AR

Question 1

What is AR?

Answer 1

A multi-faced approach to reducing or eliminating the effects of hearing loss

Question 2

What is the goal of AR?

Answer 2

Mediate the detrimental effects of hearing loss on an individual’s participation, activity, and quality of life

Question 3

What are the components of AR?

Answer 3

• Sensory management with HAs, CIs, and/or other devices
• Orientation to respective devices
• Perceptual training to enhance speech perception and overall communication
• Counseling that incorporates the patient, family members, caregivers, and/or friends (Boothroyd, 2007)

Question 4

What results in improvement of QOL?

Answer 4

Hearing aids used in conjunction with AR

Question 5

What is QOL?

Answer 5

A broad concept that refers to how an individual perceives their life in terms of their own cultural and value systems

Question 6

What affects QOL?

Answer 6

QOL is affected by an individual’s health, psychological state, level of independence, relationships, and personal beliefs (WHO, 1997)

Question 7

What are the 3 types of AR available?

Answer 7

• Individualized therapy
• Group AR
• Computer-based AT

Question 8

What is individualized therapy?

Answer 8

A form of AR that historically focused on enhancing speech and lipreading abilities (Hawkins, 2005)

• Each session is tailored for the individual patient and the patient sets their own pace
• Can last months to a year since the pace is set by the patient

Question 9

Is there evidence to support individualized AR?

Answer 9

• No recent studies have evaluated individualized AR

- Systematic review by Sweetow and Palmer (2004) demonstrated little effectiveness of individualized AR

Question 10

What is the most common form of group AR?

Answer 10

Clinician based counseling approach

Question 11

What are the three advantages of group AR?

Answer 11

Hawkins (2005)

• Individuals with HL are given an opportunity to discuss feelings, problems, and solutions related to communication difficulties
• AR model is time and cost-effective for patients/clinicians
• Clinician is able to administer the same service to multiple patients at one time
• Some studies have demonstrated reduced HA return following group AR services

Question 12

What evidence supports group AR?

Answer 12

Abrams, Chisholm, & McCardle (2002)

• Conducted cost-benefit analysis between 2 different treatment groups: HAs alone and HAs used with short-term AR
• Short-term group AR was administered over a 4-week period
• Outcomes were assessed with the SF-36V questionnaire which contains a mental component summary (MCS) scale and a physical component summary (PCS) scale
• The MCS scale asks questions about emotions, anxiety, nervousness, cheerfulness, etc.
• The SF-36V was administered at both pre- and post-treatment

Question 13

What did the Abrams, Chisholm, & McCardle (2002) study find?

Answer 13

• Significant improvements in the mean MCS scores in both treatment groups
• Treating HL can directly improve an individual’s mental health, as well as quality of life
• However, no statistically significant differences were observed between the two treatment groups
• HAs alone were sufficent in improving QOL and that short-term group AR did not have an effect
• However, this study only evaluated the short-term benefits, rather than the long-term benefits
• Lastly, the cost-benefit analysis revealed that hearing aids used in conjunction with group AR were more cost-effective in terms of long-term benefit than with hearing aid use alone

Question 14

What were the limitations of the Abrams, Chisholm, & McCardle (2002) study?

Answer 14

• Participants were all veterans and findings were generalized to the non-verteran population
• HAs included in this study are available to veterans at a lower cost than in the non-military sector
• Authors compared the costs between the two treatment groups, rather than analyzed individual costs

Question 15

Why does research not support group AR?

Answer 15

• Only short-term benefits have been studied (Hawkins, 2005)
• Lack of information regarding long-term benefits make it challenging to determine if any improvements in QOL are obtained with group AR
• There are few well-controlled studies with an inadequate number of participants
• Due to the heterogeneity of these studies, as well as the lack of well-designed methodology, it is difficult to make conclusions about the efficacy of group AR as an intervention option

Question 16

What is the goal of AT?

Answer 16

Provide instruction in auditory and/or visual-auditory perceptual skills that are involved in language perception

Question 17

What is the LACE program?

Answer 17

Listening and Communication Enhancement (LACE) (Sweetow & Sabes, 2006)

• Individuals are trained in 5 tasks that are completed for 30 minutes a day for 20 days over a 4-week period
• The 5 tasks focus on listening in degraded speech, improving auditory memory, and improving the use of linguistic and contextual cues required for speech recognition

Question 18

What do studies evaluating AT not support the efficacy of group AR?

Answer 18

• They are heterogenous in their test paradigms, feedback provided, and outcome measures used
• A study directly evaluating the LACE program found that outcomes with HA use alone were superior to outcomes with the AT program (Sweetow & Sabes, 2006)