Clinical Practice

What does a person with hearing loss know about hearing loss?

Patients know the situations they are having the most difficulty in, and what it feels like to have a hearing loss - but, an audiologist's expertise is still required.

Recently, I received an email from an audiologist asking how to help a patient hear better in the noisy workplace.

When the issue of using wireless microphone technology came up, apparently the person with hearing loss stated “No, that would not work in my situation because it is too noisy”. So I was asked to come up with some other suggestions.

Ummm, ok, I have a whole bunch of problems with this.

First, I think we need to clarify when we need to listen to our patients and follow their leads. At other times we, as audiologists, need to provide leadership and guidance. As an audiologist with hearing loss, I have walked in both sets of shoes, so I would like to offer some suggestions.

First, here is a list of things a person with hearing loss knows best:

1. All the different listening situations which cause difficulty

List them all and seriously look at how you are going to help him or her overcome those challenges.

2. How it feels to be in a given listening situation

Don’t be afraid to ask about this. When a patient says ‘I could not hear at my daughter’s wedding” find out how they felt about that. It is good to just let them explore their feelings and frustrations.

3. Past experiences with technology – both good and bad

Discuss these experiences to see what you are up against. For example, find out if wireless microphone technology or directional microphones have been used in the past. If a system was previously used and a considered a ‘failure’, find out how much coaching and instruction was given.

In short, patients know, better than you the clinician, the situations they are having the most difficulty in, and what it feels like to have a hearing loss. But, here is what they do not necessarily know and where the expertise of the hearing care professional is required.

List of things a patient with hearing loss does not know:

1. Whether or not a hearing aid is even needed

2. What electroacoustic characteristics are needed in the hearing instrument

3. What style of hearing instrument is most appropriate

They can wish all they want for a tiny hearing aid, but if the loss is too severe, it can’t be done. Period. Yes, many patients have lots of choices of the form factor, but some do not. We need to lead here, not follow.

4. What technology for managing noise is needed 

For example, if a patient has a moderate severe loss and a speech in noise test such as the LiSN-S PGA indicates that wireless microphone technology is needed, the hearing health professional needs to communicate this. Patients do not know what technology is required. They just know the situations they find challenging.

5. How to effectively use the equipment

You cannot simply toss the equipment at the patient and hope they figure out how to use it in the difficult listening situations they identified. They need our counseling and coaching here.

We have to stop letting patients dictate the wrong things. I have seen in my 20+ years of professional experience numerous people who are wearing “dirty little secret” tiny aids and are not getting the correct amplification. We need to provide leadership here and guide patients towards more appropriate amplification.

Similarly, we must always consider not just the amplification needs but also the hearing-in-noise needs as they relate to personal situations. Will the patient need directional microphone technology? Should it be fixed or adaptive directional microphones? Will directional microphone technology be enough or will wireless microphone technology be needed? Most patients with moderate-severe loss and greater will likely find themselves in situations in which a hearing aid or cochlear implant is not enough.

I agree that we cannot force anyone to take our professional advice. But patients do have a right to make informed decisions. In my opinion, we are obligated as HCPs to give them all the facts. Too often, when I give talks about directional microphones, wireless microphone systems, and other assistive devices, a patient will ask me “How come this is the first time I am hearing about this stuff?”

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