Audiology in the New Millenium

Audiology's origins are firmly rooted within the ''medical model.'' Despite our origin as a rehabilitative profession, our diagnostic abilities and interests were quickly realized and used to supplement the practice of otolaryngology. Carhart is generally credited with being the first audiologist. Carhart too, worked in conjunction with the physicians (otologists) at Deshon Army Hospital, in 1945. The practice model developed at Deshon was essentially a diagnostic one. Aural Rehabilitation (AR) was essentially limited to issues related to hearing aid prescription and later was amended to include hearing aid fitting.

Nonetheless, a unique and comprehensive program (including diagnostic and rehabilitative aspects of audiology) was developed in the early days at Walter Reed Hospital in Washington D.C. The Walter Reed program has not been duplicated and their model does not proliferate.

The application of audiology-based principles to the pediatric arena occurred later. Pediatric models (in the early days) also followed the medical model. These early ''pediatric audiology'' programs were primarily based in diagnostic tests and hearing aid fittings. The audiologist also served as ''gatekeeper'' between the child, the parent/guardian and the physician. Our AR role was restricted, at that time, to periodic hearing tests and monitoring the hearing aid status and use cycles. We referred the families to educational facilities. Few audiologists working in pediatric audiology went beyond the above described parameters and very few described themselves as ''rehabilitationists.''

In a poignant article titled ''Back to the Future,'' Ross (1997) articulates the very well founded argument that as long as the profession of audiology remains hospital based and diagnostically oriented, we will maintain our secondary position as hand maiden to the medical profession.

Ross effectively argued that our independence, professional autonomy and indeed, out future, reside in rehabilitative audiology. In brief, he argued that our willingness and ability to take responsibility for the patient after the diagnosis and fitting of hearing aids, is our most significant contribution to the patient, and is the basis for our professional survival. I wholeheartedly agree.

It is within the rehabilitative realm where we can expand our scope of practice, unfettered by other professionals. In many respects, our rehabilitative roots, established at Walter Reed many years ago, provides the basis for our continued professional growth and stability. It is likely that the change from solely prescribing hearing aids, to fitting and dispensing hearing aids, once again provided the catalyst audiologists needed to initiate and take responsibility for the rehabilitative process.

In a similar manner, with the acceptance and promulgation of universal newborn screening, our profession again needs to examine and actively participate in the aftermath of the audiologically-based diagnosis of hearing loss.

After the diagnosis of hearing loss, most audiologists refer families to early intervention programs. Importantly, data we have compiled indicates most professionals working in early intervention are not confident working with deaf individuals.

I believe, this is a problem which falls within our Scope of Practice and within our rehabilitative management abilities. We can, and should, more significantly impact the transition from diagnosis to auditory rehabilitation and education.

Presently, there is a failure of the management component of universal newborn screenings. Only 15 percent of identified children are getting amplification prior to age three months. Additionally, only 15 percent of identified children are getting auditory rehabilitative therapy prior to age 6 months. Children who are receiving auditory rehabilitative therapy are generally receiving it from a professional inexperienced in working with deaf children (see Aerhart et. al, 1998).

Because we, as a profession, are so enthusiastic regarding newborn hearing screenings, and because we have the expertise, training and education to truly and positively impact the lives of our patients beyond diagnostics, it behooves us to take responsibility for the aftermath of diagnosis. Our profession and our patients will be the better for it.

REFERENCES:
Ross, M., A retrospective look at the future of aural rehabilitation. JARA, 30 1997, 11-28.

Aerhart, K., Yoshinaga-Itano, C., Thomson, V., Gabbard, S., & Brown, A. State of States: The status of universal newborn hearing screening, assessment and intervention systems in 16 states. American Journal of Audiology, 1998. 77(2), 101-114.