The Audiologist - A Phonak podcast

The Audiologist - A Phonak podcast

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Speaker 1:

Speaker 1: The Audiologist, a Phonak podcast.

Bernadette Fulton:

Bernadette Fulton: Welcome to The Audiologist, a podcast series created by Phonak to offer audiologists and people interested in audiology new perspectives on hearing health topics. This series of podcasts is all about adults with severe to profound hearing loss. At the microphone is audiologist Bernadette Fulton. I'm audiology manager for severe to profound hearing loss at Phonak international headquarters in Switzerland. Today, I'm excited to talk to Laura Turton, a Clinical Audiologist, who is the Deputy Head of Department at the NHS in Tayside in Scotland. Laura specializes in severe and profound hearing loss and was editor of the guidelines. In this podcast episode, we'll be looking into the nature of severe and profound hearing loss. Severe to profound hearing loss is something you see every day in your audiology clinic, but is it the same for everyone?

Laura Turton:

Laura Turton: I would say, no, it's not and that's exactly why the guidelines that we've been working on suggest that we do a person-centered approach and that you take the time to get to know the person in front of you because somebody can be in front of you with a extremely profound hearing loss, but actually they have very clear expectations of what they want to achieve. They're very realistic and they know how they want to achieve them. You can have somebody who maybe has a moderate to severe hearing loss who is really struggling because of the situations that they're in. It's a much wider perspective than just the audiogram. The audiogram is a key part of what we do in audiology, but it isn't the only thing that we should be looking at.

Laura Turton:

Laura Turton: The amount of patients that we see with severe to profound hearing loss through the research that has been done is estimated at about 7% clinically. However, that was based on some research around the definition that the British Society of Audiology did, which for the guideline purposes, we've adopted the WHO hearing loss grades, which brings it a bit further up the audiogram. A severe hearing loss is 61 to 80 decibels and a profound hearing loss is over 81 decibels. You are likely to see quite a lot of these patients coming through into your clinic. Therefore, it's important that you take the time to be able to get to know them and get to understand their needs and their wants so that you can appropriately manage them.

Bernadette Fulton:

Bernadette Fulton: Some individual audiologists may see very few clients, even with this change in definition that the World Health Organization has introduced. Just how common is it in the clinic?

Laura Turton:

Laura Turton: In our clinic, is it fairly common. We do see quite a lot of them and certainly, we don't have a specialist clinic just for severe to profound hearing loss. We have what we call a complex clinic where you might see somebody with a single-sided deafness and then your next patient might have severe to profound hearing loss. Then your next patient might have dementia. There's a bit of a mix, but out of our complex clinic, we worked out, I think it's two thirds are patients with severe to profound hearing loss. For us, it's quite a lot, mainly because these patients are different because quite often, they are returning patients. They're somebody who in the UK, it's recommended every three years that you come back and you have your hearing reassessed. It's not like I've got a severe hearing loss and next year I'm going to have a mild hearing loss.

Laura Turton:

Laura Turton: These are our patients for the rest of their lives. Therefore, they have different expectations because they've had amplification for a long time. Sometimes it's that their expectations actually are very poor and they don't believe that they can socialize anymore. They don't believe that they can go out and that they can do the things that they wanted to, but that's because maybe we've taken quite a narrow view of how we can support them. It's taking time to open that up and understand where they're struggling. Sometimes you can come up with ways for them to integrate and go out more and achieve things that maybe they didn't think was possible.

Bernadette Fulton:

Bernadette Fulton: In the past, I've heard you talk about deaf identity and that's something specific to this group. Can you tell us what you mean by that?

Laura Turton:

Laura Turton: So as part of being person-centered, I think it's important to try and work out with the patient where they sit with their deaf identity. Have they had a severe to profound hearing loss from birth? Again, I don't know if this is worldwide or not, but certainly in the UK we have a capital D deaf community, which would be somebody who is born or has had hearing loss very early on in life, and they are part of a deaf community. They might use sign language and they may have chosen to have hearing aids or may not have. Their views and opinions of what they, therefore, want to achieve with audiology is very different because it's a cultural experience for them and they're living it. They don't want to things like cochlear implants and that kind of thing. It could be a very sensitive topic for them and we've got to appropriately manage that.

Laura Turton:

Laura Turton: Then you have the patients who have gradually got hearing loss later in life after they've had speech. Maybe they have different views around deafness and the fact that they want to be able to hear in different situations and challenges. It's important to find out from your patient, where they sit with their deaf identity. For some of them, they haven't even accepted their deaf identity and therefore, it's about supporting them at whatever point they're at and then being appropriately, culturally sensitive around that deaf identity, rather than just going, "Well in audiology, you fit a cochlear implant criteria and therefore we should be putting you through." It's about working in collaboration with them and being sensitive.

Bernadette Fulton:

Bernadette Fulton: I think that that concept really highlights that the audiogram is really just a leaping off point. It's really these people have very different life experiences, expectations, and beliefs about themselves. This kind of hearing loss in the general population's pretty rare. What would cause this degree of hearing loss? You're working in our hospital clinic, so you would have pretty strong diagnostic side of what you're doing. Do you find that the cause influences the management?

Laura Turton:

Laura Turton: I think sometimes it does, but I think probably in slightly more broader terms for is it a conductive hearing loss? Is it mixed? Is it a sensory neural hearing loss? Those kind of elements. How much of it may have been affecting outer hair cell damage, inner hair cell damage, that kind of thing. I think, overall, it's again taking that person as a person and finding out what impact it's having. Yes, we absolutely do have access to diagnostics, but for the most part in audiology, certainly where I work, it's more about how can we support rehabilitation from here on in? Our ENT colleagues would support if we said, "I think this patient needs to be scanned, or I think he might need to look into this for us," and would manage that if we requested it.

Laura Turton:

Laura Turton: For the most part, the diagnostics seem less important around the cause. That's not to say the diagnostics for assessment, aren't slightly different to mild to moderate hearing loss. I know that we'll be talking about that in a future podcast, but I think that fundamentally whether it's from meningitis, whether it's from otosclerosis, it's from a head injury, those kinds of things, it isn't necessary to get to that level of diagnostics as long as you feel you've got enough information to support rehabilitation.

Bernadette Fulton:

Bernadette Fulton: A theme in what you've said so far is that the consequences aren't just about the hair cells and audiogram. Can we talk about the consequences of this degree of hearing loss, and how it affects the client's life and the different aspects of their life that it can affect?

Laura Turton:

Laura Turton: Again, it would be linked back to a deaf identity because if you are definitely the capital D and most of your interactions are with other people who are deaf and you're using sign language, your consequences would be very different. That's why it's important to work out with somebody where they sit with their deaf identity to understand that. If you think about someone who has had hearing and then either gradually or suddenly is then left with a severe to profound hearing loss, and typically they're going to be the majority of patients that you see in audiology because they're the ones who are seeking help with their severe to profound hearing loss. Then if you imagine pretty much any aspect of their life, then the consequences tend to be quite far reaching around that. Every single communication that they will have will be impacted by having had a severe to profound hearing loss, whether that's at home, whether it's at work, whether it's socially.

Laura Turton:

Laura Turton: I've had patients when I worked in the charity talk to me and also their family members, and they talked about the fact they've just lost the chit chat, the every day how's your day been? That those were the kinds of things that they were really mourning because that had changed so dramatically. Traveling in a car was really horrendous for them because it was just silence because they couldn't have a good conversation because they didn't get the visual clues in the car. Therefore, they decided it was easier just to have the radio off and just sit in silence. They absolutely dreaded those kind of journeys. Then that obviously leads to an increase in depression, an increase in anxiety and frustration, a change in those roles. Wives who may be... Stereotypical, I hate that, but wives who maybe didn't do all the finances before have had to take that on because their husbands can no longer communicate on the phone with the bank. The change in dynamics around that.

Laura Turton:

Laura Turton: Then you've got all these other increasing risks, so you've got the increase in risk in falls. The fact that they're much more likely to be unemployed, that there's evidence around earlier death and all the reduction of quality of life because you can't communicate well and you're not working. Obviously, this is an absolutely everybody, but there is enough evidence out there that as a group, that there are far-reaching consequences that mild to moderate hearing loss don't have.

Bernadette Fulton:

Bernadette Fulton: Could you give us a little clue about the kind of unique amplification and rehabilitation needs that are needed to cope with this range of consequences of the hearing loss?

Laura Turton:

Laura Turton: I think that for the majority of patients, you probably want to have a complement of both technology and the psychosocial. That you shouldn't rely very heavily just on technology because although technology has come on absolute leaps and bounds in the 20 years that I've been involved in audiology, we are still in a position where it could only work with the processing capabilities of what the ear is left with. If there's been devastating damage in the outer hair cells in processing, then actually there's only so much the technology is going to do. Then equally on the psychosocial side, that the peer support, the attending lip reading classes, the charity support that can be available, all of that aspect and the rehabilitation that is really important, will support the technology. I think it's taking that broad view and trying to help your patient take that broad view because if you imagine the scales of it, if they're too heavily weighted one side or the other, then they're going to have limited outcomes.

Bernadette Fulton:

Bernadette Fulton: Okay. To just try and recap the key messages from our discussion now, I would say that with regard to the prevalence that we spoke about, that you can probably expect around 2 out of every 10 adults attending a non-specialized adult hearing aid clinic to have a severe to profound hearing loss. Although, you did tell us that in your clinic, it's more like two-thirds, that's because it's a specialized clinic and that the causes can be very different. You mentioned congenital and deaf identity, and signing deaf and so on, then those who acquire hearing loss through their lives and that the diagnosis is important, but the most important thing is understanding the needs of the individual, regardless of what their background. Do you have any closing messages that you'd like to give our listeners today?

Laura Turton:

Laura Turton: Just a plea in terms of research, really. That if I'm lucky enough to be involved in the recap of this and the review in five years time, I would love it to be flooded with new research that has been done both in terms of research lab work, but also in terms of clinicians pushing for this group to have more clinical research so that we can update it and have a much more specific set of recommendations based on the most up-to-date research in those five years.

Bernadette Fulton:

Bernadette Fulton: Great. Thank you. Laura, thank you so much for joining us today. It's easy to think of these clients with large degrees of hearing loss as our regulars, our return clients in the clinic because as you said, they keep coming. The hearing loss never goes away and they come back to the clinic again and again. It's really easy, I think, to forget how significantly this degree of hearing loss is affecting their everyday life and even impacting their identity. Because of that, I think it's also easy to forget how much we can really offer these clients. If we engage with them, as you said, they can tell us exactly what they want usually and what they expect, and if they have very low expectations, then we can really offer them maybe a lot more than they expect. Also, not just to them, but of course, also to their family.

Bernadette Fulton:

Bernadette Fulton: Thank you so much, Laura. Thank you for joining us today and thank you, especially for your work in making the guidelines for best practice a reality. If you would like to learn more or obtain a copy of their best practice guidelines, they can be downloaded from the Phonak Pro website, which is www.PhonakPro.com, and then look for severe to profound hearing loss.

Speaker 1:

Speaker 1: The Audiologist, a Phonak podcast.

About this podcast

‘The Audiologist’ is a podcast series created by Phonak to offer audiologists and people interested in audiology new perspectives on hearing health topics.

As the world’s leading hearing aid manufacturer, we regularly collaborate with top audiology experts from around the world. We launched this podcast to share their inspiring views and insights from the industry and the latest on research and learning. You will learn from the very best in their respective fields.

So, join us and our guest speakers for a fascinating journey reflecting on the past, present and future of audiology.

by Phonak

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