In his previous post, published June 11, Dr. Robert Martin explained the importance of giving patients a “black and white demonstration” that clearly proves the benefit of aided hearing over unaided hearing. This week, Bob continues his three-part discussion of how to provide compelling demonstrations.
There are many different types of demonstrations you can use to show your patients the benefit of amplification. The best ones are easy to perform and emotionally powerful to the patient. All such demonstrations are more effective if you keep them perceptually black-and-white, i.e., the patient hears the “test” sound when he is using hearing aids and cannot hear it without them.
Perhaps the best demo is done with a pulsed, pure-tone signal presented just below the patient’s unaided hearing threshold, i.e., just softer than the softest sound he can hear without hearing aids. Let’s walk through an example with a patient we’ll call “John.”
I begin by studying John’s audiogram, which shows that his threshold at 2000 Hz is 50 dB. I set my audiometer to sound field mode, activate the “pulsed” feature (this makes the sound much easier to hear), and activate the “warbled” feature (to avoid standing waves).
I place the hearing aid on John’s ear and adjust the volume to a comfortable level. Using the sound field test tone (at 2000 Hz), I find the threshold in this sound field setting. (Note: by finding threshold in the sound field, you avoid any possible calibration issues.)
I then present John with a continuing pulsed, warbled tone 5 or 10 dB below his unaided threshold. I repeatedly put the hearing aid on him, ask if hears the tone, then remove the hearing aid and ask him if he hears it now. If I’ve done this correctly, John hears the tone well with the hearing aid and does not hear it at all without hearing aids.
You can expect the patient to react very positively to being able to hear an otherwise inaudible tone with hearing aids. Reinforce his feelings by asking questions like, “Do you barely hear the tone, or can you hear it well?
GET BACKUP FROM THE FAMILY
It is very helpful to include the family in these demonstrations, so if you can, ask the patient’s spouse, child, or other family member about the patient’s hearing before you start this exercise. I also ask any family member present, “Can you hear the tone?”
The goal of such demonstrations is to create a festive, joyful experience for the patient and his family. It is likely they have come into your office fearing that the patient is going deaf. You can show them that, in fact, hearing aids will enable the patient to hear fairly well and to continue being able to communicate with the family.
Once I am sure my patient is hearing well with hearing aids, I often conduct other “black and white” demonstrations. For example, many patients say they cannot hear when someone whispers to them. In these cases, I simply move 4-5 feet away from the patient and ask them to repeat what I am saying. I start with easy-to-hear whispered sentences like, “I think it is going to rain today” or “Do you want a cup of coffee?” I whisper a sentence and ask the patient to repeat it. When I’m sure the person is hearing well, I switch to more difficult “test” words.
We have all heard the old saying, “Seeing is believing.” The concept behind this adage works against us in the field of hearing care because there is nothing for patients to “see” when they are experiencing hearing with hearing aids. We need to give them simple, yet powerful demonstrations proving that wearing hearing aids will make them hear better. For, in our field, “Hearing is believing.”