Hearing Handicap and Hearing Aid Fitting Recommendation

November 15, 2010 by Martin Fortin
Hearing Handicap and Hearing Aid Fitting RecommendationThe number of people who have hearing loss is increasingly regularly. These individuals often question the need to wear hearing aids. The decision as to whether to wear hearing aids should never be based solely on audiometric test results and eligibility requirements of government insurers.

In the early 1980’s, a World Health Organization subcommittee developed a conceptual framework that helps clarify some concepts, specifically, the nature of impairment, disability, barrier, and handicapping situations.

  • Impairment pertains to a problem at the level of the organ.
  • Disability pertains to a loss in the function of the organ.
  • A barrier is linked to the environment.
  • A handicapping situation is a result of the interaction between the impairment, the disability and the barrier.

To better understand, here is an example of a person who has a hearing loss in one ear and is working in a warehouse and coming upon a moving fork lift:

  • In the case of hearing loss, the impairment could be a problem in the inner ear (clear sound perception from only one ear).
  • The disability would be the inability to localize sounds.
  • The barrier could be the work environment itself.
  • The handicapping situation would be the inability to localize alarm signals at work (e.g., coming from a fork lift backing up), placing the worker at risk of injury at work.

Two possible lessons based on the example above:

The first lesson is that, despite having one normal ear and one impaired ear, it remains advisable to wear a hearing aid on the impaired ear even if the user doesn’t qualify for subsidy from RAMQ.

The second lesson is that the hearing aid recommendation need not be based solely on the auditory thresholds recorded on the audiogram, but should instead take into account the hearing handicap situation.

Eligibility criteria for RAMQ (e.g., 35dB HL for an adult in both ears) are purely administrative standards. Unfortunately, this standard leads you to believe that hearing aids must not be necessary if the hearing loss doesn’t at least meet the 35dB HL standard, and, that a single hearing aid will suffice even if both ears are affected! The outcome of this belief is an unfortunate delay in the acquisition of hearing aids and increased difficulty in rehabilitation. Well, many hearing handicapping situations could be described, even in people who have mild hearing losses. These handicapping situations include difficulty listening in the presence of background noise or in a group listening situation.

In other words, the audiogram is not the only indicator of a need for a hearing aid. A hearing aid recommendation must also take into account the degree of hearing handicap. Hearing deficiencies involve disabilities that are experienced differently from one person to another.

For more information, don’t hesitate to consult your audiologist at one of Lobe Santé auditive et communication’s clinics.