By: Dr. JJ Whicker
Every audiologist says it: “Hearing aids are not like glasses; you can’t just put them on and have everything be fixed.” While I’m never a fan of clichés like this, it rings very true. Yet, the misperception of what hearing aids are like is ever-present. What’s more, even among audiologist, the misperception that hearing aids are the only treatment for hearing differences is staggeringly popular. In fact, almost every audiology practice establishes a practice model around the idea that hearing aids are the final answer, thereby justifying making the sale of hearing aids the primary source of revenue for the clinic. The result is that hearing aids are stupidly expensive, seldom covered by health insurance, and sometimes a big regret for the consumer.
The Problem with Stopping at Hearing Aids
Another cliché you may hear in the audiology world is: “We hear with the brain, not with the ears.” This is also very true. Listening and the brain are so completely interconnected that, when there is a difference with listening that goes untreated, implications for cognitive decline, memory loss, and communicative barriers become front and center. And, when cognitive functioning is on the line, doesn’t it make sense that, beyond just making sounds accessible, we focus on helping individuals optimize how they use those cognitive mechanisms to be successful in communicative exchanges? Because, in the end, making sounds more accessible is really all the hearing aids or other amplification technologies (i.e., cochlear implants) do.
Of course, getting amplification technology is an important first step, but the emotional and physical overwhelm of being exposed to new sounds for the first time in a long time can be extreme. Unless there is appropriate audiologic support in place, this overwhelm can trigger a cycle of nonuse of the technology on which you spent a lot of your money.
So, what are the other treatments for hearing differences? At Little Heroes, our forte is aural rehabilitation, or listening therapy. A few months ago, I wrote about listening therapy. Essentially, listening therapy is an audiologic intervention that focuses on helping the listener know what to do with what he hears and develop communication strategies for what he can do when he does not understand. When working in pediatrics, listening therapy is essential in helping children with hearing differences make auditory meaning of the world around them, engage in learning, and remain on par with their peers for social development.
The Nonlinearity of It All
Even with aural rehabilitation, improved listening behaviors do not occur over night. While this is frustrating, maintaining an effort to engage in listening therapy can help accelerate progress. Sometimes it may seem like you or your child are making leaps and bounds, but new barriers can arise throughout treatment that make it seem like you’re moving backwards. Don’t give up! In my line of work helping children with auditory processing disorders, I see a wide variety of time frames for improved listening behaviors. Some kiddos have very isolated cases of auditory processing deficits that are quickly remediated, and they “graduate” from listening therapy after only a few sessions. Other kiddos may have a multitude of differences occurring at the same time which make progression slow.
As a case-in-point, I’d like to talk about one of my favorite patients. For privacy reasons, we’ll call her Henrietta. Henrietta is a 9-year-old girl with one of the most severe cases of auditory processing disorders I’ve ever seen. She is bright and fun and so willing to work with me; but I remember on the day of her first assessment, Henrietta struggled to maintain listening effort just to follow instructions. She used an excellent listening body (kept eye contact, body still and calm), yet I could tell she was struggling to listen. Her eyes glossed over in that I-can’t-keep-listening-but-I’m-trying-my-hardest way. I asked questions to which she replied with totally irrelevant information. She showed strong decoding and memory deficits.
At first, listening therapy seemed to move quickly and Henrietta showed a lot of improved listening behaviors. I was so impressed. Then, summer came, I started this new practice (yay Little Heroes!), and when Henrietta returned to me at the beginning of the new school year, she had been triggered emotionally and auditorily in many ways. I learned that a fire drill at school caused a bit of an anxiety attack. I began to understand that perhaps Henrietta had some hyperacusis happening as well. Her articulation regressed and Henrietta had become a little less intelligible. What’s more, Henrietta was back to glossing over at me and responding to questions with irrelevant information. It felt like we were back at step one.
It was hard, but I was able to pivot and introduce new listening therapy strategies that helped get Henrietta back on track. She is now so intelligible and is engaging in conversations with me that are so fun to have, simply because I can see how far she’s come in her ability to make meaning from what she hears. She is now working on listening to non-fused two-word phrases (e.g., instead of saying “warm coat”, I say “w-o-r-m-k-o-t”) and synthesizing the sounds she hears to make words. As a reference, at one point we were working on helping Henrietta understand that /b/ and /p/ are different sounds. This is huge! But it’s taken time, and that is 100% okay.
Nonlinear Improvement Is Still Improvement
The biggest thing to remember about treatments for hearing differences is that, even if the journey is long, improvement is still improvement. In today’s world, it feels like everyone puts such a priority on exceptionalism and slow improvement can put us in the mindset to give up and move on. This does, on occasion, happen in my clinic. I see parents (with wonderful intentions) choose to stop coming because their child didn’t make changes after only a couple of listening therapy sessions with me. They want their child to be what, in their minds, is perfection. Understanding that neurodiversity exists and is the most normal thing out there is so important to understand as you begin your journey to helping either yourself or your child learn to thrive in listening and communicative environments.
For the most part, children who come to me nearly always bring tears to my eyes, because I can see they are wanting to understand, but the listening world will not just slow down, even a little. And they are desperate. And kind. And loving. And perfect in every way. I’m here for them, no matter how nonlinear their improved listening skills are. I know we can find a way to help them be successful. Each child is different, and each child matters a million times over.
Do you think listening therapy is right for your child? Call us! (801) 996-7510.