Optimizing Your Hearing Aid Experience by Training Your Brain to Listen
Robert W. Sweetow, Ph.D., Professor of Otolaryngology, University of California, San Francisco
Introduction - Hearing Aids are Not Enough
We don’t really hear in our ears; we hear in our brain. Hearing aids can help a person detect softer sounds, but they don’t necessarily provide good listening skills. There is a fundamental difference between hearing and listening. Normal hearing alone does not assure that one is a good listener. We all know people who have normal hearing but are pretty poor listeners. Conversely, many hearing- impaired individuals are wonderful listeners. While hearing is a physical function that requires an auditory system that allows access to sound, listening is a skill that requires effort, and when a hearing loss is present, that effort becomes particularly difficult.
Good listening skills are one of the components essential for effective communication. As technically advanced as modern hearing aids might be, they alone cannot produce the listening skills needed for communication. There are a number of reasons for this. For example, to be a good listener, one must integrate a number of skills including attending, understanding, and remembering. Unfortunately, many of these cognitive skills deteriorate as we age. This may show up as a worsening of short-term memory, or increasing difficulty understanding rapidly presented speech. Modern hearing aids have certainly improved the quality of sound in noisy environments, but they do not eliminate background sounds. People with hearing loss have particularly great difficulty understanding speech in noise. In addition, we now have evidence that a loss of hearing in the ear literally produces physical changes in the brain. These changes are called neural plasticity and data show that when parts of the brain are not being utilized, they actually change their function (and usually not in a positive manner). Thus, the old adage of "use it or lose it" actually applies to listening because the hearing impaired person's brain may not be receiving the kind of stimulation it needs to maintain its proper function.
In addition, confidence that what you thought you heard was in reality what was spoken, is vital. Often, when people lose confidence in their ability to communicate in noisy social situations, they simply drop out and avoid those environments. While this may save them effort and embarrassment, it ultimately costs them important personal and social contact. Some individuals utilize compensatory strategies that may result in successful hearing aid use. Others, however, are not so fortunate. In fact, it is not uncommon for people with hearing loss to develop counter-productive compensatory behaviors, such as nodding their heads as if they heard, or monopolizing the conversation so that they don't have to rely on their hearing. As stated earlier, modern, well fit hearing aids can provide audibility, but may not resolve susceptibility to noise, or degradation of cognitive skills associated with aging. The need for additional therapy beyond that provided by devices alone is underscored by the fact that individuals presenting similar hearing patterns frequently report a wide range in satisfaction and benefit from amplification.
Supplemental Communication Strategies Are Needed
The good news is you can optimize your hearing aid hearing experience using a number of methods, strategies and techniques as documented on the Better Hearing Institute website:
Supplementing hearing aids with additional rehabilitation methods as mentioned above can be very useful in giving you the kinds of skills and communication strategies that can make the difference between understanding versus being left out of a conversation, particularly in tough listening environments. Talk to your professional about establishing a comprehensive communication enhancement plan for you.
Training Your Brain to Listen
The great news is you can minimize your listening skills from deteriorating and you can improve your ability to function in noisy situations.
Comprehensive auditory rehabilitation uses any and all approaches to compensate for hearing loss. While hearing aids are often an essential element of aural rehabilitation, other vital components are education to help you understand what is going on in your own body and brain, learning and incorporating interactive communication strategies, and cognitive and auditory training, processes designed to enhance the ability to interpret auditory experiences by maximally utilizing whatever physical capacity remains.
Supplemental, adjunctive therapies are used for many disorders. When a person injures an arm or leg, for example, professionals and patients recognize the importance of physical therapy to strengthen adjacent muscles and instruction to optimize function. Similarly, it is likely that the mere introduction of amplification (hearing aids) will not produce optimal re-adaptation of the auditory system and most advantageous auditory skills unless accompanied by training.
Group rehabilitation can provide this training and has been shown to improve patient satisfaction. However, most hearing healthcare professional do not offer this type of service. For most people a more individualized approach allows for more intensive therapy along with proceeding at the individual’s optimal pace.
In addition, there are exercises you can try immediately. Here are three examples:
- Use closed- captioned TV, or record programs using a DVR or TIVO. Watch the show live. Then replay it with closed captioning or by slowing it down.
- Listen to, while reading, audio books.
- Buy two copies of the newspaper. Have your spouse or colleague read the newspaper aloud while you are listening only, and then go ahead and read it yourself. Try this in quiet at first, and then proceed to noisier listening environments.
Self-help Computer Assisted Training Programs (LACE)
There are currently low cost training programs available through your hearing healthcare professional that allow people to perform supplemental training in the privacy of their own homes. They are proven methods to improve one's ability to listen more effectively especially in noisy situations, which is the main complaint of people with hearing loss.
One such auditory training therapy program designed to help the brain listen, Listening and Communication Enhancement (LACE) , is done using a computer or DVD. LACE is designed to enhance listening and communication skills, get the patient involved in the therapeutic process, improve confidence levels, and provide communication strategies. The program consists of a variety of interactive and adaptive training tasks for listening to speech in noise, rapid speech, and auditory memory. Besides the immediate feedback given for each task, LACE provides the patient with a graph depicting daily improvement and progress from the start of the training.
It should be reinforced at this point that better hearing is not a passive process where you simply let the hearing aids do all the work; success does not rest solely on the hearing aid and the expertise of the hearing healthcare professional. To optimize your hearing aid experience you must become an active participant. One of the best ways to do this is to become an active listener using software like LACE.
LACE training is conducted in the privacy of your own home at a pace comfortable to you; though some hearing healthcare professionals may have a computer lab where you can take all or part of the training in their office. LACE consists of twenty 20-30 minute listening exercises of progressing difficulty and can be completed in ten days, or longer if you wish. Research on thousands of people with hearing loss demonstrates that you can expect on average a 40% improvement of speech comprehension in noisy situations, if you complete the training program. Using the listening skills you will acquire with this software, along with communication strategies as well as the advanced features of your hearing aids such as directional microphones or wireless technology you could do even better depending on your degree of hearing loss.
Here are some questions and answers about LACE.
Q. How do I know if I need LACE auditory retraining therapy?
A. All people whose hearing loss is less than profound or deaf will benefit from auditory retraining therapy. In fact even normal hearing people can benefit by training their brain to listen better in noisy situations.
Q. Where do I get LACE software?
A. You can get LACE directly from your hearing healthcare professional or you can order it online at www.neurotone.com.
Q. How much does it cost?
A. The cost may vary based on the hearing aid you purchase from your hearing healthcare professional and based on which versions you purchase (DVD for TV, CD-ROM for computer, or both). In general, the price will vary between $100-$149.
Q. What equipment will I need to do LACE?
A. It is preferred while wearing your hearing aids that you use a computer with loudspeakers through your mouse or keyboard. If you do not have a computer the DVD version allows you to take the listening skills training using the DVD remote but for those with manual dexterity problems this may be difficult. In addition you will not be able to connect to the Internet to send your on-going results to your hearing healthcare professional, which is a helpful part of your therapy program.
Q. Will my acquired listening skills be permanent?
A. Yes they will; but some people may need refresher training with their software.
- The mere use of hearing aids will not produce optimal improvement in your hearing unless accompanied by training.
- The process of better hearing requires you to become an active participant.
- Modern computer technology now allows you to train your brain to listen and focus thus optimizing the use of your hearing aids.
- Using the listening skills you will acquire through self-pace computer training, along with the employment of communication strategies and the advanced features of your hearing aids such as directional microphones, telecoils or wireless technology you will be well on your way to improving your ability to communicate more effectively and enjoy the world of sound.