Siemens Beethoven Discussions 2000 brochure

Hearing Training against Hearing Frustration –
When High-Tech alone is not enough

Beethoven Discussions 2000

Hearing Training against Hearing Frustration –

When High-Tech alone is not enough

Beethoven Discussions 2000

Bonn, 23rd March 2000

4

About the Beethoven Discussions 2000

Studies in Europe and the USA show that user satisfaction with hearing instru-

ments has increased significantly in the last years and that the quality of life

for these people has improved considerably. Despite this positive trend, there

remains a problem which needs to be addressed – too many hearing instru-

ments end up in a drawer instead of in the ears of their owners. A study which

was initiated by Siemens recently confirmed this problem.

What causes this contradiction?

It is apparent that high technology products alone are not enough to provide

complete satisfaction for many hard of hearing people. Experts know that a

hearing impaired person who waits too long to get a first hearing instrument

may have troubles adjusting to all the sounds which they have forgotten exist.

These people must relearn the skill of hearing and communicating in order

to fully benefit from their hearing aid.

As the worldwide leader in the area of hearing instrument technology, the

Siemens Audiology Group recognized the need to address this issue and thus

put together the program for the Beethoven Discussions 2000 with the help

of the German Association of the Hearing Impaired (DSB).The goal is to make

not only the hard of hearing and their friends and families aware of this

problem and possible solutions, but also to increase awareness among

professionals and healthcare policy makers in order to assure the best possible

help for the hard of hearing.

Beethoven Discussions 2000 5

The Beethoven Discussions were initiated by Siemens in 1997 to inform the

public about various aspects of hearing loss and to overcome prejudices

against the hearing impaired. Each

year the meeting brings leading

experts from the medical and

audiological community together

with representatives of the in-

dustry to exchange views and dis-

cuss these topics with the journa-

lists.

We would like to extend our speci-

al thanks to the experts who contributed their knowledge and experience to

this meeting. The fact that some of them are themselves hearing impaired also

added to the quality of the meeting as they were able to not only share their

expertise but also their personal experiences. Without their continued support

and commitment to this topic this conference booklet would not have been

possible.

Erlangen, July 2000

Maria-José García

Marketing Manager

Siemens Audiology Group

6 Beethoven Discussions 2000

Contents

The speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

n Part I

Harald Seidler, MD

Why do many Hearing Instruments end up in the Drawer?

1. Hearing Impairment in Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2. What can Modern Hearing Instruments do? . . . . . . . . . . . . . . . . . . . . . 12

3. Auditory Functions – Hearing Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4. Therapy with Hearing Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

5. Where are the Difficulties? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

6. The “Drawer Hearing Aids” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

7. Possibilities of Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

8. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

n Part II

Professor Gerlinde Renzelberg

Hearing Poorly for too Long

Means Forgetting how to Hear Correctly

1. Implications of Hearing Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

2. Age and Fitting of Hearing Impaired People . . . . . . . . . . . . . . . . . . . . . 22

3. Overload and Disappointment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Contents n 7

4. Learning how to Hear and how to Ignore . . . . . . . . . . . . . . . . . . . . . . . 26

5. Success Factor Hearing Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

6. DSB- Pilot Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

n Part III

Petra Speth

Hearing Training in Practice

1. Hearing Training as Early as Possible . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

2. The Way to Understanding is through Interaction . . . . . . . . . . . . . . . . . 34

3. How is a Hearing Training Conducted? . . . . . . . . . . . . . . . . . . . . . . . . . 35

4. Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

n Useful tips for the Hearing Impaired

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

8

The speakers

Harald Seidler, MD

Dr. Harald Seidler is specialized in ear, nose, and throat medici-

ne in Neunkirchen/ Saar, Germany. In 1996 he became

President of the German Association of the Hearing Impaired

(DSB), Berlin and has also been Chairman of the DSB regional

group in Saar since 1992. He is a member of the ADANO commission

“Audiometry and hearing prosthetics” and has been Vice President of the

German Association to Promote the Hearing Impaired since 1999. He is a

delegate of the State Medical Board of Registration of the Saarland. His lec-

tures and publications deal especially with hearing impairment, tinnitus, and

psychosomatic effects of hearing impairment as well as career and political

issues for the hearing impaired. Dr. Seidler has been severely hearing impai-

red since he was four years old, and has been wearing hearing instruments

for nearly 40 years.

P r ofessor Gerlinde Renzelberg

Professor Gerlinde Renzelberg is a specialist for peda-

gogical Audiology and hearing/speech promotion of the

University of Hamburg. Her work concentrates mostly on

hearing impairment pedagogic. She is a lecturer for communications training

Beethoven Discussions 2000 9

at the Academy for Hearing Instrument Specialists in Luebeck, Germany.

This pilot program was initiated by the German Association of the Hearing

Impaired (DSB) and is designed to continually educate hearing instrument

specialists, hearing trainers and teachers. Professor Renzelberg has many

years of experience in the area of pedagogic audiology. In 1980 she passed

the deaf-mute teacher’s exam and worked for many years in various depart-

ments of the Institute for Career Oriented Educational for the Hearing and

Speech Impaired (BBW) in Nuremberg.

Petra Speth

Petra Speth is a consultant for tinnitus, noise hypersensitivity, hea-

ring impairment and balance disorders in Aschaffenburg, Germany.

For many years, she has been dealing with the subject of hearing

training and cooperates with a hearing instrument specialists to

integrate hearing training into the basic care of the hearing instrument

wearers. After finishing her training as a registered nurse Ms. Speth worked

as a hearing therapist at the Tinnitus Clinic in Bad Arolsen where she was

involved in the development of a hearing training program as well as reha-

bilitation and retraining therapy. Petra Speth is also lecturer at the Siemens

Academy.

10 Beethoven Discussions 2000

Why do so many Hearing Instruments

end up in the Drawer?

Harald Seidler, MD

“In spite of the outstanding technology of

modern hearing instruments there is a

fundamental problem which no one seems

to talk about. Whereas most people who

get a new pair of glasses will immediately

experience perfect compensation of their

poor eyesight – most hearing impaired

people have to re-learn how to hear in order

to fully benefit from their hearing aid."

Part I n Harald Seidler, MD 11

1. Hearing Impairment in Germany

Approximately 15 Million hearing impaired people live in Germany. Not only

hearing instrument wearers are included in that number, but also everyone

with an acoustic communicational dysfunction. Some are impaired only in

certain situations, (e.g. loud background noise) while others suffer in many

situations, so communication becomes much more difficult for them. The

majority of the hard of hearing suffer from an inner ear hearing impairment.That

means that the part of the ear is damaged which is responsible for the

transmission of sound waves and the conversion of the mechanical waves into

electrical neural impulses. This type of hearing impairment can usually not be

treated with surgery or medicine. Hearing instruments are the only option.

According to the hearing instrument specialist guild, there are presently

2,7 million hearing instrument wearers in Germany. Increasingly affected are

older people. So, at least 40 percent of the population over 60 are medium to

severely hearing impaired in Germany.

12 Beethoven Discussions 2000

2. What can Modern Hearing

Instruments do?

The satisfaction rate is about 64 percent

with average hearing instrument tech-

nology (Kochkin 1997). Still, it must

be differentiated in which situations

hearing instruments reach satisfaction. One of the main areas is the improve-

ment of speech comprehension in a quiet environment or the listening to

music. State of the art hearing instruments also improve speech comprehen-

sion in situations with background noise. 74 percent of the hearing instrument

wearers would recommend a hearing instrument to others (Sohn 1999). This

situation was quite different only a few years ago.

3. Auditory Functions – Hearing Loss

It is important to note that the rehabilitation of the hearing impaired does

not mean to just turn up the volume of the radio so they can hear again. There

is a person between the ears, which means that the hearing impairment also

has psychosocial repercussions.

Experiencing new acoustic events n

The hearing impaired will notice a person who enters the room from behind

with delay, because they will not hear the opening of the door. They will

be startled when a hand touches their shoulder because they are not prepared

for it.

Teil I n Harald Seidler, MD 13

Inability to follow the conversation n

Many hearing impaired people do not understand all fragments of information.

Their difficult task is to put the acoustic puzzle pieces together into a mean-

ingful unity.This task often leads to being misinterpreted as being a slow. They

need milliseconds to put the heard fragments of information into a meaningful

context. This demands a great amount of concentration.

Limitation of self-determination n

A lack of important auditory functions often leads to feelings of insecurity.

The selfconfidence of many hearing impaired people diminishes when they

can not trust their ears.They are not sure if they will be reacting appropriately

to the given situation. In extreme cases they need a constant companion to

translate and explain everything that is being said.

R ole problems n

If one considers that a majority of hearing impairments start at an advanced

age, then it becomes clear that all areas of life are affected. When a manager

in a conference gradually notices that he or she does not understand every-

thing that is being said and increasingly gets lost in the discussion, he or she

is faced with new problems that have to be overcome. One can easily feel

unable to continue functioning in the same role.

14 Beethoven Discussions 2000

Withdrawal and depression n

Unfortunately, most hearing impaired do not get offensive, but rather withdraw.

That is why the German Association of the Hearing Impaired constantly recom-

mends people to show openly their hearing impairment. Withdrawal with the

excuse “I don’t have to go there anyway” is basically the beginning of a very

depressive attitude. Depression is very common, especially among the seve-

rely hearing impaired.

Controlling emotions and hearing stress n

Emotions are also affected. If one is not sure whether he or she understood

correctly, not even laughing helps. The hearing impaired person will be afraid

to laugh at the wrong moment or to give a wrong answer. In the course of

time this leads to tension which in turn will result in the loss of the normal

composure, increased nervousness, all the way to exhaustion. Hearing stress

develops because the hearing impaired always have to be on the ball, in order

to follow the conversation. A permanent, maximum concentration leads to

exhaustion symptoms, many times to burn-out-syndrome.

Articulation problems and missing speech melody n

The severely hearing impaired, in particular, will develop articulation problems

because they can no longer acoustically control their own voice. That means

many hearing impaired people not only have problems in understanding, but

often are not understood either.

Teil I n Harald Seidler, MD 15

4.Therapy with Hearing Instruments

Indication: Patients must be able to wear their hearing instruments and to use

them. They must have made up their mind to accept the hearing instrument.

They also must know that auditory cells can atrophy the longer they wait to get

a hearing instrument. Even with an optimal hearing instrument fitting the

optimal speech intelligibility can not be reached, for the auditory cells are

simply not accustomed to hear certain sounds anymore.

The time spent wearing the instruments is also important. It does not make

sense to wear the hearing instruments only while watching the news, and

then to lay them aside. The hea-

ring training means that one

wears the instrument throughout

the whole day. The important

thing here is to provide a binaural

fitting, for one needs both ears to

recognize from which direction a

noise is coming from.

16 Beethoven Discussions 2000

5. Where are the Difficulties?

Unrealistic Expectations n

Slight to medium severe hearing impaired usually adapt well to their

hearing instrument, in particular those with modern technology. But the

severe hearing impaired are often disappointed because they expect normal

hearing.

A coustic overload n

The hearing instrument neither solves all communication problems nor does it

solve psychosocial problems. Without proper instructions it can create acoustic

overload for many. After not hearing well for many years, these people

suddenly, with the help of the modern hearing instruments, are able to hear

everything. This may be considered nice for the moment, but in the long-term

the person may be overwhelmed. They need structured assistance because

they can not cope with the amount of incoming information. In other words:

Hearing can be unlearned and therefore must be re-learned step by step.

6.The “Drawer Hearing Aids”

This development represents one of the biggest wastes. According to a

study (Sohn 1999), 50 percent of hearing impaired older then 60 do not wear

their instruments at all or not all day. The consequences can be dramatic:

withdrawal, isolation and depression.

Teil I n Harald Seidler, MD 17

7. Possibilities of Rehabilitation

The objective of rehabilitation is not to restore normal hearing, but to gain an

optimum communication competence with what is available. The hearing

instrument is an important part of the rehabilitation of the hearing impaired,

but not the only one.

1. Support groups

Support groups, such as the DSB help the inflicted to see their limitations

in relative terms. Here, they have the chance to get to know others with

similar or even worse hearing problems. In this circle of fellow-sufferers,

openness is possible. Everyone can admit their hearing problems, because

the others also do so. Within this group there is communication assistance.

The sense of community is promoted and gives the opportunity to get poli-

tically and socially involved to help the hearing impaired as a whole.

18 Beethoven Discussions 2000

2. Communication training

The hearing impaired should receive additional support with the help of

communication training, so that the possibility for an optimum communica-

tion is given. Such training should include, hearing training, hearing tactics,

lip-reading, sign language corresponding with pronunciation, and psycho-

social- and technical consulting as well as speech education. Examples of

communication training already exist in Denmark and Switzerland, where it

is integrated as an important aspect of the fitting. First encouraging efforts

are being made in Germany. In Saarland and in Baden Wuerttemberg for

example, costs for communication training are totally or partially covered by

the health insurance. Also, the possibility of an integrated fitting, initiated by

the new health reform law, offers an important perspective, as it allows a

rehabilitative and medicinal

care next to the technical

fitting. If more than slight

communicative problems

are determined after the fit-

ting, communication training

should be urgently pre-

scribed and implemented.

Teil I n Harald Seidler, MD 19

8. Conclusions

A communication training should be viewed as a further step towards the

quality improvement within the fitting process. It means outpatient rehabilita-

tion for the hearing impaired, because not every hearing instrument wearer can

be sent to a rehabilitation clinic.The ENT-specialists and the hearing instrument

specialists have to accept this reality – which is happening to an increasing

degree. The objective is to see the hearing impaired as a complete person and

not as a person with a technical problem needing to be solved. This will

ultimately lead to a higher acceptance of the own hearing impairment. In order

to make further progress we must strive for optimal rehabilitation for the

people affected.

20 Beethoven Discussions 2000

Hearing Poorly for too Long Means

Forgetting how to Hear Correctly

Professor Gerlinde Renzelberg

“The ears belong to a human being who

has individual needs and desires.

This must be considered at each and

every fitting. Unfortunately, a hearing

impaired person is often treated only

in medical or technical terms. In order to

improve satisfaction, hearing instrument

specialists should learn from the very start

of their professional training about the need

for a hearing training program based on

individual requirements.“

Part II n Professor Gerlinde Renzelberg 21

n “Unfortunately, my ears are like a wall through which it is difficult to have

friendly communication. Otherwise – maybe – I would have had more trust in

them.” n

Ludwig van Beethoven to Bettina Brentano on August 11, 1810

Everyone can imagine how important hearing was for Beethoven. When he

wrote these lines, he already had been severely hearing impaired for over ten

years. He had been through and was still going through a process that is

known to many people. Sad resignation replaced the attempts to hide the

diminishing hearing ability. The unfulfilled hope to improve his hearing with

therapeutic or technical aids began to increasingly bear down on him. Many

letters as well as his note pads that he used at a later time, when he was

nearly deaf, document this.

1. Implications of Hearing Loss

Beethoven’s fear to be considered incompetent was deep from the very

beginning of his suffering. The knowledge of the loss of easy (verbal) commu-

nications turned him into a misanthropist.

22 Beethoven Discussions 2000

Today we know that results of hearing defects can cause a broad spectrum

of impairments and handicaps. To follow on from previous passages, it is not

necessarily the primary hearing disorder that troubles the afflicted, but more

so the secondary repercussions on the psychosocial and emotional levels.

2. Age and Fitting of Hearing Impaired People

Interesting is not so much the age of the afflicted, but each individual’s hearing

age.This refers to the point in time when first hearing experiences were made.

For the hearing impaired this often means the time of the fitting with a first

hearing system and possibly habilitative or rehabilitative measures to stabilize

or regain auditive awareness. Therefore, the hearing age only correlates with

the actual age in a few cases.

The attempt to roughly categorize according to real age, onset of the hearing

impairment and registration may put it into concrete terms. The stereotype

sounding explanations are purposely chosen and are supposed to serve as a

clarification.

Teil II n Professor Gerlinde Renzelberg 23

Example A

Age: 2 years old (severely hearing impaired from the time of birth)

Fitted with Hearing instrument: at 6 months

Hearing age: 1,5 years

A hearing impaired child is diagnosed and treated prior to language acquisition.

The two auditory pathways undergo some essential, delicate maturing phases

during the first two years. This knowledge together with the technical advan-

cement of hearing systems and the interdisciplinary cooperation and inter-

vention of parents, pediatric audiologists, hearing-instrument specialists and

teachers during the early treatment stage, enable the child’s acquisition of

hearing- and speech skills. These skills could only have been dreamed of,

without today’s knowledge about hearing threshold.

In this case, the real age and the hearing age are very close together.

Example B

Age: 5 years (severely hearing impaired since birth)

Fitted with hearing instrument: at age 5

Hearing age: 0

A child is severely hearing-impaired since birth. The hearing impairment

was not diagnosed. The child is regarded as being retarded. Treatment did not

begin until the child was five. The most essential stages of the hearing- and

speech development, and worse the emotional development are over. The

hearing age is 0. Hearing must still be learned, and: “Being different“ must be

accepted.

24 Beethoven Discussions 2000

Example C

Age: 18 years (hearing impaired since the age of 14)

Fitted with hearing instrument: at the age of 14

Hearing age: 4 years?

A young man became hearing impaired during his puberty and was fitted

right away. The language development is completed. Phonetic- and sound

patterns are present. However, the hearing instruments are in a drawer. Maybe

he already has been through a “career“ during which he was being regarded

to as arrogant, maybe communication shy, or even as being unwilling to work.

He may be only little integrated into a professional or social life.The hearing age

can not really be counted because he refused to wear the hearing instrument.

Example D

Age: 45 years (hearing impaired for 3 years)

Fitted with hearing instrument: at age 45

Hearing age: ?

A man, in midst of his professional - and social life, at the peek of his career,

loses his hearing. Despite immediate intervention, a new professional reorien-

tation might be necessary. The risk of withdrawal from a (seemingly) stable

family and society, the withdrawal from the afflicted and from society becomes

increasingly visible. A crisis! The search for a new identity begins.

Teil II n Professor Gerlinde Renzelberg 25

3. Overload and Disappointment

Today, hearing instruments, also fully or partially implantable hearing systems

and other assistive listening devices are available at a high standard. However,

between the ears exists a human with all the momentary moods, specific

needs and individual demands.

Despite medical and technical know-how many hearing impaired people still

have difficulties to adapt to their new acoustical environment after the fitting.

Next to the personal circumstances which have been discussed, two possible

factors can be seen as causes: overload and disappointment.

Hearing impaired people are often stressed when sudden sounds break

through their usual silence. They fight against the irritating roars and hamme-

ring which they can no longer or not yet categorize. This phenomenon can be

observed in children and adults alike, although completely different explanation

patterns could apply.

If hearing impressions were already present, maybe the new sound perception

might just not be able to be integrated into memories of acoustic sound expe-

riences of older days. Misinterpretations are often the results of blurred per-

ceptions. Disappointment replaces illusions. By the time the hearing instru-

ment is degraded to a drawer instrument, its owner already has been through

a rough time of acceptance and rejection, between euphoria and resignation.

26 Beethoven Discussions 2000

4. Learning how to Hear and how to Ignore

The question, whether hearing can be (re)learned, depends on the individual

and the factors that exist around him or her. On a medical and technical level,

one can see the challenge of providing adequate fitting that is based on a

comprehensive diagnosis, involving all available knowledge. On a pedagogic-

psychological side it is very important to introduce subtle dimensions of

sounds and noises so they can be refilled with known meanings.

Besides hearing (classifying acoustic perception into specific, defined events),

an important goal is to relearn how to ignore – to recognize momentary, un-

important sensations. To the hearing impaired, this so-called semi-conscious

hearing could be a chance to make hearing situations easier – a break in con-

stantly demanding intense concentration. To get this unconscious process off

the ground, long and intense phases of a conscious connection to the acoustic

reality are necessary.

For people who were not fitted with hearing instruments, this means taking on

hearing as a challenge. For those who were fitted late, it means accepting

hearing in its changed form.

Teil II n Professor Gerlinde Renzelberg 27

Some short quotations, taken from a poll, on the occasions of the Beethoven

Discussions, show how significant a constant linkage to acoustic reality can be

to (convinced) hearing instrument wearers.

n I never dared to not wear my hearing instrument for longer periods of time,

not even when I was sick. I plugged them in now and then, just to stimulate

the auditory nerve.

n Once, when I forgot my hearing instrument on a trip, I was very unhappy.

At home it took nearly a day until I regained the complete hearing ability. I was

really shocked.

n In the morning I have to tune in, first with soft noises, then with louder

noises. I can never make phone calls in the morning, immediately after getting

up. Everything sounds tinny and blurred.

With the feeling for the significance of hearing, another aspect becomes clear.

To learn how to hear is not a onetime event. Wanting to hear and being able

to hear also means a never-ending re-acceptance of a noisy environment.

Or in other words: It is about a lasting connection to the outside world.

28 Beethoven Discussions 2000

5. Success Factor Hearing Training

The question of who should be responsible to educate the hearing impaired

to make the most of their residual hearing and their hearing instrument. It is the

responsibility of all those, who contribute to the education process, and

ultimately the hearing impaired themselves.

In this context “hearing training”is a learning situation controlled from outside,

where an attempt is made to build a logical correlation of acoustical events.

The question is whether a process, controlled from outside and under artificial

conditions, offer the stimulating basis to gain auditive structures?

Real stimuli undergo a different psychic assessment at any given time.

Something heard might seem interesting in one minute, but could just as ea-

sily get lost due to an amusing conversation at the next table. What is fascina-

ting today might become insignificant tomorrow. What catches someone’s

attention, does not necessarily reach someone else.

Teil II n Professor Gerlinde Renzelberg 29

What actually moves a person is difficult to capture in experimental situations.

Hearing can not be stimulated causal-mechanically from the outside.

Hearing must be experienced and understood as an existential need.

The hearing instrument specialist must have a great deal of understanding for

the problems of the hearing impaired. (This requirement also applies to every

other person that is involved in the educational process.) If a patient is asked

to hear, the hearing instrument specialist must also be able to listen. They must

be able to comprehend the human as a whole - not just a neuro-psychological

process that can be documented in the form of a graph. The fitting with a

hearing instrument resembles a long, adaptive process that is never really

entirely finished. If the focus of the fitting is on the recognition of individual

needs and the motivation of the patient to want to hear, this is an important

step towards a successful hearing training.

A renowned hearing instrument

specialist put it simply: “Hearing

training means wearing hearing

instruments.”

30 Beethoven Discussions 2000

6. DSB-Pilot Project

A pilot project at the Academy for Hearing Instrument Specialists in Lübeck,

initiated by the German Association of the Hearing Impaired (DSB) is using for

the most part the aspects mentioned in the previous text.

The program is for competent hearing impaired and non hearing impaired

experts with qualifications in education for the hearing impaired, pedagogics,

sociology, psychology, ENT-health care, acoustics and/or audiology.

Besides insight into manual systems, sign language and body language as well

as the impartings of lip-reading tactics, the focus is on the methods to acquire

hearing- and communication competence.

The DSB’s goal is to certify communication trainers and communication

therapists who are qualified to pass on these strategies to school children.

The general strategies in the dealing with hearing impairments can be taught

in individual or group settings. The limitations of technology, medicine and

communication should also be made clear. But most of all, it is important to

encourage everyone to accept and take part in this great challenge.

Teil II n Professor Gerlinde Renzelberg 31

Then! – Maybe – more people than in the past will be able to find the confi-

dence to gain new experiences, in themselves and their environment.

32 Beethoven Discussions 2000

Hearing Training in Practice

Petra Speth

“Initially, all expectations are directed

towards the hearing instrument,

which is supposed to compensate for

the hearing loss. By examining the hearing

processing, the role of the hearing

instrument is put into the proper perspective.

This perspective is extremely important

to the motivation and satisfaction of

the user of a hearing instrument.”

Part III n Petra Speth 33

1. Hearing Training as Early as Possible

The first experiences that are made with a hearing instrument are critical to the

future acceptance or rejection. Those who have been hearing impaired for a

long period of time before wearing a hearing instrument will be overwhelmed

by the loud hearing impressions. Everything seems to be too loud; unpleasant

background noises, such as traffic noise, step into the foreground dispropor-

tional. The statement from a hearing impaired: “I felt completely overwhelmed

by the flood of noises.This is not how I imagined the “new hearing” would be.”

The well meant advice from the hearing instrument specialist about the

handling of the hearing instrument is easily forgotten, and the unpleasant expe-

rience remains. This negative hearing impression complicates the further

progress of the fitting process.

Positive experiences are the key. n

During the hearing training, the hearing instrument wearer is carefully intro-

duced to this new hearing situation. The hearing impressions are chosen

carefully. Especially in the beginning. The objective is to collect positive expe-

riences with the hearing instrument. This means to hear again noise, signals

and sounds that could not be heard without a hearing instrument. It is a great

joy, even a deep inner movement, if one can again hear the chirping of birds

or the taping of raindrops on the windows.

With this positive experience, one can now approach difficult and unpleasant

noises.

34 Beethoven Discussions 2000

2.The Way to Understanding is through Interaction

Superficially, the fitting processes is a technical task to find the optimum

adjustment of the hearing instrument during consulting with the specialist.

This can create the impression that only the ear with its ability to function

has to be improved. The afflicted, as well as their family and their personal

surroundings, expect that the hearing instrument will bring back the hearing

ability and the re-integration into the world of the “good hearing.”

The complexity of the hearing impairment, which especially influences the

social lifestyle, is forgotten. The hearing impaired still do not hear the way they

did before the hearing loss, despite the hearing instrument.

The main focus during the hearing training is on the hearing impaired individual

– not the person reduced to a hearing impairment.This requires a good amount

of empathy and readiness to talk.

Hearing as a Competitive Sport n

A prerequisite of empathy is experience. One needs to be able to know how

the other person feels. A somewhat accurate idea about the situation of

hearing impaired people can be acquired through literature. But one’s own

experience is always the best teacher. All people who are together with a

hearing impaired person should close their ears with earplugs just once for

one whole day and experience various aspects of life. Of course, this hearing

experience is not equal to the individual hearing perceptions that hearing

impaired deal with every day, but it does allow a small personal insight into

Teil III n Petra Speth 35

their difficult life. More so, it makes us aware of how much these people have

to accomplish day by day. They are “competitive sportsmen” in hearing.

W orking like Partners n

Partnership lays the foundation for a successful hearing training. The consulting

and guidance is based on attitude, which shows respect and appreciation

towards hearing impaired people. With such a basis, the problems of hearing

impairment can be conveyed and accepted much easier.

3. How is a Hearing Training Conducted?

Motivation to wear a hearing instrument n

At the beginning of the hearing training the reasons that lead to wearing a

hearing instrument, are determined with the help of a questionnaire. A discus-

sion about this takes place afterwards. The reasons vary: For some it was the

wish of family members who were aggravated by constant questions. For

others it was the own dissatisfaction with their present situation because they

could not understand everything that was being said during conversations

among friends.

The individual attitudes towards hearing impairment can be critically observed

in a group discussion. Fears of not being attractive anymore, to be considered

dumb, old, handicapped or other existing prejudices are commonly heard.

For example, the neighbor who also has a hearing instrument, but isn’t happy

with it - could hear much better without it. There are also concerns that the

hearing will deterriorate with the hearing instrument because the hearing is no

36 Beethoven Discussions 2000

longer trained, or there are unrealistic expectations to be able to hear just as

good as before. It is particularly important to analyze these thoughts and

discuss them in a group. These misconceptions must be corrected and the

people educated about the real value of the hearing instrument. This way a

realistic foundation for the motivation to wear a hearing instrument can be laid.

Explaining the hearing processing in a way that can be

understood n

Who is really aware, that hearing does not happen in the ears alone, but takes

place in the brain? Hearing must be learned which means we also unlearn the

hearing.This happens if a hearing impairment is present.The brain, more so the

part that is in charge of the hearing memory, forgets what noises, signals, and

sounds sound like.

A comprehensive education about the process of hearing makes it possible to

understand the necessity for a hearing training. “Initially, all expectations are

directed towards the hearing instrument, which is supposed to compensate for

the hearing loss. By examining the hearing processing, the role of the hearing

instrument is put into the proper perspective. It is a “HEARING-instrument”not

a COMPREHENSION-instrument.”

A hearing instrument creates a new hearing situation n

The hearing situation changes with the hearing instrument: Everything sounds

different and the brain can not yet fully recognize and categorize the noises.

The hearing instrument amplifies the frequencies, which were heard less

or much softer. This means, that missing frequencies are heard louder than

Teil III n Petra Speth 37

before. For example, the noise caused by friction of one’s own clothes is heard

louder. The old hearing impression is not yet replaced by the new hearing

impression. The brain has to be retrained.

T he hearing training supports the brain during the retrai-

ning process! n

The auditive center in the brain must, with the help of the hearing instrument,

relearn the new hearing impressions. With the hearing training, one relearns

how to categorize and to differentiate noises, to push unpleasant noises into

the background, to bring the useful sounds into the foreground and to adjust

to the new volume. The hearing training helps the auditive center to adapt

faster and easier to the new hearing situation with the hearing instrument.

P r actical hearing exercises n

The exercise program is set up in a way, so that the noise recognition and

categorizing takes place at the beginning of the hearing training. Acoustic

stimuli must be processed correctly. The hearing impressions have to be re-

identified, coded and interpreted. Only in the last third of the hearing training

is the area of speech covered. The exercises are conveyed in a playful way,

so that hearing can be experienced with fun and joy.

38 Beethoven Discussions 2000

Practical hearing exercises during the hearing training n

n Hearing with and without a hearing instrument

n Listening to the rush of a stream or the chirping of birds from a CD first

without a hearing instrument, then with a hearing instrument: the hearing

impaired are asked to describe the hearing impressions and find that with

the help of the hearing instrument, they can hear the sounds again. This

exercise enables a real “wow” effect and promotes the motivation to wear

the hearing instrument. After all, it’s benefit can be heard.

n Re-discover every day noises and experience through hearing

n Participants listen for noises in a quiet surrounding. The purpose is to iden-

tify the sounds and to get accustomed to them again. What does the own

voice sound like? Which sounds can be heard in one’s own apartment?.

What does the flushing of a toilette sound like?

n Training directional hearing

n The participants sit in the center of a room with their eyes closed. The

trainer produces a noise and changes position. They point to the direction

of the noise.

n Recognizing similar sounding noises

n Playing memory with the sense of hearing: Various noises are made. The

goal is to recognize similar sounding noises, as every noise is made twice.

Teil III n Petra Speth 39

n Differentiate individual noises in noisy environments

n One person stands in a fixed place. With eyes closed, another person finds

the first person by following the calls of his/her name.The difficulty is to filter

out disturbing background noise and to recognize the voice of the leading

person out of several other voices.

n Hearing and understanding speech

n All participants listen to speech in a room with very little background noise.

With the help of their individual audiographs they find out that everyone has

a different audio pattern, thus has a different ability to understand.The group

tries several other communication strategies to see which additional help is

useful, such as lip-reading.

n Rules for the hearing impaired and their families

n Same behaviours are necessary to support the conversational situation.

(Compare with p. 42)

4. Reactions

Personal experiences show how important hearing training is for the hearing

instrument wearer.

“I forgot how much I couldn’t hear anymore. With the hearing training, I expe-

rienced the benefits, that the hearing instrument could offer me. Without the

hearing instrument I misinterpreted the roar of water as just a strange noise,

that I could not classify.The hearing training made me really aware of the sound

difference.”

40 Beethoven Discussions 2000

“Thanks to the intensive hearing training I discovered noises that were long

forgotten, for example the dripping of a water faucet or the chirping of birds.”

“In the beginning of the hearing training, many times I did not know what

direction the noises came from. Now I can recognize the direction of the noise

much better, and I feel much safer in traffic.”

“With the knowledge that my brain has to re-adjust to the new volumes,

it became much easier to take up the challenge of loud situations. To my

astonishment, my own perception of loudness changed.”

“My selfconfidence is much higher and I demand certain rules from my fellow

men for a better hearing situation”

“I hadn’t been wearing my hearing instrument for one year. With the help of

the hearing training, I was able to accept my hearing instruments in the second

attempt, and getting used to the new hearing situation became easier as well.

I am so glad, that I found out about the hearing training, and I wished this

opportunity would be given to others at a much earlier stage of their hearing

impairment.”

n Useful tips for the hearing impaired 41

Useful tips for the hearing impaired dealing with normal hearing people

1. Let others know about your hearing disability, so they can speak

clearly and directly to you. Explain that it is not necessary for them

to speak to you extra loud or perhaps even yell.

2. Do not hide your hearing instrument. Always wear it visible to others.

3. If you notice that the volume does not seem to be loud enough,

make sure that your hearing instrument is properly adjusted or if new

batteries are required.

4. Make sure that the mouth, respectively the face of the other person

stays visible. If necessary, ask the other to turn in such a way that the

face can be clearly seen in the light.

5. Set a good example by speaking clearly.

6. Be patient and kindly ask the other person to repeat himself, if you

did not understand what was being said. There is no use in pretend-

ing that you understand, if that is not the case.

7. Don’t be ashamed to admit that you misunderstood something.

Take it with humor and tell the others what you understood.

42 Beethoven Discussions 2000

8. At a party, you may find it convenient to sit next to a person that

speaks clearly and who keeps you informed about the subject at

hand.

9. Try to keep a good attitude, even if sometimes you are not able

to participate in the conversation.

10. Let others know if you are troubled by exhaustion, tiredness, or

the feeling of being left out. Do not just walk away. This causes

astonishment and does not improve the situation.

(Source: German Association of the hearing impaired.)

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