Hearing loss can have an impact on a person’s quality of life and there are many factors that can cause a person to seek hearing services, and as a result, they too can affect rehabilitation. These factors vary depending on the person’s current attitudes or lifestyle and can result in depression, social isolation, poor social interactions, cognitive dysfunction, and reduced emotional, behavioral, and social wellbeing (Stephens, & Hetu, 1991). Lifestyles can also be altered by other significant life events such as relocating to another neighborhood with lower levels of ambient noise, the death of a loved one, etc. (Sherbourne et al., 1992). Hearing loss can have a significant effect on one’s close family and friends. Scarinci, Worrall, and Hickson (2008) showed in their study that both the person with hearing loss and their family members (particularly their significant other) experienced frustration and anxiety as a result of the hearing loss. In the case of our client, Mr. Peterson, some of these issues will be addressed from the initial appointment so as to highlight how they can influence the rehabilitative outcomes. Ways in which these issues can be overcome so as to achieve an effective rehabilitative outcome measure for Mr. Peterson will be looked into.
Barriers to Aural Rehabilitation
Despite being fond of his wife, Mr. Peterson mentioned that he did not think it necessary for his wife to be present at the appointment since he thought he was causing her enough trouble with his hearing loss. It could be the case that Mr. Peterson is fearful of what his wife may say at the appointment despite his acknowledging of the problems caused by his hearing loss. His wish not to involve his wife in the audiological services can pose a significant barrier to the rehabilitative process since his wife is the person most often around him and she will be greatly affected. Moreover, Mr. Peterson’s hearing loss is the main reason for his not wanting to go out, which significantly affects his wife’s social interactions.
Stark and Hickson (2004) assert that spouses play an important role in aural rehabilitation, as they are the most frequent communication partners and primary motivators to the hearing impaired person. Scarinci, Worrall, & Hickson (2008) state that clients and their significant others form a partnership and it is essential to treat them as a unit as opposed to focusing exclusively on the client with the hearing loss. It was therefore recommended that his wife attend the next appointments. From a clinical perspective, her comments on his hearing provided valid information for assisting with the rehabilitative process. Previous studies have documented the positive impact of family support and encouragement on the hearing impaired person’s ability to manage and adjust to their hearing loss (Miller, 1983).
Another barrier to the rehabilitative process is a stigma which is the primary reason for avoiding hearing aids (Kochkin, 2007). There could already be a negative stigma attached to Mr. Peterson’s hearing loss, due to his previous bad experiences with hearing aids. In addition, there could be an external negative stigma associated with hearing loss from family and friends. The internal and external negative stigma could be the major reason for Mr. Peterson not going out frequently with his wife. Internal and external negative stigma can pose as barriers to the rehabilitative process. Therefore it is a good idea to get family members involved. It is essential for the clinician to ensure that Mr. Peterson’s expectations are realistic. It could be that Mr. Peterson has expectations of being fitted with a better hearing aid which will not give him any problems. This cannot be promised. The clinician will have to ensure that all options of intervention are discussed with the client. Weinstein (2000) states that when perception exceeds expectation, the client is satisfied, however, if expectations are less than perceptions, dissatisfaction ensues irrespective of the outcome.
Another barrier that can influence the rehabilitative process is Mr. Peterson’s health problems since a relapse will prevent him from wearing his hearing aids. Initially, Mr. Peterson reported that he had only worn his hearing aids. When he lost one of his hearing aids, he relied on the other. Prolonged wearing of one hearing could have a significant effect on his hearing and possibly affect his speech discrimination results, which could have been caused by auditory deprivation. When retested in the aided/unaided conditions using AB words after binaural amplification and increased hours of usage of hearing aids, Mr. Peterson’s speech discrimination scores improved. This suggests that the word recognition scores for the unaided ears improved significantly. This typically illustrates the phenomenon of recovery from adult-onset auditory deprivation when fitted binaurally (Silman et al., 1992). It was therefore vital to address to Mr. Peterson the importance of binaural amplification.
Outcomes
Mr. Peterson’s rehabilitative outcomes were generally positive. The barriers that could have impacted negatively on the rehabilitative process were considered and addressed. The clinician’s responsibility is primarily give Mr. Peterson an accurate picture of his hearing and the benefits of intervention (Dillon, 2001). Each concern Mr. Peterson reported was clearly addressed at each appointment stage and evaluated accordingly. Working with the client was an effective way of keeping him involved as well as creating a positive relationship (that you are acknowledging their concerns and can work with them to achieve reliable and realistic goals).
The COSI was administered to enable the clinician to identify and address the specific problems that caused the client to seek help. The APHAB was administered to better inform on the benefit of aided conditions. Weinstein (2000) states that the APHAB’s unaided and aided performances can be assessed at one point in time after hearing aid use or at two different points in time. Because of poor speech discrimination and possibly auditory deprivation from Mr. Peterson’s previous test results, the HELEN test was administered to demonstrate the importance of visual cues. Following the administering of the HELEN test, the clinician could inform the client that even with hearing aids, it is still important to make use of visual cues, and that hearing aids cannot restore hearing, ut aid their hearing impairment. All these outcome measures were quick to administer and could readily demonstrate to the client the benefits of his hearing aids.
A group program such as SHHH was recommended to further assist Mr. Peterson in his daily listening situations. The adjustment back to an active lifestyle or social participation can be particularly overwhelming as Mr. Peterson begins adjusting to new sounds. Group programs can not only act as a supportive role but can also help increase his quality of life.