What are the audiologic rehabilitation options for patients with residual hearing loss?

Audiologic Rehabilitation Options for Patients with Residual Hearing Loss

Patients with residual hearing loss should receive a comprehensive audiologic rehabilitation plan including hearing aids or assistive listening devices, communication strategies training, and regular follow-up monitoring to optimize hearing function and quality of life. 1

Amplification Options

Hearing Aids

• First-line treatment for mild to moderate residual hearing loss 1
• Options include:
  • Monaural hearing aids for those who can benefit from amplification in the poorer ear without crossover 2
  • Behind-the-ear or custom digital instruments that are smaller and more cosmetically appealing than older models 2

Specialized Devices for Unilateral/Asymmetric Hearing Loss

• CROS (Contralateral Routing of Signal) hearing aids:
  • Use a microphone on the impaired ear to transmit sound to the better ear 2
  • Recent digital developments have resulted in smaller, more cosmetically acceptable devices 2
• BICROS (Bilateral Contralateral Routing of Signals) hearing aids:
  • Recommended for those with pre-existing hearing loss in the better ear 2
  • Allow both CROS and hearing aid characteristics as necessary 2
• Osseointegrated bone conductive devices:
  • Transfer sound from affected side to better hearing cochlea via bone conduction 2
  • Available as surgical option or with headband placement for non-surgical candidates 2
• Deep intracanal devices and dental bridges with ear-level devices:
  • Employ bone conduction sound transmission for single-sided deafness 2

Hearing Assistive Technologies (HAT)

• Can improve communication in specific listening conditions 2
• Particularly useful during initial stages of medical treatment 2
• Components include:
  • Headphones
  • Handheld or lapel-worn microphones
  • Sound transmission via hardwire or wireless technologies (infrared, FM) 2
• Additional considerations include auditory, visual, and tactile alerting systems 2

Communication Strategies Training

• Essential component of audiologic rehabilitation 1
• Effective strategies include:
  • Face-to-face communication with good lighting
  • Minimizing background noise during conversations
  • Rephrasing rather than repeating when not understood
  • Using visual aids for important information 1
• Should be implemented in real-time for immediate effectiveness 1

Counseling and Support

• Psychological counseling to address adjustment to hearing loss 3
• Internet-based audiological counseling programs can:
  • Facilitate adjustment to first hearing aid
  • Provide opportunities to address user experiences
  • Reinforce positive adjustment behaviors 3
• Consumer-based organizations like Hearing Loss Association of America (HLAA) provide valuable support and information 2

Follow-up and Monitoring

• Regular evaluation of hearing and amplification devices:
  • At least annual monitoring of device function, settings, and benefit 2
  • More frequent monitoring for fluctuating hearing loss 2
• Comprehensive audiologic evaluations to guide treatment and rehabilitation options 2
• Assessment of communication goals and hearing-related quality of life within 1 year 1

Factors Affecting Rehabilitation Success

Key predictors of successful outcomes include:

• Higher socioeconomic status
• Greater initial self-reported hearing disability
• Advanced stages of change (action stage)
• Lower chance locus of control
• Greater hearing disability perceived by others and self 4

Emerging Technologies

• Cochlear implantation:
  • Beneficial for patients with severe to profound sensorineural hearing loss 1
  • Ongoing clinical research on utility for single-sided deafness 2
  • Should be considered for those with persistent hearing difficulty despite appropriate hearing aid use 1
• Inner ear hair cell regeneration research continues as a major goal 2

Common Pitfalls to Avoid

• Relying solely on patient self-report rather than comprehensive audiologic evaluation 2
• Underutilizing communication strategies that can provide immediate benefit 1
• Failing to consider cochlear implantation for patients with persistent difficulties despite appropriate hearing aid use 1
• Neglecting regular follow-up monitoring of hearing and device function 2
• Not addressing sociodemographic factors that influence access to hearing healthcare 1

By implementing this comprehensive approach to audiologic rehabilitation, patients with residual hearing loss can experience improved hearing-specific quality of life, enhanced communication, reduced listening effort and fatigue, and better overall quality of life 1.