Clinical Practice

Severe/profound hearing loss goes deep

The challenges of severe/profound hearing loss aren’t ‘just a bit worse’ than mild/moderate hearing loss – they’re much more than that, for patient and audiologist alike.

The full impact of SPHL

Audiologists know the challenges faced by patients living with mild/moderate hearing losses, which include frustration, misunderstandings, and the risk of frequent withdrawal from social communication especially when listening conditions are difficult. The challenges faced by patients living with severe/profound hearing losses certainly include these same problems, but they go way beyond that.

The cognitive processing demands of lipreading interfere with short- and long-term memory storage; the intense listening effort needed to follow speech causes strain and fatigue; the emotional cost of being on the receiving end of puzzled and often unsympathetic reactions from friends and strangers alike when conversations don’t flow smoothly takes its toll; and above all, the sense of always being on the edges of the conversation or group and always one step behind becomes the norm rather than the exception. Conversing with others is simply hard work and often unrewarding despite the best of technology, and can easily begin to seem more effort than it’s worth (a sentiment often reported not just by those with hearing loss but by their close family members as well).

And so begins the downward spiral of social withdrawal and isolation, with everything that flows from that – including suboptimal use of hearing devices.

SPHL follows your patient everywhere

The patient with a severe/profound hearing loss lives with severe communication challenges not only when listening conditions are difficult, but actually in EVERY conversation they have. Whether they are at home with family in a quiet room, socializing with friends in a busy pub, or engaging with colleagues in the workplace, every single time they want to talk to someone their hearing problems impose a communication barrier that is often insurmountable.

This barrier directly affects their ability to form and maintain important relationships. Our relationships with others lie at the very core of our humanity – it’s how we know who we are and where we fit in the world.

People with severe/profound hearing losses not only lose easy communication because of their hearing, they also experience two further losses. First, they lose self-confidence, knowing as they do that any and every conversation is likely to end up being stressful for them and confusing or off-putting for their conversation partner. Second, they lose their sense of independence because they so often have to rely on the goodwill of others to speak clearly or to act as an intermediary for them with a third party.

Impact on mental health

Anything that adversely affects our relationships on a broad front will affect our core relationship with ourselves. It’s not hard to see how this can spiral into problems in the mental health domain, most often manifesting in reactive depression and anxiety. These have been well-documented in the literature on severe/profound hearing loss.1-3  Depression and anxiety themselves increase the likelihood of social withdrawal which is already a problem due to communication problems, and so a vicious circle sets in.

It’s worth noting that the literature also documents a higher-than-expected level of depression and anxiety in the well-hearing partners of people with severe/profound hearing loss.4-5  This demonstrates that the core of the problem is not hearing per se, but the disruption caused to relationships that depend on a normal flow of communication in both directions.

SPHL patients need you … and more

It stands to reason that these patients absolutely need the best audiological intervention they can get. As their audiologist you will aim to meet their needs by pulling out all the stops to restore their hearing as far as possible. This includes both ensuring their devices are right for their needs, and arranging access to auditory training to help them get the most from these devices.

But they need more, something no audiologist with good hearing can offer. They NEED contact with other people who are experiencing the same extreme and devastating challenges in their everyday life. Peer support has been robustly demonstrated to be effective across a huge range of human needs, and hearing loss is no exception. Simply being able to look someone else in the eye and see that they bring not just empathy and understanding but actual lived experience of what you’re going through is incredibly powerful.

Indeed, it’s so powerful that I would almost argue it’s the most important part of the rehabilitation process for these patients. It’s especially so if they can be put in touch with someone who has emerged fitter and stronger for their experience. It can restore hope, it can increase motivation, and it can provide the shift in attitude that means all your efforts in clinic will have maximum impact.

How can you deliver?

While it’s easy to argue the value of peer support, it is not always quite so easy to provide it. Busy clinic schedules do not lend themselves to setting up regular peer support groups or one-to-one contacts. If it is not possible for you to setup your own network, then look to your local community to complement what you do in clinic. There may be a local hard of hearing group or lipreading class which might offer a way forward, with the caveat always that most members are more likely to have mild/moderate losses than severe/profound losses and this can be a real problem for SPHL members. Some countries have specialist organizations that offer support for people with severe/profound hearing losses which is of course an ideal scenario, like Hearing Link in the UK (www.hearinglink.org). And these days, since we are all much more familiar with online social contact than we would perhaps wish to be, geography need not be a problem.

Make it your business to know where you can find individuals or groups that fit the bill so you can signpost your patients with severe/profound hearing loss to the right place. You can be certain that not only will they thank you for it, but also your own interventions will be so much more effective as a result.

 

 

For more evidence-based audiological guidance, the recently published guidelines on how to manage adults with severe and profound hearing loss can be found here.

 

References

  1. Carlsson, P., Hjaldahl, J., Magnuson, A., Terneval, E., Eden, M., Skagerskarand, A., & Jonsson, R. (2014). Severe to profound hearing impairment: quality of life, psychosocial consequences and audiological rehabilitation. Disability & Rehabilitation, Early Online: 1-8.
  2. Chung, S.D., Hung, S.H., Lin, H.C., Sheu, J.J. (2015). Association between sudden sensorineural hearing loss and anxiety disorder: a population-based study. Eur Arch Otorhinolaryngol. 272: 2673-8.
  3. Tseng, C.C., Hu, L.Y., Liu, M.E., Yang, A.C., Shen, C.C., Tsai, S.J. (2016). Risk of depressive disorders following sudden sensorineural hearing loss: A nationwide population-based retrospective cohort study. J Affect Disord, 197:94-9.
  4. Preminger, J. & Meeks, S. (2012) The Hearing Impairment Impact-Significant Other Profile (HII-SOP): A tool to measure hearing loss-related quality of life in spouses of people with hearing loss. Journal of the American Academy of Audiology, 23(10):807-823.
  5. Scarinci, N., Worrall, L. & Hickson, L. (2012). Factors associated with third-party disability in spouses of older people with hearing impairment. Ear & Hearing, 33(6):698–708.

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