Douglas L. Beck, AuD, spoke with Dr. Johnson about auditory rehabilitation (AR), psychosocial aspects of hearing loss, micro-BTEs, stigma, AR programs, and more.
Academy: Hi, Carole. Thanks for spending some time with me today.
Johnson: My pleasure, Doug. Thanks for the kind invitation.
Academy: Carole, congratulations on the new book. I’ve read dozens of books on auditory rehabilitation (AR) and yours is, without doubt, the most comprehensive, covering cochlear implants, hearing aids, and assistive and alerting devices from newborns to seniors. Seems like you’ve covered everything and everyone!
Johnson: Thanks, Doug. It is an undergraduate-level textbook and it certainly kept me busy for several years!
Academy: Several years! Oh my goodness! Carole, before we get into the details of the book, please tell me when and where you earned your doctorates?
Johnson: Sure. I earned my PhD from the University of Tennessee at Knoxville in 1989 and my primary area of research was the development of children’s speech recognition skills in reverberation and in noise. In 2006, I received my AuD through Salus University to make sure I was up to date with my clinical knowledge and skills for teaching in an AuD program—and that turned out to be a terrifically worthwhile pursuit.
You know Doug, so many clinical issues, procedures and protocols have changed in audiology over the last two or three decades, and getting my AuD allowed me stay current for teaching in an AuD program.
Academy: I think you’re one of perhaps a few dozen (or less) people in the world with a PhD. and an AuD, which clearly demonstrates an outstanding foundation of knowledge as well as patience beyond comprehension!
Johnson: Thanks, Doug.
Academy: Okay then, so with regard to your new book, “Introduction to Auditory Rehabilitation—A Contemporary Issues Approach,” I was surprised to realize it’s not a collaborative effort of peers and colleagues, rather, you actually wrote the whole thing. How did that come about?
Johnson: I wanted to develop a cohesive text that addressed all aspects of AR from early life to elderly and to make sure the chapters were complementary, and that each built on the others. The more I thought about it, the more I realized I’d have to bite the bullet and just create the whole thing from scratch, which is why it took so long!
I felt it was important to present core content within a framework of contemporary issues to prepare students for clinical practice in today’s world. And when writing a textbook, authors stand on the shoulders of the giants in the field who have advanced AR to its present state. I hope the text captures and honors their outstanding efforts and contributions.
Academy: Again reflecting your amazing patience! Fair enough. Carole, many audiologists use the term “aural rehabilitation” to describe bits and pieces of the things you address in the book. Why did you use the term “auditory rehabilitation”?
Johnson: Great question. In 2001, American Speech-Language-Hearing Association advocated using two terms, “aural/ audiologic rehabilitation” to acknowledge the interrelated, overlapping, and complementary roles of audiologists and speech-language pathologists in serving patients with hearing loss and their families. Use of two terms is just too confusing and has led to problems in reimbursement when audiologists used codes with the term “aural rehabilitation,” which has been associated with speech-language pathology. Use of a professionally neutral term “auditory rehabilitation” helps to identify audiologists as the providers.
Further, advancements in hearing aid and CI technology coupled with advantages of early intervention through newborn hearing screening has focused rehabilitative efforts on development of auditory skills. Therefore, the book uses the term “auditory rehabilitation” to be “in tune” with contemporary issues and current approaches.
Academy: Okay, you’ve convinced me. And just to be clear, when you use the term “auditory plasticity,” I presume you’re speaking about neural plasticity as it applies specifically to the central auditory nervous system?
Johnson: Exactly. Yes.
Academy: With regard to auditory plasticity. What are your expectations relating to take-home AR programs such as Listening and Communication Enhancement (LACE), Fast-Forward and Earobics? Have you found that these programs do improve listening skills and to facilitate auditory rehabilitation?
Johnson: Yes. In particular, LACE performed very well with evidence-based outcomes. I know our sister campus in Montgomery found Fast-Forward to be a very good AR program for children with (central) auditory processing disorders, too.
Academy: I’m glad to hear you say that because the “take-home” DVD-driven programs provide an excellent and relatively inexpensive opportunity for the busy private practice audiologist to offer AR opportunities and alternatives for their patients, too.
Johnson: Absolutely. And it seems to me the vast majority of people who complete these programs will improve their listening skills…but it is indeed related to their motivation for and compliance with these protocols. Obviously, a major obstacle for AR is patient follow through with treatment. So I’ve found that it’s usually best for audiologists to offer a menu of AR programs and opportunities. Some people really like doing their AR work at home on the computer, while others find group sessions that are “live-and-in-person” to better meet their needs and may include significant others. So it’s not a “one size fits all” situation—flexibility and meeting the needs of the individual are key.
Academy: And today we’ve got about 10,000 baby boomers per day turning 65 years of age, and these people are very different from the previous generation.
Johnson: Absolutely. The boomers today are very sophisticated technically and they tend to do a lot more research prior to committing to any treatment program. The boomers look for information, outcomes, and flexibility so we can tailor AR programs to fit their particular needs.
As you might expect, when the individual participates in the creation of the plan, they’re very likely to follow through and achieve their goals. And when their auditory needs are fulfilled, that provides “carry over” into other areas of their life. So, for example, if they learn new and improved listening skills sitting at home while working with their computer in a no-pressure environment, those efforts carry over to other areas such as improved communication with loved ones.
Academy: Carole, please tell me a little about “psycho-social” issues related to hearing loss?
Johnson: Well, there are many aspects of psycho-social issues related to hearing loss. For many people with hearing loss, the traditional stigma related to hearing aids is still very much an issue—that is, for the three of four (or perhaps four of five) people with hearing loss who never walk in the door to learn about and manage their disability, the fear that they’ll have to wear highly visible BTEs is (in their minds) a real issue. The good news is the hearing aid manufacturers now offer amazing amplification solutions, many of which are nearly invisible—and that helps a lot.
It’s not that anyone should be ashamed or embarrassed by their hearing loss or their amplification systems—but many people still think of hearing aids as the “big beige bananas,” which signifies old, imperfect, less than ideal and all those other negative terms and concepts that audiologists have been addressing for more than 50 years. So having excellent hardware solutions that barely show is a major step in the right direction. Products which are barely visible really help to remove and deflate the stigma and importantly, it allows more people with hearing loss to consider getting help for their hearing loss.
Academy: I agree. Stigma and cosmetic issues are very important for all of us, not just boomers and not just people with hearing loss. Frankly, if I had a mild-to-moderate hearing loss and had to wear that same stereotypical “big beige banana” and I doubt I would do it. However, as you say, because so many of the new products are attractive
and barely visible, I would absolutely consider wearing them, as have many others. In fact, the majority of hearing aids fit in 2011 are the very tiny, barely visible, behind-the-ear hearing aids, which I’ve been referring to as “micro BTEs.”
Johnson: And getting back to your question on psycho-social issues, when I was studying for my AuD, I took a course from your good friend, psychologist Michael Harvey. I learned so much about important issues that I previously had not considered. For example, we explored the problems that might result when the parents of a child with hearing impairment haven’t gone through the grieving process and may not have resolved the emotions that come with that, or what would happen if they hadn’t yet come to grips with the fact that their child has hearing loss? And of course, if the mom and dad aren’t dealing with it well, the child has little chance of developing a healthy attitude and self-concept or framework from which to find and discover solutions—and then, add in the stigma issues which we already addressed – and the child’s likelihood for AR success is diminished.
Academy: However, and of significant importance, the whole internalization equation can change, right?
Johnson: Absolutely. When we do an excellent job with AR and counseling using barely visible products, the whole process and scenario can change from “what other people think about you” to “what you think about you.” Further, psycho-social issues can also vary with congenital versus acquired hearing losses, and they can range from surface-level, shallow issues to very deep emotionally based issues.
Academy: And that reminds me of your work from the University of California at Santa Barbara, where you wrote about “the hearing aid effect,” which is more-or-less that when people wear traditional large BTEs and body-aids, the typical onlooker does assume the person wearing the hearing aids is 10 years older and has 10 fewer IQ points!
Johnson: Right, and so that’s been an ongoing area of interest for me for all these years. But again, as we’ve discussed, with the new “micro BTE’s,” the physical appearance of the hearing aids has become, and continues to evolve into a moot point. And so again, it’s changed from what others see and think of you, to how you manage your hearing loss and what you do to improve your own situation.
Academy: So in many respects, micro-BTEs combined with an excellent AR program helps promote and allow self-efficacy while minimizing stigma?
Academy: Carole, it’s always a delight speaking with you—I know we’ve already gone way over the time limit, and I want to thank you so much for your time and knowledge. I believe your book is excellent and if I were teaching a class on AR, this is the book I’d be using. Further, I totally endorse this book and I believe it’s very useful for anyone interested in exploring and developing a contemporary AR program.
Johnson: Thanks, Doug!
Carole E. Johnson, AuD, PhD, is a professor, Department of Communication Disorders, at Auburn University in Alabama. She is also the author of Introduction to Auditory Rehabilitation—A Contemporary Issues Approach.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.