|Year : 2016 | Volume
| Issue : 1 | Page : 24-27
Adult auditory training is it part of aural rehabilitation? Focused group discussion
G Archana, Y Krishna, B Rajashekhar, PG Bhargavi
Department of Speech and Hearing, School of Allied Health Science, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||16-Feb-2016|
Department of Speech and Hearing, School of Allied Health Science, Manipal University, Manipal, Karnataka
Source of Support: None, Conflict of Interest: None
Aim: To conduct focused group discussion on audiologist and hearing aid users to find out the necessity of auditory training in adults and geriatrics. Materials and Methods: A qualitative focused group discussion was conducted on 30 audiologist and 10 hearing aid users to gather the information on auditory rehabilitation in adults and geriatrics. Eight different questions were proposed for the discussion on aural rehabilitation in these population. Discussion was recorded and analyzed for the outcome of the study. Results: The participants of the group collectively agreed that just fitting of hearing aids on adults was insufficient and that they require further auditory training to facilitate their communication skills. There was a consensus of the group on the need to develop an auditory rehabilitation program that catered to the variations of culture, language, and dialects of the same in Indian population. Conclusion: Focused group discussion revealed that adults and geriatrics should undergo auditory training after fitting hearing aid.
Keywords: Audiologist, Focused group discussion, Hearing aid users
|How to cite this article:|
Archana G, Krishna Y, Rajashekhar B, Bhargavi P G. Adult auditory training is it part of aural rehabilitation? Focused group discussion. Indian J Otol 2016;22:24-7
|How to cite this URL:|
Archana G, Krishna Y, Rajashekhar B, Bhargavi P G. Adult auditory training is it part of aural rehabilitation? Focused group discussion. Indian J Otol [serial online] 2016 [cited 2021 Jul 28];22:24-7. Available from: https://www.indianjotol.org/text.asp?2016/22/1/24/176514
| Introduction|| |
Hearing loss is a hidden condition, in which it affects the speech perception skills of the individuals. Normal hearing is a prerequisite for the normal speech and language development. In adults with acquired hearing loss even though their language skills are developed, individual with hearing loss will be facing difficulties in perceiving speech signals. Amplification device may improve audibility, but it fails to improve auditory resolution skills. Thus, hearing aid users will not be satisfied with their prognosis in terms of their listening skills.
Aural rehabilitation (AR) is defined as “any device, procedure, information, interaction, or therapy which lessens the communicative and psychosocial consequences of a hearing loss.” Hearing loss in the individual affects their quality of life. It has a significant impact on their speech perception abilities. It affects social interactions, in employment, in leisure pursuits, and in the enjoyment of sound. The goal of rehabilitation is to restore the quality of life by eliminating, reducing, or circumventing these deficits and limitations. Auditory rehabilitation consists of four components which include sensory management, instruction, perceptual training, and counseling. All these steps are mandatory in auditory rehabilitation. The goals and aims of AR vary depending on the age of the individual who is suffering from the hearing loss. There is a tendency for audiologists to focus on sensory management (hearing aid/cochlear implant) of auditory rehabilitation leaving other components of auditory rehabilitation specifically in the older population.
According to the literature  hearing aids alone cannot improve central cognitive processes. Hearing aids can provide audibility but may not rectify impaired frequency and temporal resolution. As a result, most hearing aid users receive incoming acoustic signals that are, to some degree, different, and presumably inferior, to that which the individual with normal hearing. As a result, the hearing aid user generally receives a filtered out signal or partially degraded signal, either because of extrinsic sources such as noise interference or limited bandwidth, or from underlying intrinsic limitations such as imperfect audibility, cochlear distortion, and impaired frequency and temporal resolution.
Especially in geriatric population, certain cognitive processing skills which are important for comprehending speech in adverse acoustic environment, tend to diminish with age. It is now accepted that peripheral hearing disorders lead to central auditory changes. Hence, by just introducing the amplification device will not produce optimal readaptation of the auditory system and most advantageous auditory skills unless accompanied by training.
The recent concept of auditory plasticity also supports the auditory training as an important step in auditory rehabilitation. Willott  suggested three ways that central auditory system (CAS) plasticity might be relevant to the AR of adults with acquired hearing loss. First, reduced auditory input from peripheral damage such as cochlear pathology may cause functional changes in the CAS and affect auditory perception. Second, provision of amplification may lead to secondary plasticity because of altered input to the auditory system; this might yield secondary changes in auditory perception. Third, learning can cause functional changes in the auditory system and can lead to alterations in auditory perception. Electrophysiological studies also support the fact that adults can be trained for a new stimulus.
Sweetow and Palmer  conducted an evidence-based analysis of research related to individual adult auditory training and found mixed results, suggesting that at least with synthetic training, improvements in communication can be expected. These authors surveyed the literature to address the following question “Is there evidence of improvement in communication skills through individual auditory training in an adult hearing impaired population?” Only six articles out of a possible 213 met their criteria of providing sufficient detail and methodological rigor to obtain an evidence-based assessment of the benefits of auditory training. The training methods were similar across the programs, providing analytic and or synthetic training. Of the six investigations reviewed, four provided evidence that auditory training enhances the listening performance of adults who have hearing impairment ,,, one did not, and one reported mixed results.
With the improvement of technology people started training the individual using the computerized program, author  provided computerized training to 65 experienced adult hearing aid users. Training was conducted with the home-based computerized program for 30 min/day 5 days a week for total 4 weeks. Testing included two sentences tests and questionnaires that were administered immediately after 4 weeks training program and then again 4 weeks later. Data were reported for 42 of the participants. Results indicated improvement for the trained participants in degraded speech task and auditory memory task.
Need for the study
The goal of AR is to reduce the consequences of difficulties faced by the individual with hearing impairment. Auditory rehabilitation for adults with hearing impairment is restricted only to providing hearing aids. These amplification devices may improve audibility, but it fails to improve auditory resolution skills. Even though an adult with a hearing impairment has a good language skill, hearing through the amplification device is a new modality and needs extra effort in understanding speech. In the pediatric population, fitting of hearing aid is followed by mandatory auditory training. Thus, the hypothesis is even adult with hearing impairment should follow the auditory training followed by hearing aid fitting. Especially in Indian scenario, auditory training has been followed only in the pediatric population, and there is a dearth of strong data which will help audiologists to focus on auditory rehabilitation for adults with hearing impairment.
| Materials and Methods|| |
The current study aimed at focused group discussion regarding the necessity of auditory training in adult with hearing impairment.
Two groups of people were included in the study. Convenience sampling was used in the study, with that group one (n = 30) included audiologist and group two (n = 10) hearing aid users. Audiologist with 5 years of experience in the field of auditory rehabilitation was considered in the first group. Similarly, hearing aid users of more than 2 years of experience were included in the second group. As an initial step focused group discussion made familiar for both the groups. Focused group discussion was conducted in the closed area without much sound disturbance. It was conducted separately for both the groups. For audiologist English is used, whereas for hearing aid users Kannada (Dravidian language spoken in Karnataka) was used as a medium of language for focused group discussion. During the focused group discussion audiologist further divided into three groups 10 in each for the ease of discussion. Focused group discussion was carried out in the structured room with good light and less interfering noise in it. Participants projected with eight questions in the area of auditory rehabilitation [Appendix 1]. These questions were collected with the help of literature and linguistically modified with the help of linguistics. Questions were also translated into hearing aid users first language by the linguist. For each focused group discussion, maximum 10 individual were included, and it was conducted for an hour. There is a need for active participation of two individual in the focused group discussion. One as a moderator who introduce a topic, pose a question, and make the group discuss on the topic. Another being analyzer or writer, he/she has to record the session and can assist in analyzing the data. Author being a moderator was projecting a question and making the group participate actively for the entire session. Analyzer/writer was recording the session. All the sessions were analyzed separately for the research output.
| Results|| |
The inputs from the focused group discussions were subjected into qualitative analysis. Further inputs from the audiologist and hearing aid user were analyzed separately. Under each section, all eight questions were analyzed separately.
Focused group discussion with audiologist
In the focused group discussion, audiologist participated actively in the entire session. There according to them definition and aims of auditory training have to be revised. Training should incorporate maximum utilization of residual hearing, and more importance has to be given to comfort listening. They report auditory rehabilitation does not end with just putting a hearing aid to the individual. They should train for graded stimulus in auditory training on regular basis. Even adult and geriatrics are a candidate for auditory training, whereas adults should train for degraded listening condition and geriatrics should train for auditory memory task along with auditory training program for successful auditory rehabilitation. They also preferred using a synthetic type of auditory training for adult with hearing impairment. It was also highlighted that in Indian scenario; there is a need to give importance to language used and cultural background while preparing the material used in AR. They also emphasized that in adults, like pediatrics there is no need for individual training required, wherein AR tool should be home-based or self-usable.
Focused group discussion with hearing aid users
Focused group discussion with the hearing aid users took a lot of time in making them understand the question posed to them. Questions were simplified, and it was asked them in their mother tongue. Visual cues and case examples were also provided to the hearing aid users for understanding of posed questions. Once they comprehended the questions further discussion were carried out. They reported that intension behind putting a hearing aid in them is to hear better and comfortably in difficult listening situation. However, only with hearing aid they will not be able to manage these situations. Hence, according to them, they should undergo some training which helps them to face these difficult listening situations. Thus, the participants of the groups collectively agreed that just fitting of hearing aids on adults were insufficient and that they require further auditory training to facilitate their communication skills. Hearing aid users also expect that training material should be readily available in their own languages considering the challenging which they face during communication.
| Discussion|| |
The aim of this study is to know the need for auditory training in adults with hearing impairment. The focused group discussion created a thought provoking information regarding auditory training. Audiologist thought regarding auditory training is changed, and all were insisting for regular auditory training, especially for degraded speech condition. The aim and objectives of putting hearing aid in the current scenario are moved toward comfort listening, thus it improves quality of life in the hearing impaired individuals. The hearing aid users also reported that for the satisfactory benefit hearing aid fitting should be followed by some training. This training should be able to focus on their improving speech identification task specifically in difficult to hear situation. Thus, the overall outcome of focused group discussion between an audiologist and hearing aid users, even though had differences in terms of procedure of auditory training, but both the group concluded to undergo auditory training after fitting a hearing aid. Literature also supports the viewpoint of postauditory training for adults and geriatrics hearing aid users (Sweetow and Sabes 2006). Both the group highlighted on developing training materials in different Indian languages considering India is a multilingual nation.
| Conclusion|| |
Focused group discussions brought out that adults and geriatrics should undergo auditory training after fitting hearing aid.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ross M. AR revisited. J Acad Rehabil Audiol 1987;20:13-23.
Boothroyd A. Adult aural rehabilitation: What is it and does it work? Trends Amplif 2007;11:63-71.
Van Hooren SA, Anteunis LJ, Valentijn SA, Bosma H, Ponds RW, Jolles J, et al
. Does cognitive function in older adults with hearing impairment improve by hearing aid use? Int J Audiol 2005;44:265-71.
Wingfield A, Tun P. Spoken language comprehension in older adults: Interactions between sensory and cognitive change in normal aging. Semin Hear 2001;22:287-302.
Stecker GC, Bowman GA, Yund EW, Herron TJ, Roup CM, Woods DL. Perceptual training improves syllable identification in new and experienced hearing aid users. J Rehabil Res Dev 2006;43:537-52.
Willott JF. Physiological plasticity in the auditory system and its possible relevance to hearing aid use, deprivation effects, and acclimatization. Ear Hear 1996;17:66-77.
Sweetow R, Palmer CV. Efficacy of individual auditory training in adults: A systematic review of the evidence. J Am Acad Audiol 2005;16:494-504.
Bode D, Oyer H. Auditory training and speech discrimination. J Speech Hear Res 1970;13:839-55.
Montgomery A, Walden B, Schwartz D, Prosek R. Training auditory visual speech recognition in adults with moderate sensorineural hearing loss. Ear Hear 1984;5:30-6.
Walden BE, Erdman SA, Montgomery AA, Schwartz DM, Prosek RA. Some effects of training on speech recognition by hearing-impaired adults. J Speech Hear Res 1981;24:207-16.
Rubinstein A, Boothroyd A. Effect of two approaches to auditory training on speech recognition by hearing-impaired adults. J Speech Hear Res 1987;30:153-60.
Kricos PB, Holmes AE, Doyle D. Efficacy of a communication training program for hearing-impaired elderly adults. J Acad Rehabil Audiol 1992;25:69-80.
Kricos PB, Holmes AE. Efficacy of audiologic rehabilitation for older adults. J Am Acad Audiol 1996;7:219-29.
Sweetow RW, Sabes JH. The need for and development of an adaptive listening and communication enhancement (LACE) program. J Am Acad Audiol 2006;17:538-58.