Last week, in my article “Why I Dread My Annual Hearing Test”, I wrote about how hearing evaluations make us anxious even if – or especially if – we’ve had them before.
Comments from readers ranged from “yeah, I don’t like them either” to this: “I can’t tell you how much I HATE hearing tests! I live daily knowing just how bad my Hearing is, and hearing test is just another reminder. I get so stressed out during the test but know results are needed by my audiologist.” Like this reader, I understand that hearing tests are a necessary evil, but it feels good just to vent sometimes.
But in the midst of the chorus of grievances, Melissa Karp, an audiologist in North Caroline, responded with this: “Audiologists don’t want your hearing to decline or for you to dread coming in. What can we do to make the process less anxiety-provoking?”
We are so glad you asked, Melissa! But then I realize I’m not quite sure what can be done, so I’m putting a couple of questions to the universe. I’m inviting responses from both people with hearing loss and the professionals that serve us.
What would make us calmer before, during and after the hearing evaluation?
What would be the benefits of less anxiety? Would the test show more accurate results?
Since my cochlear implant in January 2017, hearing evaluations measure how my word recognition has improved, which does with every visit. You’d think that the positive trend would help eliminate anxiety, but the good feelings come afterward when I find that my comprehension has gone up 20% or whatever. During the test, it was the same as ever; every time I don’t understand a word or phrase or sentence and I have to give it my best guess, I experience frustration. Is that because in real life – out there, beyond the clinic doors – it’s frustrating when we mishear something, get it wrong, or give an insane answer to a misunderstood question? Those feelings of failure, no matter how small, carry over into the hearing test, when the consonants of speech are just beyond our ability to understand.
And those beeps! For those of us with tinnitus, it takes only a few seconds of beeping before our inner head noise starts singing along. Last week, in a CI mapping, the goal was to ascertain the softest sounds I could hear at various levels. My task was to identify how many beeps I heard, ranging from 1 to 4. Sometimes when I heard the beeps – they just kept on going – 5, 6, 7, 8! My brain liked that sound so much it wanted me to keep hearing it. The good news is that I did well and I have a new mapping with a better dynamic range of hearing.
But back to anxiety and the questions we need to ask.
The Pre-Test Talk: For hearing loss veterans, when we hear that it’s “time for a new test”, we groan. Clearly our audiologist thinks our hearing is worse. Or maybe we made this appointment because we haven’t been hearing so well lately and this hearing test is going to confirm our worst fears.
How can hearing professionals better prepare the client for the test; what words will help keep anxiety low? Are changes required in overall client-centered care?
The Sound Booth: We don’t like being in the sound booth. We feel separated. It’s dark in there and we don’t do dark. We feel as if we’re being examined.
What modifications to the test environment, including the booth, would help lessen the stress and still maintain the technical requirements?
I look forward to hearing from you. You can respond in the comments section below the blog (it’s down there, keep scrolling), or comment on the Facebook, Twitter or LinkedIn page that you read this article.
Thanks for the feedback – I will share it!
I think it is important for the clinician to be facing you. Some clinics have the clinician and audiometer not directly facing the window the client is peering out of. Making eye contact through the test and facing the client, I believe, can make the client feel more comfortable and less separated.
While I get this aspect, as someone who is currently training to be a clinician, we have been taught to look out for those who can see the clinician when they press the buttons to play the beep. We worry that the patient will pick up a pattern or see when we press the button to play the beep and the patient will answer that they heard it, even if they didn’t and exaggerate their hearing loss.
Yes, I learned about bias as well and that is a valid point. I should have elaborated-over time you learn to be very subtle while pressing button and to not look up when you press it. I only make eye contact when giving instructions to the patient. Also, the clinic I work in has it set up so the client cannot actually see the audiometer or your hands, only your face.
The pre-test talk: Well there are a few things here, I guess. Some of it may be reinforcement of why we’re doing this. You mentioned that one comment you received was that the hearing test is just another reminder of how bad my hearing is (I live it. I know.) But the purpose of the test (I think) is not to say “yep, you still can’t hear very well”, it’s to pinpoint “where are you now?” against a baseline (i.e. prior tests). I once had an audiologist tell me, when I asked if he wanted to see my prior tests, “nah, we just need to know where you are now”. I totally disagree with that philosophy. I believe trends (up, down, plateau) are important. (I stopped seeing that “professional”).
But I guess my long-winded point is that we need the obvious stated to us (again). This information can help. Maybe simple adjustments can be made with current hearing instruments to make things even a little better.
The sound booth – Oy! Where to start? Yes it’s dark but that may be a blessing (to me anyway). Bright lights can be distracting so it may even be calming. For me, it’s the size. I know office space can be at a premium but, geez-o-whiz is that space small. Usually when sitting down my feet touch the front wall. I’m only six foot and have size 9 shoes. It’s a very confining space which can make people a little twitchy, shall we say. Now this is structural. I get it. But should be acknowledged.
And something not mentioned. During the test with respect to phrase recognition. Don’t make me guess. If I say I don’t know, I don’t know. “Just your best guess” he says. NO. I don’t know. Even if I guess right it’s not accurate. It doesn’t take into account I’m in a (very confining) booth with no wind, or TV on, or water running. It’s not a true test. Others I’ll miss, sure. But if I just blurt it out and miss it, that’s a test. But if I’m truly struggling let me say “pass”.
Cheers.
Put a recliner in there and give them coffee to relax. All kidding aside, I asked my audiologist a few years back on how to improve my results. she said it all depends on the stress. environment and lots a support from others. I understand the torture booth has to be free of distractions for them to get the best results. I am a CI user for 33 yrs. I would strongly encourage both to find ways to reduce the stress levels. Maybe a trial test on both to compare the difference?
Hi Gael:
I think the first problem is calling it a “test”. No one wants to fail a test. So call it a hearing evaluation instead–you can’t fail an evaluation–it just tells you where you are at hearing-wise at that moment.
Furthermore, being a curious old soul, I like to know what my hearing is doing. So I’m eager to be evaluated. I don’t think it as being “horrible”. Sure you have to concentrate, but I concentrate on lots of things anyway so this is no better or worse.
As far as the booth is concerned, yes, they are small, but with my severe hearing loss, I can’t hear anything “out there” anyway, so I just ask them to leave the door open–and I’ve never been refused. I’ve even been evaluated sitting beside the person testing me outside the booth (since I can’t hear any background sounds to throw the results). This won’t work if you have a mild to moderate hearing loss though.
Cordially,
Neil
I have Meniere’s Disease, have lost much hearing in both ears, have tinnitus, and wear hearing aids. Oh I dread those hearing tests for so many reasons. Where to start…yes it’s a vivid reminder of my daily frustrations mishearing a word or even syllable which changes the whole context of the sentence and I’m often left patching together nonsensical sentences. My daughters say they like the song “Boom Boom Pow” and I repeat what I heard: “Moo Moo Cow”??? Hilarious to them but frustrating to me because that’s my world! I KNOW it doesn’t make sense but that’s what I heard. Audiologists can you please mix up the word list? I know it after hearing the same words year after year: baseball, hotdog.. Also, please don’t ask me to remove my hearing aids and then continue to talk to me, expecting me to comprehend what you’re asking/telling (?) me as you put on my headphones. Another frustration: when the audiologist clearly and slowly enunciates each word over a microphone in a perfect hearing environment and my repeating those words back is somehow supposed to translate to my word comprehension in the real world full of noisy conversations, dishes clanking in restaurants, overly loud background music, mumblers who use snuff, people with accents, and those who cover their mouth when they talk and eat etc.? The audiologist reports “Well your comprehension was pretty good”! I feel like saying “Sure, if only all conversations were slowly enunciated word by word into my headphones with total silence in the background I would hear just fine and wouldn’t need to be here taking this test!” So to those kindred spirits out there in the deaf and hard-of-hearing world, the next time you’re in the hearing booth please know you’re not alone in your anxiety and distain for those lifeless grey pressurized hearing booths! I know the feeling!
“Test” is a dirty word to every one of us who went to high school. “Evaluation” or some similar word will be kinder and gentler on us fragile creatures. Yes, we want to succeed in any test — the higher the score, the more validated we are (or human?). Reality is hearing tests are a tool of measurement, so 100% is not attainable, and if you get THAT, what are you doing in the booth with perfect hearing? So there is no “failure” in real terms, just a marker of exactly where you are. It is stressful trying to squeeze the last ounce of sound into comprehension, even as they are getting fainter. Of course we feel we failed — that’s our old test mentality rearing it’s ugly head again. Actually the problem is we’re trying too hard. It’s normal for our hearing to be a bit worse over time — it never improves with age. The sound booth should be well lit, as dark is intimidating and isolating. The results should help us get better results from the HA and CI. Gael did get improvement!
Since I discovered that audiologists will revisit thresholds if there is hesitancy over pressing the button I have been less stressed in hearing assessments. I was explaining to a new audiologist at the clinic I attend how worried I was about the instruction to press the button even if I just thought I had heard the beep. Sometimes it is so difficult to be sure when tinnitus gets in the way. I suppose they have some idea of how clearly we hear each beep by the time lapse between the beep and us pressing the button. The audiologist said he would revisit a threshold up to four times. It made such a difference to me. The reclining chair mentioned by someone else in this thread seems like a good idea too. Not much chance on the NHS I suspect.