Auditory Training

Few audiologists would argue with the notion that additional training beyond the use of wearable amplification could potentially benefit patients. Unfortunately, despite the logic and growing body of evidence supporting this position, most audiologists do not offer or prescribe additional therapies, and most patients do not ask for, or even wish to participate in, additional rehabilitation. There are many possible reasons for this bilateral reluctance. They include cost (both from the patients' outlook that they have already spent enough money, and from the audiologists' perception that they will not be reimbursed for time-consuming activities), the perceived lack of evidence-based data, and-dare I say it-a bit of laziness and abdication of responsibility.

It is with great pride and hope that the information presented in this issue of Seminars will be considered by the audiologic community for application and incorporation into emerging programs and opportunities in auditory training. Patients and professionals alike need to understand that responsibility for success must be a shared process.

For professionals to embrace the concept of the need for aural rehabilitation and auditory training, research data must be gathered and presented in a compelling manner, backed by scientific methodology, and brought forth by established and respected investigators and clinicians. In this issue of Seminars, a group of individuals meeting these criteria has been assembled to produce a variety of articles highlighting some of the cutting-edge work that is helping to reinvigorate this important field of study.

Patricia Kricos and Patricia McCarthy lead off this issue by presenting an historical perspective on auditory training commencing with the 1st century writings of Archigenes, through the pioneering work of A.G. Bell, Goldstein, Pollack, Beebe, Carhart, Ling, Ross, Erber, and others.

From the United Kingdom, David Moore and Sygal Amitay bring the Nottingham perspective to the importance of studying auditory learning with a strict scientific approach. Their work emphasizes how auditory learning can occur very rapidly from a wide range of training scenarios and how popularly held beliefs regarding training task difficulty and active engagement should be reexamined.

David Woods and E. William Yund detail the effects of neuroplastic changes resulting from sensorineural hearing loss. They describe the consequent impairment of high-frequency hearing by the enhancement of the efficiency of synaptic transmission of low-frequency signals, and the deterioration in the central auditory system that occurs with normal aging, even without clinically significant hearing loss. They discuss the benefits of at-home personal computer-based phoneme identification training in new hearing aid users.

Kelly Tremblay brings her wealth of knowledge and experience regarding the role of auditory-evoked potentials in examining training-related changes in the central auditory system. She provides the reader with physiological evidence of plasticity and reflects on how this information might contribute to training protocols.

Robert Sweetow and Jennifer Henderson Sabes discuss the development of LACE (listening and auditory communication enhancement), a home-based, interactive adaptive computer program designed to engage the adult hearing-impaired listener in the hearing aid fitting process, provide listening strategies, build confidence, and address cognitive changes characteristic of the aging process, while providing the audiologist with a means of remotely monitoring patient progress. They present the results of a multisite validation study.

Qian-Jie Fu and John J. Galvin III outline the challenges faced by cochlear implant recipients in learning electrically stimulated speech patterns. They discuss a computer-assisted home-based speech-training program that targets important acoustic contrasts between speech stimuli and provides auditory and visual feedback, as well as progressive training. They report on studies that have demonstrated the effectiveness of such specialized auditory training programs.

In the final article, Joe Barcroft, Mitchell Sommers, and Nancy Tye-Murray provide a unique look at how Krashen's principles of second language acquisition can be applied to methods of auditory training for the hearing impaired. They argue that these principles imply the need for assessment of how the individual patient learns and currently processes language, underscoring the importance of individual, rather than group, auditory training.

Each of these articles presents auditory training from a unique perspective; nevertheless, the authors all agree that individualized training is important and new programs need to be developed, revised, and importantly, implemented. In addition, it is clear that individual assessment of a patient's learning style, auditory skills, and communication strategies will help refine training protocols. Moreover, evidence-based research using behavioral, psychoacoustic, and electrophysiologic data must be collected and disseminated.

It is my hope that in the near future, auditory training programs will be embraced with the same confidence and fervor as amplification, and that all patients entering an audiologist's office will exit with a therapeutic plan that focuses on communication, not just hearing.