Hearing Loss - Beyond Early Childhood

See the Treatment sections of the Hearing Loss (Adults) and Hearing Loss (School-Age) Evidence Maps for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Service provision for patients with hearing loss begins soon after the diagnosis is made and comprises audiologic rehabilitation, including the selection, fitting, and evaluation of technology (if amplification is selected as a treatment approach). When selecting any treatment approach, the audiologist considers and incorporates the individual's and his/her family's goals, preferences, values, beliefs, and cultural and linguistic background.

Treatment approaches include

  • medical referral for evaluation;
  • counseling regarding the nature of the hearing impairment and the effects of the impairment on communication and well-being;
  • counseling to address specific interpersonal, psychosocial, educational, and vocational implications of hearing impairment for the patient, family members, and/or caregivers;
  • counseling regarding the use of effective coping and compensatory skills to minimize the effect of the hearing impairment;
  • selecting and fitting of amplification devices and assistive technologies and education regarding the use, benefits from, and adjustments to these systems;
  • training in selected modalities to maximize receptive communication skills and performance environments relevant to the patient;
  • periodic review of short- and long-term treatment goals and specific objectives determined from self-assessments and interactive decision making;
  • regularly scheduled outcomes measures to identify need for modifications to the treatment plan;
  • follow-up to monitor treatment benefit and outcomes;
  • involvement of family members and/or caregivers in the rehabilitative process;
  • referrals to speech-language pathologists for individuals whose speech and/or voice production may be affected by their hearing impairment;
  • referrals to other professionals as necessary.

Individual Practice Portal pages on amplification, cochlear implants, audiologic rehabilitation, and aural rehabilitation are being developed; links will be provided in the future.

Hearing Assistive Technology Systems

Hearing assistive technologies systems (HATS) include a large variety of devices designed to improve audibility in specific listening situations. HATS may be designed for use with hearing aids or cochlear implants or to be used alone and may be intended for personal use or group use. See classroom acoustics.

The American Academy of Audiology Task Force (2011) suggests several steps for the provision of HATS. While the guidelines are specific to remote microphone HATS for children, these steps may also be relevant to adults and to other forms of HATS. They include:

  • evaluating the client's candidacy for HATS;
  • considering the acoustics of the client's daily environments, social/emotional factors, functional abilities, and external support;
  • selecting the most appropriate device;
  • fitting and verifying the HATS;
  • implementing and validating the HATS.

Examples of HATs include

Frequency Modulation (FM) Systems—radio waves are used to transmit sound from the source to a receiver worn by a person. FM systems are often used in large settings (e.g., classrooms, restaurants, nursing homes, theaters, places of worship, museums).

Infrared Systems—sounds are converted into infrared waves then back to sounds by the listener's infrared receiver. These systems are often used in the home with television sets, but can also be used in large settings, such as theaters or classrooms.

Induction Loop Systems—hard-wire loops are placed under floors or around walls, and sounds are converted to magnetic forces. Cochlear implants and hearings aids with telephone switches or t-coils pick up these forces and convert them to sounds.

Telephone Amplifiers—speech heard over the phone is amplified. Telephone amplifiers are useful for people who don't wear hearing aids.

Voice Carryover Telephones (VCO)—VCO telephones connect a person with hearing loss to a local relay service.

Text Telephones (TTD or TTY)—this telephone works like a typewriter and sends and receives typed messages through telephone lines.

Alerting Devices—devices that provide a signal in response to sound may use strobe lights, regular lights, or vibrating systems to alert a person with a hearing loss that a sound has occurred. Examples include

  • doorbell, knock-at-the-door, or telephone alerting devices;
  • fire alarm/smoke alarm devices;
  • baby-crying or room-to-room sound alerting systems;
  • vibrating clock alarms, paging systems, and watch alarms.

Personal Amplification Systems—systems such as streamers (Bluetooth), mini remote microphones, and apps are designed for individuals with hearing loss.

HATS system selection considerations include

  • the need for, and potential benefits of, HATS as determined by the patient;
  • compatibility of HATS when used in conjunction with hearing aids, cochlear implants, and other devices;
  • appropriateness of the electroacoustic characteristics of HATS for the patient's hearing impairment;
  • compatibility of HATS in different environments (e.g., church, home, school);
  • self-reports of successful use and satisfaction with HATS.

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.