Aural Rehabilitation, the AR Value Proposition, and Cochlear Implants: Interview with Mark Ross, PhD
Douglas L. Beck, AuD, speaks with Dr. Ross about bi-modal amplification, how the world sounds through a cochlear implant (based on personal experience), and more.
Academy: Good morning, Mark. Thanks for your time!
Ross: Hi, Doug. You’re welcome. It is always fun getting together with you.
Academy: Mark, you are probably one of the true “legends” in audiology. I always appreciate getting your thoughts and perspectives. Briefly, I should mention that you were one of the recipients, a patient actually, who went through the remarkable aural rehabilitation program at Walter Reed Army Medical Center (WRAMC) some 55 years ago.
Ross: Well, I guess that is about right. I attended their rehab program in January of 1952, so it has been a little while! However, in retrospect, what a remarkable program it was. It lasted for two months, and during that time, all of us who were patients were learning to speech read, and they trained us how to use hearing aids, and we learned basic and some not so basic strategies regarding how to listen more effectively.
Academy: It really is amazing to consider an AR program lasting eight hours a day, five days a week for two months.
Ross: Yes, there is probably nothing like that available today, but I have to tell you, when you put in the time, make the effort, and participate, you can really accomplish quite a lot! From today’s perspective, however, not only was it a bit of overkill, but clearly out of the question economically. The lesson we should take from it, is that at the time, the U.S. government conceptualized hearing loss as a serious condition, and that attitude needs to prevail and underlay any serious effort at AR today.
Academy: Of course. Mark, what was your hearing loss like when you entered the WRAMC program?
Ross: Well, as best I can recall, I would think it was a bilateral moderate sensorineural hearing loss at that time. Of course, it did progress to severe-to-profound many years later.
Academy: And I know you had significant noise exposure as a young man. Can you review that for me?
Ross: I served in the U.S. Army Infantry for a couple of years during World War II. Then I re-enlisted in the U.S. Air Force and served in the Korean War. However, I really was not terrifically aware of my hearing or hearing loss at that time. One day, I was actually working in the Fire Department and I missed a fire call! The Fire Chief called me on that and he thought I was faking…and that led to a series of hearing tests, the discovery of a significant hearing loss, and then I was off to Walter Reed.
Academy: And then as I recall… after your military experience, you spent a decade at the University of Connecticut, then you directed the Willie Ross School for the Deaf in Massachusetts for a few years and then went back to the university for another 15 years or so?
Ross: Yes, that sounds about right. I was at the Ross School for three years. I took the job primarily so I could put into practice the many management themes I emphasized in my classes and in my writings. One primary theme was to emphasize auditory management of the children, and I think we succeeded. I should mention that although the school and I share the same name, there was no familial relationship. After my second 15 years at UConn, I retired and then became the director of research and training at the New York League for the Hard of Hearing, and I finished with the NY League in 1993 or so.
In addition, for the past 15 years, with support from the RERC at Gallaudet University, I have written an article in each issue of Hearing Loss, the organ of the Hearing Loss Association of America. What I try to do is, in my writing, bridge the gap between consumers and professionals.
Academy: You have had an amazing career!
Ross: Thanks, Doug. Yes, it has been a lot of fun and I have learned so much! I got so much from WRAMC, which has influenced my thought processes and my career, and participating in that program proved to be highly beneficial in so many ways.
Academy: Okay then... armed with that experience and knowledge, I wonder if you can tell me your thoughts as to where we are as a profession with regard to aural rehabilitation in 2009, particularly compared to where we were 50 years ago?
Ross: Well, Doug, one of the points we have talked about before is that aural rehabilitation is arguably the single most important thing we do as audiologists. When you think about it, when a professional picks a hearing aid and programs it for a patient, that’s very important and certainly a significant part of taking care of the patient—but frankly, that’s a technical skill that other professions share, such as hearing instrument specialists and maybe some physicians, too.
There is much more to being an audiologist. The thing that separates us from the pack is our training, knowledge, and education in aural rehabilitation and counseling—, which, when applied to patients, produces incredible results— much like I, experienced at WRAMC.
It is so important that audiologists provide AR services to maximize the patient’s ability to use amplification and to minimize the effects of hearing loss for the individual.
Academy: I agree, but unfortunately providing AR services costs money, and in general, audiologists cannot bill for AR services, so of course, audiologists do not generally offer formalized AR courses.
Ross: That is true and that is a significant problem. However, there are some very good, new, and financially viable at-home programs that audiologists can work with.
Academy: You mean programs such as Listening and Communication Enhancement (LACE).
Ross: Exactly, that is a well-designed program and very creative and it can be supervised by the audiologist online. Then there are programs such as the new one Harry Levitt is working on (an audio-visual program called “Read My Quips”). I am excited to see how that looks when it is commercially available, and I think it will be available soon. Therefore, we have creative solutions that really work and are extremely useful to patients. Therefore, to me, these are tools we need to embrace and encourage our patients to use. Further, if you combine these tools with AR group sessions—that would be ideal.
Academy: That makes sense, and in fact, the AR “value proposition” becomes more favorable with each participant working independently on their own AR program, and then getting together as a group to share experiences, observations and trouble-shoot.
Ross: Absolutely. The group time is very valuable, and even if the group only met twice a month, it would be significant and highly beneficial. That would give the participants a chance to talk about their experiences and to learn about speech reading, repair strategies, communication strategies, auditory training, and so much more.
Academy: Makes sense to me Mark! Okay, so then before I let you go, please tell me about your experience with your cochlear implant?
Ross: Yes, well I am glad you asked. I got my cochlear implant almost three years ago when I was 80 years old. It will be three years in December 2009. First, I am very thankful to have the implant. As you recall, Doug, my hearing was so bad, about 105 to 110 dB across the board, and there was little information to be had from the best hearing aids. With the cochlear implant, I do understand speech in quiet very well—most of the time. However, I always use the bi-modal system—cochlear implant on one side and hearing aid on the other. Of course, in noise, I do very poorly, so I try to do the best I can to stay in quiet communication environments when conversing!
Academy: That seems like a good strategy. What does the cochlear implant sound like?
Ross: Good question. I would have to describe it as mechanical, or perhaps electrical. There is a quality to the sound of the cochlear implant that is not natural at all, but is still so much better than not hearing! When I use the two systems together bi-modally, the hearing aid and the implant together improve the sound quality.
My audiologists are my colleagues and they work so well with me and I am so grateful for them, but here is what I noticed. Sometimes, when they make a new MAP for me, I try the new MAP and after a little while I can get used to it, but it is so difficult to compare it to the previous MAP because the auditory memory for CI sounds goes away very quickly. Therefore, unless there is a dramatic difference, I cannot tell which is better or worse. I would like to see paired comparisons used clinically and incorporated to get to a better cochlear implant fitting. I think that would be more scientific and perhaps produce better results. All of us wearing cochlear implants just want one simple thing—to hear better!
Academy: And if that were actually simple, it would be wonderful! Hey, one of my favorite Mark Ross quotes is something you told me some 10 or 15 years ago. I recall you saying, “The worst thing about having a profound hearing loss—is ‘you don’t hear so good.’”
Ross: Yes, I remember that. It is a true statement, and you see it really does come down to simple things!
Academy: Mark, thanks so much for your time. It is always a delight to chat with you.
Ross: Thank you, too, Doug. It has been a lot of fun for me, too.
Mark Ross, PhD, is an audiologist and associate at the Rehabilitation Engineering Research Center at Gallaudet University.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.