s another idea. The Tennessee Tonality Words are “test words,” which are grouped by pitch into five tonal groups: Low-pitch (L), Low-Mid (L-M), Mid (M), Mid-High (MH), and High (H).
I use these words to do another type of black-and-white demonstration that shows patients how well they hear words with the hearing aids and how poorly they understand without them.
I ask patients to repeat the words I say. I speak in a normal voice, but cover my mouth so patients can’t read my lips. I adjust the hearing aid to a comfortable level, then remove it. Standing three feet away from the patient, I start uttering some high-pitched words: “itch, teach, ship, beach…” After saying two or three words, I ask the patient to repeat them. If the patient does so correctly, I increase the distance between us and repeat the test.
At some point the patient will no longer be able to hear and repeat the words. For this example, suppose the patient can no longer repeat what I say from 12 feet away. I turn to the family members and ask them, “Can you hear the words?” They usually say, “Yes, easily.”
I then put the hearing aid back in the patient’s ear and ask them to repeat the same words, which I say standing at the same place where the patient was unable to hear me unaided.
If I have set up this demonstration correctly, the patient will be able to hear all the words with the hearing aid, and none of the words without it. I emphasize the difference by asking the family, “Are the hearing aids working?” At this point, the patient’s family members become a very important part of the demonstration, because they typically become excited and are overjoyed that their husband or father will be able to hear.
Demonstrations like these do more than show patients the benefit of the hearing aids. They also keep us honest. If for any reason the fitting is not working correctly, the demonstration will fail. That tells us that something is not working properly and that we need to put extra effort into fine-tuning the fitting.