After having worked in Audiology for over 20 years I am still astounded that as a global profession we have managed to ’make do’ in some areas with little evidence to back up our clinical decisions. There seem to be pockets within our clinical spectrum where this has happened, and severe and profound hearing loss is one such area. That isn’t to say that there haven’t been centers and professionals where excellent clinical care has not been achieved, but that these trailblazers have often had to create this service without the evidence base to lean their practice on or have any national or international guidance to base their decisions.
So, for clients who have the most severe audiometric thresholds, often the greatest disability from their hearing loss and arguably the greatest need, we have done well to support our clients in the ways we have for so long.
What makes this client group so distinctive?
They are often long-term users of hearing aids who are highly reliant on their devices, having unique amplification needs. These clients make up nearly 7% of the clinical population so cannot be ignored.1 Even though cochlear implants can be an option, only 7% of adults choose this intervention, compared to 94% of children by the age of 17.2
I am sure we can all relate to clients we have seen when they have described the consequences of severe and profound hearing loss. It permeates all areas of their life and overwhelmingly changes their expectations. It impacts on their communication skills.3 They can describe increased feelings of anxiety, depression, frustration, isolation,4,5 and have a rise in their dependency on others.6 It has been associated with dementia,7 with a greater risk of having falls,8 early death,9 and an increased likelihood of unemployment.10
Based on all of this, our profession needs to support this client group in a different way to those with mild to moderate hearing loss. Their challenges often are vastly different to their better hearing peers and we therefore need the skills to help support them differently.
We have several challenges with this client group:
- Completing a person-centered assessment with the client and communication partners which lays the foundations for a successful treatment, and which will most likely need joint working or signposting to external agencies
- Understanding the limitations of hearing aid amplification whilst using all the hearing aids digital tools to full advantage for each client
- Have the knowledge and skills to appropriately recommend and fit other assistive listening technology (including the use of remote microphones)
- Understanding the benefits of cochlear implantation and offering all suitable clients the opportunity to consider this as a treatment option
- Having appropriate counseling strategies for supporting adjustment, developing effective communication practices, and recognizing the importance of peer support
- Having strategies for clients with severe and profound hearing loss and tinnitus, where sound therapy may not be as effective due to the severity of their hearing thresholds
- Measuring the outcomes of this special population, as standard outcome measures do not fit this client group
So, when I was invited by Phonak to edit international guidance for adults with severe and profound hearing loss I was delighted. Not only was this an opportunity to work with like-minded researchers and clinicians to produce this long-needed document, but it provided the prospect for adults with this severity of hearing loss across the world to receive an equitable access to their care.
Guidance now available!
We have worked with some international leaders to bring together this guidance. All of us discussed openly the lack of evidence for this population and asked each other questions about different clinical situations we had been in and how we handled these. The guidance is clear about the gaps in research knowledge and repeatedly calls for these to be addressed by the international research community. It is hoped some of these gaps will be in place for a revised edition in 5 years’ time.
In the meantime, the guidance is written in such a way that depending on your learning preferences you may want to just use the recommendations in each section. Or to fully understand where each recommendation came from you can read the full evidence tables in the appendix, which have been graded for you to see how strong the evidence is for each statement.
I would like to thank all of the authors for the work they have put into this project and for Phonak for funding and bringing together everyone so this guidance has come to fruition.
This newly published document on how to manage adults with severe and profound hearing loss can be found here.
1. Turton, L., & Smith, P. (2013). Prevalence & characteristics of severe and profound hearing loss in adults in a UK National Health Service clinic. International Journal of Audiology, 52(2), 92–97.
2. Raine, C., Atkinson, H., Strachan, D., Martin, J. (2016) Access to cochlear implants: Time to reflect, Cochlear Implants International, 17:sup1, 42-4.
3. Sherbourne, K., White, L. & Fortnum, H. (2002) Intensive rehabilitation programmes for deafened men and women: an evaluation study. International Journal of Audiology. 41:195–201.
4. Carlsson, P., Hjaldahl, J., Magnuson, A., Ternevall, E., & Ede, M. (2014). Severe to profound hearing impairment: quality of life, psychosocial consequences and audiological rehabilitation, Disability and Rehabilitation. 37, 1–8.
5. Chisholm, T. (2007) Linking hearing aids to quality of life: What’s the evidence? The Hearing Journal. 60(9)10-14.
6. Levinge, M. & Ronen, T. (2010) The link among self-esteem, differentiation, and spousal intimacy in deaf and hearing adults, Journal of Social Work in Disability & Rehabilitation, 9:1, 27-52.
7. Lin, F.R., Metter, E.J., O’Brien, R.J., Resnick, S.M., Zonderman, A.B. & Ferrucci, L. (2011). Hearing loss and incident dementia. Arch Neurol. 68(2): 214-20.
8. Lin, F. R., & Ferrucci, L. (2012). Hearing loss and falls among older adults in the United States. Archives of Internal Medicine, 172(4), 369–371.
9. NHS England and Department of Health (March, 2015). Action Plan on Hearing Loss. Retrieved from https://www.england.nhs.uk/wp-content/uploads/2015/03/act-plan-hearing-loss-upd.pdf.
10. Grimby, A., & Ringdah, A. (2000). Does having a job improve the quality of life among post-lingually deafened Swedish adults with severe-profound hearing impairment? British Journal of Audiology. 34(3); 187-195.