Open Letter to Patients
by Jay B. McSpaden, PhD
Editor: Here's a great article by an audiologist about the need for
folks with hearing loss to be involved in the process adapting to a
hearing aid, and also about the need for aural rehabilitation.
Jay B. McSpaden, PhD, CCC-A, BC-HIS, is an audiologist who retired from
private practice and currently works part-time as a hearing instrument
specialist in Jefferson, Ore.
The author and HR grant permission to duplicate or modify this article.
Correspondence can be addressed to HR or Jay B. McSpaden, PhD, at SLPAUD@aol.com.
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Hard truths and "straight talk" on hearing better
This blunt letter focuses on one simple truth: There is not enough
money for me to work with a patient should they refuse to participate in
(at least) some basic recommended exercises that are necessary for success
with a hearing instrument. Life is too short, and there are about 31
million people in the United States who need hearing help. A person needs
to "own" their hearing loss and play an active participatory role in
hearing better.
There is a saying that luck is the residue of hard work, and the more
you practice, the luckier you get. If you will work diligently for the
first 30 to 45 days of your hearing aid acclimatization program, then 1
year from now, you will wonder how you ever questioned the value of
hearing aids.
Hearing aids have been designed for the purpose of taking full
advantage of a person's residual auditory system-in other words, the
hearing you have left. Those hearing structures that you have lost due to
a lifetime of recreational and occupational (including military) noise,
ototoxic chemicals (ranging from aspirin to chemotherapy), "the aging
process," and your inherited genes are essentially lost forever. We can't
bring them back. But what we can do is optimize the use of your remaining
hearing-which, in the vast majority of cases, is more than enough for you
to hear well and communicate effectively when sound is amplified
appropriately.
It's obvious that understanding speech is extremely important and
probably the main reason you have come to our practice. However, there has
been a gross misunderstanding for more than 40 years that auditory
habilitation/rehabilitation is about understanding speech, reading it,
producing it, listening to it, hearing it, processing it, and assigning
meaning to it. The "geniuses" and decision-makers-those who craft
extremely important policy at Medicare, Medicaid, the insurance
commissions, etc-authorize therapies for this problem when indicated "as
necessary (by an audiologist) for reimbursement" only by speech/language
pathologists who function as "teachers of speech" only on physician's
orders and only to those with impaired hearing and with normal vision.
However, relative to most of my patients, this policy is fundamentally
flawed. These professionals are only permitted to teach speechreading.
That's the wrong solution for the wrong problem and, clearly, the wrong
approach to a rather straightforward situation-namely, a need for
understanding speech via "audition" (the sense of hearing). There are also
limitations to the "teachability" of speechreading, as it is based on the
ability to make perceptual closure. This is a skill not easily, or often,
taught. "Watch my lips" may be the professional's mantra, but it can be a
difficult task for some people to perform.
Finally, one of the sad by-products of this policy has been that, due
to a lack of reimbursement and economic recognition for the value of
"aural rehab," the audiological field has de-emphasized its most important
task. That, too, is clearly wrong. Our job (my job) is to provide you with
a customized set of solutions that will allow you to hear and understand
speech and your auditory environment-an individual program suited to your
auditory capabilities and personal needs.
And I will do this ... with your help.
Aural Rehab: Let's Start Here
There are 26 letters in the English language arranged into 44 phonemes.
A phoneme is a letter, or group of letters, that has a specific sound in
our language, like the /th/ in the word "three" as opposed to the /th/ in
"those." In large part, it is the apprehension and comprehension of these
phonemes that comprise the acquisition of speech processing facility and
the mental image of fluency in communication.
Beyond amplification, you should know that there can be many different
components to aural rehabilitation, including auditory training, training
to improve speech processing and cognition, and training in the use of
contextual cues. However, in my opinion, none is as crucial as reading out
loud in a normal conversational voice for at least 30 to 45 minutes per
day while wearing your hearing aids. You can read anything you wish: your
favorite newspaper, a book, a magazine, The Bible-whatever you like. The
best thing would be to borrow a grandchild and read Dr. Seuss to them,
because of all that wonderful, alliterative language. This also strikes at
the heart of what we're trying to accomplish: getting used to processing
these phonemes while enjoying a renewed sense of communication-getting
your auditory system and brain working together and receiving the
information that you were not receiving on a regular basis before you
obtained hearing aids. Poetry and joke books are also ideal. Your
challenge is to get used to and enjoy verbal communication again.
Phonemes-when processed through a digital hearing instrument-are not
exactly like the unaided phonemes that you could hear when you were 17
years old, and they can also be quite different from those processed
through older analog devices in that they have the potential for greater
content and character. The energy in these phonemes is arranged in
"formants," which are the energy concentrations within these words. When
you read aloud, your brain knows with 100% accuracy what you said. You are
not listening for "content"; instead, you are practicing the "processing
of the phonemes" through your new digital hearing instruments. It can be a
very different sound. As repetition familiarizes your brain with the
phonemes, meaning is assigned and more accurate "hearing" is achieved.
These hearing skills are not an accident, but rather a deliberate
application of "effort to endeavor." They are not obtained by luck, but
rather by practice. And this reading exercise is not an option in my
office; it's required reading.
