Interview with Carole Johnson Audiologist, Professor, and Author, Auburn University.

AO/Beck: Good morning Carole. It's a pleasure to catch up with you. Would you please review your professional background for us?

JOHNSON: I received my Ph.D. from the University of Tennessee at Knoxville in Speech and Hearing Sciences in 1989.

AO/Beck: Can you tell me who was on the faculty at the time?

JOHNSON: Dave Lipscomb, Anna Nabelek, Alan Diefendorf, Carl Asp and I hate to admit it - but I am probably leaving someone out!

AO/Beck: What was your dissertation on?

JOHNSON: It was on speech perception in reverberation and noise. Basically, I looked at the elderly with high frequency hearing loss in lecture halls and similar situations.

AO/Beck: Okay. After you got your Ph.D., where did you work?

JOHNSON: I worked at the University of Oklahoma Health Sciences Center (OUHSC) in the Department of Communication Sciences and Disorders (John W. Keys Speech and Hearing Center) in Oklahoma City, OK from 1989-1992 and then I've been here since 1992.

AO/Beck: Carole, if I recall our previous discussion, I believe you are one member of a rather elite club. Specifically, as a Ph.D., you are also seeking your Au.D - am I correct?

Johnson: Yes, you're right. I'm working on my Au.D.

AO/Beck: Why are you pursuing that?

JOHNSON: Well, I feel that to be in the program, to add credibility, you really have to stand behind the degree. The Ph.D. is more of a research and teaching degree, and I really felt the need to go back and get my Au.D..

AO/Beck: Well, I'm proud of you. That's fantastic. What school are you attending?

JOHNSON: Pennsylvania College of Optometry (Go PCO!).

AO/Beck: How many classes do you have until graduation?

JOHNSON: Seventeen!

AO/Beck: And each class is six weeks in duration?

JOHNSON: Yes.

AO/Beck: Carole, that's really excellent. Let's switch topics to the Audiology program at Auburn. Do you currently offer an Au.D. program then?

JOHNSON: We are accepting applications for the first class to begin in Fall 2003. We've been accredited through CAA . Of course, we've had a traditional master's and Ph.D. doctoral program for a long time. Our program in audiology was the first in Alabama and it has a 45-year history. We have two Ph.D.'s, myself and Sridhar Krishnamurti. He's been with us six years, he recently got tenured and he's now an associate professor. His areas of expertise are electrophysiology and psychoacoustics.

We have two Au.D. clinical associate professors. Dr. Sandra Clark-Lewis got her Au.D. at the University of Florida and Dr. Martha Wilder Paxton completed her Au.D. through the Pennsylvania College of Optometry (PCO). Between them, they have almost 50 years of clinical experience. We also have Angie Hodges, whose a master's level clinical supervisor. She works part-time with us and the other half of the time she works with an ENT in town and with the cochlear implant program.

An exciting new aspect to the program is that it is shared with the Department of Communication Disorders and their Speech and Hearing Clinic at Auburn University at Montgomery (AUM) directed by Dr. Thomas Borton. Also, on staff are Georgia Holmes, M.S., CCC-A, clinical Audiologist, who is currently obtaining her Au.D at the Arizona School of Health Sciences and Dr. Bettie Champion Borton who received her degree from the University of Florida. Sharing the program with AUM provides increased visibility within the state and a wealth of academic and clinical opportunities for our students.

AO/Beck: That's really phenomenal.

AO/Beck: Is your new Au.D. program residential or distance-based?

JOHNSON: We're focusing on residential students.

AO/Beck: How many students are you looking for?

JOHNSON: We're accepting 10 per year and maximum of 40 at any phase within the program.

AO/Beck: Do you have all of the clinical facilities on campus?

JOHNSON: We have two campus locations, and they each have full clinics, seeing patients five days a week, eight hours a day, 40 hours a week. Our clinic serves newborns to the elderly. We have a high technology hearing aid dispensary. We have universal newborn hearing screening follow-up. We have a complete ENG program and we have a variety of aural habilitation and rehabilitation programs. You name it, we've got it! All of those components are on campus, so we're essentially self-contained, but we have numerous additional opportunities off-site too.

One exciting development through Dr. Clark-Lewis' efforts has been enabling students to observe cochlear implantation on individual patients from pre-implant evaluation, surgery, to post-implant management through a local otolaryngology practice.

AO/Beck: Excellent. For the readers who may not recognize your name, let's talk about your area of expertise too.

JOHNSON: My area of expertise is audiologic rehabilitation and speech perception.

AO/Beck: I recall your book was one of the assigned texts when I was at the University of Florida.

JOHNSON: Yes, the book is called the Guidebook for Support Programs in Aural Rehabilitation. Jeff Danhauer and I completed a second book this year Handbook of Outcomes Measurement in Audiology.

AO/Beck: Carole, if you could wave a magic wand and have AR done as you deem necessary - How would you prefer to offer aural rehab as a service to patients, and at what time is AR intervention most effective?

JOHNSON: I think a team approach is definitely necessary and I think what ideally should happen is that we need to educate all healthcare providers within the constellation around the elderly patient! Everyone should know what an Audiologist is and what an Audiologist does. The other professionals need to understand the new World Health Organization reclassification of hearing loss, disability, and activity limitation, and they need to think about hearing loss as being really detrimental to quality of life. And that means primary care physicians, ENT's, social workers, OTs, PTs, everyone knowing about hearing, about Audiology, and about quality of life. If our professional colleagues are educated, they can recognize signs of hearing loss, and many of these signs pose as dementia or something else, and the Audiologist can quickly and efficiently determine if hearing loss is the primary issue, or whether it co-exists with other issues.

I'd like to see hearing loss and related AR as part of the standard healthcare items routinely checked, you know, for all elderly patients. And again, getting this information to other professionals is very important as they serve many of the same people we take care of daily. We need for them to understand that hearing is part of the whole picture. You can't work with a therapist for stroke recovery if you can't hear!

AO/Beck: It is well documented that effective AR lowers return rates, and I suppose that in a dispensing program you can help justify the AR component by reducing the return for credits, but when you offer a rehab program, independent of dispensing, how do you pay for the time?

JOHNSON: It's frustrating because AR is something they can benefit from. I think you're right, most of the time AR is included in the price of dispensing, but we should ideally bill for our services based on an hourly rate, independent of dispensing.

AO/Beck: Yes, and when you say AR is included in the price, I think some people will turn around and say Okay, well if I don't take that service, how much can I get off?

JOHNSON: Yes, well again that gets to the point of AR having it's own value with and without hearing aids. So people go to a physician and ask for a bargain on their appendectomy. You know, they would never say Use a little less anesthesia and save me a few dollars! It's a funny position we find our profession in right now. People are always looking for a bargain.

AO/Beck: When you're talking about adult aural rehab, for people who have presbycusis who come in after years of saying, What? Huh? What did he say? what's the ideal AR program?

JOHNSON: A good starting point is establishing a group of people similar in age. Dr. Clark-Lewis is currently overseeing our adult hearing aid orientation group. We've had people with varying degrees of hearing loss, some are single, widows, and widowers. And what we try to do is to have two clinicians per couple, which is obviously ideal in school, but not realistic in the real world. Usually we offer a four-week program and each clinician is responsible for case management.

Usually the first week is kind of an icebreaker to get people to know each other and to know their history. We go over the anatomy of the ear, what the audiogram means, and why they're hearing, and why they're not hearing things they should be hearing. Attitudes are changed, and attitudes toward disability are changed, more effectively in a group and from modeling.

Often we try to have somebody who is an experienced hearing aid user work with someone who is a first time hearing aid user, so they can get ideas about what to expect, hints, pearls of wisdom etc. At the end of each session we try to get some type of participation activity where they can use the knowledge that they've learned that week.

The second week really touches on visual aspects of speech and speech reading, and trying to raise consciousness about how they can fill in information they've missed, and why they confuse certain words and things like that. We offer some demonstrations about what speech reading is and how context can make a real difference. We try to make it fun and get people involved. People are really surprised to learn there are things that they really don't think about, but that are very important for effective communication.

The third week has to do with assertive listening. We also address the Americans with Disabilities Act and assistive listening devices. We have some ALDs available in our ALD library, and that's usually very useful for the AR participants.

The AR program also emphasizes telephone strategies and in general, working on problems that they've been having during the trial period. Ideally, we like to get people into the group after they have had their hearing aids for approximately two weeks so we can address and solve problems and can help them make the decision of whether or not to keep the device, or whether to extend the 30 day trial period.

AO/Beck: OK, well, I know I've kept you a little late here, and I need to let you go. But I want to thank you for your time and expertise, and I wish you luck with the new Au.D. program and the A.R. program too.

JOHNSON: Thanks a lot for the opportunity to discuss these issues on Audiology Online. I appreciate your time too.