Download Chapter 11 AR for Adults

Chapter 11
AR for Adults
Perry C. Hanavan
Strategies for Planning
• Subjective
– Comments, case history, communication partners
comments, questionnaires, etc.
• Objective
– Audiologic diagnostic tests, speechreading tests, etc.
• Assessment
– Subjective and objective summary
• Plans
– Strategies, goals, and objectives based on
assessment
8 AM Appointment
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Subjective: 50 yr old white male with noise exposure experiencing increasing
difficulty understanding conversations at work and home, seems to be “saying what”
more often and spouse complains the TV is too loud and seems to have selective
hearing loss, questionnaires shows he is experiencing difficulty listening in noisy
environments
Objective: Pure tone results show a moderate high frequency hearing loss, SN,
WRS are 84% AU, SNR loss is 10, tympanograms are WNL AU, ART are WNL AU,
OAEs are abnormal AU, speechreading score is 20%, speechreading enhancement
is 100%.
Assessment: Results indicate a moderate high frequency SNHL, fair WRS, with
poor ability for understanding speech in noise, with good speechreading
enhancement ability. This degree and type of hearing loss will result in
communication difficulties at home, work, recreational and social situations. Spouse
interested in AR including hearing aids, however, patient not interested in help for
hearing problems
Plans: The following recommendations are in order:
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Refer for medical advisement regarding hearing loss
Hearing aids will provide benefit, therefore, provide counseling regarding benefits of hearing
aids
Counseling family regarding facilitative and repair communication strategies
Counseling regarding use of hearing protection
Counseling regarding ALDS
Speechreading and auditory training will provide benefit
Counseling Benefits
• Enhanced understanding of hearing loss
• Improved self-disclosure and self
acceptance
• Improved understanding of hearing loss
and resulting in compliance to treatment
• Reduced stress and discouragement
• Increased satisfaction with AR intervention
• Increased motivation with AR
Types of Counseling
• Informational
• Rational Acceptance
• Adjustment Counseling
Informational Counseling
• Goals: patient learns about hearing loss,
communication strategies, hearing aids,
ALDS, etc.
• Desired Outcomes: patient understands
hearing loss, communication strategies,
various amplification technologies, etc.,
and is more willing to participate in AR
intervention
Rational Acceptance Counseling
• Goals: patient learns how to manage
hearing loss and manage communication
difficulties
• Desired Outcomes: patient optimally uses
communication strategies and structures
listening environments; is more willing to
participate in AR
Adjustment Counseling
• Goals: Patient works through negative
feelings about hearing loss and decreased
sense of self-worth
• Desired Outcomes: Patient begins to view
disability as separate from self; begins to
regain positive self-image; is more willing
to participate in AR
Stats
• 28 million Americans have hearing loss
• (95%) with hearing loss have their hearing loss
treated with hearing aids
• Only 20% purchase a hearing aid
• Only 60% are satisfied with hearing aids
• 20% who own a hearing aid do not wear
• Many do not receive AR following fitting of
hearing aid
• Many are not informed about ALDS
• Only 30% of hearing aids have telecoils
• Only 20-30% fitted with directional hearing aid
Rejection of Hearing Aids
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Cost
Vanity
Fear of aging
Social stigmata
Hearing loss not severe enough to warrant
use
• Does not meet expectations
• Does not help in noisy listening
environments
Model for Hearing Aids
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5.
Education: provide clear explanation of hearing loss,
loss not reversible, options for managing hearing loss,
quality of life issues, value and limitations of HAs
Value Change: HA will reduce communication
problems, HA will not result in devaluation by others, or
been seen as old
Attitude Change: Discuss and select styles, monetary
and non-monetary costs of HA, hopefully individual will
determine benefits are cost effective
Action: provide explanation of steps involved in
acquiring hearing HA resulting in person undergoing
hearing aid evaluation and hearing aid fitting
Establishment of Use Pattern: After purchase or
acquisition of hearing aid, person continues to wear
hearing aid and improve communication interactions
Acquisition of Hearing Aids
1.
2.
3.
4.
Hearing evaluation
Hearing aid evaluation/selection
Hearing aid fitting/orientation
Follow-up
HAO
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Parts of HA
Operation of HA
Care and Maintenance of HA
Trouble-shooting techniques
Return for repair procedures
Maintenance
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Battery
Cleaning
Inserting/removing
Care when not worn
Expectations of HA
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Amplifies all sounds
Speech understanding
Comfort issues
Speechreading
Establishing Use Patterns
• Full time pattern
• Rejection pattern
• Intermittent pattern
AR
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The ear, hearing, hearing loss
Adjusting to hearing aids
Communication strategies
Speechreading
Auditory training
Listening strategies
ALDS
ADA
AR
• Group
• Individual