Aural Rehabilitation Protocol
Successfully managing hearing loss takes patience and persistence. Many people find that aural rehabilitation provides valuable assistance as they strive to achieve better hearing.
FIRST DAY
Goal
Get re-accustomed to living again with continuous sounds.
Location
The quiet of your home (without radio, TV, or chatter of other people).
Activities
Do not wear your hearing aids when you are tired or nervous.
- Sit down and relax.
- Make sure the hearing aids are turned off.
- Insert the battery (if not already done so), after insuring that the battery is good.
- Practice putting the hearing aids on as demonstrated by your dispenser.
- If you have a volume control wheel, turn the hearing aids on, and adjust the volume slowly until you reach the lowest comfortable listening level, or allow the aids to self-adjust the volume if that is what they are intended to do.
- Listen to the sounds around you. Check their identification by tracing them to their source. By becoming familiar with the different sounds around you, it becomes possible to disregard them more easily when later you are engaged in a conversation. These sounds will become less bothersome.
Repeat this exercise until you can clearly distinguish the various types of sounds (i.e., the refrigerator, water running, fans, footsteps, etc.)
- Wear the aids for the time limit indicated on the previous page, unless they cause discomfort. If the discomfort is physical, contact you dispenser at your earliest convenience. If the discomfort is due to the quality of the sound, do the following:
- Turn the volume controls down slightly, if possible.
- Try the hearing aids again after 1-hour rest.
- Adjust the volume controls to get used to both soft and louder
levels if the hearing aid allows this.
- It is not advisable to wear the aids in noisy places and crowds until these first steps are accomplished.
Make Haste Slowly!
Unrestricted use of these hearing aids should not be attempted before the date specified by your hearing aid dispenser, unless your progress and satisfaction is such that your schedule is approved for advancement.
Your speed in reaching unrestricted use will depend mostly on your impairment. However,
your ultimate success-and this is of the greatest importance-will depend on your patience and cooperation.
Solid progress is important. Speed alone could spell defeat!
SECOND PERIOD
Goal
Beginning to listen carefully. Add 30 minutes each subsequent day. Try not to listen to too much too soon.
Location
Use the aids in a quiet, familiar situation. Do not wear them in noisy places or when you are tired or nervous.
Activities
- Read aloud to yourself. Read with your best diction and listen to the sounds of your own voice. Learn to monitor the loudness of your voice with the hearing aids on. Your voice may sound different to you when you wear aids. This is because your voice is closer to the hearing aids than anyone else, and as a result, may seem louder than usual.
- Practice listening to one person at a time who is three to six feet away and talking in a normal voice. If adjustable, set the hearing aids so that you can listen comfortably, even if you miss a few words. Talk about topics well known to you, look at the speaker, and make certain you have good lighting and minimal noise. Listen to the tone of their voice for inflection: question-upward swing; statement-downward swing; command-ends abruptly.
Try this for a few days with different people and notice the varying qualities of their speech. Some speak clearly while others mumble their words. Some speak slowly and others rapidly; others quietly and others loudly. This means that you must get used to the speech habits of different people. Watch the speaker closely. Interrupt if you do not understand and ask the person to modify their speech habits to make it easier for you to understand. Don’t worry about trying to listen to
what is being said, but rather try to find the most comfortable listening level for setting your aids’ controls.
- If it is possible, have someone speak slowly or read to you in a normal tone of voice 10 to 15 minutes a day. This may be necessary in the beginning if you have difficulty understanding what is said. This is because speech may seem too rapid or the words seem to run together.
- Gradually extend the distance between you and your helper. Leave the volume controls at the same level if they are adjustable. You will find that you must concentrate harder on distant sounds.
- You will find that hearing aids are easier to use in quiet situations than in noisy situations.
- Television
Listen to news broadcasters and solo singers. Let someone else with normal hearing set the volume (newscasts are best). Listen to the report without interference by other persons in the room. Watch the facial expressions and lips; concentrate on ideas, not words.
- Radio
Easy listening music only. Have someone else adjust the radio to normal volume. Relax and enjoy the music. Listening to music will provide practice in concentration and also teaches you to discriminate between the various sounds. Try to distinguish musical selections by the melody or rhythm.
THIRD PERIOD
Goal
Listening in more complex listening situations. Do this only after you feel comfortable listening to other people in your home or in one-to-one communication situations.
Location
At our out of the home where there are few competing sounds.
Activities
- After a few days and you have adjusted listening to another person(s), practice listening in more difficult listening situations. As you succeed, move from one to the next.
- Wear your hearing aids in the house while you are performing normal functions that do not involve noise. Listen to the sounds of your home and the people around you.
- Join in group conversations with two persons in a quiet environment who are willing to talk with and help you. Practice concentrating on one person at a time. Even a person with normal hearing cannot listen to and understand two or three voices at the same time.
Do not become discouraged if you do not hear everything that is said. If you occasionally have to ask someone to repeat, don’t feel that it is a reflection on your hearing or the efficiency of the hearing aids. Frequently, in group conversations, no matter how good one’s hearing, it is necessary to say: “I didn’t’ get what you said.” Continue to concentrate on distinguishing between different voices.
- As you move out of the home be aware of, and accustom yourself to, different sounds. Some can be startling, such as slamming doors, dropped objects, coughing, sneezing, etc. Others may be much noisier than you remembered, such as papers being shuffled, running water, barking dogs, and other sounds of daily life.
- Treat Yourself to Easy Listening Situations During the First Few Days and Weeks.
Don’t be discouraged if, at first, you cannot understand soft voices or a conversation in a noisy room. Stand close and face the person with whom you are talking. Gradually, you will find that you are able to follow the conversations.
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- Don’t Overtire Yourself. If the hearing aids make you begin to feel nervous, irritated, uncomfortable, or tired, turn them off or remove them. However, do not give up! Put them back on later and wear them for a few more minutes. Each time you put them on, try to increase your wearing them a few more minutes. In a few weeks you probably will be able to wear them from morning until night without fatigue or nervousness.
- Television
Gradually work into programs where there are several persons speaking or singing.
- Radio
Try to listen to commentators, talk shows, and single talkers- simple and common information.
FOURTH PERIOD
Goal
Listening in social events outside the home and increasing the listening distance. This should occur after about a week, and you have built up to wearing the aids 4-5 hours per day.
Location
Begin wearing the aids in small groups of people at home, outside, and at work in small groups.
Activities
- Continue your first week practice, but for longer time periods, and only as you are able to tolerate these longer times.
- You may find that reducing the volume a little helps during this adjustment stage.
- Continue the practice of the first three lessons, but for longer time periods, as you are able to tolerate them.
- At first, wear the aids for only a few hours in these more difficult
listening situations. Gradually increase the wearing time.
- Go outside and listen. Identify as many sounds as you can. Because wind blowing into your hearing aids may be annoying, try not to do this initial exercise while the wind is blowing hard.
- Try some new situations such as those encountered in quieter stores.
- Continue to avoid the situations in which you want most to wear your
hearing aids, such as: large crowded stores, restaurants, parties,
automobiles and streets, auditoriums, houses of worship, movies,
lectures, meetings, theatres, and situations where high noise levels
could be expected.
- Television
Continue with news broadcasters and solo singers.
- Radio
Continue with music and increase the time, but avoid tiring yourself.
FIFTH PERIOD
Goal
Wearing the hearing aids in public places such as parties, crowds, meetings, restaurants, auditoriums, etc. These will be the most difficult to adjust to, so be patient!
Location
All locations.
Activities
- Set realistic goals for yourself and don’t compare your progress with others. Don’t be a perfectionist. Be satisfied with small successes as you progress. Remember, you did not learn to hear and understand in one day- relearning to hear and understand will take some time also.
- For street traffic, begin on a quiet street and gradually move to a busy street.
- In restaurants, begin with one that has good acoustics, lighting, and is fairly quiet. Work up gradually to the noisier restaurants and you will be more secure in your use of hearing aids.
- In auditoriums or large seating places, choose a center seat near the front (never under a balcony) and adjust the controls of your hearing aids until you can hear sounds and voices best. Remember, applause can surprise and startle you. You may want to turn the volume down or switch the aid off when applauding, depending on your aids.
Don’t worry if you do not hear all that is said the first few times. It is sometimes impossible to catch a speaker’s every word, even for persons who do not need to use hearing aids. Try to get the meaning of what is being said.
This is due to (1) poor acoustics in the room, and (2) the fact that a speaker may not speak distinctly.
- In crowds or at parties, practice following one person’s speech while others are talking
or there is other noise in the background. At first, speech may seem to be unintelligible. You must focus your attention on the speaker’s voice. Also, watch the facial expressions and lip movements of the speaker.
If the social visit is very long, rest at intervals by shutting off your hearing aids or moving to a quieter location. Under no circumstances let yourself become tired or nervous.
Initial Adjustment Period
By the end of this initial adjustment period, the benefits will be, in the simplest terms, a return to a more normal life-style. Still, for the best hearing, at times you may have to turn your head a little, tilt it, or adjust a control on the hearing aids- all which will appear to others as nothing more than a normal motion.