Emotion and reason in hearing healthcare

Prompting conversations about the emotional impact of hearing loss.

The past 50+ years of research in aural rehabilitation has led to many important insights highlighting the emotional consequences associated with impaired hearing. Despite this long tradition, there is recent evidence (Grenness et al., 2015) that suggests, that in the vast majority of cases, the topic of emotion is not discussed by patients and clinicians. In some ways, the lack of communication about emotion is surprising, but on the other hand, it could be that clinicians feel ill-equipped to broach the topic of emotion.

In a previous blog post (“Emotion in speech – words are not enough”), I described research from a collaboration with Stefan Launer (Sonova AG) and Professor Frank Russo and Lisa Liskovoi (Ryerson University) exploring the development of the Emotional Communication in Hearing Questionnaire or EMO-CHeQ. The EMO-CHeQ is a brief 17-item questionnaire designed to explore hearing handicap related to affective (emotional) speech. One example item is as follows:


Although the EMO-CHeQ was originally designed to better understand emotional communication hearing handicap, our group has come to the realization that the EMO-CHeQ may be useful in a second, and perhaps more important, clinical application. Specifically, the EMO-CHeQ may act to sensitize our clientele to the topic of emotion, and possibly address underlying motivations for their visit.

Why is this important? There are two reasons to suspect why conversations about the emotional impact of hearing loss are critical for promoting positive audiologic outcomes. First, there is good evidence to suggest that discussions of emotion foster the therapeutic alliance between clinicians and patients and improve patient satisfaction (e.g., Brinkman et al., 2007; Brédart et al., 2005). Second, and perhaps more intriguingly, evidence from research on emotion suggests that discussions and processing of emotion may actually facilitate decision-making and behaviour change in patients (Damasio, 1994). The root of this second idea is that emotion sets into motion preparatory consequences linked to decision making and action. For example, Goldberg et al. (2014) presented brief audiovisual clips that varied in their emotional content while undergoing functional magnetic resonance imaging (fMRI) scans. In contrast to affectively neutral stimuli, emotionally-arousing stimuli were associated with greater activity in brain regions associated with action-related functions.

Hence, it would seem that not only do conversations about emotion provide a potential pathway to foster closer relationships between clinicians and patients, but that conversations about emotion may also support the process by which patients make decisions about how best to manage their hearing loss. Accordingly, clinicians may find value using the EMO-CHeQ as a means to prompt discussions about emotion. For more information, please consult Singh et al. (2017).


Brédart A., Bouleuc C., Dolbeault S. Doctor-patient communication and satisfaction with care in oncology. Curr Opin Oncol. 2005;17:351–354.

Brinkman W. B., Geraghty S. R., Lanphear B. P., et al. Effect of multisource feedback on resident communication skills and professionalism: a randomized controlled trial. Arch Pediatr Adolesc. 2007;161:44–49.

Damasio A. Descartes’ Error: Emotion, Rationality and the Human Brain. New York, NY: Putnam;1994.

Goldberg H, Preminger S, Malach R. The emotion-action link? Naturalistic emotional stimuli preferentially activate the human dorsal visual stream. NeuroImage. 2014;84:254-264.

Grenness, C., Hickson, L., Laplante-Lévesque, A., Meyer, C., & Davidson, B. The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations. Journal of the American Academy of Audiology, 2015;26:36–50.

Singh, G., Barr, C., Montano, J., English, K., Russo, F., & Launer, S. Family-Centered Audiologic Care: Emotion and Reason in Hearing Healthcare. Hearing Review, 2017; 24:30-32.