Is Auditory Training Effective in Improving Listening Skills?

photo of Dr. Mark Ross

Dr. Mark Ross, Ph.D. has contributed a wealth of wisdom and information about hearing loss treatment and management to the field of rehabilitative audioloty. As Professor Emeritus from the Department of Audiology at University of Connecticut, he was a regular contributor to Hearing Loss Magazine, sharing important information about aural rehabilitation with persons with hearing loss. Dr. Ross currently serves on the Board of HLAA’s Eastern Connecticut Chapter. He is a cochlear implant user.

 

by Mark Ross, Ph.D.
This article first appeared in the
Hearing Loss Magazine (Jan/Feb 2011)

Auditory training can be defined as formal listening activities whose goal is to optimize the activity of speech perception (Dr. Arthur Boothroyd).   It is based on an assumption that listeners often need help in dealing with the speech perception deficits that remain after auditory function has been optimized through an appropriate hearing aid selection process.  This point cannot be overemphasized: engaging in auditory training without first being assured that the hearing aids are doing exactly what they should be doing is a waste of time for both the clinician and the consumer.

Note that the definition above includes the words “formal listening activities.” This serves to distinguish auditory training from the auditory learning that takes place whenever hearing aid users, particularly new users, are simply listening to speech. The amplified signals often sound a bit different to them, a bit strange. Hearing aid dispensers, from time immemorial, have always counseled new hearing aid users that it may take some time for them to “get used” to the new sounds the hearing aids are providing to their ears and their brains. It is an observation well grounded in years of experience.

In fact, a great deal of informal “auditory training” does take place during this initial hearing aid (and cochlear implant) adjustment phase. Hearing-impaired people are constantly trying to make sense of speech signals that are distorted in some fashion. Listening to speech is always a bit of a guessing game for them, in which they use their knowledge of the language and the context to fill in the acoustic gaps and distortions of the incoming speech signals. People do get better at this, over time. A formal listening program of auditory training assumes that hearing aid users have completed this initial adjustment stage, i.e., that they have reached a plateau in their listening skills and are now ready to attempt to further improve their performance through explicit training.

While auditory training has always theoretically been included within the scope of practice of Communication Disorders professionals, it was rarely used clinically – for several reasons. One was that, unlike speechreading (the other procedure which basically defined aural rehabilitation years ago), auditory training does not lend itself to group lessons; it must be practiced on a one-to-one basis. The other reason was that convincing research evidence attesting to its value was relatively sparse and did not appear to justify the time and expense that the activity required. But this view of auditory training has been changing in the last decade or so, thanks to developments in three areas.

The advent of the cochlear implant (CI) several decades ago was the first of these developments. The auditory sensations that the first generation of CI users received was so different from what they had been used to that they needed help in adjusting to, and learning to comprehend, these new and strange sound sensations. This is akin to orthopedic patients who routinely receive physical therapy after some sort of surgery (hip, knee, shoulder, etc.). In other words, if physical therapy helped people with post-surgical physical issues, why wouldn’t auditory therapy (training) be similarly helpful for people with hearing problems? And why limit therapy only to CI users, why not people wearing hearing aids as well? While the practice of auditory training had been with us for years, it seems not entirely coincidental that, since the advent of the CI, auditory training has been seeing a revival for both hearing aid and CI implant users.

The second of these developments was the emerging appreciation that mature neural systems – once viewed as immutable – are now beginning to be seen as malleable and subject to modification. Neuroscientists, using such procedures as magnetic resonance imaging (MRI), have quantified neural plasticity in adult human subjects. It appears that structural and physiological changes in the central nervous system can take place as a consequence of therapeutic intervention, such as repeated exposure to meaningful auditory stimuli in a training situation. Furthermore, there is evidence that these changes can be measured in the way the cortex responds to sound. In short, it seems that old dogs can learn new tricks.

The third development that has encouraged a new look at auditory training is the widespread use and familiarity with the personal computer and the Internet. Before this, it simply was not economically practical for clinicians to offer this service. To be effective, therapy has to be conducted frequently and over a relatively long period of time; any agency, including non-profit ones, concerned with the bottom line simply couldn’t afford to offer it as a routine clinical procedure. With personal computers and/or online training, however, it is now possible for people to conduct frequent training sessions at home, at a great savings in cost and personal convenience. The most effective model, in my opinion, is a blend of clinical and home activity, where the professionals can interact with the clients to monitor and provide assistance when needed.

Traditionally, auditory training can be separated into the analytic and synthetic approaches.  In the analytic technique, the focus is on the elements of speech, to improve a person’s ability to identify the various sounds of speech, specifically those with which the person has difficulty. Thus in training vowel identification, a person may be required to distinguish between such words as /beet/ and /boot/, which have two vowels that considerably differ acoustically. From there, a person may be challenged to distinguish finer and finer vowel differences. In analytic consonant training, the vowel remains the same, but now the target consonant is changed. This training also proceeds from large to finer acoustic distinctions. Analytic training is termed a “bottoms up” approach because the intent is to improve overall speech comprehension by focusing on the acoustic “building blocks” of speech messages. The reasoning is that if someone can reliably distinguish the acoustic elements of speech, then he or she should be better able to comprehend the larger units, such as sentences and paragraphs.

A synthetic training approach, on the other hand, employs meaningful sentences as training stimuli. Most often the sentences are presented to the listeners in the presence of noise, thus mimicking the situation in which most people with hearing loss have the greatest difficulty. The task of the listener is to focus on comprehending the sentence meaning without attending to specific acoustic elements. Modern techniques use a   presentation method in which the noise level is either increased or decreased automatically, depending upon whether or not the sentence was correctly understood. The intent is to ensure that listeners are continually challenged during the training session. The goal is for a listener to be able to comprehend speech in increasing levels of noise. As opposed to the “bottoms up” approach of the analytic technique, synthetic training is termed “top down,” as it requires listeners to employ their knowledge of language and context to fill in the acoustic/perceptual gaps in the message. In my judgment, both techniques have a place and both should be employed.

But now the central question of this article: Can auditory training assist hearing aid and cochlear implant users to improve their listening skills beyond that seen when people “get used to” the devices they are wearing? The short answer is “Yes,” provided the program is appropriate and sufficiently intensive. A few years ago, Sweetow and Palmer reviewed all the studies they could find that might even remotely be related to auditory training. They found 213 of them, but only six met the inclusion criteria that they employed (i.e., whether the study was “on topic” and met various research requirements).   The results of these six studies, dating from 1970 through 1996, suggested that auditory training can improve speech recognition skills to some extent, especially if it used a synthetic training approach. The best results were obtained with the more intensive programs (longer duration and more sessions per week).

Recent research on auditory training has focused on home-based training programs, with results that are less ambiguous than the early studies.   Currently, the most popular such program is termed LACE (for “Listening and Communication Enhancement”). This program can be completed at home, with or without the online guidance of a professional. In addition to the usual task incorporated in an auditory training program (recognizing speech in noise), LACE includes other relevant listening dimensions, such as comprehending rapid speech, and improving working auditory memory and processing speed. In a study published a few years ago, Sweetow and Henderson-Sabes found that their subjects made significant improvements in all the listening and cognitive dimensions for which they received specific training. It is reasonable to assume that these gains would positively impact on a person’s ability to communicate in the real-world. Furthermore, the study demonstrated significant improvement with listening tests for which the subjects had not been directly trained, demonstrating generalization beyond the training material. But it does take a sincere commitment by the user: five days a week, for at least thirty minutes per session, for a minimum of a month (see neurtone.com).

A new entry into the home-based auditory training market is termed “ReadMyQuips.” This is an audio-visual training program in which the subject both sees and hears the quips (sentences) being spoken. (Disclosure: I consulted on this program during some stages of its development.) It is an adaptive program in which the audio signal is alternately raised or lowered depending upon whether or not the answer was correct.  The response format is that of a crossword puzzle, with each box containing a word not a letter. The entire quip (taken from such luminaries as Groucho Marx and Winston Churchill) is spoken and the listener fills in all the boxes that he or she can. The format is meant to be entertaining and to engage a subject’s interest for a long period of time. Two studies were carried out with this program; both showed that the majority of subjects significantly improved their performance. Further, the analysis showed that improvements were directly related to the duration of time that a subject worked on it (see sensesynergy.com).

While cochlear implants have been extensively studied, relatively little formal research has been carried out specifically on the effectiveness of auditory training. At the House Ear Institute, Dr. Qian-Je Fu and his colleagues have conducted much of the available research and have employed both analytic and synthetic approaches. For analytic training and testing, they developed a program termed CAST, or Computer Assisted Speech Training. A version of this (called Sound and Way Beyond) is now available commercially through the Cochlear Corp. Ten experienced cochlear implant (CI) users tried the program at home for about one hour a day, five days a week, for one month or more.  The average results demonstrated significant improvements in the subjects’ vowel and consonant scores after training.  Other studies, conducted at the House Institute and elsewhere, required identifying sentences under noisy conditions. The results of these studies also showed significant improvements in sentence recognition after training. Overall, it seems that both bottoms up and top down training can produce gains in the speech perception skills of CI users.  For the interested person, listening activities can be found on all three cochlear implant websites (advancedbionics.com, med-el.com, cochlear.com). Practiced sufficiently assiduously, I have no doubt that individuals can improve their performance using these resources.

A number of authors have cautioned us that in order to be effective, a formal auditory training program must meet certain criteria: • One, very pertinent for this day and age, is that it must be cost effective.

  • It must be sufficiently engaging to sustain participation, not too easy and not too difficult.
  • It must be practical and easily accessible (home-based is best).
  • It should provide immediate feedback regarding responses.
  • Optimally, it should incorporate elements of both bottoms up and top down processing.
  • Optimally, too, it should include the active collaboration of a knowledgeable professional.

    From my perspective, it does appear that auditory training is being resurrected from the dormant state it has been in since after WW II. Current developments, particularly in computers and the Internet, permit activities we could only dream about years ago. While professionals have a responsibility of making this option (home-based programs) known to their clients, it is still their clients – the person with a hearing loss – who often has to take the initiative. When it comes to hearing better, passivity is not an option.

A Tinnitus Success Story

THE BETTER HEARING CONSUMER

Gael Hannan, Editor

The Better Hearing Consumer addresses the personal experience of living with hearing loss. Editor Gael Hannan, and her occasional guest bloggers, explore every corner of the hearing loss life with humor and poignancy.

Jan. 2, 2017 – As a recent inductee into the world of tinnitus, I am pleased to welcome guest writer Glenn Schweitzer whose new book on tinnitus will be of interest to anyone dealing with those unwelcome – and unceasing – bells, whistles, roars and whooshing playing in their head.   

By Glenn Schweitzer

For as long as I can remember, silence had a sound.

When I was a kid, I thought everyone could hear the soft, high-pitched tone that I could hear when it was quiet. It wasn’t a bad sound; it was just normal.

Seven years ago, I was diagnosed with an incurable inner ear disorder called Ménière’s disease, and suddenly the quiet tone that never bothered me became the sound of sirens blasting in my ears.

When you live with tinnitus, the medical term for ringing in the ears, the sound never stops and can turn your life into a living nightmare.

Today, I’m happy to report that my tinnitus doesn’t bother me at all. Several years back, I stumbled onto a simple exercise that radically altered the way I react to the sound.

And it changed everything.  [Full article]

Coping With Every Musician’s Nightmare: Hearing Loss

photo of Richard Einhornby LOU FANCHER , September 30, 2016 in “San Francisco Classical Voice”

Waking up to find that he was suddenly and entirely deaf in his right ear on June 15, 2010, composer Richard Einhorn’s biggest worry wasn’t that he’d never work again. Nor was his greatest concern the spinning room and nausea, the way human voices sounded like screeching devils riding on crazed, squealing robots, or the piercing tinnitus, buzzing like a high-pitched, enraged refrigerator in his ear. Einhorn knew that he had only 30 percent hearing in his left ear, but didn’t know enough to worry about permanent damage to his other, “good ear.” He attributed the problem to allergies.

Einhorn wasn’t the only person in the world unfamiliar with the term, “Idiopathic Sudden Sensorineural Hearing Loss,” a medical emergency that occurs when the vestibulocochlear nerve goes wacky and basically, without immediate treatment with steroids, a person abruptly loses hearing forever.

Eventually, learning the cause was not allergies or earwax, as emergency room doctors in the hospital to which he fled first supposed, the then 57-year-old composer’s most monstrous fear was of becoming isolated. Married, with a daughter, accustomed to an interactive social life, Einhorn thought more like an average human being than like a musician. What would dinnertime be like? How would he converse and hear at parties and concerts? Would he be miserably lonely?

“It was easily the worst night of my life,” says Einhorn, in an interview from his home in New York City. “It was devastating on a personal level. It took me well over two years before I could physically and psychologically manage it.” [Full article]

How to Enjoy Music After a Hearing Loss

Stu Nunneryfrom HearingLikeMe.com, by Stu Nunnery on December 27, 2016:

Does hearing loss affect how we enjoy music? If so, is it possible to regain our enjoyment of music even after hearing loss?

Many of us with hearing loss have stopped listening to music because it does not sound how we remember it. Nevertheless,  more musicians, singers and music lovers with hearing loss are coping and finding their way back to music.

Recently I attended a seminar about the impact of hearing loss and hearing aids on music enjoyment that was hosted and led by Geoff Plant, a hearing rehabilitation specialist, musician and mentor of mine. The seminar explored the challenges of experiencing music after hearing loss, the claim that hearing aids do not always provide a quality musical experience, and strategies being used to more fully enjoy music.

Here’s what I learned…  [Full article]

Convention 2016: Salt Lake City, Utah

A Research Symposium, Breakout Sessions, Awards – and the most fun anyone ever had on a scavenger hunt!

Next up on the Museum of Fine Arts Boston FM-Accessible Tour Schedule–Americas: Making Modern

Americas: Making Modern assorted paintings
Above, clockwise from top: ~ Jackson Pollock, Number 10, 1949, 1949. Alkyd (synthetic paint) and oil on canvas mounted on panel.  ~ Georgia O’Keeffe, Deer’s Skull with Pedernal, 1936. Oil on canvas. Gift of the William H. Lane Foundation.  ~ Frida Kahlo, Dos Mujeres (Salvadora y Herminia), 1928. Oil on canvas.

Americas: Making Modern

Museum of Fine Arts

Sunday, February 5   – 10:30 AM

Registration begins on January 9  and closes on January 27

A five-gallery exhibition on the third floor of the MFA’s Art of the Americas Wing explores what it meant to be in the vanguard of Modern art in the 20th century. From Frida Kahlo to Jackson Pollock, original voices of Modern artists working in the Americas were influenced by a variety of contemporaries, teachers, rivals, and friends. Incorporating diverse sources of inspiration, 20th-century painters took their artistic practice in dramatic new directions. Each gallery represents a moment—from Mexico City to New York to Boston—illustrating the evolution of Modern art in North America. Featuring new acquisitions, rarely seen loans, and masterpieces from the MFA’s collection, the installations provide fresh perspectives on Modern artists working in the 20th century.

How to Pre-Register for MFA Accessible Guided Tours

Attendance is limited and pre-registration is required by the dates listed for each program.  To pre-register or for more information, email  lwarren@mfa.org or  phone 617-369-3302.  

When you register, please indicate (in the subject line if you are emailing) the name of the tour and if you would like a neckloop or headset for the tour.

Registered participants will receive a confirmation prior to the date of the tour with entrance and cancellation information.  

Because the Gallery Tour Listening System equipment is reserved for hearing loss support group participants, the equipment is not available to other MFA Boston visitors for drop-in tours.  For that reason, guests of this program are requested to be aware of the the following policies:

  • Participants who register for accessible tours but cannot attend should note the cancellation policy on the confirmation to ensure that listening equipment is available to other visitors.  
  • Late registrations  cannot be accepted.  
  • Those who have not pre-registered may only join a tour on a standby basis and will be turned away if registration is full.  

Tours will begin promptly at start time.  Attendees should arrive 15 minutes prior to start time.  

Questions?  Contact the museum at  lwarren@mfa.org or  phone 617-369-3302. 

Juliette Sterkens to Present at Hearing Loop Dedication at North Kingstown, RI Free Library

photo of Juliette Sterkens
Juliette Sterkens, Audiologist &  Advocate, HLAA Get in The Hearing Loop Task Force

What you need to know about hearing aids and hearing loops:

  • How hearing loops help you hear in large public places
  • Experience a hearing loop at this event

Informational community meeting for people living with hearing loss (and anyone close to them) with Juliette Sterkens

Saturday December 17, 2016 From 2:00 – 4:00 PM

North Kingstown Free Library
100 Boone Street
North Kingstown, RI

Event flyer

 

 

 

 

 

 

 

HLAA’s Katherine Bouton Interviewed on Healtheo360

HLAA’s Katherine Bouton was recently interviewed on healtheo360’s weekly 30-minute live health talk show.

Katherine BoutonKatherine Bouton is a longtime former editor at the New York Times, including 10 years as Deputy Editor at The New York Times Magazine. She continues to write for many sections of the Times, and is a weekly blogger at AARP Health. She is the author of the critically acclaimed ”Shouting Won’t Help” and “Living Better With Hearing Loss. Katherine developed idiopathic progressive hearing loss at age 30 and today wears a cochlear implant and a hearing aid. She currently serves on the Board of Trustees of Hearing Loss Association of America. Katherine is married to the writer Daniel Menaker and they have two grown children.

healtheo360 is a caring community for patients with chronic conditions, their caregivers, family members and friends to share their stories of inspiration, motivation and support. Every Tuesday at 1 PM ET, you can tune in to hear stories of survival, support, and innovative research from leading physicians as well as people just like you.

 

Help Hearing Healthcare Professionals at University of Connecticut Learn About Your Experience with Effortful Listening

cartoon image illustrating auditory fatigueThe Department of Speech, Language and Hearing, Aural Rehabilitation Laboratory Sciences at University of Connecticut is conducting a qualitative research study  on auditory fatigue / listening fatigue.

HLAA members and friends with hearing loss who would like to participate can learn more about the study on the attached flyer and contact Alison.Marinelli@uconn.edu.

Breaking a Logjam on Over-the-Counter Hearing Aids

photo of Katherine Bouton

Katherine Bouton is a longtime former editor at the New York Times, including 10 years as Deputy Editor at The New York Times Magazine. She continues to write for many sections of the Times, and is a weekly blogger at AARP Health. She is the author of the critically acclaimed ”Shouting Won’t Help” and “Living Better With Hearing Loss. Katherine developed idiopathic progressive hearing loss at age 30 and today wears a cochlear implant and a hearing aid. She currently serves on the Board of Trustees of Hearing Loss Association of America. Katherine is married to the writer Daniel Menaker and they have two grown children.

Bloomberg News, y Katherine Bouton

In the uncertainty over the future of U.S. health care, there is one ray of hope for a group of people who need more options, not fewer.

People with hearing loss usually pay out of pocket for hearing aids, and those pockets must be deep indeed. The average cost for a hearing aid is $2,300, and most people need two. They don’t last forever, and if your condition is progressive you may need to replace them as often as every four or five years.

No matter what your income level, hearing aids for adults are not covered by health insurance. They are not covered by Medicare, and they are not covered by state Medicaid programs. The Affordable Care Act does not cover hearing aids. Some private insurers are beginning to pay, but it’s usually only a fraction of the whole. The V.A. and some state vocational bureaus do provide hearing aids. But essentially, you’re on your own.

The good news comes in the form of a bipartisan bill introduced in the Senate by Republican Charles Grassley of Iowa and Democrat Elizabeth Warren of Massachusetts.

Their Over-the-Counter Hearing Aid Act of 2016, introduced on Dec. 1, would make certain basic hearing aids available over the counter and at a far cheaper price than what a decent hearing aid costs today. Whether these devices would be called “hearing aids” under Food and Drug Administration regulations remains to be seen, but they will be hearing-aid-like devices made by hearing-aid manufacturers.

These devices are not for people like me with severe to profound loss. But they are what the more than 30 million Americans with age-related hearing loss could use, at least as starter devices.  [Full story]