SPEECH: Lip- reading, auditory training and hearing tactics

Question 1

what is the objective of fitting hearing aids?

Answer 1

to restore a range of loudness experience, to make speech audible without introducing distortion as amplifying sounds can make them more audible but also make the intense portions of sound too loud causing distortion

Question 2

how do hearing aids address the issue of distortion caused by modification?

Answer 2

Modern hearing aids use techniques such as frequency shaping, graduated compression, multichannel compression, directional microphones, and noise reduction circuits to mitigate distortion.

Question 3

what is a disadvantage of compression circuitry?

Answer 3

compression circuitry in the aid limits amplification of more intense vowel sounds making them harder to hear too

Question 4

how might the improvements in hearing aids impact the understanding of speech?

Answer 4

The improvements may also reduce frequency and timing information, making speech harder to understand.

Question 5

why are hearing aids a good choice for people with mild to moderate HL?

Answer 5

-the basic nature of the sound signal is unchanged from the original so keeping the essential features of normal sound with minimal distortion

1-the hearing aid makes an acoustic signal louder overall

2-it can make sounds relatively more intense in some frequencies to match the audiogram

3-it is possible to limit its maximum intensity level to fit within individual dynamic ranges (ULL) so the sound is comfortable

• people can adapt quickly to the sound without further training

Question 6

why are hearing aids less helpful for people with severe HL?

Answer 6

-people with this level of HL need more amplification to hear sounds which increases distortion in the ear and sometimes in the aid

1- increasing the intensity of sounds increases the risk that low frequency background noise will mask high frequency speech sounds

2- damage to the cochlea increases the risk of recruitment so people cannot tolerate loud sounds requiring more sound processing in the aid… which increases the risk of distortion

Question 7

why are implantable devices (CI) more effective than hearing aids for people with profound HL?

Answer 7

-hearing aids are unlikely to help people with profound HL

• An implant replaces the basilar membrane in the cochlea and stimulates the auditory nerve directly
• Many people have significantly improved speech perception compared to hearing aids
• But not everybody is suitable for an implant so we need to provide them with appropriate support

Question 8

what are some thing sa hearing aid user can do to make things easier?

Answer 8

-be near the sound they wanna hear and look at the person speaking to them (Lip reading)

-where possible, get rid of background noise as they can only process 1 sound at a time

Question 8

how can we help patient decide what they want to do about their hearing?

Answer 8

-encourage them to ask the following questions and use options grid to answer

Question 9

why is it important to signpost and encourage patients to use other communication strategies other than technology

Answer 9

-most peoples strategies are ineffective or nonspecific which can reduce the quality of their interactions and can increase social anxiety and withdrawal from social settings

-signposting and encouraging other communication strategies can help minimise such difficulties and help patients communicate more effective

Question 10

what are the barriers to developing new communication strategies?

Answer 10

-people don’t want to step out their comfort zone, no chnage, don’t wanna learn

-the discomfort zone can have uncertainty and require learning

-people are scared to e in their panic zone where they freeze up, don’t change and don’t learn

Question 11

what is the stages of change model?

Answer 11

• The Stages of Change model provides a framework, which helps in understanding how people change when faced with a health issue
• It was developed as an integrative model of change drawing on a range of theoretical schools
• It suggests there are distinct stages that people go through to change behaviour
  Individuals can remain at one stage or another for a long time but will work their way through them
• Our role is to identify the patient’s stage and support them through the process of change

Question 11

how do we enhance effective communication?

Answer 11

-lip shapes
-gestures
-hearing
-body language
-topic/ subject
-facial expression
-putting 2+2 together
-intelligent guesswork

Question 11

what are the rules to social interactions?

Answer 11

1. So we tacitly agree to share interests – at least for as long as we talking together
2. We select what to talk about, and try to be relevant in our content
3. We try to provide the right amount of information, dependent on the situation
4. We don’t hog the conversation but take turns
5. Both of us would expect the conversation to be mutually beneficial – so building our social capital

Question 11

why might hearing impaired people risk breaking the rules of conversation?

Answer 11

They might miss important cues and :

• interrupt or introduce topics unexpectedly
• disrupt turn taking in conversation and need frequent clarification of the conversation
• People may modify how they speak to them so the conversation becomes superficial because it is too difficult to convey information

Question 12

what are hearing impaired people advised to do?

Answer 12

• Tell people they have a hearing impairment
• Ask the topic of conversation
• Use hearing tactics
• Stop the speaker as soon as they have missed something
• Write things down
• Keep relaxed!

Question 13

how do our senses help us communicate in difficult listening situations?

Answer 13

-lip reading (speechreading skill develops early in babies and younger people are better at it than older

-gestures
-facial expressions
-visual cues
-body lanaguage
-situational cues

Question 14

why do people with hearing loss need to use lip reading skills systematically?

Answer 14

• because the SNR (signal to noise ratio) needs to be improved by 1dB for every 10dB of hearing loss

Question 15

how many dB can lipreading increase the SNR (signal to noise ratio by)

Answer 15

Lip-reading can increase SNR by about 6dB

Question 16

how is effective lip reading carried out?

Answer 16

Effective lip readers use context, guesswork, and flexibility of interpretation of the signal to improve communication

Question 17

what is the percentage of speech that is not visible?

Answer 17

It needs to be remembered that 60% of speech is not visible

Question 18

what limits the help provided by lip reading?

Answer 18

-the clarity and speed of the speaker’s speech;
-number of speakers;
-visibility of speaker etc

Question 19

why are we not able to lip read every letter?

Answer 19

Many parts of speech give particular shapes to the lips, but not everything can be seen - such as ‘k’ or ‘g’ or ‘…ing’, and nothing can be seen of ‘h‘

Question 20

why is lip reading challenging?

Answer 20

most people recognise less than 20% of the words they see

-Some speech sounds look the same – ‘b’, ‘m’ and ‘p’, ‘buy my pie’ – will look in fact look the same. These are known as homophenes as they look alike on the lips bur are pronounced differently.
So if you say pat, bat, mat for example without using your voice they will look the same on the mouth.

• For this reason, lip readers may substitute one word or phrase because they guess at what they have misheard

Question 21

what is visemses

Answer 21

Visemses are the way speech sounds appear on the face.

Question 22

what s the percentage of English words that are homopheenous?

Answer 22

40-60% English words are homophenous i.e. They all look alike but have different meanings and spellings

Question 23

what are homophenes?

Answer 23

Homophenes should not be confused with homophones which are each of two or more words having the same pronunciation but have different meanings or spelling, for examplenewandknew.

Question 24

what is the McGurk effect?

Answer 24

• The General Auditory (GA) and learning approaches suggest that the brain doesn’t necessarily rely on recovering specific motor or articulatory gestures to perceive speech. Instead, it’s proposed that listeners use various acoustic cues to categorize speech sounds, even if those cues are imperfect. This implies that listeners are adept at interpreting speech based on overall patterns in sound, rather than precise articulatory details
• The McGurk effect suggests we can’t separate these two things – we are integrating audio and visual information simultaneously

Question 25

what is auditory training?

Answer 25

Auditory training is the use of listening practice, designed to increase the amount of information that hearing contributes to a person’s total perception

Question 26

who benefits more from auditory training: new HA users or experienced?

Answer 26

Some research has shown that new hearing aid users show greater benefit from auditory training than experienced hearing aid users but the research is not conclusive

Question 27

what do hearing aid tactics do?

Answer 27

Hearing tactics deal with facilitating communication, optimising signals, and using conversational strategies

Question 28

what are some different types of hearing aid tactics?>

Answer 28

1. Instructional strategies – these alter the speaker’s style of delivery e.g. talking slowly
2. Message tailoring strategies – these change the message construction e.g. closed questions with yes/ no responses
3. Environmental strategies – e.g. reduce background noise; have the light on the speaker’s face etc
4. Anticipatory strategies – minimise difficulties by preparing for communication interactions e.g. going shopping/buying rail tickets. It considers factors such as vocabulary and background information to predict an interaction
5. Repair strategies – these are used when communication breaks down – repetition, rephrasing, identify topic, confirming content of message, writing, etc

Question 29

what effect can changing the way individuals use their communication skills have on their hearing loss?

Answer 29

Changing the way people use their communication skills can change how they think about the experience of hearing loss

Changing the way people use their communication skills can change how they think about the experience of hearing loss

This may be more effective in improving communication than the use of the strategies themselves

Question 30

what does the 5 areas of cognitive behavioural therapy tool by Williams and Garland do?

Answer 30

can be used to pull apart different aspects of the patient’s experience and link them in a new way

The impact of the problem on:
-cognitions
-behaviour
-physiology (stress response)
-emotions