Auditory Deprivation: Phonemic Regression
Max S. Charltrand, Phd.
Why does a normally intelligent person with a long-standing hearing loss having difficulty understanding speech after obtaining their new hearing aids? Why would they perceive the words, “We’re off to Rochester,” as “You’re off your rocker”? To be sure, it may be difficult frustration attached to such misunderstandings. But for the new hearing aid user, these embarrassing mishaps are enough to prematurely bail out of trial with their hearing instruments. The term phonemic regression (commit this term to memory, please.) , first appeared in the literature as a psychological phenomenon, but is now accepted as a central auditory processing problem (Jerger, 1973) (Gaeth, 1948). This condition is present, to some extent, in nearly all long-standing sensorineural losses in the elderly (Gloring & Roberts, 1961). It is explained by Delk (1983) as “Deterioration in discrimination ability without lessening of sensitivity.” Another definition has been offered as: “A hearing loss where the loss of speech understanding is out of proportion to the degree of hearing impairment.” In words possibly more applicable in everyday counseling, the specialist might describe the condition to a client this way:
“As one experiences a long-standing hearing loss, you begin to ‘forget’ many of the sounds that are essential for speech understanding. Wearing a hearing aid will not necessarily mean that you will instantly regain speech understanding. Just as it took years for you to first learn language, it will now require at least 60-90 days to once again learn those sounds long forgotten. In fact, for a little while these sounds may be a little more distracting until you become more used to them.”
So much for the 30-day, you might say. This one factor, too, when not addressed by the specialist, has cost many failed trials. A case in point was a client of the author’s some years ago who had been to nearly every specialist and audiologist in a large metroplex area. In vain, he had already experienced several “Failed” 30-day trials. In each case he failed to achieve adequate speech discrimination scores in a short time. In taking an in-depth case history it became evident that he had some serious overlay problems existing since childhood.
But the frustration continued week after week until this author finally, after exasperation, pulled down a copy of Delk’s Comprehensive Dictionary of Audiology (1983) and asked him to read the definition of “Phonemic Regression” and also “Aphasia” (auditory agnosia), a condition long suspected of him as the result of being dropped as a child. After reading both definitions, he looked up with the look of tearful discovery and stated, triumphantly, “Now, I know what’s wrong with me!”. Suffice it to say, at that point in time, this fellow began his first step onto the road to rehabilitation, and his hearing instruments were better appreciated even in their limited role within the larger rehabilitative picture.
The Psychological Effect of Bad Professional Advice
For another example, let’s take the gentleman who hypothetically exemplifies a typical mild-to-moderate bilateral sensorineural loss. Voices (for him) are within 15dB of normal in loudness (i.e., the vowel sounds). The first formats of speech (700-1500Hz) are audible within 40dB of normal and the second formants (1500- 4000Hz) are within 60dB of normal.
Twenty years ago, conventional wisdom in the medical community would have declared to this individual that “a hearing aid won’t help”. Maybe that was ten years ago, or, possibly, even today that individual may have been told by some professional he consulted that his hearing loss is not yet “bad enough for a hearing aid”. With that, let’s go home with this fellow and listen to a hypothetical, yet common conversation with his wife who had spent years trying to get him to do something about his hearing loss.
“What did he say, dear?” asks his wife of twenty two years, as he walks into the kitchen.
“I’m missing a few high frequencies, but just like I told you, I hear fine!” he snaps back, defensively.
She backs off a little, knowing how sensitive he is, but hoping for a ray of light at the end of the tunnel for their progressively more troubled relationship. She then feebly asks in softened tones, “Did they say you needed a hearing aid?”
“Turn the doggone thing down!” he barks at the children in the living room watching television at a comfortable level (65dB SPL). Normally, the conversation would stop there. This time, though, he knew what was coming. He wanted to hear it. His powder was dry and he wanted to stomp this subject into the ground, once and for all, with the newfound assurance given him by his doctor that heard “OK’. With lowered voice, he turned back to his wife, “Now,” he paused, “what did you say, Honey?”
“I just asked if they thought you might need a hearing…. You know, just to help you understand me and the kids better…”, came the meek reply.
“No, they said my hearing was not bad enough, and I don’t need a hearing aid!” The proclamation had finality and there was no further discussing the matter again, nor doing anything about it for another ten years when he was eventually forced to “find other work” more suited to his diminished communicative abilities.
This scenario is repeated over and over again, everywhere, to the detriment of all concerned. It cannot be over-emphasized that the greatest mission of the hearing health industry (which includes specialists, audiologists, physicians, manufacturers, educators, publications, associations, and suppliers) is to educate and inform themselves, then their colleagues, the public, and finally, the hearing impaired of the true effects of hearing loss and how they might be overcome. With this mission in mind, we may begin to penetrate an otherwise large and unmotivated population.