Better Hearing Month:
Thinking Beyond the Audiogram

By Madeleine Campbell

During this year’s Better Hearing Month, as AuD candidates across the country transition to newly minted student clinicians, full-time externs, and practicing audiologists, take the opportunity to reflect upon what “better hearing” means to you. Is it improved hearing thresholds as a function of well-fit amplification? Increased word or sentence recognition scores? Something immeasurable within the clinic walls all together?

Incorporate speech-in-noise testing. Many patients report challenges understanding speech in the presence of background noise. It’s no secret that measuring pure tone thresholds alone does not adequately account for how these individuals are processing information in their real world listening environments. Though it’s frequently discussed, a survey from Clark et al. in Audiology Today showed only a small percentage of respondents regularly administer speech-in-noise testing. If your preceptors or supervisors are not offering this as part of their test battery, ask about the potential for incorporating measures like QuickSIN or BKB-SIN sentences.

Remember the significance of self-report. Individuals with greater self-perceived challenges are more likely to use hearing aids than those who perceive little to no difficulty (Humes & Dubno, 2021). Validated measures like the Hearing Handicap Inventory for the Elderly (HHIE; Ventry & Weinstein, 1982) and its adapted counterparts, the Speech and Spatial Qualities of Hearing Scale (SSQ; Gatehouse & Noble, 2004), the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox & Alexander, 1995) and the Cochlear Implant Quality of Life Profile (CIQOL-35; McRacken et al., 2019) often take only a few minutes to administer and provide us with a more holistic, ecologically valid perspective of our patients’ goals and progress.

Offer communication strategies for all patients, regardless of technology. Hearing aids and cochlear implants are not a panacea for all communication challenges. Discuss practical measures for environmental modifications, such as adequate lighting for optimal visual cues or DIY methods for dampening unwanted room reverberations, and strategies for self-advocacy, like making hearing loss known to new acquaintances and conversational partners and asking speakers to rephrase instead of repeat themselves. Communication strategies are necessary and effective complement to assistive technologies and must be personalized to meet the needs of the individual. For older patients, remember that cognitive function is a spectrum. As cognitive decline progresses, communication strategies must adapt to meet the needs of patients where they currently stand.

Whatever “better hearing” means to you, remember that our patients’ experiences, victories, and challenges extend beyond the audiogram.

Resources
Clark, J. G., Huff, C., & Earl, B. R. (2023, March 6). Clinical practice report card: Are we meeting best-practice standards for adult hearing rehabilitation?. American Academy of Audiology. https://www.audiology.org/news-and-publications/audiology-today/articles/clinical-practice-report-card-are-we-meeting-best-practice-standards-for-adult-hearing-rehabilitation/

Cox RM, Alexander GC. The abbreviated profile of hearing aid benefit. Ear Hear. 1995 Apr;16(2):176-86. doi: 10.1097/00003446-199504000-00005.

Gatehouse S, Noble W. The Speech, Spatial and Qualities of Hearing Scale (SSQ). Int J Audiol. 2004 Feb;43(2):85-99. doi: 10.1080/14992020400050014.

Humes LE, Dubno JR. A Comparison of the Perceived Hearing Difficulties of Community and Clinical Samples of Older Adults. J Speech Lang Hear Res. 2021 Sep 14;64(9):3653-3667. doi: 10.1044/2021_JSLHR-20-00728.

McRackan TR, Hand BN; Cochlear Implant Quality of Life Development Consortium; Velozo CA, Dubno JR. Cochlear Implant Quality of Life (CIQOL): Development of a Profile Instrument (CIQOL-35 Profile) and a Global Measure (CIQOL-10 Global). J Speech Lang Hear Res. 2019 Sep 20;62(9):3554-3563. doi: 10.1044/2019_JSLHR-H-19-0142. Epub 2019 Sep 4.

Ventry IM, Weinstein BE. The hearing handicap inventory for the elderly: a new tool. Ear Hear. 1982 May-Jun;3(3):128-34. doi: 10.1097/00003446-198205000-00006.