The case for LACE

Abstract

Human beings adapt to sensory deprivation in at least two manners. One, they modify their behavior in a way they believe, sometimes incorrectly, to be beneficial. Two, they undergo a physiologic adaptation by means of neural plasticity. Such an adaptation is often observed in the reorganization of sensory maps following damage to peripheral receptors. 1 Furthermore, patients presenting similar audiometric profiles frequently obtain very different benefits from amplification. Various factors may account for this. One factor relates to an individual’s assimilation of acoustic, linguistic, and environmental cues. To optimize this integration, a person must call upon many skills and processes, including cognition, auditory memory, auditory closure, auditory learning, metalinguistics, use of pragmatics, semantics, grammatical shape, localization, visual cues, repair tactics, and—since communication is transactional, not one-way— effective interactive communication strategies. While modern hearing aids can make the acoustic signal audible, they may fail to rectify impaired frequency and temporal resolution, improve the skills listed above, or correct misguided compensatory strategies. Limitations in any of these areas, accompanied by the reduced redundancy found in adverse acoustic conditions, require the listener to make decisions based on acoustic information that is fragmented compared with what a normalhearing person receives. Given this fragmented signal, the hearing-impaired person must use compensatory strate