As her graduation drew near from Clarke College in Dubuque, IA, as a speech and drama major, Dr. Donna Wayner learned that she had received three scholarships for graduate study. One was in theater, the second was in linguistics and the third was in audiology.

"Of course, I chose audiology," she says. "Not being able to hear had fascinated me since early childhood because I had an older cousin who worked as a teacher of the deaf, and I was intrigued when she would talk about her work. I always tried to imagine and understand what the world would be like hearing sound differently."

Upon graduation from Clarke College, Dr. Wayner accepted a research assistantship with Dr. Raymond Carhart at Northwestern University, Evanston, IL, in the audiology department. She completed her master's degree in l962 and worked at the VA Hospital in Chicago and then at the Hartford Hearing League in Hartford, CT, until her first son was born in l964.

"As was the custom in those years," says Dr. Wayner, "I was home with my three children until l972, whereupon I joined the staff of the audiology department at the Albany Medical Center Hospital in Albany, New York as a part-time clinical audiologist."

She also returned to graduate school to pursue a doctorate in the Department of Rhetoric and Communication at Rensselaer Polytechnic Institute in Troy, NY, where she studied the impact of hearing impairment on a marriage relationship. After completing her PhD in l979, she taught in the graduate program in the Communication Disorders Department at the College of Saint Rose in Albany, NY, until she was offered the position of director of the Hearing Rehabilitation Center (HRC) at Albany Medical Center Hospital in l981.

The "Golden Thread"

In l969, she experienced a serious accident for which "no real care was provided aside from the physical," and she realized that much more was needed to help a person heal besides good medical care; that considering the effect of an illness, injury or physical change required providing care for the "whole" person and their families.

"Combining my personal experience with the academic investigation during my doctoral studies significantly impacted the way I would deliver hearing healthcare," says Dr. Wayner. "From my perspective, the concept of audiologic rehabilitation was not merely an 'add-on' to our audiology services, but the underlying 'golden thread' that was woven throughout audiology care."

She implemented this philosophy in almost a quarter-century of experiences as HRC director, which she summarizes in a 2005 article appropriately entitled "Aural rehabilitation adds value, lifts satisfaction, cuts returns," as follows:

"Documented evidence over many years in a clinic where I practiced made it clear that diligent practice with hearing instruments, proper training on their use and care, hearing therapy that includes communication strategies and listening practice, and a positive attitude are essential components to improved auditory function and more effective communication. Such a program provides added value and increased satisfaction to the consumer and reduces returns for the practitioner."¹In the article, she describes her audiologic rehabilitation program in which hearing aids were dispensed and followed up by a thorough, systematic AR curriculum. Her approach is predicated on the three beliefs that "most persons with hearing loss can benefit from amplification; a hearing aid is only one of a number of aids for successful rehabilitation and improved communication; and the most reliable hearing aid evaluation is conducted in the patient's own environment."¹After the initial visit and the fitting of the hearing aid, Dr. Wayner offered new hearing aid wearers a three-session, 6-hour hearing aid orientation (HAO) program and a refresher curriculum of one or two sessions for patients who had worn hearing aids before. The orientation program consisted of the following steps as outlined in the article:

• Practical information and instruction concerning operation, care and use of a hearing aid;

• Development of multi-sensory strategies (auditory-visual) to improve communication;

• Modifications to the aid and/or ear mold as needed;

• Informational and adjustment counseling to patient and significant others; and

• Trial of other communication, convenience and assistive listening systems.¹To measure the success of the orientation programs, she used a number of performance scales, including the Client Oriented Scale of Improvement (COSI), the Communication Performance Assessment (CPA) and the Hearing Aid Use and Satisfaction Measure (HAUSM), all of which are "effective tools for patient reflection and self-evaluation."¹

"Participants liked being able to observe changes in their abilities and thoughts," she wrote.

Dr. Wayner feels the success of her aural rehabilitation program is best measured by the fact that out of almost 8,700 hearing aids dispensed at the HRC from l976 through 2000, more than 97 percent were kept by their users, with less than a 3 percent return rate, "which is significantly different from the industry return rate in the double digits."¹"Our experience in fitting and dispensing hearing aids with a careful education follow-up program yielded extremely satisfying results," concluded Dr. Wayner. "Our approach, in which audiological rehabilitation was interwoven throughout, provided significant rewards to the professionals involved and, most importantly, led to improved quality of life for our hearing-impaired patients and their families."¹Over the years, Dr. Wayner developed, tested, refined, and published a significant collection of written material concerning hearing healthcare with a strong AR component. Her initial books were published by Gallaudet University Press in 1990. In 1995, Learning to Hear Again: An Audiologic Rehabilitation Curriculum Guide was co-authored with Judy Abrahamson, MA-the first book of many listed on the Web site www.hearagainpublishing.com.

"Dear to My Heart"

After her retirement from clinical services at The Hearing Center, Dr. Wayner embarked on a project with Ellen I. Rupert, MEd, that had "always been dear to my heart." They collected oral and written responses to questions related to educational, environmental, occupational, social, psychological, and emotional issues from 16 individuals with varying degrees of hearing impairment.

"We compiled the material 'in their own words' and in 2001 published the book entitled Voices from a Quieter Land: Insights into the Impact of Hearing Impairment," she says. Each of the participant's writings is paired with their pre- and post-treatment audiological data, including hearing aids and/or cochlear implants.

"As a teaching tool, I feel this is an outstanding base from which to learn how complex and frustrating a hearing loss can be for an individual and family members in all aspects of life, and I would recommend it as required reading for all interested in providing compassionate AR care," she says.

Credits to Many

Dr. Wayner credits many professionals with providing instruction and guidance in the development of her AR philosophy, including Raymond Carhart, PhD, Laura Wilcox Kretschmer, EdD, and Robert Johnson, PhD. Of special significance are the following:

• Jerome Goldstein, MD, "because as chief of otolaryngology at Albany Medical Center, he made available to me his encouragement and the opportunity to implement an audiology service designed for the whole person;"

• Pauline Winkler, PhD, "because as a teacher of the deaf, her expertise and skill helped to create an educational guideline for the services to be offered at The Hearing Rehabilitation Center, thus laying the groundwork from which we built;"

• Rocky Stone, "because through him and Self Help for Hard of Hearing People (SHHH), now Hearing Loss Association of America (HLAA), and our local chapter, Hearing Loss Association of America-Albany Chapter (formerly Hearing Endeavor for the Albany Region-HEAR), I learned and continue to learn so much about the impact of hearing loss on peoples' lives."

References

1. Wayner, D. (2005). Aural rehabilitation adds value, lifts satisfaction, cuts returns. The Hearing Journal, 58(12): 30-38.

Jess Dancer, EdD, is professor emeritus of audiology at the University of Arkansas at Little Rock and can be reached at jedancer@ualr.edu.

Donna S. Wayner, PhD, is an audiologist and former director of The Hearing Center at the Albany Medical Center Hospital, Albany, NY. Additionally, she has served as an associate clinical professor of surgery at the Albany Medical College and consultant to various organizations, government agencies and private industries. Recognized in the field of hearing impairment and rehabilitation, Dr. Wayner has made numerous presentations at national and international conferences and has published books, chapters and articles about hearing loss and tinnitus. She is the current president of Hear Again Inc., www.hearagainpublishing.com.