Empowering Patients Through Audiologic Rehabilitation Classes

Editor: Here's a nice article about an audiologist who "gets it". She even says that hearing aids are only part of the solution! This article originally appeared in the BHI eNewsletter and is reprinted with Dr. Remensnyder's kind permission.

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According to the latest MarkeTrak VIII study on the "Impact of the Hearing Health Professional on Hearing Aid User Success" hearing health professionals spend on average 1.2 hours (.5 hours dedicated to audiologic rehabilitation) counseling new patients and less than 20% of new users receive any form of audiologic rehabilitation.

I had the pleasure of attending a three hour audiologic rehabilitation group (in 3 one hour segments) conducted by Dr. Linda Remensnyder in the Northern suburbs of Chicago. Linda is President of Hearing Associates, P.C. a private practice in Audiology, celebrating its 30th Anniversary this June. The practice was established in Libertyville, Illinois, by Linda in 1980 with an additional office in Gurnee and a newer satellite in Lincolnshire.

She attributes the longevity of her practice to her strong commitment to patient empowerment. She empowers her patients via three means:

* Choosing the best hearing aid technology that incorporates directional microphones, sophisticated sound processing, telecoils, and connectivity, if needed for the television and/or telephone,

* Encouraging attendance of patients, spouses, and family members at her complimentary group audiologic rehabilitation (A.R.) classes, and

* Incorporating hearing assistance technology (HAT) in her treatment plan for those situations in which hearing aids are not sufficient.

Dr. Remensnyder believes that Doctors of Audiology have an obligation to help their patients hear in all listening environments: face-to-face, in background noise, on the telephone, when watching TV, and when in poor acoustical environments such as places of worship and other large gathering places. She further believes it is relatively easy to make patients hear better but it is very difficult, and takes considerable skill, to make them hear their best.

The first technique Dr. Remensnyder uses to rehabilitate hearing loss is education. She deflates the common assumption on the part of the public that hearing aids return hearing to normal and that once hearing aids are used, that they are similar to glasses with all things perceived clearly in all environments.

She educates that all hearing aids incorporate microphones and but have inherent deficiencies not common to the unaided, normal hearing, ear. Dr. Remensnyder reminds her patients that microphones always pick up what is closest, they always pick up what is loudest, and they have no innate ability to know which speaker is important to the listener. Thus, she teaches strategies that need to be employed, by both patients and family members, that implement this new knowledge about the hearing aid microphones to resolve hearing issues in everyday listening environments.

Her initial A.R. Class is devoted to learning about the ear and about hearing loss and where along the auditory pathway the condition is located. Topics such as ear wax, diseases and conditions that contribute to hearing loss, the importance of a diagnostic hearing test, and the critical sound voids missed by each respective class attendant, are shared. The patients are empowered by being provided the same copy of their diagnostic audiogram that was forwarded to their primary care physician. Thus, they see for themselves the history and etiology of their hearing loss, their diagnosis, the diagnostic Impression, and the recommended treatment plan. In addition, their hearing test results are transcribed to an easy-to-understand audiogram of familiar sounds where both patients and family members can see why the hearing impaired individual hears some things quite well and others, quite poorly or not at all.

Dr. Remensnyder considers the second class, devoted to communication strategies, the most important class for all to attend. Recommendations regarding where to sit at public gatherings, how to structure the home environment for maximizing audibility, and positive steps that can be taken to restrict situations in which the person with hearing loss is isolated from conversations, empower patients to positively deal with hearing loss and become self-advocates.

The final class discusses the rights of the people with hearing impairments (as mandated by the Americans with Disabilities Act-the ADA) and methods and means to preserve and protect hearing. Education about ototoxic medications, chemotherapy agents, noise exposure, and general health is provided. Assertiveness training is taught to encourage those with hearing loss to educate others how to improve the communication breakdown when they are struggling. In addition, she explains and demonstrates hearing assistive technology such as television amplifiers, telephone amplifiers, smoke detectors, and alarm clocks.

Most recently, Dr. Remensnyder has been instrumental in providing hearing loops to facilitate better hearing at large gathering places, such as places of worship, senior centers and meeting halls. These places often have poor acoustics with high ceilings, hard floors, lack of sound-deadening material, and considerable window space that cause individuals with even a minimal hearing loss to miss a significant portion of what is presented, despite the fact that the sound is amplified via a microphone at the podium or pulpit.

The hearing loop, which is already present in various places like The House of Representatives, Westminster Abbey, and the Grand Rapids Airport, is literally a copper wire that is looped around the periphery of a room allowing a hearing aid's telecoil to act like an antenna which links directly into the facility's sound system. Both of the waiting rooms at Dr. Remensnyder's Libertyville and Gurnee offices are looped so that listening to a television via a hearing loop can be demonstrated.

Dr. Remensnyder was recently appointed to the Get in the Loop Task Force, a joint initiative comprised of the Hearing Loss Association of America and the American Academy of Audiology. The joint initiative is to promulgate the use of hearing loops nationwide, and Dr. Remensnyder is the state's spokesperson.