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Aural Rehabilitation

Aural rehabilitation is a broad term that encompasses all of the treatment that can be provided to help people overcome the challenges related to hearing loss. It includes amplification (hearing aids, cochlear implants, assistive devices), instruction (how to use those devices), education (about hearing loss and coping strategies), resources (how and where to plug in to hearing loss communities), and auditory training (kind of like physical therapy for the ears and brain). It is important to know that hearing aids are only one piece of the puzzle when it comes to treating hearing loss, and finding an audiologist who provides all of the components of aural rehabilitation will ensure more successful outcomes with the treatment process.

Importance of Assessment in Aural Rehabilitation

Aural rehabilitation begins with a thorough assessment of the listening and communication situations that are the most difficult and most important for each individual person. This assessment should incorporate a case history, written questionnaires, and an in-person session for the audiologist to clarify what was included in the written forms. The assessment is so important because it provides the framework for the entire treatment phase of the rehabilitation process. There is no “one-size-fits-all” approach when it comes to treating hearing loss. Everyone has different hearing and communication challenges and so each aural rehabilitation plan should be tailored to that person’s unique needs. A thorough assessment allows audiologists to create the most appropriate plan for each individual.

What are the types/components of aural rehabilitation?

There are essentially 5 components of aural rehabilitation: audibility, instruction, education, resources, and auditory training. Let’s take a closer look at each one.

Audibility: Audibility means giving the patient access to sounds that their hearing loss prevents them from hearing. It is the technological part of aural rehabilitation. Audibility can be provided in the form of hearing aids, cochlear implants, personal sound amplification systems, assistive listening devices, and wireless hearing aid accessories. Unfortunately, many people think that hearing loss treatment stops here, but that is not the case. The other 4 components are just as important, and are often necessary in order for people to be successful with the technology.

Instruction: Instruction teaches patients everything they need to know to effectively use their technology. Instructions about hearing aids would include how to insert and remove them from the ears, how to change the batteries or charge them, and how to keep them clean. It would also include how to make volume and program changes and how to use the Bluetooth functions of the hearing aids for phone calls, music, and adjustments through the smartphone app.

Education: This critical part of aural rehabilitation teaches patients about hearing and hearing loss. It also teaches important communication strategies for both the person with hearing loss as well as their communication partners. Effective communication strategies for the communication partner might include tips like getting the listener’s attention before speaking, enunciating words clearly but without over-exaggerating them, and rephrasing sentences that were missed rather than saying the same sentence again louder. Effective communication strategies for the person with hearing loss might include repeating back what they think they heard rather than simply saying, “What,” anticipating what might be said based on the context of the situation, and watching the speaker’s face to use important visual cues. There are also many environmental modifications that can make a world of difference when it comes to hearing and communicating successfully. These might include choosing a booth or going to restaurants at off-hours when they aren’t so busy, turning off distracting noises in the house or the car, and making sure you are always in the same room as your communication partner before trying to have a conversation. All of these effective communication strategies, and more, should be reviewed and practiced as part of your aural rehabilitation program. An excellent source of education about communication strategies is the 5 Keys Communication program which includes a handbook and an online program with lessons delivered via email.

Resources: There are many wonderful resources and consumer organizations that support people who have hearing loss, and part of a comprehensive aural rehabilitation program is making sure people know about these resources. The two largest consumer organizations in the United States for people with hearing loss are the Hearing Loss Association of America (HLAA) and the Association for Late Deafened Adults (ALDA). Another large organization that is wonderful for people who suffer from tinnitus (ringing in the ears) is the American Tinnitus Association (ATA). These consumer organizations have inexpensive membership options that provide so many benefits, including educational newsletters, local chapter meetings and presentations, and even national conferences. These organizations are wonderful for both education as well as connection with others who have hearing loss. It can be very comforting to know that you aren’t alone, and connecting with the hearing loss community is a great way to learn from others who may be struggling with some of the same challenges that you are. In addition to the national consumer organizations, there are some online resources such as blogs and websites that provide wonderful information. A couple of examples of hearing loss blogs are which is sponsored by a hearing aid manufacturer, and which is written by Shari Eberts, who is a speaker and hearing health advocate.

Auditory Training: Also called auditory perceptual training or auditory brain training, this is the part of aural rehabilitation that is kind of like physical therapy for the ears and brain. Auditory training can be done through computer programs, smartphone apps, home-based programs, and one-on-one with a clinician. Auditory training is simply the process of listening to different sounds and helping the ears and brain to decode those sounds correctly and efficiently. A very simple form of auditory training would be listening to your communication partner read a book out loud while wearing your hearing aids. This task could then be made more difficult by adding some background noise, such as a fan, and training your brain to focus on the book and ignore the fan noise. It could also be made more difficult by having your communication partner read faster.  So we are literally training the auditory system to process sounds in more and more difficult situations. A slightly more sophisticated version of this would be listening to an audiobook. Some audiobook apps, like Audible, allow you to increase the speed of the narration. There is also evidence that listening to music, specifically classical music, can provide effective auditory training. On the other end of the spectrum, there are some very sophisticated auditory training computer programs that provide auditory training lessons in a videogame-like format. Two of these programs are Amptify and LACE. The activities in these programs focus on training very specific areas of the auditory system and also provide some education and additional support.

What is aural rehabilitation for children?

Aural rehabilitation is critical for children who have hearing loss. It is sometimes called aural habilitation as children who are born with hearing loss will be learning skills for the first time (as opposed to aural REhabilitation where adults are RE-learning skills that they knew before losing their hearing). All five components of aural rehabilitation must be implemented in order to help the children and their families learn to successfully cope with hearing loss. Working with children who have hearing loss is very different than working with adults, so it is important for parents to find an audiologist who specializes in pediatric audiology. Pediatric audiologists will have the equipment, training, and resources to make sure that children (and their parents) receive appropriate aural rehabilitation. When working with children, much of the instruction, education, and resources are directed toward the parents. There are also auditory training programs that are made for children. These programs are so important as children learn to identify and attach meaning to all of the various sounds in their world. As children get older, they will start taking on more responsibility for their hearing loss treatment and the aural rehabilitation will change accordingly.

What is adult aural rehabilitation?

For adults who lose their hearing later in life, aural rehabilitation helps them to re-learn skills that may have been lost as their hearing deteriorated. It is literally re-introducing sound to the brain and therefore the emphasis is on helping the ears and brain remember what to do with that sound. It also provides all of the critical instruction, education, and resources to ensure that adults will lead a happy and productive life, despite the hearing loss.

What professions can provide auditory rehabilitation?

Audiologists are the main professionals who are trained to provide aural rehabilitation for all patients who have hearing loss. Audiologists earn a doctorate degree in Audiology and therefore have the education and skills to effectively diagnose and treat hearing loss as well as several other disorders of the hearing and balance systems. Hearing Instrument Specialists are trained to test hearing and fit hearing aids for adult patients and can also provide their patients with the other components of aural rehabilitation. Hearing Instrument Specialists do not work with pediatric patients. Speech-Language Pathologists are trained to provide auditory training therapy for people with hearing loss but they cannot fit hearing aids or cochlear implants. 

Many people think of hearing aids as the main treatment for hearing loss. And while hearing aids are important to increase access to sounds, they are only one part of a comprehensive aural rehabilitation program. Aural rehabilitation encompasses everything that professionals provide their patients in order to help them live well with hearing loss. It includes audibility, instruction, education, resources, and auditory training. While some patients may need more extensive aural rehabilitation than others, it is important that these services are offered to everyone who seeks treatment for their hearing loss.

At Columbine Hearing Care, we are proud to provide a comprehensive aural rehabilitation program for every patient that includes the 5 Keys Communication program which was created by our owner and head audiologist, Dr. Dusty Jessen.

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