How to be the Boss of Hearing Loss: Insights from TODs, EdAuD, and Clinical AuDs

Weill Cornell Medicine’s Director of Audiology Dr. Michelle Kraskin, Educational Audiologist Dr. Kimberly Szabo, Educational Specialist Sammie Levy, and Teacher of the Deaf Laurie Winter discuss how to enhance support for pediatric patients and students with Oticon Medical's Dr. Alicia Wooten.

 

Alicia Wooten, AuD: Let's start by defining the roles of clinical audiologists, educational audiologists, and teachers of the deaf (TOD) in supporting pediatric patients and students.

Shelby Peeler: The role of the clinical audiologists is to diagnose and treat hearing imbalance disorders in patients of all ages. Doing hearing assessments, fitting hearing devices - whether that be a traditional hearing aid, bone conduction, or cochlear implants - and managing and treating ear-related conditions. Perform checks on those ears and make sure they're nice and healthy.

The role of educational audiologists is to support students with hearing loss in the school setting. So, they also sometimes do assessments and hearing screenings, comprehensive tests, and work with IEPs and 504s to help kids receive accommodations.

The role of the teacher of the deaf is to specialize in educating students who are deaf or hard of hearing. They provide individualized or small-group instruction for children who have hearing loss. Helping to develop their curriculum with any adaptions they need. They're also focusing on language development and communication for those students, whether that be ASL, auditory, verbal, or whatever that student is pursuing, and then providing support in the classroom.

Alicia: Is there anything clinical audiologists can do to help support their patients in schools other than appropriate hearing aid recommendations?

Laurie Winter: What's helpful is a recommendation for an FM system. If there's something that the student needs, such as an audio shoe or a boot on a hearing aid, I haven't seen that much lately, but it is very helpful, as the educator, to have that information from the audiologists to know what I need to order for that person so that when they come in, whenever they do come in, they have something available that's really geared specifically to their needs.

Michelle: I think one of the things we do here at our center is provide all our pediatric patients with copies of their hearing tests so that they can provide them to the school. So that everyone is aware of what the baseline is for that child at that moment and that they're not working with the student from something from five or six years ago. They have the most recent hearing test and are setting that child up for success for the school year.

Dr. Kimberly Szabo: Yeah, that's always super helpful. I know for initial cases and new students in the clinics, if you're able to or have the time to, it's great to have speech and noise testing done. That gives us a lot of information on how that translates into the classroom so that we can figure out what's best educationally for them if you're able to

Laurie: I would agree with that. Yes, for sure. When you look at an audiogram, it does give me an idea of the type and degree of hearing loss that I'm working with, but it doesn't tell me how that person functions with their hearing. So that was a great suggestion. It really is helpful to have a piece of that type of assessment.

Sammie Levy: We're also sometimes able to extend that a little bit further with simulating the hearing loss so that when our patients then go back to school and participate in some of these IEP meetings or kind of conversations with our teachers of the deaf or even their classroom teachers, they have an idea of, “Hey, it's really hard for me to hear in the cafeteria.” We kind of simulated that experience in the office, just so we could kind of give some tips, tricks, and things like that so that we could set our patients up for success as well.

Laurie: For sure. I know when I find out I have a student coming in September, I have them make their own PowerPoint that describes their hearing loss, how they function in school, and what their accommodations are. I send this power point and simulations to teachers, and I cannot tell you how many come back saying, “I had no idea. You know, you gave me all these great tips on making sure I face the student when I speak to them and not writing on the board without getting their attention first.” When you send those simulations and they see what it's really like for those students to have to hear in your classroom, it's just an amazing eye-opener.

Sammie: Yeah. I always love seeing that, like, aha moment. I think those PowerPoints and any of those simulations really help teachers who otherwise don't have a lot of experience working with kids with hearing loss to kind of put those pieces together and really look at it from a different perspective.

Shelby: There's a huge lack of support in the school system for patients with hearing loss. Do you have any advice on how to best bridge that gap in those cases? 

Michelle: I think one of the biggest things is empowering the parents with the information. And we always say, "You don't know what you don't know." I think fitting counseling is helping the parents know what they should be asking for: asking the right questions and not accepting no for an answer. I know a lot of the districts won't love that, but I think parents need to know the information because they don't know what their rights are, what their child should or should not be receiving, or what the law is. As a clinician, I can give that information.

Laurie: That's fantastic, because you are so right on that. Parents do not know what their rights are. They don't know what's out there for their children. They don't know what schools can provide. I can't tell you how many times kids have come in and parents don't know where to begin.

Michelle: At the end of the day, it's the child that suffers. They're going to be the ones sitting in the classroom, and then the teacher gets frustrated because they have this child in class who's not paying attention, but maybe they don't have their FM system or what they need to succeed.

Kimberly: Prior to working for the Department of Education, I was clinical and at a pediatric hospital. At that time, I started reaching out to the local school districts or, if I had a student, finding a point person that could get me in touch with the right people. So, if you are in the clinics and can, that's always great if the parents don't know where to start. I usually tell them to reach out to the school system, get that IEP opened, or start that initial case.

Sammie: I think we can all agree that it does take a village. We're kind of getting things sorted out, kind of connecting them also with resources within our center or families that we know of that have kind of walked similar paths so that we can gather as much information as possible and then kind of find a more tailored approach for that specific patient or student.

Alicia: What kind of verbiage is helpful from the educational team for clinical audiologists to put in their clinic notes? Just so that the students really can have as much access to what they're entitled to without having to get a lot of pushback.

Michelle: So, from my standpoint, I've found over the years that not using “wishy-washy” terms will benefit. I think it's just being very conscientious when the clinical audiologists are writing the report. Everything should be in definitive terms, because if you leave any gray area or any room for interpretation, it's always going to go on the side of “we're not going to give it.” It’s the child must have x, y, and z in place. I think using very definitive and strong language goes a long way in clinical reports.

Sammie: Yeah, to that point, too. Like, we started instead of saying, like, preferential setting, because that preferred setting is subjective. By saying, "We know that x, y, and z would be very beneficial for the student because,” we're able to kind of home in on what we're looking for, versus letting it be at the discretion of someone who may otherwise not be familiar with working with a student with hearing loss.

Michelle: I also think if there's literature or articles that you can cite that are data-driven, that supports it as well.

Laurie: It's helpful what you ladies are saying, because as someone who would set up the accommodation or recommend them, I should say, if it's in that report, I can say this child needs this accommodation. But if it's kind of, like you say, a gray area, “Well, maybe not. Maybe let's just see how they do, and we can always add that later.” I appreciate it when it's all written there and it says they require x, y, and z. Now I must recommend that, and they can't say no. That's the goal.

Sammie: I think to that point, too, there's always kind of that concern of, like, are we being too restrictive? I think that if we are open with “we really want to set this kindergarten student up for success, here is how I envision it,” Then, reevaluate with a whole team approach: looking at data, looking at different checklists, checking in with the speech therapist, checking out the clinical audiologists, the teacher of the deaf—we can really make sure that the support is appropriate. I think setting those milestones versus saying “we just need all the things” sometimes kind of breaks down that lack of willingness to give all the resources. I think being realistic with what we know is the best practice.

Alicia: We hope to emphasize the importance of improved communication between people in different parts of the child’s care team to hopefully enhance our problem-solving among clinicians, teachers of the deaf, and even classroom teachers. Ultimately, we need to empower families so that they have the necessary resources and can advocate for their children, and so their children can advocate for themselves. Sometimes, hearing loss can be something that hinders students, but most of the time, these kids really embrace who they are. They embrace this piece of their lives. We want to help give them those resources and give their parents those resources so that they feel empowered and can use this as their superpower. Ultimately, we want to have positive outcomes; our students want positive outcomes, and that helps us stay motivated and helps future students as well. Thank you all for the great discussion!