How emotions impact hearing healthcare

Dr. Gurjit Singh is a passionate researcher and academic who advocates that technology alone cannot fully compensate for the communication difficulties that accompany hearing loss and aging. 

Before the pandemic, I was fortunate to hear him speak on the role of emotion in aural rehabilitation. I have thought a lot about his talk and how this pandemic has impacted the emotional well-being of those living with hearing loss. I believe his message is even more important today.

In this short interview, he explains the importance of talking about emotions with your patients.

Gurjit, I really enjoyed your stimulating talk on ‘Hearing Rehabilitation through the Lens of Emotions’ at the Well-Hearing is Well-Being conference back in 2019. It made me wonder, what drew you to this area of research?

We’ve long been so audiological in our outcome measures. We don’t do this work just for the sake of doing better on an audiogram or a COSI. Rather, it is how this is relevant regarding the more important and valuable outcomes of life.

And so, what matters to a person is usually other people, their emotions and their well-being. That was the motivation.

Was there a paucity of research in this area within Audiology?

There has been some great work but relatively speaking, there is a paucity of research looking at outcomes through the lens of social relationships and emotions.

Stefan Launer and I have written a chapter on this very topic, called “Hearing Rehabilitation considered through the lens of social relationships” in Montano & Spitzer’s Adult Audiologic Rehabilitation (3^rd Ed)¹, which was released last year.

It just seems so obvious that your social relationships and your emotions are going to have a significant impact on your motivation to change or your adherence to any change you want to make in yourself!

Yes! That’s such an important point.

How well do you think the profession of Audiology is at undertaking audiologic rehabilitation?

That’s a fascinating question. I think at its worst, audiological care is seen as a seller of hearing aids and that’s about it. At its best it’s seen as a comprehensive source of rehabilitation.

If you are asking me where we are in this journey, that’s a good question, and I honestly don’t think there is one answer, because I think there is just so much variability.

I think we all have an understanding of probably where our strengths and weaknesses are but ultimately it comes down to the individual clinician. But what I would say is that for those clinicians who are just providers of hearing instruments – be wary because technology will become cheaper and it’ll become easier to access so yes, they will become vulnerable.

I see this as providing not only more satisfaction for the clients but also for the clinicians.

That’s it. We all want to be change-agents for patients and you get so much more meaning from this rather than just having a passive recipient of your care.

It turned out that those with hearing loss do experience more handicap when listening to signals that contain emotional information.’

You can look partly at the emotional impact of living with hearing loss but also the challenge of detecting emotions in the speech of others when you have hearing loss.

This was a hypothesis that I and my colleagues discussed and we recognized that we didn’t even know what kind of issues patients have.  So we decided to send out a questionnaire to people with normal hearing and with hearing loss and aided listening.

We recognized though that there wasn’t a questionnaire out there so we developed one.

It turned out that those with hearing loss do experience more handicap when listening to signals that contain emotional information. They feel the impact of this inability and that was eye-opening for us. And then we had people with hearing instruments complete this same questionnaire and they didn’t do any better but they didn’t do any worse than people with hearing loss.

In your work have you been looking at generational differences in terms of how age/emotion impacts the response to management? Sometimes we think in terms of stereotypes (e.g. the stoic older adult).

We’ve looked at differences between different age groups in a few different ways actually. In one case with respect to emotion handicap we had a < 65 year old group and then a group that was older than 65 and we found no differences in how much handicap there is associated with hearing loss when listening to signals that contain emotions.

So we didn’t see anything there, but we haven’t looked at it with respect to decision making. I’m not a pediatric audiologist but any audiologist you talk with – if you talk about the prospect of devices for a teenager, that is completely fraught with the emotional consequences/social-emotional stigma of wearing those devices.

From the work that you’ve done to date, what are some things that clinicians could look to do in their day-to-day practice now, that you have learned from your research?

The big challenge is I think, it’s not a complicated step but it’s a challenging step. That’s to be open to talking about emotions with your patients. As a clinician, one has to engage in self-reflection and ask themselves: Am I comfortable enough to go down this road in talking about emotions with a patient?

That’s probably not how a lot of us were trained and if we are, we kind of retreat into the safety of our audiogram and I’m not saying do this with everyone but certainly be attuned to openings, because we know from the literature that when these openings present themselves we don’t tend to respond in a way that continues the conversation.

So the big message is, ‘Just do it!’

I presented some videos² at the conference that highlight the idea that we’re wired for social-emotional connections right from basically day one and I would just love to have the audiology community think about, what did hearing loss do along these dimensions that are foundational?

I don’t have an answer at this point.

One other question that I’m trying to answer but I don’t have an answer yet is from the last questionnaire that we did. We asked every patient about their relationship satisfaction with their significant other thinking that maybe we’d see a deficit for those because we can see it in the qualitative literature. Then when we asked patients, we didn’t see any differences so there’s some disconnect and I don’t understand why.

So I’m wondering if maybe we’re just asking it the wrong way? Maybe it’s insufficient to ask one person. Well that’s maybe another takeaway when you have the significant other in the room is you can ask about the impact of the hearing loss on communication broadly but you can also ask how it impacts their relationship.

It’s an honest question. It’s one simple thing they can ask and get ready for a can of worms but that’s what we want – but you might as well address it because it’s there anyway and it’s a way to make us relevant.

I could not agree with you more, Gurjit. Thank you for sharing your thought-provoking insights.

---

Key takeaways for your practice:

1. For clinicians who are just providers of hearing instruments – be wary because technology will become cheaper and easier to access, which will make you vulnerable as a provider.
2. Those with hearing loss do experience more handicap when listening to signals that contain emotional information so it is important to be open to talking about emotions with your patients.
3. When you have a significant other in the room, consider asking about the impact of the hearing loss on communication broadly and how it impacts their relationship. Addressing these type of questions will make you relevant.

To learn more on this topic, we invite you to read Dr. Singh’s previous blog post on emotion and reason in hearing healthcare. 

References

1. Montano, J.J. & Spitzer, J.B. (2020). Adult Audiologic Rehabilitation 3^rd Ed. San Diego, CA: Plural Publishing.
2. The Gottman Institute (2013). The Still Face Experiment. Retrieved from https://www.youtube.com/watch?v=apzXGEbZht0,  accessed June 22, 2021.