Hearing Each Other Is a Two-Way Street
Simple Strategies Can Help People Live Well With Hearing Loss
by Nicole Marrone, Mary Rose Durkin & Frances P. Harris

http://www.asha.org/Publications/leader/2012/121218/Hearing-Each-Other-Is-a-Two-Way-Street.htm

Below are the top six most commonly recalled communication strategies. These strategies may be most effective because they are easily implemented and can show immediate positive effects on communication and decrease communication breakdowns.
1. Get attention first.
2. Walk before you talk.
3. Speak slowly.
4. Give the topic.
5. Rephrase.
6. Use keywords.

Louise is frustrated. At her assisted living facility, menu options are presented aloud in the large, noisy dining hall. It is so noisy, one caregiver always calls out, “Are you hearing me?!” Louise—experiencing age-related hearing loss—routinely misunderstands and sometimes misses that she is being spoken to. Then, suddenly, it seems like the caregiver is yelling at her.

But the caregiver assumes Louise is experiencing cognitive decline, and makes meal choices for her. As a result, Louise finds herself served food she dislikes. During a group audiologic rehabilitation session at her care center, facilitated by audiology doctoral students from the University of Arizona (UA), Louise explains, “Sometimes I don’t eat. I just want to get some food that I like. I want to say, ‘Are you hearing me?'”

Louise’s story illustrates that communication is a two-way street, where both partners share responsibility for communication breakdowns. Louise is eager to learn strategies for better living with her hearing loss. So she and her caregivers are taking steps toward more effective communication by learning to use simple communication strategies through a Living WELL With Hearing Loss group program.

The groups are for people with hearing loss and their frequent communication partners, including caregivers, family, community workers, and health care professionals. Louise and her caregivers participated in a group held at her care center, facilitated by students in the university’s AuD program.

Living Well With Hearing Loss
The Living WELL With Hearing Loss groups are part of a UA program that grew from the efforts of private donors James and Dyan Pignatelli and the Unisource Energy Corporation. In 2009, they collaborated with the UA Department of Speech, Language, and Hearing Sciences to develop a community-oriented program of direct intervention, research, and training for the next generation of health care professionals. The program seeks to improve the lives of people with hearing loss and their families (Marrone & Harris, 2012). Group classes are at the heart of the approach, based on their effectiveness in spurring positive adaptations to acquired hearing loss (Hawkins, 2005).

Group training in the use of communication strategies is one aspect of a multidimensional approach to rehabilitative audiology with adults (e.g., Hickson, Worrall, & Scarinci, 2007; Hogan, 2001; Stephens & Kramer, 2010; Tye-Murray, 2009). Communication partners are included not only to provide support, but also to raise awareness of how hearing loss affects their lives and what each person can do to make communication more effective (Preminger, 2003). In some groups, the focus is specifically on the needs of caregivers or partners.

To date, more than 400 adults have participated in Living WELL With Hearing Loss groups on-campus and more than 140 people have participated in the group programs at assisted and skilled-nursing facilities and community centers.

Six Key Strategies
After the first group session—which focuses on education and communication strategies—Living WELL With Hearing Loss participants are asked what they most clearly recall from the session. They are encouraged to begin incorporating these strategies in their daily communication immediately.

Below are the top six most commonly recalled communication strategies. These strategies may be most effective because they are easily implemented and can show immediate positive effects on communication and decrease communication breakdowns.

1. Get attention first. Improve speech understanding by getting a person’s attention first. For example, tapping Louise on the shoulder would let her prepare to receive the incoming message and allow her to direct her attention appropriately. This strategy is useful when speaking to anyone, but especially for someone with hearing loss because it provides additional cues to the listener about when and where the signal will occur (Best et al., 2009).

2. Walk before you talk. It is beneficial to be in the same room and facing the listener. This strategy not only decreases the distanec between the speaker and the listener, but also allows the listener to take advantage of visual cues. Integrating auditory and visual cues has been shown to improve speech understanding for listeners with hearing loss (Grant, Walden, & Seitz, 1998). Decreasing the distance between the speaker and the listener increases the intensity of the signal, thus improving the signal-to-noise ratio. More favorable listening conditions may lead to increased speech understanding (Boothroyd, 2004; Jordan & Sergeant, 2000). For example, walking to the same side of the table and facing Louise would be more effective than speaking from above and behind her.

3. Speak slowly. Slow your rate of speech when speaking to someone with hearing loss to improve comprehension and recall. A recent study showed that at a typical conversational rate of speech, listeners with hearing loss recall significantly fewer elements of the message than those with normal hearing. However, when listeners with hearing loss are allowed to adjust the rate of speech, these differences are eliminated (Piquado et al., 2012). Louise might consider asking others to speak more slowly and clearly.

4. Give the topic. When listeners know the topic of conversation before the talker begins speaking, speech understanding is enhanced. Listeners are able to fill in the gaps when they miss auditory input. Listeners with hearing loss may use knowledge of the topic or context to reduce the number of possible alternatives, thus increasing accurate perception of speech (Grant et al., 1998). For example, when the caregiver takes a dinner order, conversation topics naturally may shift. Letting Louise know that the next topic is a menu choice could help.

5. Rephrase. When a listener misunderstands, a speaker’s typical response is to repeat the message. Although this is the most common repair strategy, it is the least effective after one repetition. The preferred strategy is to then rephrase the message by changing the word order or selecting different vocabulary (Tye-Murray, 1991).

6. Use keywords. Miscommunication may occur due to poor understanding rather than not hearing. Responding with a keyword instead of a nonspecific

“What?” or “Huh?” gives speakers additional information about how to rephrase their responses. For example, “What did you say about dinner?” rather than, “What?” might reduce emotional reactions and increase communication. The speaker knows the listener is engaged in the conversation, and how to repair the breakdown (Tye-Murray et al., 1990).

Why Work in Groups?
Preventing and repairing communication breakdowns is a shared responsibility, yet neither partner may understand how to make necessary changes (Trychin, 2006). This is one reason group programs are effective, allowing participants to learn from each other, and realizing that each person is capable of successful adaptations (English, 2008; Erdman, 2009; Hawkins, 2005). Communication habits and attitudes develop over a lifetime, well before the onset of age-related hearing loss. So it may take time for people to recognize and acknowledge hearing loss and develop new communication habits in response. Participants’ feedback confirms that common communication strategies can make a difference.

There is growing evidence of the benefits of building confident communication behaviors among older adults with hearing loss (Smith & West, 2006) and perhaps, most important, of the cognitive and health benefits of maintaining social engagement as we age (Cacioppo et al., 2011). Providing caregivers and other communication partners with the knowledge and skills needed to decrease communication-related frustration will likely reduce their stress and improve their quality of life (Preminger, 2003; Preminger & Meeks, 2010; Scarinci, Hickson, & Worrall, 2011; Scarinci, Worrall, & Hickson, 2008).

These strategies are simple, and with practice new communication habits may replace those that are no longer effective. Some of the most exciting moments in groups occur when partners recognize that strategies to improve communication are already within reach. They learn from one another that their problems and frustrations are common experiences, and that it is possible to make positive changes, motivating them to continue to adopt the new strategies.

Nicole Marrone, PhD, CCC-A, is an assistant professor in the Department of Speech, Language, and Hearing Sciences at The University of Arizona. Marrone’s research area is hearing loss and rehabilitative audiology across the lifespan, with specific interests in speech communication in noise and factors that influence treatment outcomes. She is an affiliate of Special Interest Groups 6, Hearing and Hearing Disorders: Research and Diagnostics, and 7, Aural Rehabilitation and Its Instrumentation. Contact her at nmarrone@email.arizona.edu.

Mary Rose Durkin, BS, is a third-year AuD student at the University of Arizona and a research assistant for the Living WELL With Hearing Loss Program. Her research is focused on quality of life outcomes from the Living Well With Hearing Loss programs. Contact her at mrdurk2@email.arizona.edu.

Frances P. Harris, PhD, CCC-A/SLP, is the James S. and Dyan Pignatelli/Unisource Clinical Chair in Audiologic Rehabilitation for Adults at the University of Arizona. Her interests include exploring multifaceted solutions for maximizing communication while minimizing the effects of hearing loss. She is an affiliate of SIG 7. Contact her at fpharris@email.arizona.edu.

cite as: Marrone, N. , Durkin, M. R. & Harris, F. P. (2012, December 18). Hearing Each Other Is a Two-Way Street : Simple Strategies Can Help People Live Well With Hearing Loss. The ASHA Leader.

The NIH was responsible for sponsoring the study, published online June 17, 2008, in the Annals of Internal Medicine, which was conducted by researchers from the NIDDK, the National Institute on Deafness and Other Communication Disorders (NIDCD) components of the NIH, and Social and Scientific Systems, Inc., which provides support on the public health topics to NIH and other government agencies.
“Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004.
1. Kathleen E. Bainbridge, PhD, MPH
2. Howard J. Hoffman, MA
3. Catherine Cowie, PhD, MPH
Abstract
Background: diabetes might affect the vasculature and neural system of the inner ear, leading to hearing impairment.
Objective: To determine whether hearing impairment is more prevalent among U.S. adults with diabetes.
Design: Cross-sectional analysis of nationally representative data
Setting: National Health and Nutrition Examination Survey, 1999 to 2004.
Participants: 5140 non-institutionalized adults age 20 – 69 years who had audiometric testing.
Measurements: Hearing Impairment was assessed from the pure tone average of thresholds over low or mid frequencies (500, 1000, and 2000 Hz) and high frequencies (3000, 4000, 6000, and 8000 Hz) and was defined as mild or greater severity (pure tone average greater than 25 decibels hearing level (dB HL) and moderate or greater severity (pure tone average greater than 40 dB HL).
Results: Hearing Impairment was more prevalent among adults with diabetes. The association was independent of known risk factors for hearing impairment, such as noise exposure, ototoxic medication use, and smoking.
(In a separate article The NIH News reported on Monday, June 16 2008 that “Hearing loss is about twice as common in adults with diabetes compared to those who do not have the disease, according to a new study funded by the National Institute of Health.”
Adults with pre-diabetes, whose blood sugar is higher than normal but not high enough for a diabetes diagnosis, had a 30 percent higher rate of hearing loss compared to those with normal blood sugar tested after an overnight fast.)
Limitations: The diagnosis of diabetes was based on self-report. The investigators could not distinguish between type 1 and type 2 diabetes. Noise exposure was based on participant recall.
Conclusion: Hearing impairment is common in adults with diabetes, and diabetes seems to be an independent risk factor for the condition.

References: “Guide to Clinical Research Papers” – Total Learning Concepts Inc. The Annals of Internal Medicine, July 2008. NIH News, the National Institute of Health, (NIDDK), June 16 2008. Hearing Healthcare Marketing Company, 2012. Data on File.©HHMC.

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(content from Healthy Hearing. Com)

Tuesday, November 27th 2012

The leaves are down and the turkey has been carved. You’re getting ready to put up the holiday decorations and, in many parts of the country, that means throwing on a hat and gloves to accomplish outdoor chores. It also means protecting your hearing aids as colder weather and the loud sounds emitted by equipment of the season make it necessary for you to take a few extra precautions.

1. Use your memory settings for noise reduction. According to the American Speech-Language-Hearing Association, prolonged exposure to noise at a level of more than 85 dB (decibels) can result in permanent hearing loss. For reference, both a snow blower and a snowmobile emit sounds of more than 100 dB. Since hearing aids amplify sounds in your environment and you want to protect your hearing from further noise damage, it’s important to adjust your hearing aids accordingly. Check with your hearing aid center or audiologist to see if your hearing aid has memory setting features. If so, ask them to show you how to program one for noise reduction.

2. Protect with earmuffs. If your hearing aids don’t have memory settings, consider investing in a pair of noise reduction earmuffs. This stylish addition to your winter wardrobe not only protects your hearing, it can also keep your ears warm while you’re enjoying a good skate on the neighborhood pond or ice fishing with your favorite nephew. Depending upon the style you choose, expect to pay anywhere from $10 on up for earmuffs that reduce noise by as much as 30 dB.

3. Buy a pair of sweat bands. To minimize the amount of moisture your behind the-ear hearing aids are exposed to as a result of perspiration — or precipitation — during the winter months, consider investing in hearing aid sweat bands. These accessories are available in a variety of colors and sizes, with an average price of $20 per pair. Most of them are washable and slip on easily, acting as a moisture repellant and providing a wind screen for your microphone. If your hearing aid center doesn’t sell them, you can find them easily online.

4. Keep batteries dry. Hearing aid batteries are adversely affected by changes in temperature, so it’s extremely important to keep the battery compartment dry and free from moisture. Inspect your hearing aid before you turn it off at night, making sure to remove the batteries and wipe the battery compartment thoroughly with a warm, dry cloth before storing.

5. Purchase a dehumidifier. If you live in an environment where the temperatures dip below freezing, you’ll want to protect your hearing aids from the cold weather. Extreme changes in temperature can cause condensation inside the instrument, which can keep it from functioning properly. Consider investing in a hearing aid dehumidifier if you haven’t already done so. This inexpensive piece of equipment can help prolong the life of your hearing aids by safely and effectively removing moisture overnight as you sleep. Dehumidifiers range in price from $5 to $100 and can be purchased online or in most drug stores.

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Articles referencing loudness levels, hearing loss and hearing protection discuss options regarding when you should use hearing protection or the effects of the noise.

Like any good message, here it is one more time.

When are earplugs necessary? Every time you are around sound that is 80 decibels (dB) or louder! Don’t know how to measure the sound?  If you feel it is too loud then wear hearing protection.  It is better to be safe than sorry.

To illustrate my point let me share an experience.  Recently I took my family to Disneyland.  Many of the rides at Disneyland use special effects to give you the desired thrill.  The ride Space Mountain has speakers directly behind your ears and uses light to intensify the ride.   The sound easily exceeds the 80 dB sound level.  According to government standards the duration plus the intensity is not enough to cause hearing loss or make them legally responsible for effects the ride may have on your hearing.  It does not mean it is comfortable for the rider.  My experiment with this ride was to ride it the first time as a normal participant, second time with foam ear plugs (30dB NRR ), third time with Surefire Sonic Defender earplugs (all sound is kept below 80 dB), and the fourth time with electronic earplugs.  [Additionally I used sunglasses for rides 2, 3, and 4]  The results were that the ride was much more enjoyable using hearing protection, and I could still hear my children with the Surefire and electronic hearing protection.

I realize that everyone does not walk around with earplugs in their pocket or purse, but maybe they should.  Foam earplugs are less than a dollar, and the Surefire earplugs can be purchased for around $12.  If you are around loud noise consistently then it would be a wise investment to look at electronic hearing protection.  These can range from $60 to $1000.  So please consider all the options.

 The article referenced in healthy hearing website titled: “Are Earplugs Necessary? Can I Use Something Else?”   Dated: Wednesday, November 14th 2012.  Is copied from Healthy Hearing with a thank you to them for sharing great information.

Earplugs are made of acoustically imperforate materials and of a specific size so that when properly worn they can provide appropriate hearing protection. That said, you must make sure that your earplugs are inserted correctly into the ear.

There are several types of hearing protection, from low-cost, low-tech foam or wax to high-tech, high-end noise cancellation earphones, the best one depends upon your protection needs. If you have a specific specialize need for hearing protection, consult with a hearing professional who will help you determine the best option for you.

An important consideration on any hearing protection is that you wear it properly.  When not worn properly, hearing protection is less effective, so take time to read the directions on how to use.

But, you have to go pro-active. You have to be the one to make the purchase and actually wear them! You’ve only got two ears. And noise-induced hearing loss is permanent.

Audiologists advise that other general-purpose materials should not be used as hearing protection! They offer little, if any, protection from noise.

I have also examined cotton balls, motorcycle helmets and simply putting your fingers in your ears. In short, cotton provides only 5 10 dB except at the highest frequencies; surprisingly motorcycle helmets, which are quite acoustically leaky, are not much better. However, fingers in your ears (though not terribly functional for general activities) nets you 25 30 dB; and could be sufficient for a brief noise emergency.

http://www.healthyhearing.com

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Thank you to:  www.healthyhearing.com for sharing this information.

 

Wednesday, October 17th 2012

Thank you to Energizer for the free batteries.  To all who recieved them, if you like them and feel they are better than previous batteries please let me know.

If you would like to be on our email list for future promotions like this: Free Hearing Aid Batteries.  Please email us or stop by and give us your email.

This is reposted from the ASHA.org website. It is by Kevin St.Clergy.

People of any age can be screened for hearing loss. Newborn infants are now routinely screened before leaving the hospital. Most preschoolers and school-age children are screened periodically at their schools or in their doctors’ offices. Adults can receive screenings from their doctor or at health fairs.
Hearing loss increases as a function of age, especially for frequencies of 2000 Hertz (Hz) and above. Sounds above 2000Hz are the soft consonant sounds such as /s/ in “sun” and /th/ in “thumb.” While more than 30% of people over age 65 have some type of hearing loss, 14% of those between 45 and 64 have hearing loss. Close to 8 million people between the ages of 18 and 44 have hearing loss. Adults should be screened at least every decade through age 50 and at 3-year intervals thereafter.
Certainly, anytime you have a concern about your hearing or your child’s hearing, you should ask your doctor about getting a hearing screening. Anyone failing a hearing screening should be referred to a certified audiologist for a more comprehensive audiologic (hearing) evaluation. The follow-up evaluation should be conducted as soon as possible after the failed hearing screening and no more than 3 months later.

healthyhearing_comprehensive_guide_get_happy_0710 

This is a new link from Healthy Hearing . com.  Feel free to download the guide or look at their website.  If you have questions about the guide or your hearing call Young Hearing today 801-489-7948.

Mention this post or guide when you make your appointment .