Week 4, Spring 2008

This week, I saw a grumpy man with a history of noise exposure. Throughout the case history interview, he offered short, vague answers, and he acted as though he would rather be somewhere else. He was a bit impatient during immittance testing, but he had normal tympanograms bilaterally.

During pure tone testing, he was directed toward the right speaker; however, he didn't make any attempts to look my way. In fact, he kept his head down during testing. I tried to be as cheery as possible during our interactions in order to make him feel more at ease, but the client never seemed to warm up. I just assumed that he was a grumpy man who didn't want to be there, but was required to come for an annual evaluation.

Pure tone testing revealed a slight to moderate sensorineural hearing loss in his right ear and a slight to moderately-severe hearing loss in his left ear. My supervisor and I reviewed his audiogram prior to discussing results with the patient. We observed that his hearing had worsened 10-15 dB HL since last year. He had been coming to our clinic for several years for annual evaluations, and I expected that explaining results wouldn't be particularly eventful. Still, we asked the client to come into the hearing aid room so that we could explain results and discuss amplification.

What I didn't anticipate was ... the patient's reaction to the results.

While I explained how to interpret the audiogram, the client was very quiet. I talked about pitch and loudness and sounds that those with normal hearing perceive at various frequencies. I then described the amount of hearing loss that was displayed on his audiogram. We talked about what sounds might be difficult for him to hear, and we used the speech banana as a visual aid. Throughout the explanation, the client remained silent.

Then, when my supervisor and I talked with him about the change in his hearing from last year and the possibility of amplification, the client became visibly upset. At that point, he began to open up about the increased difficulty with communication that he has been facing and the mounting tension between he and his wife. In part, he seemed relieved that he could tell his wife that he actually had a hearing loss. He even asked for a copy of his audiogram so that he could explain it to her. Conversely, he also seemed deeply saddened that his hearing had deteriorated.

My supervisor and I spent some extra time talking with him and counseling him about amplification options. However, he just didn't seem ready to pursue amplification at that time. I talked with him about making an appointment for a later date if he ever decided that he would like to try amplification.

The most important thing that I learned from this experience was ... Sometimes, irritability masks a more profound problem. In this case, I think he was afraid to learn the outcome of our test results. This was a great learning experience that emphasized the importance of being kind and patient with all clients ... especially the crabby ones!

In the article "How Personality Types Correlate with Hearing Aid Outcome Measures," the authors sampled 21 adults ages 60-80. All individuals had mild to moderate bilateral, symmetric SNHL and were first-time hearing aid users. Subjects underwent a HE and a HAE and also completed the COSI and the Myers-Briggs Type Indicator (MBTI). From the MBTI, 16 possible personality types could emerge from combinations of 4 personality dimensions: 1)extroversion vs. introversion; 2)sensing vs. intuition; 3)thinking vs. feeling; 4)judging vs. perceiving. After 4 and 8 weeks of hearing aid use, participants were asked to rate the degree of change resulting from hearing aid use, and the COSI was re-administered in order to monitor perceived benefit. These results were compared to established personality types in a correlational analysis.

The authors found several trends. A moderate negative correlation was found between perceived hearing aid benefit and the thinking and judging personality types. On the other hand, a strong positive correlation was found between perceptive individuals and their perceived benefit from amplification. Using this information, clinicians could informally assess patients personality preferences and use results to tailor appropriate informational counseling. In particular, it may be necessary to spend more time counseling "thinkers" and "judgers" about realistic expectations.


http://www.audiologyonline.com/theHearingJournal/pdfs/HJ2005_07_pg28-34.pdf