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  • The Final Word: Complex Problems, Often-incomplete Solutions
    26 Sep , 2015

    It is 9:00 PM at the Minneapolis airport, MSP Concourse G, Gate 13. A uniformed Delta gate agent finally picks up her microphone and begins her announcement for the 9:30 PM flight to Los Angeles. It is immediately apparent that English is not her first language. To complicate things, there are at least two other unintelligible announcements going on at the same time, and the agent is holding the mic in such a way that any hope of gaining visual cues during her announcement is futile.

    As I often do in these difficult listening situations, I tried to determine if it was just me having difficulty—as a result of my auditory system’s inability to process speech in noise, or was this just a bad situation. Fortunately, the familiarity of the situation for me helped a great deal. There was a passenger in a wheelchair waiting, as was a family with a child in a stroller. It was clear that boarding had not started yet. The suprasegmental elements of the gate agent’s dialog suggested a welcoming message, and I was able to determine what I had just heard was a pre-boarding announcement for passengers needing extra time to get down the jetway and to their seats.

    A young adult standing next to me turned with a puzzled look on his face and asked “What’s going on? I have no idea what she just said!” I explained my interpretation of the situation, and offered that the next announcement would be for first-class and premium passengers. He probably wondered how a gray-haired guy wearing hearing aids was able to hear the message when he couldn’t.

    The truth of the matter was that I didn’t hear the message, but relied on situational information and past experience to put things together. This is unfortunate for Delta, because I rewarded their insufficient communication attempts with behavior that suggested I heard the announcement. What they should do, is combine their audible announcements with a visual indicator of what is happening. A simple message on the screens that are constantly rotating would be sufficient: “DL flight 1283 to LAX now pre-boarding.” It couldn’t be that difficult.

    The broader question is what we should do to prepare our patients for these inevitable situations where audibility alone cannot be relied upon for effective communication. Initially, I try to make a strong point that there are conditions that exist in our daily lives where it just isn’t reasonable to expect adequate hearing and understanding. Starting with the information the patient offered during the initial session as we discussed needs, I ask them to describe in detail the situations where they would like to hear better. If it is a typical situation like a restaurant, or group conversation, I ask for more details: “What kind of restaurant? Where do you sit? Do you ask for a booth, or table?”

    I’m amazed that many patients do not give the choice of restaurant or the seating location much thought. If they do, their choice is often influenced by past experience before acquiring hearing aids. It is not unusual for a patient to comment that they like to sit next to a wall, noting that reflected sound helps with audibility. At that point, we start a longer conversation, including not only the choice of the restaurant, but how the features in their hearing aids may best be put to use.

    With directional microphones, their old strategies may no longer be appropriate. My coping strategy hints often include situations that simply need to be avoided. If a situation cannot be avoided, like my example of the airline boarding gate, we discuss ideas about what can be done in those situations. We cannot predict all situations, but picking a few representative examples can help initiate a process that encourages a thoughtful approach.

    Beyond the expectations and situational behavior counseling, I’m starting to recognize that broader educational approaches about lifestyle may be of benefit. My interest was recently piqued by a Twitter message from the National Institutes of Health (NIH) about calorie restriction: “Researchers found calorie restriction modified risk factors for age-related diseases and influenced indicators associated with longer life span, such as blood pressure, cholesterol, and insulin resistance.

    Cardiovascular health and diabetes mellitus type 2 are both linked to hearing loss. If educational efforts for our patients included diet, exercise, and lifestyle recommendations that promote health status influencing better hearing, a couple of outcomes occur. The potential for direct health benefit to the patient is obvious if they follow the advice. Additionally, the message that hearing loss is not an isolated condition with one simple solution that one can throw money at is effectively communicated.

    The Final Word? The achievement of better hearing requires a process with many elements. Recognizing the problem, learning about it, doing something, and coming to the understanding that solutions are complex and often incomplete, are some of the necessary steps. An important element is the recognition that there is not really an end to the journey. It can be a long and enjoyable one if one approaches it with the idea that it takes some effort to stay on course, or it may be difficult if one just allows it to happen without thoughtful participation.

    Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Technologies, Eden Prairie, Minn.