Stimulating phonemic information within the residual auditory area

Stimulating Phonemic Information within the Residual Auditory Area

With today’s digital hearing instrument technology, the measurement of each patient/client’s frequency specific LDL’s becomes most critical in the successful stimulation of the complete residual auditory area.


The arbitrary applications of compression knee-points and ratios, while providing comfortable amplification to a patient/client, does not always provide the patient/client with maximum stimulus of their defined residual auditory area.


The patient/client’s residual dynamic range must be defined and fully stimulated for maximum patient satisfaction and perhaps, their auditory health (with regards to auditory deprivation).


Would you prefer to listen to your favorite song performed over a small music box? Or, a multi-speaker, digital surround sound?


A reduced bandwidth stimuli of residual hearing ability equals a performance on a small music box.

Preferred bandwidth stimuli should fully stimulate the measured/revealed patient/client residual ability.


By fitting maximum output to the patient, electro acoustically, you will achieve less distortion and less feedback.

Psychoacoustically, the patient will perceive better sound quality and reduced chance for any continued auditory deprivation.


For a person with a moderate to severe hearing loss, the range between just audible and uncomfortably loud is significantly reduced (relative to a normal hearing individual’s range of hearing).



The goal in terms of fitting a hearing instrument to this individual’s ear would be to provide appropriate amplification so that speech will be audible and comfortable, and as much of the dynamics of speech will be preserved.


A hearing instrument specialist must fully define each patient/client’s residual auditory ability, and stimulate that defined area completely.

Today’s current hearing instrument technology and diagnostic testing equipment will allow for a truly electroacoustic custom fit for the patient/client.


The English language has 26 letters in it.

They are arranged in 44 phonemes.

It is the phonemes that we must "apprehend."

These combinations are the raw material from which meaning is made.


We must teach individuals with hearing impairment to hear, process, use, and understand these amplified phoneme “fragments”; and extract meaningful information from them.


In many cases what the patient/client’s brain once knew as recognized acoustic information; now, due to phonemic regression, their brain has forgotten how to process it!

It is incumbent on hearing instrument specialists to guide the patient/client in “rediscovering” these sounds.


Patient/clients need to read aloud in a normal, conversational voice for twenty minutes per day, for at least 30 days.

They can read anything: the newspaper, the Bible, a novel, or Dr Seuss.


When the patient/clients do that--their brains will know what they said with one hundred percent accuracy!


What the patient/client is practicing is the processing of the phonemes through the hearing instruments.

Via the amplification devices, they will sound uniquely different than ever before.

If the patient/client will do this regularly, aided discrimination scores will improve by about twenty percent.


The hearing instrument specialists' ability to identify and map, then fill the residual auditory area with aided sound, allows them to deliberately choose “fullness” in the character of the sound.


It is our professional responsibility to make certain that the patient/client is communicating comfortably and as efficiently as their residual hearing ability will allow.

There is simply no excuse for a patient/client not wearing a hearing instrument because it is too loud or because there is uncontrolled feedback.


As hearing health care professionals, we must provide realistic prognosis/expectations to our patient/clients—not prescribe to them some "super electro-acoustic device" which their defective auditory system is unable to accept or process.


We tell our colleagues who are entering the field that they will spend sixty percent of their time with five percent of their patient/clients.

Some don't quite understand this at first, but they soon come to agree.

Taking extra time at the beginning of your custom HI fitting will save you and the manufacturer hours of grief later.

Education

Stimulating phonemic information within the residual auditory area