Chapter 57: Aural Rehabilitation and Hearing Aids

WHAT IS AURAL REHABILITATION?

Aural rehabilitation can be defined as the remediation of the functional component of hearing loss. This is best accomplished by a combination of 3 factors: (1) hearing devices to provide audible sound input, (2) auditory training for the brain to make sense of sounds, and (3) counseling, for the patient to understand the issues, options, processes, expectations, and solutions pertaining to hearing loss and rehabilitation. In this chapter, each component will be discussed separately, but they are intertwined, codependent, and each integral to a total aural rehabilitation plan.

As we move toward a more holistic approach in hearing healthcare, total aural rehabilitation is becoming the center of focus rather than dispensing devices. Because of the complexity of hearing loss and its diverse ramifications, an amplifying device alone is only a portion of the process. In order for a person to utilize the prosthetic source of sound, and to integrate new listening habits into improved functional communication, a broader plan of treatment must be used. The entire scope of patient needs, including listening behavior, lifestyle, neural plasticity, motivation, and age-related cognitive changes all need to be considered in determining methods and measures of aural rehab. Aural rehabilitation is not an add-on service to the fitting of amplification, but rather the overriding structure that can incorporate a hearing device as 1 component. A comprehensive plan includes the management of the person’s amplification system, necessary training to maximize speech-perception performance, and a heavy dose of counseling.

Boothroyd (2010) proposed a framework for a progressive approach to aural rehabilitation, as seen in Figure 57–1. The patient lies at the center of the plan, and components are added based on patient-specific needs. The way to determine those needs is through evaluation (standardized testing), professional–client interaction (eliciting and listening to the patient’s real-life needs), and outcome assessment (verification and validation, which will be discussed later in this chapter). The first step is sensory management: providing the patient with access to sound through the fitting of an appropriate amplification system. After that is in place, professional–client interaction and outcome assessment at regular intervals will determine the next step in the aural-rehabilitation plan.

HEARING DEVICES

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