For audiologists, one of the basic foundations of training is the concept of the degree of hearing loss. By assessing the degree of hearing loss in a person, the audiologist is able to predict communication outcomes in both adults and children. A person’s degree of hearing loss can range from mild to profound. By assessing a person’s hearing loss as mild, for example, an audiologist can anticipate common communication difficulties and outcomes, and help prepare the patient to manage these situations.
However, the concept of the degree of hearing loss is not flawless. While the degree of hearing loss still remains a strong predictive variable, there are additional factors that must be considered when predicting a patient’s communication outcomes. With the incredible technological advances that have been made in the field of audiology in recent years, the correlation between degree of hearing loss and communication outcomes has become less direct.
For example, a person with cochlear implants may have hearing loss that is considered “severe” when assessed by degree. However, cochlear implants allow functional hearing in a person’s everyday life. This means that their communication outcomes may often surpass what would be predicted for a person with such severe hearing loss.
Rather than using the degree of hearing loss as the greatest indicator of communication outcomes, some in the audiology field are calling instead for the use of the concept of the degree of hearing access. This concept utilizes the World Health Organization’s International Classification of Functioning, Disability and Health model (ICF), which helps to evaluate the degree to which a person’s life is impacted by a disorder. The ICF model includes assessment components such as environmental factors, body functions and structures, activity and participation, and personal factors.
When these factors are considered cohesively, the audiologist may gain a greater understanding of a patient’s likely communication outcomes. For example, a person with minor hearing loss who does not use their hearing aids, does not receive support from their family, does not seek assistance at school or in their workplace, and is very shy may have communication outcomes worse than what would be predicted by the degree of hearing loss alone.
On the other hand, consider a person with severe hearing loss who uses hearing aids or cochlear implants, seeks assistance at school or in their workplace, receives support from their family, and is outspoken in making others aware of their hearing loss. This person has a more severe degree of hearing loss, yet their communication outcomes will be greater than that of the above person with mild hearing loss.
This concept is known as the degree of hearing access. Recent research indicates that assessing a patient’s degree of hearing access should incorporate four key points:
- Auditory Integrity –
This factor evaluates the characteristics of a person’s hearing loss and auditory system, including the ability to detect pure tone stimuli. This should include a thorough assessment of several measures, including localization, loudness perception, and speech discrimination.
- Amplification Integrity –
This factor refers to the need for an appropriate hearing device that is properly fitted and meets the patient’s individual needs. However, it must be recognized that just because a person is wearing a hearing device does not mean that it is optimally fitted. Similarly, patients who do not use their hearing device do not have as great a degree of hearing access.
- Individual Factors –
This category includes various factors, such as the person’s age, degree of self-advocacy, cognitive ability, and more.
- Environment –
This factor includes the person’s physical space, as well as variables in the communication partner. It is important to remember that environmental factors can change at any time; for example, someone mowing a lawn outside an open window can change the hearing environment for the individual with hearing loss.
With an understanding and evaluation of these factors, audiologists can better assess the degree of hearing access for each person and help the patient anticipate and better manage communication challenges.
To learn more about the concept of the degree of hearing access, please contact our audiologist office today. We are happy to provide you with the information you need.