Patient Counseling After the Hearing Test

Audiometric technicians often ask what is the best method to advise a patient of their hearing test results. After all, it has often been said, "It’s not the hearing test but the patient counseling conducted after the exam that may prevent a noise-induced hearing loss". Therefore, it is important for the examiner to know what to say, and equally important, what not to say to the patient after completing the hearing test.

It should be the examiner’s goal to obtain a routine, standardized and effective method of patient counseling. Therefore, after obtaining the test results, it is recommended that the examiner answer the following questions:

1. Is there a hearing loss?
2. Which side is the hearing loss on?
3. What is the degree of the hearing loss?
4. What are the consequences of this hearing loss?
5. What should be recommended?

Is there a hearing loss? The normal "range" of hearing sensitivity is considered to be from zero to no greater than 25 dB. If the audiometric thresholds obtained at all test frequencies are within this range, the patient’s hearing should be considered "normal". Therefore, to initiate patient counseling, one of only two sentences should be used: "You have normal hearing" or " You have a hearing loss". Beginning with such vague and occasionally misunderstood comments as, "you did fine" or "your hearing is ok" should be avoided. Beginning with the statement "You have a hearing loss" is not only more accurate and clearly understood, but conveys the seriousness of the situation and assists the examiner in establishing creditability. This creditability will later be essential if the examiner expects their recommendations to be accomplished.

Which side is the hearing loss on? This is frequently overlooked. Often the examiner assumes the patient knows what he meant when the patient is told, "You have a hearing loss" or "normal hearing". Therefore, to be accurate and complete, the examiner should end this opening sentence with such phrases as, "in both ears", or "in the right ear only". For example, "You have normal hearing for both ears". Simply describe the test results reported on the audiogram.

What is the degree of the hearing loss? Only in cases of workers’ compensation should the degrees of hearing loss be described as a percent. The standardized words: "normal, mild, moderate, severe, profound", and "deaf" are recommend. Frequently these words are used together. For example, "You have a mild, sloping to severe hearing loss predominately in the high frequencies". Textbooks often assign a range of intensity levels to each of these words. However, a good rule-of-thumb is to remember that conversational speech is often considered to be in the range of 50 to 60 dB. Therefore, any hearing loss below the level of conversational speech (between 25 and 50 dB) should be considered "mild" or "moderate". Any hearing loss above this range (50 dB or higher) should be considered, "severe" or "profound". Deafness has traditionally been defined as no response to sound for the majority of the test frequencies at the maximum intensity level of the audiometer.

What are the consequences of this hearing loss? Most workers understand that a "high tone" hearing loss is often associated with occupational noise exposure. Unfortunately they are poorly informed as to the consequences of this type of hearing loss. Again to help establish the examiner’s creditability, there should be a brief comment made regarding what it actually means to have an inability to hear "high tones". For example, if a high frequency hearing loss is observed, such comments should be said to the employee as, "Although conversations may appear to be loud, you will have difficulty understanding what is said particularly if there is noise in the background".

What should be recommended? It is critical that appropriate recommendations be made following the administering of a hearing test. In addition, it is important to attempt to motivate each worker. For example, even those with normal hearing should be reminded to "keep up the good work". Therefore, regardless of the test results, the following recommendations should be made for all patients:

1. Return in one year to obtain another hearing test.
2. Continue to wear your hearing protection device.
3. Attend the required noise exposure training class.

Obviously, additional recommendations can be made depending on the test findings. When the recommendation is made to schedule an appointment with a physician and/or audiologist, it must be stressed that these employees return with the specialist’s report. It is important to remember that the employer should have a written policy addressing the issue of payment or reimbursement for referrals prior to making this recommendation.

In summary, although it is desirable to be effective in patient counseling, it is essential to know what not to say. Specifically, even if the examiner is certified by the Council for Accreditation in Occupational Hearing Conservationists (CAOHC) the "type" and "cause" of the hearing loss should not be discussed. To state that the hearing loss is "sensorineural" or "permanent" or that the hearing loss was "caused by noise exposure" would be inappropriate and not advised.

© 2004, Precision Hearing Conservation