A Hearing Needs Assessment Assessment:: Individualizing the Recommendations LARRY MEDWETSKY, PH.D GALLAUDET UNIVERSITY 202-448-6965
[email protected]
Agenda
Some Background to Topic
Importance of the Case History
Audiometric Assessment Assessment Benefits
Communication Needs Assessment
Hearing Handicap Questionnaires
Prioritization of Listening Needs
Background
Nowadays, individuals can hear about Personal Amplifying Systems (PSAPs) on TV/Internet, and order from Internet
Recent PCAST recommendations that individuals individual s with mild to moderate hearing loss be able to purchase PSAPs without audiologist involvement
Can doing the above really meet one’s hearing needs? Is this a good thing?
For Your Information
Most individuals with a mild hearing loss do not have hav e difficulty in quiet, 1-1 listening settings
Their difficulties tend tend to occur in difficult listening settingssettings- especially in group settings
Great majority of PSAPs are essentially amplifiers, thus, do not have capability of enhancing the ability to hear in noisy environments, and, similar in many ways to older ol der hearing aid technologies
Thus, even though may possibly work well in quiet, may be annoying in noisy settings as also amplifies the noise
FYI- cont’d Yet, some of these devices may be quite helpful to someone who lives alone and does no go out often ofte n or to someone some one residing in a nursing home
Thus, an audiologist can help to ascertain if the product if of good technical quality, might meet one’s needs, and make sure that the device is properly set according to the wearer’s needs
Factors Guiding an Audiologist’s Possible Recommendations
Case History
Results of the Hearing Heari ng Test
Lifestyle Needs
Knowledge of the listening/com l istening/communicat munication ion difficulties being encountered
Case History
When an individual schedules a hearing test, they are usually sent a questionnaire to complete
This questionnaire usually usuall y asks questions concerning:
General medical medical history (illnesses, (illnesses, surgeries, surgeries, conditionsconditions- such as diabetes, medications, etc.) - Certain conditions conditions such as diabetes diabetes or medications medications (such as as blood thinners) guides the audiologist as to possible future issues relative to making earmold impressions (possibility of uncontrolled bleeding)and need to take extra cautions
Case History- cont’d
Ear related issues
History of cerumen (wax) buildup
Such difficulties might suggest that, if possible, an open ear fitting be done to minimize issues with cerumen buildup
History of recent middle ear problems
Individual may need to be monitored more closely (may not always know that is experiencing middle ear issues)
Middle ear issues may mean that individual is more likely to need ENT referrals
If client gets hearing aids, at times may not derive as much benefit
in those times, may need to adapt communication strategies
consider purchase of an augmentative listening system (remote mic system- could be hearing hearing aid streamer) streamer)
Case History- cont’d
History of Vertigo, Balance, Tinnitus related issues
By themselves, themselve s, indicate further probing by audiologist as to whether these are the primary issues. I f so, further f urther assessment likely likely to be done: - many audiologists are specialized in balance disorders and and depending on issue may diagnose/engage diagnose/engage in intervention intervention or refer to ENT - if significant tinnitus tinnitus is present, if audiologist specialized in area, area, may do assessment/interventi assessment/ intervention on or refer to someone so meone specialized in area
If these issues are recent, they may be indicative of a possible pathology of the vestibular nerve or lower l ower auditory auditory brainstem (such as a tumor), and audiologist will initiate special audiometric tests
If results are significant, will subsequently refer the client to an ENT
Case Cas e His Histor toryy- Sum Summar mary y
Information that is gleaned:
Primary reason why client has scheduled the appointment
Indicators of a possible possibl e underlying medical condition, condition, and, if so, guide selection of audiometric tests chosen to administer a dminister
Issues that may need to be monitored over time
A need to consider possible possibl e subsequent intervention/referrals intervention/referrals
Contribution of Audiometric Results
Is there a hearing loss?
If so, is there a medical aspect to the hearing test results? If so,
Is there a conductive co nductive component (such as middle ear fluid, middle ear bones issues?) requiring an ENT referral?
Is there a possible issue with w ith the auditory nerve or brainstem (such as a tumor, or, processing related issue that suggests the need for continued testing testing and/or a possible ENT referral?)
The thresholds, maximum tolerance levels at different frequencies help the audiologist determine the type of hearing aid (re gain/power needs, possible styles) and set the initial programming characteristics characteristics
Audiometric Results- cont’d
If there is a hearing loss but no suspected medical component, then what do the results suggest relative to recommendations?
Mild hearing loss
Depending on individual’s lifestyle needs, may result in suggestion of:
monitoring of hearing hearing over time Communication strategies and monitoring
If the individual very active (experiencing difficulty at work or during social activities), may result in a hearing aid recommendation and/or use of HATsuch as remote mic system
Moderate or greater degree of hearing loss
Hearing aid and possibly possibl y hearing aid streamer and/or HAT
Communication Needs Assessment Cynthia Compton-Conley while at Gallaudet Gall audet University University developed a Communication Needs Assessment tool that is very effective in identifying an individual’s listening/communica listening/communication tion needs. needs. The following is based on this work.
A communication needs assessment can be categorized as examining:
Client Factors
Four differen differentt communic communication ation needs needs
Three general settings
Client Factors ①
Type & Degree of Hearing Loss
②
Age
③
Health Issues
④
Cognitive Function
⑤
Cosmetics
⑥
Budget
Client Factors-cont’d Hearing Loss Individuals with 40 dB+ PTA would likely benefit from having T-coils in hearing aids for telephone/recreational use. Age
child, teenager teenager,, working worki ng adult- likely in noisy, group settings
socially inactive senior, bedridden senior- quieter lifestyle, -
Activities/socio-emotional factors need to also be considered relative to one’s stage of life (e.g. healthy active seniors)
Client Factors-
cont’d
Health Issues & Cognitive Factors
Eyesight/physical dexterity- if poor, need for a remote control unit with large buttons
Activity level (active, sedentary)
Cognitively intact, different stages of dementia- perhaps dementia- perhaps photos on landline landline telephone telephone re phone phone memories
Cosmetics
Is this a concern for the client?
Client Factors-
cont’d
Budget
Are there any budget constraints?
Are there any possible 3 rd party funders (school, Vocational Rehab, Employer)?
Communication Needs Assessment Regardless of one’s hearing status, the following are four general overarching receptive communication needs: 1. Fac Face-t e-to-F o-Face ace Com Commun munica icatio tion n (1-1 conversations, group conversations, lectures)
2. Reception of Electronic Electronic Media (TV, computer, Music, Movies, Theater)
3. Te Tele leph phon one e Recep Recepti tion on (landline, cordless, cell phone, computer)
4. Al Aler erti ting ng Sig Signa nals ls
Summary: Four overarching receptive listening needs.
Environmental/Listening Environmental/Lis tening Settings The following include some key listening settings:
Home (house, apartment, dorm)/Senior Care facility (nursing home, senior care)
Work/School/College
Recreation (restaurant, movie theater, play, museum, a presentation) /Trav /Travel el
Hospital/Doctor’s office, Church/Synagogue
Listening Environment Factors Client Factors
Home
Work/School/ Community
Recreational Activities Activiti es
Type Degree HL Age Health Issues Cognitive Function
Communication Needs
Face to Face
Face to Face
Face to Face
Media
Media
Media
Phone
Phone
Phone
Alerting
Alerting
Alerting
Cosmetics Budget
Listening Environment Factors Client Factors Type Degree HL Bilateral normalmoderate SNHL Slow progressive •
•
Age: 72 Health Issues Not an issue •
Cognitive Function Not an issue •
Cosmetics Wants something small
Work/School/ Community
Recreational Activities Activiti es
Face to Face Sunday family dinner Wife from another room
Face to Face Consultant meetings (1-1/small groups)
Face to Face Friday night poker night with the guys
Media TV loud, wife complains
Media none
Media Frequent movie goer
Home
•
•
•
Phone Some difficulty hearing on home and cell •
•
Budget: no limit
•
•
•
•
Phone Cell phone with clients
Phone Cell phone
Alerting No problems
Alerting No problems
•
•
Alerting No problems
•
•
•
Case # 1: Summary Listening/Communica Listening/Co mmunication tion Difficulties Expressed
Face-to-Face: group meals, hearing from another room, work meetings, poker nights
Media: plays TV too loud, frequent movie goer
Phone: some difficulty hearing on landline and cellphone
Alerting: no reported difficulties
Possible Recommendations
Hearing aid:
because of cosmetic issues, a small size behind-the-ear, receiver in the hearing aid (somewhat inconspicuous and stylish); this aid also al so allows low-frequency sounds to be heard in unimpeded fashion while avoiding occlusion
Hearing aid needs to adapt to various listening environments, have good noise reduction/directional capability
Include T-coil, not so much for phone but for use with HAT at movies movi es and plays
Streamer or direct blue-tooth connectivity:
Paired with cellphone or blue-tooth blue-toot h landline phone phone (if not, then can use T -coil to hear phone)
Paired with Blue-tooth TV transmitter allowing to hear TV at lower volume
Paired with BT computer to hear media or music, etc.
Listening Environment Factors
Client Factors Type Degree HL Moderate to Mod-Severe SNHL •
Home Face to Face Resides in nursing home Difficulty hearing nurses/other residents •
•
Age: 88 Health Issues Diabetic Severe Arthritis • •
Cognitive Function Early Dementia •
Media TV loud, room mate complains •
Phone Difficulty hearing on room landline phone •
Cosmetics Not a concern •
Budget: limited
Alerting Nursing staff •
Work/School/ Community
Recreational Activities Activiti es
Face to Face Difficulty hearing in dining room
Face to Face Difficulty hearing others during recreation
•
Media Not Applicable
•
Phone Not Applicable •
Media Not hear TV in recreational setting
Alerting Not Applicable
Phone Not Applicable
•
•
•
•
Alerting Not Applicable •
Case # 2 Summary Age, Health and Cognition:
88 years old, ol d, early dementia, arthritis
Listening/Communicatio Listening/Com munication n Difficulties:
Resides in nursing home
having difficulty hearing nurses
TV loud, roommate complains
Difficulty hearing landline phone
Difficulty hearing in dining room/recreat room/recreation ion activities, hearing TV in common area
Possible Recommendations
Hearing Aid
Cosmetics no concern, limited budget
Because of lifestyle (nursing home, relatively sedentary/quiet environment), does not need expensive expensiv e technology, yet benefit from directional mics because of difficulty hearing in dining room
Because of early stage dementia, might consider one hearing aid but in this case because of likely likel y ability to hear better in noise with two versus one hearing aids, recommend two lower-co low er-cost st hearing aids
Because of severe arthritis yet early stage dementia, recommend hearing aids that adapt to environments rather than manual programs/remote control where client might use wrong program or lose remote
Possible Recommendations- cont’d
Hearing Assistive Technology
Hearing aid compatible, amplified ampl ified telephone with photos re each telephone memory (due to dementia) and big buttons (severe arthritis, if must try and call someone not in telephone telep hone memory bank)
Induction loop in the main recreation area, if possible, otherwise lend personal personal FM receiver and have FM transmittertransmitter- with direct direct mic if someone speaking or line-in to transmitter from TV or music player
If client able to keep up with w ith text, captioning on TV
Assessing Communication Deficits and Needs- cont’d
Hearing Handicap Questionnaire
Client Oriented Scale of Improvement (identifying the client’s specific areas where he or she wants most help)
Daily log/diary whereby the client monitors areas of listening/communication difficulty
The above not only can guide areas to explore re a possible hearing aid/HAT fitting, but also to some extent the devices that might best address these needs.
Hearing Handicap Questionnaire
# of Hearing Handicap, Hearing Aid Benefit/Satisfaction, etc. questionnaires - selec selection tion of which which depends depends on aspect aspectss an audiologist audiologist wants wants to measure measure
I will focus on the hearing handicap handicap questionnaire; I will present one developed at the Rochester Hearing & Speech Center, C enter, which is focused on perceived listening/communication listening/comm unication difficulties difficulties and socio-emotional aspects
Hearing handicap questionnaire is administered prior to (pre) and after a hearing aid fitting (post)
The Pre-questionnaire can determine what the listener perceives as his/her listening difficulties and possible socio-emotional socio- emotional issues; also can be administe administered red to significant other to compare answers (responses guide counseling and contribute to recommendations)
Post questionnaire findings help determine degrees of success attained and if
Hearing Assessment Pre-Questionnaire: Client Do you feel you have any hearing difficulties?
□ Yes
□
Sometimes
□
No
Do others notice you have hearing difficulties?
□ Yes
□
Sometimes
□
No
If you answered no to both of these questions, you can stop here. Otherwise, please answer the followi following ng questions. Do you currently wear hearing aids? □ Yes
□
No
If you currently wear hearing aids, please answer the following questions as they apply to you when you wear them. Doesn’t
Yes
Sometimes Sometim es
No
Apply
1. Do you have trouble trouble hearing when someone talks softly?
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2. Do you hear what others say, but it's not always clear
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3. Do you have trouble hearing others others speaking when they are not facing you?
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4. Do you have to to ask people people to repeat repeat them themselv selves? es?
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5. Do you have diffic difficulty ulty heari hearing ng on the teleph telephone? one?
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6. Do your family/f family/frien riends ds say you you play the TV/radio TV/radio too too loud?
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7. Do you have difficulty difficulty hearing the the doorbell/telephone doorbell/telephone ring?
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8. Do you have trouble hearing others others in noisy places or group group settings? settings?
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9. Do you have diffic difficulty ulty heari hearing ng the speaker speaker in a large large group sett setting? ing?
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10. Does your level of hearing interfere interfere with your personal or social life?
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11. Does a hearing problem cause you to feel frustrated frustrated when talking to others?
NAL CLIENT ORIENTED SCALE OF IMPROVEMENT Name :
Category.
Audiologist : Date Da te : 1. Nee Needs ds Esta Establi blished shed
New
Deg re re e of Ch an an ge ge
10%
2. Outcome Assessed
SPECIFIC NEEDS
Indicate Order of Significance
F in in al al A bi bi lili ty ty ( wi wi th th h ea ea ri ri ng ng ai d) d)
Return
e s r o W
e c n e r e f f i D o N
r e t t e B y l t h g i l S
r e t t e B
r e t t e B h c u M
Y R O G E T A C
r e v E y l d r a H
Person can hear 25% 50% 75% 95% y l l a n o i s a c c O
e m i T e h t f l a H
e m i T f o t s o M
s y a w l A t s o m l A
Daily Log/Diary
Client monitors areas of listening/communication difficulty (unaided/aided)
Information is helpful in discussions with audiologist re when and how much difficulty the client experiencing in different listening settings: (a)
prior to a hearing aid fitting
(b) post-hearing aid fitting
Post hearing aid fitting, the information is helpful in fine-tuning the hearing aids and/or discussion of possible communication strategies in perceived difficult settings
Hearing Aid Data Logging
Hearing aids now have capability of determining how often an individual is in a certain listening environment (quiet, noise, environment + noise, etc.) and how often an individual uses the various hearing aid programs:
Useful in helping the audiologist know where the clients spends most of his/her time, which may aid in counseling re communication strategies
Useful for determining if client is setting hearing aid corresponding to the environment o
if using manual programs, some newly aided individuals sometimes don’t remember to switch sw itch programs to the different listening settings
Summary of Talk
The audiometric assessment can determine:
If there is a hearing loss l oss and the severity
Type of hearing loss
If medical component present, if a primary care or ENT referral is warranted
If sensorineural hearing loss, (a) monitoring sufficient?; (b) counseling strategies sufficient? , (c) hearing aid, and/or hearing assistive technology warranted?; warranted?; and (d) if hearing aid, initial programming characteristics characteristics (gain, compression, maximum output, etc.)
Communication Needs Assessment can determine:
Type/style of hearing aid and desired program characteristics characteristics
If client would w ould benefit from a hearing aid streamer/BT streamer/BT hearing aid
If client would w ould benefit from specific HAT HAT
Importance of Audiolo Importance Audiologistsgists- My Biases Biases as an Audiologist but Evidence-Based Opinions
Relative to current discussions re PSAPs, etc., at the minimum audiologists must be involved in assessing one’s hearing and ensure no medical issues
Audiologists use audiomet Audiologists audiometric ric data beyond thresholds (such as tolerance levels at different frequencies) to program a hearing aid
Audiologist can provide communication strategies appropriate to the needs of that individual
everyone ‘s hearing is different and lifestyle needs vary greatly
Audiologists can help determine the technology that best meets client’s needs:
Hearing aid with manual programs and/or able to adapt automatically to different listening settings
