A Hearing Needs Assessment:

Individualizing the
Recommendations

LARRY MEDWETSKY, PH.D

GALLAUDET UNIVERSITY
202-448-6965
LARRY.MEDWETSKY@GALLLAUDET.EDU
Agenda
Some Background to Topic

Importance of the Case History

Audiometric Assessment Benefits

Communication Needs Assessment

Hearing Handicap Questionnaires

Prioritization of Listening Needs

 Background

Nowadays, individuals can hear about Personal Amplifying

Systems (PSAPs) on TV/Internet, and order from Internet

Recent PCAST recommendations that individuals with mild to

moderate hearing loss be able to purchase PSAPs without
audiologist involvement

Can doing the above really meet ones hearing needs? Is this a
good thing?
For Your Information

Most individuals with a mild hearing loss do not have difficulty in quiet,
1-1 listening settings
Their difficulties tend to occur in difficult listening settings- especially in group
settings

Great majority of PSAPs are essentially amplifiers, thus, do not have

capability of enhancing the ability to hear in noisy environments, and,
similar in many ways to older hearing aid technologies
Thus, even though may possibly work well in quiet, may be annoying in noisy
settings as also amplifies the noise
 FYI- contd

Yet, some of these devices may be quite helpful to someone who lives
alone and does no go out often or to someone residing in a nursing
home

Thus, an audiologist can help to ascertain if the product if of

good technical quality, might meet ones needs, and make
sure that the device is properly set according to the wearers
needs
Factors Guiding an Audiologists Possible
Recommendations

Case History

Results of the Hearing Test

Lifestyle Needs

Knowledge of the listening/communication difficulties

being encountered
Case History
When an individual schedules a hearing test, they are usually sent
a questionnaire to complete

This questionnaire usually asks questions concerning:

General medical history (illnesses, surgeries, conditions- such as
diabetes, medications, etc.)

- Certain conditions such as diabetes or medications (such as blood

thinners) guides the audiologist as to possible future issues relative to
making earmold impressions (possibility of uncontrolled bleeding)and
need to take extra cautions
Case History- contd
Ear related issues
History of cerumen (wax) buildup
Such difficulties might suggest that, if possible, an open ear fitting be done
to minimize issues with cerumen buildup

History of recent middle ear problems

Individual may need to be monitored more closely (may not always
know that is experiencing middle ear issues)
Middle ear issues may mean that individual is more likely to need ENT
referrals
If client gets hearing aids, at times may not derive as much benefit
in those times, may need to adapt communication strategies
consider purchase of an augmentative listening system (remote
mic system- could be hearing aid streamer)
Case History- contd
History of Vertigo, Balance, Tinnitus related issues

By themselves, indicate further probing by audiologist as to whether

these are the primary issues. If so, further assessment likely to be done:
- many audiologists are specialized in balance disorders and
depending on issue may diagnose/engage in intervention or refer to ENT

- if significant tinnitus is present, if audiologist specialized in area, may do

assessment/intervention or refer to someone specialized in area

If these issues are recent, they may be indicative of a possible pathology

of the vestibular nerve or lower auditory brainstem (such as a tumor), and
audiologist will initiate special audiometric tests

If results are significant, will subsequently refer the client to an ENT

Case History- Summary

Information that is gleaned:

Primary reason why client has scheduled the appointment

Indicators of a possible underlying medical condition, and, if so,

guide selection of audiometric tests chosen to administer

Issues that may need to be monitored over time

A need to consider possible subsequent intervention/referrals

Contribution of Audiometric Results

Is there a hearing loss?

If so, is there a medical aspect to the hearing test results? If so,

Is there a conductive component (such as middle ear fluid, middle ear
bones issues?) requiring an ENT referral?

Is there a possible issue with the auditory nerve or brainstem (such as a

tumor, or, processing related issue that suggests the need for
continued testing and/or a possible ENT referral?)

The thresholds, maximum tolerance levels at different frequencies help

the audiologist determine the type of hearing aid (re gain/power needs,
possible styles) and set the initial programming characteristics
Audiometric Results- contd
If there is a hearing loss but no suspected medical component, then what
do the results suggest relative to recommendations?

Mild hearing loss

Depending on individuals lifestyle needs, may result in suggestion of:
Communication strategies and monitoring of hearing over time
If the individual very active (experiencing difficulty at work or during social
activities), may result in a hearing aid recommendation and/or use of HAT-
such as remote mic system

Moderate or greater degree of hearing loss

Hearing aid and possibly hearing aid streamer and/or HAT

Communication Needs Assessment

Cynthia Compton-Conley while at Gallaudet University developed a

Communication Needs Assessment tool that is very effective in identifying an
individuals listening/communication needs. The following is based on this
work.

A communication needs assessment can be categorized as examining:

Client Factors

Four different communication needs

Three general settings

 Client Factors

Type & Degree of Hearing Loss

Age
Health Issues
Cognitive Function
Cosmetics
Budget
 Client Factors-contd

Hearing Loss
Individuals with 40 dB+ PTA would likely benefit from having
T-coils in hearing aids for telephone/recreational use.

Age
child, teenager, working adult- likely in noisy, group
settings
socially inactive senior, bedridden senior- quieter lifestyle, -

Activities/socio-emotional factors need to also be considered

relative to ones stage of life (e.g., healthy active seniors).
 Client Factors- contd

Health Issues & Cognitive Factors

Eyesight/physical dexterity- if poor, need for a remote control
unit with large buttons
Activity level (active, sedentary)
Cognitively intact, different stages of dementia- perhaps
photos on landline telephone re phone memories

Cosmetics
Is this a concern for the client?
 Client Factors- contd

Budget
Are there any budget constraints?
Are there any possible 3rd party funders (school,
Vocational Rehab, Employer)?
 Communication Needs Assessment
Regardless of ones hearing status, the following are four general overarching
receptive communication needs:

1. Face-to-Face Communication
(1-1 conversations, group conversations, lectures)

2. Reception of Electronic Media

(TV, computer, Music, Movies, Theater)

3. Telephone Reception
(landline, cordless, cell phone, computer)

4. Alerting Signals
(doorbell, phone ring, smoke detector, alarm.)
Summary: Four overarching receptive listening needs.

Diagram courtesy of C. Compton-Conley

Environmental/Listening Settings

The following include some key listening settings:

Home (house, apartment, dorm)/Senior Care facility

(nursing home, senior care)

Work/School/College

Recreation (restaurant, movie theater, play, museum, a

presentation)/Travel

Hospital/Doctors office, Church/Synagogue

 Listening Environment Factors

Client Work/School/ Recreational

Factors Home
Community Activities

Type Degree
HL
Face to Face Face to Face Face to Face
Age

Health Issues Communication

Media Media Media
Needs
Cognitive
Function
Phone Phone Phone
Cosmetics

Budget Alerting Alerting Alerting

 Listening Environment Factors
Client
Work/School/ Recreational
Factors Home Community Activities
Type Degree HL Face to Face Face to Face Face to Face
Bilateral normal- Sunday family Consultant Friday night
moderate SNHL dinner meetings poker night
Slow progressive Wife from (1-1/small with the guys
another room groups)
Age: 72
Media Media Media
Health Issues TV loud, wife none Frequent
Not an issue complains movie goer
Phone
Cognitive Function Phone Cell phone Phone
Not an issue Some difficulty with clients Cell phone
hearing on
Cosmetics home and cell Alerting Alerting
Wants something No problems No problems
small Alerting
No problems
Budget: no limit
 Case # 1: Summary

Listening/Communication Difficulties Expressed

Face-to-Face: group meals, hearing from another room, work

meetings, poker nights

Media: plays TV too loud, frequent movie goer

Phone: some difficulty hearing on landline and cellphone

Alerting: no reported difficulties

 Possible Recommendations
Hearing aid:
because of cosmetic issues, a small size behind-the-ear, receiver in the hearing aid
(somewhat inconspicuous and stylish); this aid also allows low-frequency sounds to
be heard in unimpeded fashion while avoiding occlusion
Hearing aid needs to adapt to various listening environments, have good noise
reduction/directional capability
Include T-coil, not so much for phone but for use with HAT at movies and plays

Streamer or direct blue-tooth connectivity:

Paired with cellphone or blue-tooth landline phone (if not, then can use T -coil to
hear phone)
Paired with Blue-tooth TV transmitter allowing to hear TV at lower volume
Paired with BT computer to hear media or music, etc.
 Listening Environment Factors
Client
Factors Work/School/ Recreational
Home Community Activities

Type Degree HL Face to Face Face to Face Face to Face

Moderate to Resides in Difficulty Difficulty
Mod-Severe SNHL nursing home hearing in hearing others
Difficulty hearing dining room during
Age: 88 nurses/other recreation
residents Media
Health Issues Not Applicable Media
Diabetic Media Not hear TV
Severe Arthritis TV loud, room Phone in recreational
mate complains Not Applicable setting
Cognitive Function
Early Dementia Phone Alerting Phone
Difficulty hearing Not Applicable Not Applicable
Cosmetics on room landline
Not a concern phone Alerting
Not Applicable
Budget: limited Alerting
Nursing staff
 Case # 2 Summary

Age, Health and Cognition:

88 years old, early dementia, arthritis

Listening/Communication Difficulties:
Resides in nursing home

having difficulty hearing nurses

TV loud, roommate complains

Difficulty hearing landline phone

Difficulty hearing in dining room/recreation activities, hearing TV in

common area
 Possible Recommendations
Hearing Aid

Cosmetics no concern, limited budget

Because of lifestyle (nursing home, relatively sedentary/quiet

environment), does not need expensive technology, yet benefit from
directional mics because of difficulty hearing in dining room

Because of early stage dementia, might consider one hearing aid but
in this case because of likely ability to hear better in noise with two
versus one hearing aids, recommend two lower-cost hearing aids

Because of severe arthritis yet early stage dementia, recommend

hearing aids that adapt to environments rather than manual
programs/remote control where client might use wrong program or
lose remote

T-coil (see next page)

 Possible Recommendations- contd

Hearing Assistive Technology

Hearing aid compatible, amplified telephone with photos re each

telephone memory (due to dementia) and big buttons (severe
arthritis, if must try and call someone not in telephone memory
bank)

Induction loop in the main recreation area, if possible, otherwise

lend personal FM receiver and have FM transmitter- with direct
mic if someone speaking or line-in to transmitter from TV or music
player

If client able to keep up with text, captioning on TV

Assessing Communication Deficits and
Needs- contd

Hearing Handicap Questionnaire

Client Oriented Scale of Improvement (identifying the

clients specific areas where he or she wants most help)

Daily log/diary whereby the client monitors areas of

listening/communication difficulty

The above not only can guide areas to explore re a possible

hearing aid/HAT fitting, but also to some extent the devices
that might best address these needs.
Hearing Handicap Questionnaire
# of Hearing Handicap, Hearing Aid Benefit/Satisfaction, etc. questionnaires
- selection of which depends on aspects an audiologist wants to measure

I will focus on the hearing handicap questionnaire; I will present one developed
at the Rochester Hearing & Speech Center, which is focused on perceived
listening/communication difficulties and socio-emotional aspects

Hearing handicap questionnaire is administered prior to (pre) and after a hearing

aid fitting (post)

The Pre-questionnaire can determine what the listener perceives as his/her

listening difficulties and possible socio-emotional issues; also can be administered
to significant other to compare answers (responses guide counseling and
contribute to recommendations)

Post questionnaire findings help determine degrees of success attained and if

there are still needs to be addressed
 Hearing Assessment Pre-Questionnaire: Client
Do you feel you have any hearing difficulties? Yes Sometimes No
Do others notice you have hearing difficulties? Yes Sometimes No
If you answered no to both of these questions, you can stop here. Otherwise, please answer the following questions.
Do you currently wear hearing aids? Yes No
If you currently wear hearing aids, please answer the following questions as they apply to you when you wear them.

Doesnt
Yes Sometimes No Apply
1. Do you have trouble hearing when someone talks softly?
2. Do you hear what others say, but it's not always clear
3. Do you have trouble hearing others speaking when they are not facing you?
4. Do you have to ask people to repeat themselves?
5. Do you have difficulty hearing on the telephone?
6. Do your family/friends say you play the TV/radio too loud?
7. Do you have difficulty hearing the doorbell/telephone ring?
8. Do you have trouble hearing others in noisy places or group settings?
9. Do you have difficulty hearing the speaker in a large group setting?
10. Does your level of hearing interfere with your personal or social life?
11. Does a hearing problem cause you to feel frustrated when talking to others?
12. Do you avoid being with others because of your hearing?
 NAL
CLIENT ORIENTED SCALE OF IMPROVEMENT
Name : Category. New Degree of Change Final Ability (with hearing aid)
Audiologist : Return Person can hear
Date : 1. Needs Established 10% 25% 50% 75%
95%
2. Outcome Assessed

Almost Always
Slightly Better

Half the Time

CATEGORY
No Difference

Most of Time
Occasionally
Much Better

Hardly Ever
SPECIFIC NEEDS

Worse

Better
Indicate Order of Significance
 Daily Log/Diary

Client monitors areas of listening/communication difficulty

(unaided/aided)
Information is helpful in discussions with audiologist re when and how
much difficulty the client experiencing in different listening settings:
(a) prior to a hearing aid fitting
(b) post-hearing aid fitting

Post hearing aid fitting, the information is helpful in fine-tuning the

hearing aids and/or discussion of possible communication strategies in
perceived difficult settings
 Hearing Aid Data Logging

Hearing aids now have capability of determining how

often an individual is in a certain listening environment
(quiet, noise, environment + noise, etc.) and how often
an individual uses the various hearing aid programs:

Useful in helping the audiologist know where the clients spends

most of his/her time, which may aid in counseling re communication
strategies

Useful for determining if client is setting hearing aid corresponding

to the environment

o if using manual programs, some newly aided individuals

sometimes dont remember to switch programs to the different
listening settings
 Summary of Talk
The audiometric assessment can determine:
If there is a hearing loss and the severity
Type of hearing loss
If medical component present, if a primary care or ENT referral is warranted
If sensorineural hearing loss, (a) monitoring sufficient?; (b) counseling strategies
sufficient? , (c) hearing aid, and/or hearing assistive technology warranted?;
and (d) if hearing aid, initial programming characteristics (gain, compression,
maximum output, etc.)

Communication Needs Assessment can determine:

Type/style of hearing aid and desired program characteristics
If client would benefit from a hearing aid streamer/BT hearing aid
If client would benefit from specific HAT
 Importance of Audiologists- My Biases as an
Audiologist but Evidence-Based Opinions

Relative to current discussions re PSAPs, etc., at the minimum audiologists must

be involved in assessing ones hearing and ensure no medical issues

Audiologists use audiometric data beyond thresholds (such as tolerance levels

at different frequencies) to program a hearing aid

Audiologist can provide communication strategies appropriate to the needs of

that individual
everyone s hearing is different and lifestyle needs vary greatly

Audiologists can help determine the technology that best meets clients needs:

Hearing aid with manual programs and/or able to adapt automatically to different
listening settings

Hearing aid streamer or BT hearing aid, and/or HAT