Me and My Audie: A New Relationship

by Gael Hannan and Joanne Deluzio

Editor’s Note: This blog was originally published in the Better Hearing Consumer in February 2013. However, in view of recent upheaval in opinion about how hearing health should be delivered, we find it still pertinent today. In the preceding blog, How I Learned to Love My Audiologist, I had talked about my ideal hearing health professional – someone who is client-centered and trainable. And I’ve been lucky to find a couple of those in my lifetime. However, my favorite audiologist is not my provider, but my friend and colleague Joanne DeLuzio. We share a passion for hearing health advocacy and once drove through a blizzard for a weekend writing retreat to start a book (which, in a nutshell, we never finished, so let’s just move on).

In 2003, we gave a presentation at the HLAA convention in Atlanta. “Me and My Audie” looked at the importance of the consumer-audiologist partnership and, although the turnout was poor – we were competing with an ice cream social – the workshop participants who did attend applauded our message:

A person with acquired hearing loss can reach their optimal level of communication – that is, live successfully with hearing loss – when they have a positive, long-term relationship with their hearing healthcare professional.

In short, it takes two to tango. But why is this concept such a tough sell?

The hearing loss population is booming. Hearing assistive technology has reached unprecedented levels of sophistication and accessibility. Universities are producing hundreds of educated and skilled hearing care professionals each year. The number of hearing health clinics and hearing aid retailers is increasing rapidly, and public awareness of hearing loss issues is on the rise.

Still, only 20% of people who would benefit from hearing aids and aural rehabilitation actually receive some form of hearing healthcare, and those who do are often unhappy with their care. While affordability of hearing aids is a major problem, how professionals provide service to their clients is recognized as an equally important issue.

There is a history of mistrust between the two groups. Consumers are not happy with the paternalistic professional who presumes to know what is best for the client. There is widespread suspicion that hearing aids are recommended based not on the best fit for the consumer, but on monetary gain for the professional.

On the other side of the fence, many hearing healthcare professionals are defensive. It’s not always easy working with consumers who have unrealistic, impossible-to-achieve expectations and who are often still angry and in denial about their hearing loss. Many professionals feel burnt out. They have worked hard to perfect their craft, and are tired of being constantly criticized. And finally, even when they recognize a client’s need for more extensive counseling, fee structures do not compensate them for this service.

So, is it possible to change the existing dynamics to create positive and effective partnerships? We believe that it is – if professionals (and ultimately their clients) accept that ‘aural rehab’ is not limited to a course of action prescribed by a hearing healthcare professional. The process actually begins with the first suspicion of hearing loss and continues throughout a person’s lifetime.

Acquired hearing loss is life-changing, causing emotional upheaval and uncertainty about where to turn for support. The aural rehabilitative process is complex and confusing, especially when the consumer doesn’t know what to expect – or the professional is not providing it. Technology is changing rapidly and much of the information available on the Internet is misleading. Slick advertisements promise people the latest in invisible hearing aids, perfect hearing in quiet situations, and DVD quality sound.

Consumers need a hearing healthcare professional who takes the time to understand their unique listening needs and help them sift through a variety of products and strategies. This is not a “one shot” deal; acquired hearing loss is for life and so is the need for constructive hearing healthcare, including a consumer-professional relationship based on mutual trust and respect. Consumers need to understand and be involvedin all recommendations and aspects of their own care. They need to develop reasonable expectations about the best possible outcomes. Both parties have important roles and share responsibility for creating a clear vision and a clear path to optimal communication.

Mark Ross, esteemed audiologist and Professor Emeritus at the University of Connecticut, has often reported on the 8-week, full-time aural rehabilitation program he attended at the Walter Reed Army Medical Center in 1952. The program included hearing aid fitting, but also focused on ‘lipreading’ and auditory training, memory and cognitive training and invaluable support between the group participants. Sixty years later, hearing aids are no longer considered just a component, but almost the sole treatment for hearing loss. We feel the industry has lost sight of the real goal, and has shifted its focus from people and communication to instrumentation and technology.

We need a new hearing care delivery model – a course of care that offers the big picture of living successfully with hearing loss and an ongoing process that involves professional assessment, mental preparation, technology, and a wide array of communication strategies.  Sources of support include family, friends, co-workers and support groups, but the single most important resource, other than the person themselves, is the trained hearing healthcare professional.

From the very first meeting, client and professional should establish a collaboration that will offer powerful benefits to both parties. They have clearly defined roles and share the responsibility for success.　Otherwise, audiologists will continue to struggle with clients who balk at every suggestion, and hard of hearing clients who, if they are not exposed to additional communication strategies beyond their hearing aids, will not develop the best possible skills to successfully manage their hearing difficulties.

The ultimate goal is ‘optimal communication’ for the consumer, but what exactly does that mean? (We’re still searching for a better phrase to describe this concept that doesn’t sound like a brand of hearing aid or yogurt.)

Optimal communication is different for everyone, with an individual mix of communication tools. It necessitates addressing all of the feelings and emotions associated with hearing loss (e.g., anger, denial, frustration, isolation, and stress on relationships) as well as understanding technology and how it can be used to maximize understanding of speech and overall functioning.　Optimal communication might also involve speechreading training, sound awareness and auditory training.

Environmental manipulation, preparatory, speaker and listener strategies are other important communication tips to consider.  Assertiveness training, advocacy skills, and obtaining support others peers can all be part of someone’s optimal communication ‘package’. Ideally, the client and the professional will implement a variety of technologies and strategies over the years – which should be re-evaluated and changed as the person’s hearing and listening needs change, or as technology evolves.

Last summer, a joint communiqué from leading professional hearing associations recognized the changing face of the hearing healthcare environment and called on the professional community to focus on consumer needs in their service delivery. We hope that all US and Canadian hearing healthcare and consumer organizations will rise to the challenge.

Hopefully, soon, this concept will no longer be a tough sell, but the new reality.