Interview with Patricia Kricos, Ph.D.
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Topic: Current Topics in Audiologic Rehabilitation
CAROLYN SMAKA: Pat, welcome to AudiologyOnline and thank you for taking the time to speak with me today.
DR. PATRICIA KRICOS: Thank you, Carolyn, for letting me talk about my most favorite topic.
SMAKA: Which is?
KRICOS: Absolutely anything that has to do with audiologic rehabilitation (AR) or what some people refer to as auditory rehabilitation. It's something I could just talk about until I'm blue in the face.
SMAKA: (laughs.) Before we officially get into audiologic rehabilitation, can you tell me about your background?
KRICOS: Yes, I've been a professor of Audiology at the University of Florida since 1981. Before that, I taught at the University of Akron for five years. In addition to being a professor of Audiology, I served for five years as the Director of the University of Florida's Center for Gerontology, which had to do a lot with my interest in working with older adults.
SMAKA: You're also very active in a lot of our professional organizations as well. What types of things are you currently involved with in that regard?
KRICOS: Right now, I'm serving my second year as a board member for the American Academy of Audiology. Two of the things that I'm involved with are education and strategic documents. I'm Board Liaison for the Academy's Education Committee and there are a lot of exciting things the Academy is putting together including a wonderful meeting being held in January in Orlando which will address Au.D. and Ph.D. education in audiology (www.audiologyonline.com/calendar/display_event.asp?event=1168). I also serve as Chair of the Strategic Documents committee. That's also something that I just love working on, helping to oversee the development of clinical guidelines for the practice of audiology. So that keeps me busy.
Also, I've served as President of the Academy of Rehabilitative Audiology (ARA) (www.audrehab.org) for the past year. Audiologic rehabilitation is my great passion and love besides my family. I have thoroughly enjoyed that and I'm delighted that ARA has grown significantly in recent years - that is very good news.
I also serve on the Advisory Council for the Better Hearing Institute (www.betterhearing.org). I'm working with Sergei Kochkin writing documents about hearing and hearing solutions for people. Also, I serve as the professional member of the board of directors of the Florida Hearing Loss Association.
So I do a lot of balancing and juggling, and every once in a while I drop one of those balls. But I just pick it up and keep going. You know, people sometimes ask me, how do you do all that? And I say that sometimes I'm not sure I am doing all that - I may be stretched a little thin here or there. But I love it. I'm passionate about all of those things.
SMAKA: It seems there's been a renewed interest in audiologic rehabilitation in our profession. We've seen several presentations on the topic on AudiologyOnline this year, several sessions at AudiologyNow! and we're seeing more and more in the journals. Why do you think we're seeing this renewed interest?
KRICOS: Well, when we started this field years ago, audiology was very much interested in rehab. This was following World War II when wounded veterans like Mark Ross were coming home and needed help with their hearing losses. But then we sort of got away from our rehab roots as a field. I think part of the reason we lost that focus was because for so many years we were not allowed to dispense hearing aids by the professional association that was, at that time, our home base. And somewhere along the line, the government labeled Audiology as a diagnostic profession. So that turned us off or away from treatment of audiologic difficulties. Then we've had, and continue to have, a lack of influence on third party payers. But there are some changes coming in this area. Several audiology professional organizations want to have audiology recognized as more than just a diagnostic field, and they are working together to try to improve third-party coverage of AR for audiologists. We should be reimbursed for our services, just as speech language pathologists can bill for third party payment or for reimbursement through the federal government.
Carolyn, the other thing that I think happened to our AR roots has to do with the phenomenal advances in hearing aid technology and what hearing aids can do. We really put a lot of faith into the technology. For a while there, many audiologists thought that we didn't need AR. Many in the profession just thought that we'd have to put the right hearing aids on people with the right circuitry options - directional, non-directional, etc. - and since these are very smart hearing aids that they'd know what to do depending on the person's environment.
But now we're realizing that it's going to take more than just the hearing aids. A fascinating study was done by Larson, et. al. involving a number of VA Centers a few years ago. This study looked at hearing aid technology, and they really didn't find much difference in the various circuitry in terms of the patients' performance. And that study made us realize, wow, we've got to rethink our sole reliance on technology to help people with hearing loss. We also have some experimental data now to support post-fitting intervention, not just fitting the hearing aids, but what do we do after we fit people with hearing aids. And lastly, with cochlear implants - both with children and adults who receive cochlear implants - we've learned that just fitting them with the hardware is not enough. The audiologist needs to be involved post-implantation to maximize outcomes. And I think all that accounts for the resurged interest in AR.
SMAKA: What are the current topics in audiologic rehabilitation right now? And where do you see the future going with it?
KRICOS: We look at the two age extremes, and then at everything in between. If we look at young children, we see that with early identification hopefully most babies today with significant hearing loss are identified before six months of age and are in a program of intervention. Their chances for success are so much better with AR and that really involves the audiologist who is working with their families to maximize outcomes.
With early identification of profound hearing impairment is the option of early cochlear implantation between 12 months and 18 months of age. Having these babies implanted early means that the outcomes are so much better but they do require treatment, not just hardware. So there have to be audiologists, pediatric audiologists, to work with these children and their families so they can develop to their full potential.
I think another thing to consider with children is something that people like Carol Flexer are pointing out. They're saying that we really shouldn't be talking about hearing loss and working on auditory training, we should be thinking about auditory brain development. That thinking takes this to a whole different level. With children, it's not that we want to fix their ears, but what we really want to do is develop their brains. When we approach it that way, we get much more into intervention. So those are the trends with kids.
With adults, we have a lot of evidence showing that with some type of post fitting support they do a lot better with hearing aid adjustments, they keep their hearing aids and they become better hearing aid users. And that support doesn't necessarily mean the kinds of things that I do. I have weekly 'living with hearing loss' programs that are very collaborative problem-solving kind of groups. The data show that post fitting support really helps people retain their hearing aids and not stop using them and be much more effective hearing aid wearers.
One of the areas I think we need to think about more in the field, in our research and in our clinical practices is our pre-fitting counseling. I think there are probably still a lot of people fit with hearing aids, for example older adults, who really aren't completely acknowledging their hearing loss. Or, they say, "I have hearing loss, but it's not bothering me yet." And so if we fit these people with hearing aids, they're not really going to perceive the benefit. So I think that there's a lot of pre-fitting things that we need to be working on as a profession in order to help people become more aware of how hearing loss is actually affecting them.
SMAKA: Pat, where would an audiologist or maybe the new student out of school go for information about audiologic rehabilitation?
KRICOS: Well, the first place I would tell them to stop would be the Academy of Rehabilitative Audiology's website, which is www.audrehab.org. We're in the process right now of updating that website and making it less about the Academy itself and more about audiologic rehabilitation. There are a number of materials available like the latest research in AR for both children and adults. There's also a Members Only section where people can download materials such as presentations for the community about hearing loss. And information about courses and seminars is also on there.
Another place for great information about helping those with hearing impairment would be the Better Hearing Institute website, www.betterhearing.org. On the left hand side of that website, there are all kinds of information for patients. So your typical dispensing or private practice audiologist doesn't have to create a lot of educational materials to use with their patients. Thanks to Sergei Kochkin's efforts, that information is right there on the BHI website. There are all kinds of things for physicians and audiologists to download, too, such as presentations, press releases and more. So, I think those are two excellent sources for materials and information about rehab.
And people truly ought to look into considering membership in the Academy of Rehabilitative Audiology. Somebody told me that Jim Jerger was speaking recently at an industry talk for students and said that he predicted that the ARA was likely to be the one audiology organization that would see the greatest increase in membership in the coming years because people are really starting to realize the importance of rehab. And we have noticed that ARA has experienced close to a 14% increase in membership just this year. So, it's pretty interesting, Carolyn, to see these trends in our industry, as for years it was getting to be a smaller and smaller organization and now there's definitely an upward trend. So I think Dr. Jerger's probably right. I hope people will visit www.audrehab.org, consider joining, and come to our meetings as well because we really have a lot to offer.
The President elect of ARA is Robert Sweetow. I think that with all that he's done with the LACE program and emphasizing that it's not just about fitting hearing aids, it is going to make people even more interested in audiologic rehab in general and in ARA specifically.
SMAKA: I heard that ARA held an excellent fall conference on audiologic rehabilitation in September - three days packed with an excellent speaker line up and lots of great information. Does ARA hold an annual conference at approximately the same time of year?
KRICOS: Yes, and in fact, as soon as we end this interview, I need to really try to pin down when and where the 2009 conference will be. I have it tentatively scheduled for September 2009 about the same dates as it was this year. And the two keynote speakers, I'm so excited about this, are Mark Ross and Sam Trychin. These two individuals have been with AR from the beginning. Both of them came back from World War II with hearing impairment and they have just contributed so much to this field. I am delighted that both of them will be the keynote speakers next year. It doesn't matter if you're talking to a second year Au.D. student or somebody like me who's been around forever, when they hear those names they get excited, because they are both excellent speakers and are so knowledgeable.
SMAKA: ARA is so organized that you already have 2009 planned!
KRICOS: Well, almost planned, we're getting there. Further information about the 2009 conference will be posted on www.audrehab.org as soon as it is available.
SMAKA: Great, then we'll wrap up by reminding readers to stay tuned to www.audrehab.org for the latest information in audiologic rehab. Pat, thank you for all you do for the profession and thank you again for your time today.
KRICOS: Thank you Carolyn, it was a pleasure.
References
Larson, V., Williams, D., Henderson, W. G., Luethke, L. E., Beck, L. B., Noffsinger, D., Wilson, R. H., Dobie, R. A., Haskell, G., Bratt, G. W., Shanks, J. E., Stelmachowicz, P., Studebaker, G. A., Boysen, A. E., Donahue, A., Canalis, R., Fausti, S. A., & Rappaport, B. Z. (2000). Efficacy of 3 commonly used hearing aid circuits: A crossover trial. NIDCD/VA Hearing Aid Clinical Trial Group. Journal of American Medical Association, 284(14):1806-13.
DR. PATRICIA KRICOS: Thank you, Carolyn, for letting me talk about my most favorite topic.
SMAKA: Which is?
KRICOS: Absolutely anything that has to do with audiologic rehabilitation (AR) or what some people refer to as auditory rehabilitation. It's something I could just talk about until I'm blue in the face.
SMAKA: (laughs.) Before we officially get into audiologic rehabilitation, can you tell me about your background?
KRICOS: Yes, I've been a professor of Audiology at the University of Florida since 1981. Before that, I taught at the University of Akron for five years. In addition to being a professor of Audiology, I served for five years as the Director of the University of Florida's Center for Gerontology, which had to do a lot with my interest in working with older adults.
SMAKA: You're also very active in a lot of our professional organizations as well. What types of things are you currently involved with in that regard?
KRICOS: Right now, I'm serving my second year as a board member for the American Academy of Audiology. Two of the things that I'm involved with are education and strategic documents. I'm Board Liaison for the Academy's Education Committee and there are a lot of exciting things the Academy is putting together including a wonderful meeting being held in January in Orlando which will address Au.D. and Ph.D. education in audiology (www.audiologyonline.com/calendar/display_event.asp?event=1168). I also serve as Chair of the Strategic Documents committee. That's also something that I just love working on, helping to oversee the development of clinical guidelines for the practice of audiology. So that keeps me busy.
Also, I've served as President of the Academy of Rehabilitative Audiology (ARA) (www.audrehab.org) for the past year. Audiologic rehabilitation is my great passion and love besides my family. I have thoroughly enjoyed that and I'm delighted that ARA has grown significantly in recent years - that is very good news.
I also serve on the Advisory Council for the Better Hearing Institute (www.betterhearing.org). I'm working with Sergei Kochkin writing documents about hearing and hearing solutions for people. Also, I serve as the professional member of the board of directors of the Florida Hearing Loss Association.
So I do a lot of balancing and juggling, and every once in a while I drop one of those balls. But I just pick it up and keep going. You know, people sometimes ask me, how do you do all that? And I say that sometimes I'm not sure I am doing all that - I may be stretched a little thin here or there. But I love it. I'm passionate about all of those things.
SMAKA: It seems there's been a renewed interest in audiologic rehabilitation in our profession. We've seen several presentations on the topic on AudiologyOnline this year, several sessions at AudiologyNow! and we're seeing more and more in the journals. Why do you think we're seeing this renewed interest?
KRICOS: Well, when we started this field years ago, audiology was very much interested in rehab. This was following World War II when wounded veterans like Mark Ross were coming home and needed help with their hearing losses. But then we sort of got away from our rehab roots as a field. I think part of the reason we lost that focus was because for so many years we were not allowed to dispense hearing aids by the professional association that was, at that time, our home base. And somewhere along the line, the government labeled Audiology as a diagnostic profession. So that turned us off or away from treatment of audiologic difficulties. Then we've had, and continue to have, a lack of influence on third party payers. But there are some changes coming in this area. Several audiology professional organizations want to have audiology recognized as more than just a diagnostic field, and they are working together to try to improve third-party coverage of AR for audiologists. We should be reimbursed for our services, just as speech language pathologists can bill for third party payment or for reimbursement through the federal government.
Carolyn, the other thing that I think happened to our AR roots has to do with the phenomenal advances in hearing aid technology and what hearing aids can do. We really put a lot of faith into the technology. For a while there, many audiologists thought that we didn't need AR. Many in the profession just thought that we'd have to put the right hearing aids on people with the right circuitry options - directional, non-directional, etc. - and since these are very smart hearing aids that they'd know what to do depending on the person's environment.
But now we're realizing that it's going to take more than just the hearing aids. A fascinating study was done by Larson, et. al. involving a number of VA Centers a few years ago. This study looked at hearing aid technology, and they really didn't find much difference in the various circuitry in terms of the patients' performance. And that study made us realize, wow, we've got to rethink our sole reliance on technology to help people with hearing loss. We also have some experimental data now to support post-fitting intervention, not just fitting the hearing aids, but what do we do after we fit people with hearing aids. And lastly, with cochlear implants - both with children and adults who receive cochlear implants - we've learned that just fitting them with the hardware is not enough. The audiologist needs to be involved post-implantation to maximize outcomes. And I think all that accounts for the resurged interest in AR.
SMAKA: What are the current topics in audiologic rehabilitation right now? And where do you see the future going with it?
KRICOS: We look at the two age extremes, and then at everything in between. If we look at young children, we see that with early identification hopefully most babies today with significant hearing loss are identified before six months of age and are in a program of intervention. Their chances for success are so much better with AR and that really involves the audiologist who is working with their families to maximize outcomes.
With early identification of profound hearing impairment is the option of early cochlear implantation between 12 months and 18 months of age. Having these babies implanted early means that the outcomes are so much better but they do require treatment, not just hardware. So there have to be audiologists, pediatric audiologists, to work with these children and their families so they can develop to their full potential.
I think another thing to consider with children is something that people like Carol Flexer are pointing out. They're saying that we really shouldn't be talking about hearing loss and working on auditory training, we should be thinking about auditory brain development. That thinking takes this to a whole different level. With children, it's not that we want to fix their ears, but what we really want to do is develop their brains. When we approach it that way, we get much more into intervention. So those are the trends with kids.
With adults, we have a lot of evidence showing that with some type of post fitting support they do a lot better with hearing aid adjustments, they keep their hearing aids and they become better hearing aid users. And that support doesn't necessarily mean the kinds of things that I do. I have weekly 'living with hearing loss' programs that are very collaborative problem-solving kind of groups. The data show that post fitting support really helps people retain their hearing aids and not stop using them and be much more effective hearing aid wearers.
One of the areas I think we need to think about more in the field, in our research and in our clinical practices is our pre-fitting counseling. I think there are probably still a lot of people fit with hearing aids, for example older adults, who really aren't completely acknowledging their hearing loss. Or, they say, "I have hearing loss, but it's not bothering me yet." And so if we fit these people with hearing aids, they're not really going to perceive the benefit. So I think that there's a lot of pre-fitting things that we need to be working on as a profession in order to help people become more aware of how hearing loss is actually affecting them.
SMAKA: Pat, where would an audiologist or maybe the new student out of school go for information about audiologic rehabilitation?
KRICOS: Well, the first place I would tell them to stop would be the Academy of Rehabilitative Audiology's website, which is www.audrehab.org. We're in the process right now of updating that website and making it less about the Academy itself and more about audiologic rehabilitation. There are a number of materials available like the latest research in AR for both children and adults. There's also a Members Only section where people can download materials such as presentations for the community about hearing loss. And information about courses and seminars is also on there.
Another place for great information about helping those with hearing impairment would be the Better Hearing Institute website, www.betterhearing.org. On the left hand side of that website, there are all kinds of information for patients. So your typical dispensing or private practice audiologist doesn't have to create a lot of educational materials to use with their patients. Thanks to Sergei Kochkin's efforts, that information is right there on the BHI website. There are all kinds of things for physicians and audiologists to download, too, such as presentations, press releases and more. So, I think those are two excellent sources for materials and information about rehab.
And people truly ought to look into considering membership in the Academy of Rehabilitative Audiology. Somebody told me that Jim Jerger was speaking recently at an industry talk for students and said that he predicted that the ARA was likely to be the one audiology organization that would see the greatest increase in membership in the coming years because people are really starting to realize the importance of rehab. And we have noticed that ARA has experienced close to a 14% increase in membership just this year. So, it's pretty interesting, Carolyn, to see these trends in our industry, as for years it was getting to be a smaller and smaller organization and now there's definitely an upward trend. So I think Dr. Jerger's probably right. I hope people will visit www.audrehab.org, consider joining, and come to our meetings as well because we really have a lot to offer.
The President elect of ARA is Robert Sweetow. I think that with all that he's done with the LACE program and emphasizing that it's not just about fitting hearing aids, it is going to make people even more interested in audiologic rehab in general and in ARA specifically.
SMAKA: I heard that ARA held an excellent fall conference on audiologic rehabilitation in September - three days packed with an excellent speaker line up and lots of great information. Does ARA hold an annual conference at approximately the same time of year?
KRICOS: Yes, and in fact, as soon as we end this interview, I need to really try to pin down when and where the 2009 conference will be. I have it tentatively scheduled for September 2009 about the same dates as it was this year. And the two keynote speakers, I'm so excited about this, are Mark Ross and Sam Trychin. These two individuals have been with AR from the beginning. Both of them came back from World War II with hearing impairment and they have just contributed so much to this field. I am delighted that both of them will be the keynote speakers next year. It doesn't matter if you're talking to a second year Au.D. student or somebody like me who's been around forever, when they hear those names they get excited, because they are both excellent speakers and are so knowledgeable.
SMAKA: ARA is so organized that you already have 2009 planned!
KRICOS: Well, almost planned, we're getting there. Further information about the 2009 conference will be posted on www.audrehab.org as soon as it is available.
SMAKA: Great, then we'll wrap up by reminding readers to stay tuned to www.audrehab.org for the latest information in audiologic rehab. Pat, thank you for all you do for the profession and thank you again for your time today.
KRICOS: Thank you Carolyn, it was a pleasure.
References
Larson, V., Williams, D., Henderson, W. G., Luethke, L. E., Beck, L. B., Noffsinger, D., Wilson, R. H., Dobie, R. A., Haskell, G., Bratt, G. W., Shanks, J. E., Stelmachowicz, P., Studebaker, G. A., Boysen, A. E., Donahue, A., Canalis, R., Fausti, S. A., & Rappaport, B. Z. (2000). Efficacy of 3 commonly used hearing aid circuits: A crossover trial. NIDCD/VA Hearing Aid Clinical Trial Group. Journal of American Medical Association, 284(14):1806-13.
