Group Aural Rehabilitation session six

This session focuses on hearing assistive technology (HAT) beyond hearing aids and cochlear implants. 

Agenda

• Review from last session: Relaxation techniques
• Introduce hearing assistive technology 
• Discuss challenging listening environments and signal-to-noise ratio (SNR)
• Group activity: Use an app to identify the SNR in the room
• Introduce assistive listening devices

In the last session, the group discussed stigma and stress and tried out different relaxation techniques. Take a few minutes to ask if any group members have adopted a new stress-reducing practice. Do they have any websites, apps, books, or classes they have found helpful?

Introduce hearing assistive technology

Some types of HAT make difficult listening situations easier. Others are essential for a person with hearing loss’s safety. Describe to the group the main categories and their options for different types of HAT:

• Alerting and warning devices can help you hear doorbells, phones, alarm clocks, baby monitors, smoke alarms and carbon monoxide detectors, etc. (These items will be explored in more detail in session seven.)
• Telecommunication devices make it easier to receive and understand telephone calls.
• Assistive listening devices make it easier to follow conversations, lectures, television shows, etc. Assistive listening devices are the primary focus of this session.

What is noise, and how is it different from sound? Ask the group for examples. Discuss the effects of noise on listening. 

Discuss with the group how noise affects their ability to hear at a party. For example, do they:

• Miss softer sounds or unarticulated words in a conversation?
• Rely on context to fill in gaps?
• Find noise from other people talking to be especially challenging to hear in?

The ideal environment for listening is obviously one without noise; however, noise-free situations are uncommon. Explain to group members that in order for a person with normal hearing to hear well, the sound that they want to hear should be 15 to 20 decibels (dB) louder than the background noise. This difference is called a signal-to-noise ratio (SNR).

In other words, if they’re trying to hear someone speak, the person’s voice should be 15 to 20 dB louder than the ambient noise of the air conditioner, construction work next door, traffic outside, etc. 

Ask group members to download a professional sound meter app on their phone or tablet, such as the Decibel X: dB dBA Noise Meter for Apple devices or Android devices. Ask everyone to be quiet and have them each measure the background noise in the room with their decibel meter. Write the number down.

Start speaking again and invite group members to take a new measurement as you speak. Subtract the measurement of the background noise from the measurement of when you were speaking. This number will tell you the dB of your voice. Was your voice in the range of 15 to 20 dB above background noise? What would group members need in order to hear you more clearly?

The room you are conducting the session in is likely to be quieter than many environments group members will find themselves in. People with hearing loss may find that 15 to 20 dB is not a great enough SNR for them to hear clearly; remind group members to that they may need to asking the person they’re speaking with to speak louder or to move conversations to quieter places.

Encourage group members to play around with the app and take dB measurements in different environments before you meet. Share apps like SoundPrint, iHEARu, and NoiseCapture that crowdsource information about dB ratings in public places like restaurants, cafes, and parks.

Group members can use these apps to help find places with less noise and make smart decisions about where to meet up with family, friends, and colleagues. Discuss how helpful the dB measurements and apps are when you meet next time. 

Provide the group with this handout on assistive listening devices. Walk them through what assistive listening devices are, when they are used, and an overview of the different kinds. Group members with hearing loss may not know if their hearing aid has a telecoil or is compatible with their phone. Take a minute to go around the room, have group members check their hearing aids, and show them how to activate the settings.

If possible, bring other examples of assistive listening devices for group members to examine. You can also show YouTube videos demonstrating what assistive listening devices look like and how they work.  

There are many different contexts that assistive listening devices can be used in. Share a list of local public spaces and business where assistive listening devices are available, such as movie theatres, places of worship, or concert halls. Encourage group members to call places they frequent and ask if they have a system to help people with hearing loss.