Adult Auditory Rehabilitation

Marsha Kluesing, AuD CCC-AAssistant Clinical ProfessorDept. Of Communication Disorders1199 Haley CenterAuburn University, AL 36849Email: mak0019@auburn.eduPhone: 334-844-9600

History of Aural Rehab

World War II and military aural rehabilitation

Audiologists have knowledge skills and tools

Rehab does not begin or end with surgeryCochlear ImplantsImplantable hearing aids

Rehab does not begin or end with technologyDispensing of hearing aidsHearing assistive technology

Speech Pathologists have Knowledge , Skills and Tools

Speech productionVoiceSwallowingKnowledge of psycho social effects of a communication disorder

Address activity limitationsEnvironmental and personal factors that may affect communication

Forming a Group for Clinical Practicum

Clinical Supervisor, ASHA Certified Audiology StudentsSpeech-Language Pathology StudentsHearing Aid Patients

Need to motivate for first time visit Encouraging continued attendance Bring spouse or close family or friend

Importance of Including Significant OthersAccording to Jill Preminger, Ph.D.

• Hearing Impairment can cause – Stress– Tension– Irritation– Frustration, Anger, Resentment – Guilt– Concern

Impact of Includingthe Communication Partner

• Less need to repeat• More participation in social activities• Improvement in communication with person

with hearing loss• Decreased communication burden

Benefits of an Adult AR Group

Patient Centered Model (Adult Audiologic Rehabilitation, 2nd Ed. Ch. 2, from JJ Montano,2011,

ENT and Audiology 20(4).

Consumer Support

Technology

Verification

CommunicationStrategies

Self Assessment

Auditory-Visual Training

Patient Story

Anticipatory Strategies for Better Communication

Related to the speaker:Ask them to speak more slowlyAsk to trim moustacheBecome accustomed to the speaker’s pattern of speechDiscuss not using exaggerationAvoid a difficult speaker in a

bank or store

Communication Repair Strategies

RepetitionRephrasingClarificationKey WordsSpelling and Code WordsOral interpretersUse of amplification system by the speaker

Environmental Adjustments

Spatial RelationshipsLighting

Should be on face of speaker

AcousticsAvoid hard walls, tiled floors

Comfort LevelToo hot, too cold , too drafty

Causes of Hearing Loss

Genetic information: 50%...Age :50 %Noise exposure OtotoxicityTrauma to head or earsInfectionForeign object in ear canal, cerumen

Audiologists say CERUMENEveryone else says:

Wax

Look in ear canal (Otoscopy) HA tube blocked with wax

Inside the Organ of Corti: Inner and Outer Hair Cells with Cilia on Top of Each

Damaged Cilia Resulting in Hearing Loss

Behind the Ear Hearing Aid

Earmolds

The Best Impressions Get the Best Results

In-the-Ear Hearing Aids

Hearing Aids with Thin Tubes and Domes

Hearing Aid Insertion

Maintenance and Care

Otoscopy, cerumen, eardrum condition, etc. Dirt, wax on hearing aidsBroken, missing partsBatteries, dead, inserted incorrectly, wrong sizeWhen to refer to the audiology clinic

Cerumen in ear canalAids do not work with new battery, general cleaning

Batteries

What is a cochlear implant?1. Microphone: Picks up sound from

the environment2. Speech Processor:Selects and

arranges sounds picked up by the microphone

3. Transmitter and receiver/stimulator

4. Electrode Array

,

Cochlear Implant

Courtesy Med El Corp.

3. Transmitter and Receiver: Receives signals from the speech processor and converts them into electrical impulses.4.Electrode array: A group of electrodes that collects impulses from the stimulator and sends to different regions of the auditory nerve.

Middle Ear Implants• For patients who do not receive

benefit from conventional hearing aids

• For patients who are not candidates for cochlear implants

• Mechanically causes the ossicles to vibrate and the amplified vibrations are adjusted to compensate for the hearing loss

• Candidacy: • Sensorineural hearing loss within

a certain range, (up to 80 dB HL) • normal middle ear function,• Stable hearing loss• 18 years of age or older• Realistic expectations

• Tunnel is drilled through mastoid into the middle ear

• Gold wire is crimped to the incushttp://www.medel.com/images-downloads/?titel=Images&

More Information on Cochlear and Middle Ear Implants

NIDCD Information Clearinghouse

1 Communication AvenueBethesda, MD 20892-3456Toll-free Voice: (800) 241-

1044Toll-free TTY: (800) 241-

1055Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

Speech Reading is a Daunting Task

• Explanation provides understanding of why speech reading is difficult– Vowels– Consonants– Manner of speech– Place in mouth where consonant is made

Vowel Triangle

Lips Hump of the TongueFront Central Back

Narrow Opening see suit sit putWide say serve so Opening set up saw sat star

Consonants & Speech Reading

Visible1. /f/ and /v/2. /w/ and /r/3. /p/, /b, and /m/4. /TH/, as in then and/ th/

as in thank5. /sh/, /ch/, /j/, and /zh/ as

in measure

All Other consonants• Difficult to see• Made inside the mouth• Rely on context

Homophenes Make it Difficult

Consonants that look alike• /f/ and /v/• /w/ and /r/• /p/, /b/, and /m/• /TH/, and /th/• /sh/, /ch/, /j/, and /zh/

Words that look alike• File –vile• Rice---rise• Merge---perge• Chirp—germ• Shows—chose• Pay----bay

Hearing Loss and Vocal Strain

With hearing impairment there can be strain on the voice to speak louder to hear one’s own voiceUse of hearing aids may help

reduce this strain

The Mind, Ear, Eye Connectionto Adult Auditory Rehabilitation

Posit Science Brain HQ

Seeing and Hearing Speech

LACE

• Listening and Communication Enhancement• Neurotone.com

Read My Quips

• Speech Comprehension Training System• Process of learning that uses videos and

puzzles– Holistic approach

• Context • Facial expressions• Body language• Adapts to user’s skills

References1. Kaplan, Harriet. Speechreading: a way to improve understanding,

Second Edition Revised 1995. Clerc Books, Gallaudet University Press, Washington D. C.

2. Mancinelli, M.M., & Amster B. (2014) Rethinking clinical education. The ASHA Leader, 20, 6-7.

3. Montano, J. J. (2011) Building relationships: An important component to the aural rehabilitation process. ENT and Audiology, 204 (4), 91-92.

4. http://www.neurotone.com/ LACE5. http://www.brainhq.com/ 6. http://sensesynergy.com/ ReadMyQuips7. Sensimetrics Corporation (2008). Seeing and hearing speech:

Lessons lipreading and listening. Somerville, MA: Sensimetrics.

Thank You!

mak0019@auburn.edu