By Dr. JJ
10/18/2021
One of the areas of audiology that is somewhat (some would argue totally) neglected is aural rehabilitation. This is a shame because audiology, at its most fundamental level, is a rehabilitative profession. What does this mean? It means that our primary goal should be to help individuals with hearing differences learn to live with those differences while also living their best possible lives. So, what’s the issue? Many audiologists are not doing that. Many are treating the profession like a bio-medical-technical thing: identify the hearing loss, slap on hearing aids, follow-up in a year.
The thing is, hearing technology, such as the hearing aid or the cochlear implant, was never meant to be a fix-all. Every audiologist says it: hearing aids aren’t like glasses. You can’t just put them on and have all your hearing acuity restored. A lot of times, the new sounds made available by hearing aids are uncomfortable. Newly activated cochlear implants do not sound natural in any way. To be successful with new hearing technology, there needs to be a therapeutic relationship between the audiologist and the patient to help the patient learn how to optimize what it is they are now hearing. Hence, aural rehabilitation.
Aural rehabilitation – or, as we call it here at Little Heroes, Listening Therapy – is an intervention provided by our team to help our patients learn to use what they hear. This can look like many different things. Most commonly we use listening therapy to help children with auditory processing disorders learn to discriminate sounds and recall auditory information in sequence. However, we use these same therapies for other children as well.
As a case point, I have a patient with cochlear implants on both ears. He’s five years old, and family uses spoken language in the home. However, this child’s hearing difference is caused by what’s called cochlear hypoplasia, which means that his cochleae are not formed as they typically are in others, resulting in profound deafness. The result is that even with his cochlear implants, the sounds this patient is hearing are likely very distorted. Further, because of the hypoplasia, the parameters used to program his cochlear implant processors are all out of manufacturer recommendations. For years this patient was being seen by audiologists for programming and the child was not making progress in his ability to understand and communicate using spoken language. Parents felt confused about why. After all, he has high-level technology surgically in place – why do they seem to provide little benefit?
Well, in my opinion, they can provide benefit. But it’s not an issue of programming the processors left, right, and center. It’s an issue of listening therapy. With this patient, I have worked through the same phonemic training program I do with my patients with auditory processing disorders. I have high hopes that over time this child will thrive in a spoken language environment as he learns to make use of the sounds he hears, no matter how different they may be compared to what you and I hear. He just needs to learn that whatever his auditory version of /b/ is, he can link it to /b/ and make meaning.
Another large part of aural rehabilitation – and any audiologic encounter for that matter – is counseling. Hearing differences and disorders can impact a wide array of life factors that go beyond the physical implications of hearing differently. These can include impacts to social life, learning, and even work life. These impacts can fuel internal thoughts and feelings, such as fear and anger. In turn, these thoughts and feelings may influence our patients to do things they normally wouldn’t: deciding not to go out with friends, choosing a career to which they don’t really aspire, or not giving their best efforts in school.
These thoughts, feelings, and actions can create a sort of cycle of misery, including thoughts of lessening self-worth, stress, anxiety, and maybe even depression. In rare but serious cases, patients may even have thoughts of self-harm. Did you know that it is well within the scope of practice for audiologists to talk about these things? And why wouldn’t it be? Again, our mission is to help our patients cope and live their best life, despite having a hearing difference. Our job is to help our patients understand these feelings and create an action plan for how they can manage while also engaging in treatment plans to maintain access to sounds in a predominately hearing world.
In the pediatric audiology world, a lot of this counseling occurs with parents. Understanding children’s hearing differences and learning about complex technology can be hard, especially when there is no indication that a child may be born with a hearing difference. A couple months ago, I wrote about the emotional journey of childhood hearing loss (here). The experiences are so varied, yet it remains important that families are finding and working with pediatric audiologists who will make the time to understand how parents are feeling, validate those feelings, and set goals that match the needs the parents are prioritizing.
In sum: Technology is not the only answer to hearing differences! Ask your audiologist if they offer listening therapy. If they don’t – don’t give up! If listening therapy is a support you need, it can be found. As ever, reach out to us! We love listening therapy. Listening therapy is how we meet our clinic’s mission to provide timely and proactive listening/coping therapy to children with concerning listening behaviors, even when you’ve been told previously that nothing more can be done. Something CAN be done, and we are here to support you.
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