Divergent conceptualizations of 'hearing' in healthcare encounters between hearing aid acoustitians and patients with hearing loss
Adult-onset hearing loss affects more than 20% of citizens in the US and in the EU. This second most frequent disability (World Health Organization 2001) is mostly due to aging and noise exposure ('sensorineural'). Although usage of hearing aids effectively increases life quality (Joore et al. 2003; Anteunis 2002), in many western countries, only 15% of those who could benefit from this technology use it, e.g. in the USA, Switzerland, and Finland (Bisgaard 2009). Technological innovation has not helped improve uptake. A longitudional interview study indicates that one barrier to hearing aid acceptance seems to lie in healthcare interactions: 88% of patients with hearing loss accessing the German healthcare system do not complete rehabilitation; the average time between first diagnosis and use of hearing aids is 8-10 years (Meis & Gabriel 2006). The present study contributes to an emering body of CA work on healthcare encounters with hearing loss which show that communication problems occur frequently between healthcare professionals and patients (e.g. Skelt 2006, Laakso 2011-2014, Ruusuvuori 2011-2014; Brouwer 2012, Heinemann et al. 2012, Egbert 2013). The presentation, based on 12 hours of naturally-occurring, video-taped audiological interactions in German, focuses on a specific communication problem which is due to an asymmetricity in "epistemic domains" (Stivers & Rossano 2010:8) in that divergences in the professional's and the patients' conceptualizations of hearing emerge and are frequently not resolved. The goal of these audiological consulations is to select and fit the best possible hearing aid for clients with hearing loss. In order to achieve this goal, audiologists routinely rely on their technological and medical knowledge, the results of a pure-tone audiogram, and the clients' subjective descriptions of hearing experiences in different environments. In these consultations, the institutional conceptualization of hearing (and thus of hearing loss) is that of an objectively measurable functioning of the ear, categorized in an audiogram by decibels and hertz. In contrast, persons with hearing loss perceive of their hearing, even during audiograms, as less precise and more varied. When asked by the audiologist about hearing experiences in different settings (e.g. dyadic conversation, multiperson interaction, telephone, outdoors, train station), the descriptions by clients are diffuse, broad, and metaphorical. Compared to visual impairment, describing hearing seems to be more difficult, and frequently, persons with hearing impairment resort to visual metaphors. A CA examination of conversational order in the areas of turn-taking, sequence, repair, topic, multimodality, and linguistic resources yields partial results for these audiological data, and including epistemics in the analysis achieves to 'grasp' the phenomenon more fully. CA research "into epistemics focuses on the knowledge claims that interactants assert, contest and defend in and through turns-at-talk and sequences of interaction” (Heritage 2013:370). Given that the audiologist and the patient frequently do not achieve a shared knowledge of the patient's hearing loss, these institutional encounters appear to be highly problematic in that the imbalance is not resolved. “(W)hen a speaker indicates that there is an imbalance of information between speaker and hearer, this indication is sufficient to motivate and warrant a sequence of interaction that will be closed when the imbalance is acknowledged as equalized for all practical purposes” (Heritage 2012: 32). The presentation concludes with connecting the interactional problems at the micro-level of direct healthcare encounters to the macro-level and globel problems of the impact of untreated hearing loss. The social repercussions are stigmatization, miscommunication, loss of work, social isolation, depression, and suicide (Carmen 2001). The financial loss per person dropping out of work due to hearing loss is estimated at 200,000 US Dollars (World Health Organization 2001). In Europe, the econmical loss is estimiated at 213 billion € per year (Shield 2006). References: Anteunis, L. 2002. Response shift in the measurement of quality of life in hearing impaired adults after hearing aid fitting. Quality of Life Research 07; 11(4): 299-307. Bisgaard, N. 2009. Global Hearing Aid Usage. Internal Hearcom-Workshop. URL: http://hearcom.eu/lenya/hearcom/authoring/about/DisseminationandExploitation/Workshop/5_Nikolai_Bisgaard_Industry-perspectives.pdf [Last retrieval August 18, 2011]. Brouwer, C. E. 2012. Notes on talking cognition in the audiology clinic. In Rasmussen, G., Brouwer, C. E., & Day, D. (eds.), Evaluating cognition. John Benjamins Publishing Company, xxx Egbert, M. 2013. Technology and social interaction in the multimodal, multispace setting of audiometric testing. In: New Frontiers in Artificial Intelligence. Okumura, M., Bekki, D. & Satoh, K. (eds.). Springer, 240-252. Heritage, J. 2013. Epistemics in Conversation. In: Jack Sidnell and Tanya Stivers (eds), Handbook of Conversation Analysis. Boston: Wiley-Blackwell, 370-394. Heritage, J. 2012. The Epistemic Engine: Sequence Organization and Territories of Knowledge. Research on Language and Social Interaction 45:30-52. Heinemann, T; Matthews, B.; Raudaskoski, P. 2012. Hearing aid adjustment: Translating symptom descriptions into treatment and dealing with expectations. In: Egbert M. & Deppermann A. (eds.) 2012. Hearing Aids Communication. Integrating Social Interaction, Audiology and User Centered Design to Improve Communication with Hearing Loss and Hearing Technologies. Mannheim: Verlag für Gesprächsforschung. 113-124. Joore M.A., Van Der Stel H, Peters HJ, Boas GM, Anteunis LJ. 2003. The Cost-effectiveness of hearing-aid fitting in NL. Arch Otolaryngol Head Neck Surg, 129:3, 297-304. Laakso M. 2011-2014. Communication with Hearing Aid. A comparative study of persons with acquired hearing loss within their interactions in private settings and with hearing health practitioners. Project funded by the Finnish Academy. Meis, M.; Gabriel B. (2006): Barriers in the Supply with Hearing Systems: The View of the Customer. Proceedings of the 51st International Congress of Hearing Aid Acousticians held from 10 to 20 October 2006 in Frankfurt am Main. Ruusuvuori J. 2011-14. Supporting Work Life Involvement of Hearing Impaired People. Project funded by The Finnish Work Environment Fund. Shield B. 2006. Evaluation of the social and economic costs of hearing impairment: A report for Hear-it. Skelt, L. 2006. See What I Mean: Hearing loss, Gaze and Repair in Conversation. Canberra: Doctoral Dissertation. The Australian National University. Stivers, T., & Rossano, F. 2010. Mobilizing response. Research on Language and Social Interaction, 43, 3–31 World Health Organisation 2001. Deafness and Hearing Impairment Survey. Report of Consultative Meeting of Principal Investigators, WHO Project ICP DPR 001, New Delhi.
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International Conference on Conversation Analysis (ICCA 2014