Chapter 1
Introduction to Aural Rehabilitation
Chapter Approach
The purpose of this chapter is to provide an overview of auditory rehabilitation for the
undergraduate or graduate student in communication sciences and disorders. The chapter begins
with key definitions pertaining to hearing loss and related to auditory rehabilitation.; it t is of
particular importance that students understand how various definitions have been used over the
years for auditory rehabilitation and the implications of these definitions for audiology and
speech-language pathology.
The chapter introduces the notion that audiologists and speech-language pathologists have inter-
related, complementary, and overlapping roles in assessing and treating patients with hearing
loss. Frequently, these services are provided across various service-delivery sites based on the
age of the patients. Paramount is the realization for students that as audiologists and speech-
language pathologists, they will often provide auditory rehabilitative services within the context
of team approach.
The chapter also provides a review of basic audiologic testing. Undergraduate students need a
review of knowledge and skills learned in their introduction to audiology courses. Types, degree,
age of onset of hearing loss, as well as ways in which these losses may be manifested within a
basic audiologic evaluation, were explained conceptually. Understanding the different sites of
lesion serves as a foundation for pathways of care involving both medical and non-medical
management of hearing loss.
Learning Objectives
After reading this chapter, students should be able to:
1. Define prevalence and incidence as they pertain to hearing loss.
2. Define audiologic rehabilitation, aural rehabilitation, auditory rehabilitation,
and auditory habilitation.
3. Interrelate the roles of various professionals involved in auditory rehabilitation
across service delivery sites.
4. Interpret audiograms.
5. Describe the effects of hearing loss.
6. Explain a model for auditory rehabilitation.
5
,7. Acknowledge other areas of auditory rehabilitation.
Key Terms
Acquired hearing loss: A hearing loss that develops after development of spoken language or
after the completion of formal schooling
Activity: The execution of a task or action of an individual; has to do with what the patient can
do
Activity limitations: Difficulties that an individual may have in executing tasks, particularly
those involving speech, speech understanding, and communication
Age of onset: The chronological age of a patient when a hearing loss develops
Air-bone gap: A difference of more than 10 dB between bone- and air-conduction thresholds at
the same frequency and in the same ear
Air-conduction stimuli: Sounds that travel through the outer ear, middle ear, and inner ear
Articulation Index: An estimation of the availability of speech energy expressed in percent
ranging from 0%, no understandability, to 100%, complete understandability
Asymmetric audiometric results: Audiometric results in each ear are different
Audiogram: A graph used to record the results of an audiologic evaluation
Audiologic rehabilitation: Includes services provided by audiologists to minimize the effects of
hearing loss, balance problems, or other auditory disorders on patients’ lives
Audiometer: An instrument used to measure hearing sensitivity
Auditory brainstem response testing (ABR): A nonbehavioral test that measures how the
auditory nerve conducts impulses from the periphery to the auditory brainstem pathways in
response to auditory stimuli
Auditory habilitation: Providing services to children with congenital hearing loss or hearing
loss present at birth or acquired before the acquisition of speech and language
Auditory rehabilitation: An “ecological, interactive process that facilitates one’s ability to
minimize or prevent the limitations and restrictions that auditory dysfunctions can impose on
well-being and communication, including interpersonal, psychosocial, educational, and
vocational functioning” (ASHA, 2001)
Aural rehabilitation: services and procedures for facilitating adequate receptive and expressive
communication in individuals with hearing impairment (ASHA, 1984)
6
, Behavioral tests: Assess patients’ conscious response to auditory stimuli
Benign paroxysmal positional vertigo (BPPV): The most common form of vertigo; results
from an asymmetrical fluid movement due to a conflicting response to head movement in one of
the semicircular canals
Biopsychosocial model: Perspective that combines the medical and social models of disability
Body functions: Physiological functions of body systems (including psychological functions)
Body structures: Anatomical parts of the body such as organs, limbs, and their components
Bone-conduction stimuli: Sounds that bypass the outer and middle ears (i.e., conductive
mechanism) to stimulate directly the inner ear (i.e., sensorineural mechanism) through vibration
of the bones of the skull
Bottom-up strategies: Attempts to enhance the signal being heard and assist patients overcome
processing problems by developing their perceptual skills through auditory training (ASHA,
2005a and 2005b)
Brain Plasticity: Ability of the cortex to reorganize as a result of repeated experiences, such as
auditory training
Central hearing loss: Congenital or acquired damage to the auditory nerve, pathways, or cortex
that may cause hearing loss or other processing problems
Conditioned oriented response audiometry: A testing paradigm to be used with infants as
young as 6 months that is similar to visual reinforcement audiometry, but differs in that
responses are rewarded only with visual reinforcement (e.g., animated toys behind smoked
Plexiglass) if the head turn is made toward the loudspeaker (or earphones) actually presenting the
auditory stimulus
Conductive hearing loss: Loss of hearing sensitivity due to a problem in the outer (e.g.,
impacted ear wax [i.e., cerumen], growths, or infections that may obstruct the ear canal) or
middle ear (e.g., a perforation in the tympanic membrane, a presence of fluid in the middle ear
space, otitis media, a cholesteatoma) that prevents transmission of sound energy into the inner
ear.
Configuration: Describes the shape or direction of the air-conduction threshold symbol assumes
in the right and/or left ear when placed on an audiogram
Congenital hearing loss: Hearing loss present at birth
7
Introduction to Aural Rehabilitation
Chapter Approach
The purpose of this chapter is to provide an overview of auditory rehabilitation for the
undergraduate or graduate student in communication sciences and disorders. The chapter begins
with key definitions pertaining to hearing loss and related to auditory rehabilitation.; it t is of
particular importance that students understand how various definitions have been used over the
years for auditory rehabilitation and the implications of these definitions for audiology and
speech-language pathology.
The chapter introduces the notion that audiologists and speech-language pathologists have inter-
related, complementary, and overlapping roles in assessing and treating patients with hearing
loss. Frequently, these services are provided across various service-delivery sites based on the
age of the patients. Paramount is the realization for students that as audiologists and speech-
language pathologists, they will often provide auditory rehabilitative services within the context
of team approach.
The chapter also provides a review of basic audiologic testing. Undergraduate students need a
review of knowledge and skills learned in their introduction to audiology courses. Types, degree,
age of onset of hearing loss, as well as ways in which these losses may be manifested within a
basic audiologic evaluation, were explained conceptually. Understanding the different sites of
lesion serves as a foundation for pathways of care involving both medical and non-medical
management of hearing loss.
Learning Objectives
After reading this chapter, students should be able to:
1. Define prevalence and incidence as they pertain to hearing loss.
2. Define audiologic rehabilitation, aural rehabilitation, auditory rehabilitation,
and auditory habilitation.
3. Interrelate the roles of various professionals involved in auditory rehabilitation
across service delivery sites.
4. Interpret audiograms.
5. Describe the effects of hearing loss.
6. Explain a model for auditory rehabilitation.
5
,7. Acknowledge other areas of auditory rehabilitation.
Key Terms
Acquired hearing loss: A hearing loss that develops after development of spoken language or
after the completion of formal schooling
Activity: The execution of a task or action of an individual; has to do with what the patient can
do
Activity limitations: Difficulties that an individual may have in executing tasks, particularly
those involving speech, speech understanding, and communication
Age of onset: The chronological age of a patient when a hearing loss develops
Air-bone gap: A difference of more than 10 dB between bone- and air-conduction thresholds at
the same frequency and in the same ear
Air-conduction stimuli: Sounds that travel through the outer ear, middle ear, and inner ear
Articulation Index: An estimation of the availability of speech energy expressed in percent
ranging from 0%, no understandability, to 100%, complete understandability
Asymmetric audiometric results: Audiometric results in each ear are different
Audiogram: A graph used to record the results of an audiologic evaluation
Audiologic rehabilitation: Includes services provided by audiologists to minimize the effects of
hearing loss, balance problems, or other auditory disorders on patients’ lives
Audiometer: An instrument used to measure hearing sensitivity
Auditory brainstem response testing (ABR): A nonbehavioral test that measures how the
auditory nerve conducts impulses from the periphery to the auditory brainstem pathways in
response to auditory stimuli
Auditory habilitation: Providing services to children with congenital hearing loss or hearing
loss present at birth or acquired before the acquisition of speech and language
Auditory rehabilitation: An “ecological, interactive process that facilitates one’s ability to
minimize or prevent the limitations and restrictions that auditory dysfunctions can impose on
well-being and communication, including interpersonal, psychosocial, educational, and
vocational functioning” (ASHA, 2001)
Aural rehabilitation: services and procedures for facilitating adequate receptive and expressive
communication in individuals with hearing impairment (ASHA, 1984)
6
, Behavioral tests: Assess patients’ conscious response to auditory stimuli
Benign paroxysmal positional vertigo (BPPV): The most common form of vertigo; results
from an asymmetrical fluid movement due to a conflicting response to head movement in one of
the semicircular canals
Biopsychosocial model: Perspective that combines the medical and social models of disability
Body functions: Physiological functions of body systems (including psychological functions)
Body structures: Anatomical parts of the body such as organs, limbs, and their components
Bone-conduction stimuli: Sounds that bypass the outer and middle ears (i.e., conductive
mechanism) to stimulate directly the inner ear (i.e., sensorineural mechanism) through vibration
of the bones of the skull
Bottom-up strategies: Attempts to enhance the signal being heard and assist patients overcome
processing problems by developing their perceptual skills through auditory training (ASHA,
2005a and 2005b)
Brain Plasticity: Ability of the cortex to reorganize as a result of repeated experiences, such as
auditory training
Central hearing loss: Congenital or acquired damage to the auditory nerve, pathways, or cortex
that may cause hearing loss or other processing problems
Conditioned oriented response audiometry: A testing paradigm to be used with infants as
young as 6 months that is similar to visual reinforcement audiometry, but differs in that
responses are rewarded only with visual reinforcement (e.g., animated toys behind smoked
Plexiglass) if the head turn is made toward the loudspeaker (or earphones) actually presenting the
auditory stimulus
Conductive hearing loss: Loss of hearing sensitivity due to a problem in the outer (e.g.,
impacted ear wax [i.e., cerumen], growths, or infections that may obstruct the ear canal) or
middle ear (e.g., a perforation in the tympanic membrane, a presence of fluid in the middle ear
space, otitis media, a cholesteatoma) that prevents transmission of sound energy into the inner
ear.
Configuration: Describes the shape or direction of the air-conduction threshold symbol assumes
in the right and/or left ear when placed on an audiogram
Congenital hearing loss: Hearing loss present at birth
7
