In audiological circles, when the term "expectations" is used it usually refers to the expectations that consumers have regarding the performance of hearing aids. These expectations can differ considerably. Some people have an exalted, and completely unrealistic, idea of how well they'll be able to hear with hearing aids. After resisting the notion for years, when they finally do succumb and accept hearing aids they want to hear "everything" that "everybody" else does. Anything less is a cause for disappointment. For other people, expectations are too low. With some "fine-tuning" of the hearing aid's electroacoustic characteristics, assertive communication strategies, and the judicial use of other types of hearing assistance technologies, they can be helpe d to communicate much more effectively than they are. One important role of the professional audiologist is to assist clients balance their hopes against the limitations imposed by the nature of their hearing problem. Without realistic expectations, peopl e may either be sorely disappointed with their hearing aids or "satisfied" with much less benefit than what is possible. So consumers' expectations not only have to be satisfied to a large extent, but they also have to be realistic. If not, the aids are li kely to be returned or discarded; at the least, we can predict a very unhappy hearing aid user!
The problem is that there is no way that I know of to determine, in any objective fashion, exactly what can be considered "realistic" aided performance targets with hearing aids. Can someone do even better with a different adjustment, or a different set of hearing aids? While we really don't know the answer to this (it is not possible to compare every possible combination of hearing aid and speech processing strategy), some estimate has to be made whether "expected" targets have been reached. Using their training, experience, and various audiological tools, audiologists do try to arrive at an estimate of whether the aided performance of a particular client is sa t isfactory, i.e. whether their "expectations" have been met. The weakness of this approach is that the client's role is essentially passive, that of a recipient of a service and not someone who is really the main stakeholder in the process. Unfortunately, prospective hearing aid users usually do not know what they should and should not "expect" from the audiologist, in terms of service, follow-up appointments, and information.
Expectations, in other words, cut both ways. Not only is it necessary for audio logists to help people formulate realistic expectations regarding the hearing aid performance, it is also necessary that clients know what to expect from their audiologist. In this paper, I will outline the information and services that I think that new hearing aid users should expect from their audiologists. I emphasize that this is my personal list, based on my personal judgement, though it is one that I would gladly debate with those who may disagree with its scope and details.
A. At the first visit
1. Did you learn if you are or are not a hearing aid candidate? Based on what information?
2. Was the nature of your hearing loss explained to you? Did it include:
a. The implications of your audiogram, particularly regarding understanding speech in noise and why, sometimes, you can "hear", but not "understand".
b. General amplification goals, and how they relate to your specific audiogram, loudness sensitivity (recruitment), and your personal communication needs.
3. Were you administered some sort of self-report scale regarding the effect of the hearing loss on your life (social, emotional, vocational, etc.)?
a. Did some "significant other" (spouse, adult children) have an opportunity to complete a parallel form?
b. Did you have an opportunity to talk about the implications of the specific ratings?.
c. Will you be completing a follow-up scale after you've worn the aids for several weeks or months?
4. Were the advantages, disadvantages, and function of various hearing aid options explained to you?
a. Binaural (usually, and appropriately, recommended).
b. Telephone coils and direct audio-input (depends on your communicative needs and the nature of your hearing loss). If not, why not?.
c. Directional microphones
d. Other sophisticated signal processing possibilities (too many to list, but did you, at least, get some kind of overview?).
B. During and after the hearing aid selection process.
1. Did the audiologist explain the basis for recommending one pair of aids over another?
a. Were your personal preferences considered?
b. If rejected, do you know why?
2. Do the aids fit comfortably?
3. Were you able to insert the aids in your ears by yourself?
4. Did the audiologist perform a "real-ear" measure and explain the results to you?
5. Was the following information concerning batteries explained to you?
a. The purpose of the paper tab on the battery.
b. How to insert them in the aids.
c. How to use a battery tester.
d. The necessity and how to keep spare batteries handy.
e. Factors that affect life span of batteries (size, type aid, sound inputs, etc).
f. Where you can obtain batteries and how much they cost.
6. Was the following information regarding the care of the hearing aids and earmolds explained to you?
a. How to keep earwax out of the sound bore of the hearing aid.
b. Keeping the surface of the mold clean.
c. Using a dehumidifier box for night storage.
d. Good hygiene for the ear canal.
7. Did you receive written material that reviews this information?
C. Was the following information covered at the time of your first scheduled hearing aid follow-up (a week or two after aids delivered)?
1. Auditory experiences with aids (in noise, feelings of loudness discomfort, etc.).
2. Fit of earmolds (comfort, acoustic feedback - squeal).
3. Telephone usage with hearing aid - problems and solutions.
4. "Real-ear" hearing aid measures rechecked.
5. Were changes in any of the electroacoustic parameters explained to you?
D. Group Hearing Aid Orientation Program. This is a highly recommended service that should be incorporated into the hearing aid selec tion process, at no extra charge. It serves to reinforce and extend information covered in individual sessions, plus it gives an opportunity for valuable group interactions. The following is a general outline of the content of such a program.
1. Review nature of hearing loss, basic anatomy and physiology, audiogram and speech sounds, basic principles of hearing aid fitting, types of aids, care of aids, hearing aid troubleshooting, review and discussion of hearing aid problems.
2. Review common communication problems with group. Opportunity to exchange experiences and possible solutions to problems.
3. Review implications of hearing loss for normal hearing significant others (i.e. play audiotape "unfair hearing test"). Exchanging experiences (i.e. hearing loss a "family problem").
4. Presentation and discussion of other types of hearing assistance technologies (e.g. TV devices, aids to telephone communication, large-area assistive listening devices, personal FM systems, and signalling and warning d evices of all kinds). The need for such devices determined in respect to social and vocational implications. How such systems can be purchased.
5. Review of communication strategies (conversational repair strategies, definition and practice of assertiveness, other kinds of hearing tactics).
6. Speechreading, concept and principles.
E. At the conclusion of the hearing aid selection process.
1. You can decide, within 30 days, whether the cost/benefit ratio of the aids is sufficiently positive to justify purchase. But be realistic.
2. Finally, don't hesitate to call your audiologist if you have questions or problems (many of these would have been answered or managed if you participated in the group hearing aid orientation program). They can't do their job appropriately unless you give them constructive feedback.
3. Were your "expectations" met?
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Mark Ross, Ph.D.
August 12, 2001
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