What 3 factors do we look at when considering if the patient is a good candidate for amplification?
- Audiological profile (audiogram, speech testing scores, tinnitus, hyperacusis, performance in speech in noise, etc.)
- Communication needs (how to positively impact patients in areas that are important to them)
- Motivation (does the patient have the desire for assistance through amplification?)
What hearing aid parameters and technology should be fitted?
- Considerations in type of hearing aid
- Form, power, coupling, aesthetic preference, accessories, physical ability to handle hearing aids, programs to include, features to enable
What are the patient’s post-fitting rehabilitation needs?
Counselling appointments, involvement with family/friends, communication strategies, self-advocacy, support for patient in workplace
How do we gauge success?
- Verification and validation measures with counselling, and follow-up
- Verification: verify the HA is meeting the presecription through real ear measures
- Validation: are the HAs making a difference in the environment that they are supposed to be working in
What are 5 audiological considerations when thinking about HAs?
- Pure tone audiogram (hearing loss configuration)
- Speech audiometry (word recognition scores)
- Speech in noise scores (QuickSIN)
- MCLs, UCLs
- Presence of tinnitus reported
Better ____ do better with amplification
WRS
What are 4 physical considerations when thinking about HAs?
- Can the ear (pinna and ear canal) support an aid?
- Is the canal occluded with debris (infection, cerumen, foreign body)
- What the does canal look like (Narrow? Collapsed? Surgically modified?) this determines coupling
- Dexterity of patient: Insertion/Removal, handling of batteries, handling and use of cleaning tools, etc.
Do we require medical clearance?
Sometimes you need to get medical clearance before fitting a HA (infection)
What are 10 referral guidelines for medical clearance?
- Visible congenital or traumatic deformity of the ear.
- Growths on pinna, or unusual growths in canal (exostosis).
- History of active drainage from the ear within the previous 90 days (odour from drainage may indicate infection)
- History of sudden or rapidly progressing hearing loss within the previous 90 days.
- Acute or chronic dizziness.
- Unilateral hearing loss of sudden or recent onset within the previous 90 days.
- Audiometric air-bone gap equal to or greater than 15 dB at 500 Hz, 1000 Hz, and 2000 Hz.
- Visible evidence of significant cerumen accumulation or a foreign body in the ear canal (that cannot be safely removed by overseeing clinician)
- Pain or discomfort in the ear.
- Child under 18 years of age.
Why is medical Clearance Important?
- Suspicions of retro-cochlear, and middle ear issues must be addressed by ENT prior to fitting aids
- Active, acute medical concerns must be addressed
- Referral to ENT through family physician, ideally have medical clearance in writing prior to proceeding with hearing aids
Why is assessment important?
Considering communication needs, expectations, and motivation
What are the 5 components of assessment?
- Interviewing the patient- where is help needed?
- Client-Oriented Scale of Improvement (COSI)
- Appropriate expectations
- Involving communication partners
- Understanding motivation— without it, success of intervention can be compromised
Audiologists must consider “where” patients are, and participate in ____
Shared- decision making
Who is important to consider in a patient’s support circle?
Partners, spouses, children, close friends, and other communication partners
How can hearing loss present in clinic?
What do patients tell us (or what do they not tell us)?
- “I can hear, I just can’t understand what people are saying”
- “Everyone is mumbling”
- Difficulty following conversations (dependant on environment)
- Frustration (may be from both patients or those close to them)
- Avoidance strategies, negative social impacts
- Admitting to feigning understanding conversation— “smile and nod”
What is a common model used for counselling and supporting behavioural changes
Transtheoretical Model (TTM) of Health Behavioural Change
What are the 4 components of the TTM model?
- Pre-contemplation
- Contemplation/Preparation
- Action
- Maintenance
Explain the pre-contemplation phase
- Not ready
- Patient is unaware they have any problem with hearing
- No intention of taking action unaware that hearing loss problematic
Explain the contemplation/preparation phase
- Getting ready
- Recognition that hearing loss may be problematic, evaluate the pros and cons of seeking help, may ask questions about rehabilitation processes
- Contemplation: beginning stages of awareness, they have a desire to fix this but may not know how
- Preparation: ontention to take action
Explain the action phase
- Moving forward
- Modifying behaviour, using therapy, acquiring new “healthy” behaviours, open to assistance, and counselling
- Made a change in a positive direction
Explain the maintenance phase
Maintain that action in a positive way
What are 4 things someone may do in the pre-contemplation stage?
- Play down the impact of their hearing difficulties on their everyday life
- Display low concern for their hearing difficulties
- Provide self-initiated examples of situations where they can hear well
- Attribute blame for hearing difficulties to others (e.g. family members mumbling, or speaking softly), or situational factors (e.g. background noise)
What are the Quick Six?
Getting a sense of patient difficulty through open-ended questions
- “Tell me what brought you into the office”
- “How long have you been noticing difficulty with communication?”
- “Do other people notice you having difficulty with communication?”
- “Tell me about the areas you are having difficulty with communication”
- “Would you be willing to accept help or assistance with the difficulties you are having”
- “ On a scale of 1 through 10, with 1 being ‘I don’t need help’, and 10 being ‘I need help right away’, how would you rate your ability to communicate?”
Explain the self-perceived HL study (Palmer et al, 2009)
- 848 hearing-impaired adults in the age range from 18 to 95 years were studied and asked:
- “On a scale of 1 to 10, 1 being the worst, and 10 being the best, how would you rate your overall hearing ability”
- More than 75% of patients who report a score between 1 and 5 will pursue amplification
- Patients who rate there hearing between 8-10 will not likely pursue amplification
