Adapting to hearing loss can be overwhelming no matter how you got here--suddenly or progressively. Dr. Ingrid McBride is a champion for better hearing loss livelyhood, not just the selling a hearing aid. We live better lives when we embrace and care for our hearing loss.
Share, like, subscribe.
Join Hearing Loss LIVE! for our free events like Talk About it Tuesday and our upcoming workshop Conquering Your Next Family Gathering and our bi-monthly E-newletter.
Let's get you in the KNOW!
Hearing Loss LIVE! talks with audiologist Dr. Ingrid McBride.chelle: Chelle:
Hello, this is Chelle with Hearing Loss LIVE! and today we have a guest for our podcast, Dr. Ingrid McBride. She is an audiologist out of Arizona. I met her through our friend Gloria. I was visiting Gloria when Dr. McBride came by. And I think I spent a couple of hours with that with her there at that time. Her husband was in the background we could tell. We could tell he was a little bit eager to go. But Dr. McBride stayed there and focused on glory and answered all her questions. I would talk knowing them like I would ask a question. But Dr. McBride remain focused on Gloria, making sure Gloria could hear and lipread her and faced her the whole time. So I was really impressed. I was also super impressed with all the technology that hearing aids have today. I get hearing aids every six years or so. And I'm always amazed at how much technology improves. So the whole watching the whole appointment for me was just wonderful. So I would like to introduce Dr. McBride now, and let her introduce herself and talk a little about patient centeredDr.McBride:
Thank you so much,Chelle. And thank you forJulia Stepp:
So I was just gonna say that is absolutely wonderful. inviting me to participate. So as you mentioned, I'm an audiologist, I've been an audiologist for good 35 plus years. I'm just I'm just going to never go beyond the plus. So most of my career I spent in an academic environment. So I was a clinical professor at Arizona State University for close to 19 years. So I retired from academia December of 2018. And I decided to go out on my own. So I have been the statewide audiology consultant for the department of economic security, Arizona vocational rehabilitation for decades. And I decided simply to expand that and move into a mobile audiology practice, primarily working with vocational rehab clients, but not exclusively. So a mobile audiology practice actually I go to the patient to the client, wherever you know, they wish to meet, whether it's in their home, or their place of business. And I really love this approach of meeting with a client in their own space, because it dovetails wonderfully with the patient centric approach. So having that kind of focus, and I just enjoy being my own, my own boss, it's just me, myself and I, that I can spend as much time as I see fit with a client and not be under the pressure of there's another And we are trying to get people to be proactive with their appointment looming here. So you know, to me a patient centric approach. The most of the core element to that is a partnership. And so I see that it has to be a partnership between the audiologist and the client. And so some of the things that really helped to form this partnership, one is trust, there has to be trust that's built between both parties here. So the audiologist needs to trust the patient that they are being, you know, forthcoming and sharing their concerns and their needs. And the patient needs to trust the audiologist. So, you know, we've all had experiences, I'm sure going to a practitioner, where you felt that your best interests were really not at the forefront, or you felt that they didn't have the adequate time to answer your questions, where you felt irritation when you needed more information, and you probed or questioned perhaps the course of treatment. So having trust is a two way street. And so I really see, you know, my my general approach is I need to find out as much about the client as possible. So this is not just a brief case history, I probe, I need to find out exactly what that individual's hearing loss. And, you know, took me years to realize that it communication demands are all across all aspects of their life. Whether it's home, you know, social activities, work, etc. You know, what are their listening needs, what have their challenges been, currently or in the past, you know, what kind of technology did they like were they successful with? What are that? What are their hopes for improvement? So it's absolutely essential for me to uncover all of these things. So during the initial meeting that I have or appointment that I have, I spend a great of time, just doing that, because to me, that is 100% essential. Because that information is almost more important than the actual audiogram data. So that's important too. But I can't just make a hearing aid selection based on an audiogram without having this other vital information about the individual. So I really feel that all of those things, that knowledge about that person should drive the selection of technology, you know, not the other way around. Not just picking a hearing aid, just because that's what I use with most of my patients. You know, everybody seems to like that. That's not how I operate, I need to match the technology to the individual. So it starts with is a two way responsibility. And if they don't do their part, building that trust. So now, another very important element here is that it has to be an active partnership. So that's also a two way street. So you know, just as much as I need to be dedicated and involved here. And you know, always putting that the client's interest in the forefront, the client has to be an active participant as well. And there's a lot of data to show that when individuals are empowered regarding their own care, that they adhere better to treatment options, they become better users of their hearing aids, you know, because they are an active participant, they're not just going to someone who's dictating, you know, you need to do all of these different things, you need to wear this hearing aid, you know, you need to do these different things, rather than it being a conversation in a partnership. So, you know, another element to, you know, patient centered care, is, it's also got to be a human thing, it's got to be down to the personal level, you know, I like to get to know my patients, and I hope vice versa. So that we're connecting on on a human level. And then another vital piece is if the family or significant others, you know, patient willing, are involved in there's no way I can do my part. So it is a partnership. this process, because it's one thing to talk about all these communication strategies and clear speech and all these different things that can help. But if the family who are their primary communication partners are not buying into this, or understanding, because communication is a two way street, the onus is not just on the person with the hearing loss, and it's not just on the person on the communication partner, it's got to be both. And so they both need to learn effective communication strategies. So you know, if we can involve the family even better. So you know, the other. Yes.chelle:
Absolutely. I would like to to clarify clear speech, too.Julia Stepp: Dr. McBride:
Yes, so clear speech is a technique that one can learn. It's not difficult. I'm sure we've all experience when someone speaks very, very quickly, that it can be very difficult to decipher the speech. Because when we talk rapidly, you know, sounds of speech just get all blurred together. And we're not articulating well if we speak quickly. So clear speech is a technique that can help to make communication more effective. Really, in communicating with anyone hearing loss or no hearing loss. So first of all, there's an acronym I like to use, which is just clear speech. So first of all, the clear part of this CLEAR talks about what clear speech is not. So first of all, clear speech is not communicating in a monotone. It's not loud shouting. It's not exaggerated. It's not artificial, and it's not real staccato. So what clear speech is, so now we're using the speech part of this acronym. It's speaking slowly. It's pausing between sentences and phrases. It's emphasizing key words in a sentence. It's enunciating accurately and precisely communicating with a full range of inflections you. And then last, it's using heightened volume. So that's different from shouting. So it's kind of like using your outdoor voice where you're simply elevating a little bit, but you're not shouting. So you know, you, you know, at least as an audiologist when clear speech is working, because I've had people say, if everyone spoke like you, I wouldn't need hearing aids. [laughter] So it can go a long way to having effective communication. So the other piece that I feel is very important, you know, is that just fitting technology. Whether it's hearing aids, or hearing assistive technology, hearing assistive devices, that alone, just the technology is not going to immediately solve all of the issues. You know, individuals with hearing loss can have a number of social and emotional types of issues, psychosocial issues that come along with hearing loss. And just because we fit hearing aids doesn't mean those magically go away. And there can be some maladaptive techniques or coping strategies that have been developed over the years. And those need to be addressed to help, you know, have more problem focused strategies, such as anticipating the challenge that you might experience in a certain environment and having those communication strategies and become practiced and using them. So it becomes easy, and learning how to self advocate. So you know, I like to have individuals participate in an oral rehab type of program. And I developed one years ago, called Living Well, with hearing loss, it's a very common name that's used for this type of rehabilitation. I started it originally as a group approach. And so I would have anywhere from 12 to 15. people participating in a group, I've had different durations of the program, the longest being eight weeks, so meeting for two hours, weekly, for eight weeks, encouraging significant others, it was extremely valuable if we had not just the person with the hearing loss, but a communication partner, as you know, attending as well. So groups work great, because there are a lot of curative factors of working in a group situation where participants in the group become mentors and helping each other. So you know, that's something that's incredibly valuable when other people with hearing loss who are at different stages in their journey can provide support for others who may be just starting this journey. So I really loved the group approach. Right now I'm doing it more on an individual basis, which I also like very much. Because unlike in a group, I can't really tailor the content to that to everybody in a group, there's too many people. But if I'm working one on one, and this, this works very well, in a virtual environment, like you know what we're doing right now, I can tailor the program to that person. And so you know, I've worked with people who are bimodal users, I've worked with people who are course hearing aid users. And so it's going to be different approach, depending on the technology they might use, it's going to be a different approach, what you're depending on the degree of their hearing loss, you know, their communication issues, and so on. But the general content that I use, and I'm just going to pull this up, so don't miss this. So I focus on, you know, I really feel Knowledge is power. And it's important for individuals to understand their hearing loss, and how to read their own audiogram. And so that they have that knowledge. And they can say, Yes, this is the type of hearing loss that I have. And this is the degree you know, this is the configuration, but understanding how the auditory system works. So I do spend a fair amount of time on that. I also spend time talking about speech reading. So you know, giving the tools. I think a lot of individuals, they don't realize how much they utilize the visual cue. And so it can be a nice little exercise to demonstrate that. But of course during COVID With all the masks, many people suddenly realized, oh my goodness, I am struggling even more because now I cannot see the face right in the mouth area. So focusing on speech Reading, I will focus at great length on communication strategies. So you know, whether it's anticipatory strategies, repair strategies, corrective strategies, you know, that's really the meat of a lot of this is how to, one tried to minimize how often a communication breakdown might occur. But even with the best laid plans, you can't always prevent that communication is going to break down. But then it when it does, and expect that it will, how am I going to repair it, to keep our conversation going. And then to again, learning self efficacy, and not being afraid to use corrective strategies to speak up to the person, you know, and ask them? Can you please take your hands away from your mouth? Can you please speak a little more slowly? I mean, those would be examples. I spend time talking about how to manage your environment. You know, it's not just about background noise. It's understanding that the three things that synergistically can make it hard for us to hear. So background noise, reverberation and distance. So talking a lot about strategies there, you know, how to how to choose the best place in a restaurant, how to modify your environment, for better communication. So and I, there's an exercise I love, and it's called plan ahead for better communication. And so, you know, I really want individuals who are new to this to make this a deliberate process, like really thinking about it, okay, I'm going to be going out to this place, what types of challenges can I anticipate in advance? What can I do to help make this better, and then to actually go and do it. So sometimes they say Your homework is to go out to dinner, tell your husband or your wife, this is your homework, you have to go out to dinner, and then implementing those strategies. And then after the fact analyzing, well, how did it work? Was it successful did I do better this time than I've done in the past. So that's, you know, type of active exercise, I spend a whole session on social and emotional issues. So you know, looking at the consequences of untreated hearing loss, now looking at the not just for the communication, or excuse me, not just for the person with hearing loss, you know, the social emotional issues that can be experienced there, but also the communication partner. So there are there's, you know, the same types of things that can happen for the communication partner that we have to address, I spend time talking about the effects of hearing loss on the brain. So there's a lot of data out there now, of, again, consequences of untreated hearing loss, even physiological measures, such as, you know, an MRI, with objective data of showing how there can be brain shrinkage over time for individuals with untreated hearing loss. Yet, for those who do wear hearing aids or cochlear implant, they are exactly right there along with their normal hearing peers, in terms of brain volume. So it's fascinating information. That I think is vital information for people to be educated about, I spend a lot of time talking about hearing assistive technology, all categories. And when I'm meeting individually, I tailor it to the type of hearing assistive technology that person can benefit from, which of course, in many cases is dependent on which hearing aid manufacturer they're using. So you know, I'm not going to talk about products that belong to another company that won't work with their hearing aids. So we spend a lot of time talking about that. And then I have a whole session just dealing with assertiveness training. So you know, that's kind of it in a nutshell. These days, it's about a seven week class, occasionally, I'll extend it to eight, if there's other things that we want to talk about. So like, for example, if I'm working with a cochlear implant user, or a bimodal user, we will fent spend a fair amount of time on auditory training. And I usually would do a little bit of auditory training with at each session and give them the tools and the resources that they can be working on this on their own. So that kind of kind of gives an overview of that program.Julia:
Dr. McBride let me ask you, well, silly questions, probably. But so that program, is that open? Do you suggest that hearing partners join that program to help better communication?Dr. McBride:
There was something else now I can't remember. Telling ya my brain goes worse every day. I think that sounds like an awesome progress. Oh, here's where my other question was. You're just in Arizona; is that correct? Yeah. So your mobile unit is all over? Anywhere in Arizon? Okay.Dr. McBride:
Yeah, pretty much.Julia:
Do you know if there's anybody else who does this in any other state?Dr. McBrie:
You know, it's actually something that is taking off. You know, I have had this idea for years that this was a, I thought, a unique business model. And when I finally implemented, I actually discovered that there's a lot of audiologist out there across the United States, who are having now a mobile audiology practice. So it's kind of like bringing back the house call. You know, it's almost like the old family, you know, practice doctor that would actually visit you. So I'm not unique. It may take different forms, I have all my equipment is portable. So I can take it with me anywhere, it's not necessary to have a sound booth, I can tell you, it is not. You know, if we're in a home environment, there's there's not a lot of background noise, I use headphones and insert earphones that help attenuate the sound. And I know it's not necessary, because I can compare my test results performed in let's say, a home environment to test results completed in the sound booth, and they're exactly the same. Or if someone has normal hearing, I can get their hearing thresholds all the way down to zero and even negative numbers. So it's not necessary to have a sound booth. You know, again, I really well, I think there's so many advantages for the end of the patient, to have someone come to them, some people have a lot of difficulty with transportation, you know, especially in rural areas, because they would have the most likely come all the way down to Phoenix, and have an overnight stay. You know, a lot of times, we as audiologist issue a number of of accessories, like let's say, a TV device, I mean, I would do that in the clinic, and you know, here's your TV Streamer, never knowing if that person was going to be successful when they got home hooking it up to their televisions. So you know, that's another advantage of being in their environment, I can do that for them, I can get it set up and make sure that they understand how to use it. And they're not fumbling with I don't know what this optical connection is she's talking about, you know, and they just give up and they just leave it in the box. So there's a lot of advantages to the mobile approach. And so I don't have a brick and mortar facility, you know, if I need to access a sound booth, and I do work with some cochlear implant patients, and so, you know, we can't do real ear measures on cochlear implants. So I do need to get aided thresholds, you know, speech measures in a controlled environment. And so I do have the advantage that my husband is an audiologist as well. And he does have a brick and mortar clinic. And so I can schedule patients to do aided testing, as needed using a sound booth.chelle: Chelle:
When I met Gloria, I think was around the time she started getting fit with hearing aids with you. And she said, 'wow, you know, my audiologist was just here. And she spent six hours with me." I was like, floored. Wow, six hours. I mean, the most I ever got the past was probably an hour and a half. At the most. And so I we were talking a little bit before the podcast about how you take time to tweak the individual programs in the hearing aid. And you talked, we were talking about the telecoil and how you work with that specifically to make sure it's right. And I would like you to tell us about that.Julia Stepp: Dr. McBride:
Yes, absolutely. So you know, first of all, using verification measures is absolutely essential. So when programming hearing instruments, I mean, I couldn't fit a hearing aid without that tool. So I have my own portable equipment. I always use it. I even use it when reprogramming a hearing aid because otherwise to not have that verification to me would be like fitting a hearing aid with a blindfold on. So you know, audiologist really should not rely on the manufacturer first, that algorithm, which is you know, when you put in the audiogram, you put in all the detail about the hearing loss into the manufacturer software, and the software fits the hearing aid. Well, in my experience, very rarely is that going to be perfect right out of the box without doing verification. So but so a lot of audiologists do verification, and that's fantastic. But they primarily focus on the main program, which of course, is what the patient is going to be listening to a great deal of their time. However, all the other programs in the hearing aid, also need verification. And the telecoil is one of those programs. So I've done a fair amount of research in the past or look at looked at a lot of different manufacturers, a lot of different models for each manufacturer. And I collected a lot of data of how good the first fit match was for the telecoil. So basically, what the goal is with the verification is that if I have set the primary program, the primary microphone program to meet the amplification targets for that individual, then when they go to their telecoil program, I want to have what's called transparency, meaning I want that telecoil response to match the microphone response. So that's what we call transparency. So what I found in my research was that some manufacturers were better than others. But sometimes the difference between the microphone response and the telecoil response, if you did not program, the telecoil could be 10/15 decibel difference. And so what would happen, then, if that teleco was never paid attention to the user, it goes into a hearing loop environment, they switch into their telecoil program, they're like, wait, I'm not hearing very well, what's going on. So it's really important to make sure that that is programmed so that we have that transparency, and it's seamless, then for the user, when they go from their microphone program into the telecoil program, it should sound the same only Now the difference is the input is coming from the hearing loop. So I program or I verify the telecoil for a hearing loop application. And that would be the same whether it's a large loop around a room versus the neck loop. So the neck loop is a smaller version of a hearing loop. And so we need to program that telecoil to make sure that the response is going to be what it needs to be. So but if someone is relying on the telco for phone use, you know, and that's that's the other thing that I think is very important. Because we spend so much time talking about Bluetooth these days, and you know, being able to use our wireless devices like our cell phones or smartphones. But many people work in an environment where they're not using their cell phone at work, and they still are using landline telephones. So it's absolutely essential that we as audiologist think about that, okay, how are they how is this individual going to be using this telephone, it works successfully. So if it's going to be the T coil, I need to make sure that that telco response is programmed appropriately for use with a landline phone. You know, if we if we want to be able to use Bluetooth in the work environment, then we need to get in most cases and accessory to attach that phone to make that phone Bluetooth enabled. So you know, this is just an example where, you know, we can't just as audiologists just think about, oh, it's just all about the hearing aids because it's not, you know, we need to be thinking about all aspects of this of the user's life. And how are we going to address communication challenges all over the place? I talk a lot about captioning apps to individuals. You know, I meet people who just say, Oh, my goodness, the telephone is my nemesis. And if at all possible, I don't use it, I hand the phone over to somebody else. And it's like, well, there are options. So you know, if you're willing to try, I can help you to be more successful on the on the phone. So it's just again, it's all comes back to this patient centric approach. You know, the partnership making sure that I fully understand the needs of that individual and helping them to minimize or resolve the communication challenges that they are currently experiencing.chelle: Chelle:
We are coming up on our 30 minutes and oh my god that went fast. It did. I feel like we need you for another podcast someday. Maybe to talk about hearing assistive technology and how it works with hearing aids. I want to point out that I'm using my neck loop today with that plugs into my podcast microphone, and then that, that gives me better hearing. So neck loops are still used telecoils I will always insist my hearing aids have a telecoils. Another thing I want to point out is that, you know, Dr. McBride talked about including our hearing partners. YES. We have seen the difference in hearing partners who have attended our classes too. It's been a real eye opener for them on how it is a give and take sort of relationship with hearing loss. And I think that's all I have right now. So I'm going to remind everybody, before we go to ask for a hearing assistive echnology. While you're out in public. Don't forget to ask for FM systems, infrared systems. There's all kinds of different things out there. There's even Wi Fi systems now that I got to try and that worked pretty well. So go out there and ask for assistive listening devices because we need to train people how to maintain them, and, and where they are because sometimes they don't even know that and we're not just helping ourselves here. We're helping anybody who comes after this. So ask for assistive technology. Thank you for joining us this week. We really appreciate your time with us, Dr. McBride. We will be back in a few weeks with our session on hearing family and friends. Thank you everyone. Bye.Dr. McBride:
Thank you so much. Bye bye.