Attention and Listening Skills: A Dynamic Approach

Hearing Health & Technology Matters
July 11, 2018
By Robert Castleton Wormus

robert wormus

I retired from a successful, wonderfully fruitful, forty year career in audiology.1  I have ridiculously good health, and a seemingly infatigable love of Life, Nature and Science. Simply put, I’m blessed.
I’ve known it all my life, and yet, I’ve done very little to ‘pay it forward’; this is disconcerting to me, and I’ve decided to try to change that.  I developed a somewhat esoteric tool (used as a precursor to my formal Hearing Aid Evaluations) that significantly improved my patients ability to acclimate to artificial amplification.2 
Now, after fifteen years of retirement, as an attempt at amends, I want to share that tool with my colleagues in audiology, maybe not my original colleagues, but my colleagues today.
Although it’s somewhat of a reverse psychological approach to Hearing Aid Evaluations, it worked for me.  It’s not earth shattering, but it is a psychological ploy, that significantly improves a patient’s chance of acclimating to amplification.  It’s a ‘Dynamic listening module’, that I required every one of my patients and their spouses to attend, before I administer a formal H.A.E. (Hearing Aid Evaluation).
My patients had to understand the difference between hearing and listening.  I was adamant about this.  Once diagnosed, “a sensorineural hearing loss, is first and foremost, a ‘social problem of communication’, and, only secondarily, a pathological disorder of hearing.”  I incorporated this as my  ‘mantra’ in private practice, and taught it to my associates, my aides, and all my employees, but never to my colleagues.
For over forty years, I used this amazing, indirect, technique of acclimating to amplification. At the risk of self-aggrandizing, my patients, in whole, were robustfully appreciative of what they called, my ‘family counseling’ approach to a hearing aid evaluation.

Attention & Listening

Here in a nutshell  is the ‘module’ on attention and listening skills that I compelled every patient to understand. I start out by explaining the simple, but not fully understood facts about the ambient noise floor we all have to acclimate to from birth. 
We live in a very noisy world, most of it manmade. Although it’s a skill, we all learn subconsciously over time, to deal with these ridiculously high speech to noise levels, by intuitively realizing a portion of them are immaterial, not a threat, and can be ignored. This is how normal hearing individuals learn over time to deal with high levels of competing noise. However, any sudden, or even gradual sensori-neural hearing loss that occurs after we’ve gained these skills, can and will abruptly erase them; leaving us with the task of not only re-acclimating to them, but acclimating to any artificial amplification that is also applied. This time, gaining those skills is no longer subconscious!
This problem is compounded threefold by our conscious attempt to ‘ignore’ overwhelmingly loud speech to noise levels, amplified by artificial means, and paradoxically enhanced by recruitment.  The only way this problem can be surmounted, is by convincing your patients that overtime they will acclimate to these high levels of noise, just as they did the first time, from birth. The ‘trick’ is to get them to understand that turning down the volume is not the answer. This is counter-intuitive, unless thoroughly explained.
They must grin and bare it, that’s the first step in my dynamic listening module. 
The second step, is understanding the difference between listening and hearing. Hearing is what our ears do, it’s innate, but listening is voluntary, initially. We listen to everything, but after acclimating to the immaterial noises that we hear, that are not a threat, we begin to selectively choose what to listen to. 
It takes at least one month to acclimate to artificial amplification. Not by turning the hearing aid down, but by listening to sound, until they no longer bother us.  It’s a function of time, learning to ignore immaterial noise. 
The third step, is related to the second step, in that it also has to do with selecting what we choose to listen to, but this time it has to do with making the wrong choice.  We, inadvertently, ignore familiar sounds, that we are exposed to, even if they’re not immaterial, and are a threat (unfortunately, our spouses, friends, and loved ones fall into this category!). 
The very same skills that allow us to ignore unwanted noise, often allow us to inadvertently ignore speech as noise.  There is only one way to deal with this, our spouses must get our attention, from the same room, and often by sight or touch. There’s no compromise here.  Spouses very often have to get each others attention, manually. 
I given you only three of a thirty step listening program, but they’re the most important steps, most of the rest, have to do with ‘structured listening’, assistive listening devices, and the use of courtesy.3
  1. I opened the doors of my first practice practice, ‘Audiological Services’ in  August of 1965, On demand, my practice gradually became itinerant, and Audiological Services, opened a myriad of successful offices throughout the Los Angeles basin. 
  2. My basic science, and fundamental training in experimental psychology, drilled home, by Professor Donald Kinstler, made developing this tool possible. The psychoacoustics of hearing is a far cry from the physics of acoustics.. They’re not even measured in the same S.I. Units. Psychoacoustics is measurement of a ‘perceived’ sound.  A soundwave ‘heard’ by our organ of hearing, including but not limited to, the pinna, the external auditory canal, the eardrum, the middle ear, the cochlear, the eight nerve, and the receptive areas of the brain may very well be quantum mechanical. If so, the implications of this are known solely by quantum physicists, not audiologists.  George Von Bekesy, received a Nobel Prize for modeling the function of hearing. 
  3. I owe a debt of thanks to three of my mentors in Audiology that come to mind, Donald Kinstler, for his emphasis in the psychoacoustics of Experimental psychology, and Jannette Jeffers for her emphasis in aural rehabilitation, both of C.S.U.@ L.A., and Victor Garwood, for his post graduate courses from U.S.C.

Robert Castleton Wormus got his first Master’s Degree in Special Education of the gifted late in 1964.  He enjoyed being a ‘professional student’ for as long as the scholarships and fellowships lasted, which included an AA degree from El Camino, a BA degree in Educational methodology from CSU@LA, a certificate in Astronomy, a minor in experimental psychology, a California teaching credential in Education, Special Education,  Speech Pathology, Audiology, the directorship of the CSU@LA’s Associated Clinics, and finally three California licenses in Audiology, Speech and Language Pathology.



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