1. Chapter 11 AR for Adults
Perry C. Hanavan

2. 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

3. 8 AM Appointment
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:
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

4. 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

5. Types of Counseling Informational Rational Acceptance
Adjustment Counseling

6. 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

7. 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

8. 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

9. 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

10. Rejection of Hearing Aids
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

11. Model for Hearing Aids
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

12. Acquisition of Hearing Aids
Hearing evaluation
Hearing aid evaluation/selection
Hearing aid fitting/orientation
Follow-up

13. HAO Parts of HA Operation of HA Care and Maintenance of HA
Trouble-shooting techniques
Return for repair procedures

14. Maintenance
Battery
Cleaning
Inserting/removing
Care when not worn

15. Expectations of HA Amplifies all sounds Speech understanding
Comfort issues
Speechreading

16. Establishing Use Patterns
Full time pattern
Rejection pattern
Intermittent pattern

17. AR The ear, hearing, hearing loss Adjusting to hearing aids
Communication strategies
Speechreading
Auditory training
Listening strategies
ALDS
ADA

18. AR
Group
Individual