Transcript From the Live e-Seminar - Words of Wisdom from Marion Downs
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Topic: A Perspective on Hearing in Children
Editor's Note - The following is a transcript from a Live e-Seminar that was conducted by Dr. David Fabry on Audiology Online on January 30, 2008. (The recorded version is available here). As the session was held during the Ultimate Colorado Mid-Winter Meeting in Vail, we were also privileged to have participation from not only Dr. Marion Downs, but Drs. Linda Hood, Christine Yoshinaga-Itano, and Sandra Gabbard. We have published the transcript from the seminar in a semi-rough edited format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers - Paul Dybala, Ph.D. - Editor
Dr. David Fabry: Hello everyone. This is Dr. Dave Fabry. I would like to welcome you to the Live Expert e-Seminar, Words of Wisdom from Marion Downs, a perspective on hearing in children.
It is my great pleasure to moderate this live seminar featuring Dr. Marion Downs. I think she probably sets the record for the most mature presenter on Audiology Online, doing web conferencing for the first time today. She is truly a living legend, a rare gem, treasured by all who are fortunate enough to know her. I am honored that she has taken the time to be with us today.
We asked for the MVP, and we ended up, I believe, getting the entire All Star Team. With us at this session today, in addition to Marion, is Drs. Linda Hood, Christine Yoshinaga Itano, Sandy Gabbard, and Cheryl DeConde Johnson. With them in Vail, Colorado is Dr. Paul Dybala. On that note, I want to turn it over to Marion Downs and have her say a few words before Paul introduces everyone else.
Dr. Marion Downs: I sure will. Thank you for having me and for your kind words. Here is Paul Dybala to introduce everybody.
Dr. Paul Dybala: Thank you, Marion. Hello everyone, this is Dr. Paul Dybala with Audiology Online, and I am sitting here in Vail, Colorado with an amazing panel of audiologists. Just wanted to say thanks to all of the participants for taking time out of your busy schedules to login today. We have over 130 participants in this event, and all of you are in for a great presentation! With our group of presenters, I think what would be best, is instead of having me introduce everyone here, is to let them say hello directly. First, I will turn it over to Linda Hood.
Dr. Linda Hood: Thanks, Paul. Well, it is really great that we have a chance to be here with Marion up in Vail and also be with all of you. I am looking forward to the discussions in the next hour. Here is Christine Yoshinaga Itano.
Dr. Christine Yoshinaga-Itano: Thank you. It is always a treat for me to be with Marion, especially having just celebrated her 94th birthday.
Dr. Sandy Gabbard: This is Sandy Gabbard, and do not let us kid you, it takes a village to walk in Marion's shoes, and that is why we are all here. Unfortunately, Cheryl DeConde Johnson had to leave early due to the snow we are having and could not be here.
Now, here is Marion Downs.
Downs: Thank you. I cannot believe this. Here we are in beautiful downtown Vail with four feet of snow, and I am just delighted to be talking to my fellow audiologists this morning. It is a real pleasure. I think there is a little bit of a generation gap between us, but I don't mind if you don't. I just had my birthday on Saturday, and I feel no pain. You know, when I was 80 years old, my doctor said an 80 year old woman should not be playing tennis, I took his advice, and I could not wait until I was 90 to get back to it.
Today, I want to share with you some of my observations on the contemporary scene in newborn hearing screening. I see that almost 93% of all babies are being screened in the United States, which just pleases me.
Another observation that has simply delighted me is the number of spinoffs that keep popping up from newborn hearing screening. I would like to list them for you. I think the first one, of course, was auditory neuropathy/dyssynchrony, and it just so happens that we have the one person here in the United States who knows more than anybody else, and I am going to let her give you an update on what is happening.
Hood: Thank you, Marion. I think that auditory neuropathy and dyssynchrony is certainly a spinoff of newborn hearing screening because without looking at ABRs and otoacoustic emissions, we would not have identified this in the first place.
Certainly, we still grapple with the ability to identify this, but we are starting to get a handle on the incidence of it, which, at great surprise to all of us, is about 10 to 12% of all infants who fail their ABRs in their screening testing, We are starting to look at some of the factors that may be contributing to this in infants, but I think we still have a ways to go on that. We see a lot of variation across infants and adults, and we have actually been talking about that some over the last day up here.
One big step is that we are starting to identify some of the genes, and I think that is going to help us explain some of the variations we see in the disorder. We will understand more once we learn the source and what the gene does.
It should help to guide us more in management as well. Right now, we are fortunate with the success that patients have had with cochlear implants, and I think we certainly know so much more than we did ten years ago, even five years ago. We are learning at a very rapid rate, and I think there is a lot to continue to learn through studying newborns. With that, I am going to pass this back to Marion.
Downs: That is great! I cannot believe this is happening up here!
The next spinoff, of course, is the detection of unilateral hearing loss and how important it is to follow these children and provide them treatment. We happen to have the expert on this, Dr. Sandra Gabbard. Sandy, here you go!
Gabbard: Thank you Marion. I would just like to share a couple highlights for all of you. Some of you may be aware that the Marion Downs Hearing Center, partnered with the Centers for Disease Control and Prevention (CDC), had a conference a couple years ago to try and bring together the experts in mild, minimal, and unilateral hearing loss. The results of that conference are being published in a Seminars in Hearing edition that John Eichwald and I just finished editing. I believe the goal is to have that out by AAA, and it will include the proceedings from that conference as well as several chapters from experts in the area.
I will refer you to that for the details, but the highlights are that we now know that about 20 to 25% of children identified with unilateral hearing loss in the newborn period actually progress to bilateral hearing loss in the first three to four years of life. This makes the identification of unilateral hearing loss probably the biggest risk factor for significant bilateral sensorineural hearing loss; therefore, we certainly want to follow them for that reason. The statistics also show that approximately one third of children with unilateral hearing loss are at risk for language delays.
We now have made it a goal to identify unilateral hearing loss in the newborn period. We do not consider it a pass on a newborn hearing screening if they pass only in one ear. Their follow-up should be as aggressive as children who refer bilaterally.
Many of us are looking at early amplification options with a fair amount of success, and we are finding that kids with aidable hearing in the unilateral hearing loss ear can be very successful users of amplification if they are fit early and are enrolled in an early intervention program. We are beginning to collect some data on the kids that are fit versus the kids that are not fit with amplification, and hopefully, with some of Christine's follow up data, we will be able to get a better idea of how much it may help them.
We also know that the more significant the hearing loss in the hearing impaired ear the more at risk the child is for significant communication and educational delays. If Cheryl were here she would tell you all about the risk factors that we see in school aged children, but I think it is definitely on our radar screen.
There are a lot more questions to be answered than answers that we have, but certainly we are looking forward to shifting our focus for both unilateral and mild to minimal hearing loss. We are watching for possible progression to bilateral hearing loss, and we are assessing the effects of otitis media on these kids. We need to have an aggressive follow up as well as awareness of potential middle ear problems in this population.
I would definitely encourage you to look at that Seminars in Hearing issue if you are particularly interested in what is new in that area.
Before I give the microphone back to Marion, I would like to mention our upcoming symposium. Many of you are aware that we had a symposium on infant hearing directed historically by Marion Downs. We are continuing the symposium, and it will be this summer in Breckinridge, Colorado. If you would like to get up here when there is not white stuff on the ground, we invite you to come join us on July 10th through the 12th. The information will be on our website (www.mariondowns.com/and it is a wonderful meeting that combines our scientific knowledge and our clinical practice into one meeting. We talk a lot about what we are doing beyond the screening process. We do attract multiple types of participants, including medical professionals, early interventionists, teachers, and speech pathologists, but it is mostly audiologists.
Downs: Well, I guess that is all the news that is fit to print from you. Thank you, dear.
The most significant spinoff from newborn hearing screening has of course been the research on what has happened to the kids that are identified early. Has it all been worthwhile? We have Christine Yoshinaga Itano here, who is more than an expert and has devoted her life to it.
Yoshinaga-Itano: Thank you, Marion. Before I talk about the outcomes, I would just like to talk about some of the issues. I think we can congratulate ourselves nationwide for the amazing job that we have done in a very, very short period of time of screening every newborn. However, one of our biggest issues now is that we have a problem with our follow-through, and I think we need to really get the support of all the audiologists throughout the nation. We are really the only ones that can fix this problem.
At this point in time, we have a 50 to 60% failure to follow through from referral at screening, and that is not an acceptable rate. Now, we know that there are models in some states that are able to get it up to 80 and 90% follow through rates, which is what we are aiming for nationwide.
One of the things that I want to report about is that Vickie Thompson has just finished some amazing work on the results in the state of Colorado, and you will be pleased to find out that her most important finding is the way that we can improve follow through rates. If audiologists are involved in and particularly aware of possible impeding factors for follow up including cultural and linguistic issues, transfers from one hospital to another, etc. there is an improved follow through rate. Specifically, the programs in which the audiologists are really involved in the protocols of the hospitals yield amazing follow through from the difficult populations.
Hopefully, what will happen is that we will see more audiologists engaging in every state system nationwide to try to improve the quality of this follow through rate.
One of the big things that we have to do is reduce the refer rate to diagnostic audiology, the outpatient rescreening has done a great job at doing that, but if we send 6% of the kids to diagnostic audiology, we need a lot of diagnostic audiologists and we are going to be passing a lot of kids. If we can reduce the refer rate to 1%, which many of the good programs have been able to do, diagnostic audiologists can do what they need to do, which means that we are going to get a 40% hit rate of the kids that we do the diagnostic follow through on.
Overall, we need your help to mobilize the state system so that we can finally get these kids diagnosed and into intervention, because we know that every program throughout the United States and throughout the world now has seen what a difference it makes to identify children in the newborn period.
I would have never believed 20 years ago that we could not only screen babies in the newborn period, but identify them within weeks and get a hearing aid on them and into intervention soon after. I used to think six months was wow, how can we do it in six months, and now I see programs all over the United States doing it within four weeks. It is really remarkable what audiologists have been able to do in a very, very short period of time.
We will hopefully be publishing our outcome data on our kids that have been identified through universal hearing screening. We are really pleased about the evident advantage that these children had based on the fact that they were identified early. We now have data to show that children that are early identified and enrolled in an early intervention program are able to maintain throughout the school age period a one for one growth, meaning that their academic and language growth is one year for one year of life, which is comparable to hearing children.
I still am amazed that identifying this early in life has this amazing impact on the entire development of children, but I guess we should not be so surprised with the flexibility of the brain at this period of time.
The other place where we need help is developing professional development plans, because the information that we are gaining is coming in at such a rapid rate, it is hard for all of us to keep up to date with it and to keep our skills up.
State systems need to be able to develop better programs for professional development for our audiologists and for our interventionists.
Thank you for all the work that all of you are doing. It is really an amazing thing to watch how fast we have accomplished what we have accomplished.
Downs: Is that not the truth? I tell you, the audiologists of the United States have really risen to the front on this, and thank you all for doing it.
To go on talking about the spinoffs, of course we know that there are going to be spinoffs in the screening of genetics and CMV. I do not know whether I will be around to see it, but it is going to happen. There is no question about it; they are riding on the back of the newborn hearing screening, which is very satisfying.
Then we come to another spinoff that struck me as being very important and that is the finding that SIDS susceptibility can be identified using DPOAE in the screening program at birth. I am sure you all have seen or heard about the article that was published in the Journal of Early Human Development. Dr. Daniel Rubin was the author, but our dear friend, Dr. Betty Vore, who really in Rhode Island was the first to do universal newborn hearing screening, is responsible for this too.
This article identified the fact that in using DPOAE, the signal to noise ratio of infants with SIDS was higher in the left than in the right ear, whereas in controls, the right sided ratios were higher than the left. This has been reported by many people.
What I did not know, something that has been known for years, is that the vestibular system plays an important role in respiratory control during sleep. Vestibular stimulation has been shown to modulate firing of the respiratory central pattern generator. This goes back 30 years in the literature.
Well, why am I interested in this? I started looking into it, and I found that the studies in SIDS are really a growing importance. It seems that the method that they use to prevent SIDS, placing the infant on the back, may not have been the effective prevention that it was supposed to be.
There has been an investigation by the Scripps Howard news service which reported that the success of that technique has been substantially overstated and the figures may not be accurate. There is a renewed need to study both the identification and the prevention techniques, and it looks as if we have a role in this as audiologists, and I would like to encourage you to do that.
That study points the way, of course, to replication. It certainly should be replicated, and there should be further investigation of the identification at birth of susceptible infants by us. I think we can do that.
Fortunately, I found in the literature that for years there have been studies on the fact that just rocking the infant helped to control the respiratory brain; therefore, there is a possible prevention of SIDS available to us.
All of these things are coming together now, and we should take advantage of them. This is fascinating that it goes back as far as 1954. Of course, I have been interested in this because I see that we all have a stake in it, and I urge you all to look into it and perhaps do dissertations on it, and so forth. I think it is a great source of research for us in the future. I want you to dream up some new ideas. Perhaps you have learned some new ideas on identifying this thing.
I think we are through with what we were going to say on that, and Dave, I understand you have some questions for me.
Fabry: Yes. Several attendees have submitted questions. First, you have been a mentor to so many audiologists over the years; did you have any professional mentors when you started?
Downs: I came into this field so early that there were not really any women to have as a mentor. It was all men in the field when I came in; this was 1947, remember? For years, I was the only audiologist in Colorado.
Over the years, however, my mentors have been everybody in the field who has contributed to audiology, and particularly pediatric audiology, and, of course, Jerry Northern, who has inspired me and pushed me. I will always tell him, you made me what I am today. I hope you are satisfied. [laughter]
Fabry: Great! Now, I understand that you are the honorary chair of the ABA Pediatric Audiology Certification initiative. Can you tell me why you think it is a good idea?
Downs: Anything that promotes pediatric audiology is right up my alley, and I will give a hundred percent to it, if I can do anything for them. Of course, everybody in that committee is so smart and so much smarter than I am now; therefore, I just back them a hundred percent.
Fabry: What is the most important piece of advice that you would give an audiologist at the beginning of his or her career?
Downs: Well, I think that the one thing that you should do if you are starting out is to learn to think about everything that you see. Do not just do your testing and then pass it off. Think about what is happening there. It is like a detective study to me, really. What is going on there? Keep it in your mind, and if you see the same thing the next time or another time, hey, you can do a little research study on this. I think that is what we all should be doing. Therefore, my answer is think!
Fabry: Excellent! What one piece of advice would you give for the experienced audiologists, and how do you keep the passion for audiology alive over such a sustained period of time? How do you guide experienced audiologists to prevent burnout?
Downs: I think that is true. After a while, the experienced audiologists may get a little bored or tired with the whole thing. Again, I would say, think about the new things to do. Think about it. You see something, put it together, then research it, and see if it is something that would interest you.
New areas of research are what we should be looking for constantly. We see that in the spinoffs of newborn hearing screening. New areas of research are popping up all the time. Never get bored with it, because you can look for all of these wonderful new ideas in research and search them out. Be a detective. Search everyone out. It has just been a wonderful, wonderful profession to me, right up right up to this time! I still just think it is the greatest thing in the world!
Fabry: I completely agree. If you can make a living fulfilling your passion, then work will not seem like work.
Now, what is the most enjoyable thing you have done in your lifetime, that you can discuss online of course?
Downs: That I can discuss online, well, that limits it a little bit I am afraid, but actually, you know, everything has been enjoyable in my life. It has been wonderful! Every day I think about what new and exciting thing is going to come around the corner next? Something new usually does come, and everyday has been exciting. I think it is going to be exciting right up to the last day, and I am going to enjoy every minute of it.
Fabry: The next question is more clinical. What is your view on directional microphones on infants?
Downs: I am going to ask Sandy Gabbard, who is an expert on this, to answer this question, because she is fitting the infants every day!
Gabbard: Well, thank you, Marion. One thing I have learned from you is we do not settle for anything less than the best for babies. That being said, we certainly want to get advanced signal processing in some form, even to the babies. I think the bigger question of multiple memories, noise reduction circuits, and directional microphones is a bit more challenging, and I do not know that we have a lot of research data except perhaps in school children.
For the babies, one thing we do know is that babies learn from incidental listening, and I say babies, but that really goes up until the age when they are getting directed education, one on one, when they are looking at you. That age varies by the child, but I would say at the very least, they probably need to be 5 to 8 years old. Before that time, they need to get input all the way around them. They learn incidentally, and it is very important that we do not limit their access.
With that being said, we are fitting advanced signal processing hearing aids, but we are not fitting directional microphone technology. There is not a lot of research data on directional microphones and young children at this point. We do have a lot of anecdotal observations, and we are watching those kids very carefully to decide when to transition them. It really has to do with how they are learning, their learning style, are they directing their attention, and can they move themselves around in their environment to help optimize a directional microphone or a noise reduction circuit.
This seems to be the general trend in all of the pediatric clinicians that I talk to, and hopefully we will have more research and new circuits come out as to what age needs advanced signal processing. We do believe that the high fidelity, high frequencies, and the multiple bands are all very important to the fidelity of the sound, but not so much the noise reduction circuits.
Fabry: Very good. What are your feelings on the issue of bilateral implants as the standard of care?
Gabbard: I just have one comment on this topic. There are a number of studies being completed right now in that area. One interesting study that has been recently published by Schafer and Thibodeau does look at children that have unilateral cochlear implants, then assesses them after adding a second implant or using a hearing aid, and then on top of that they added FM. Although we do know that binaural amplification seems to be better for all children, I think the jury is still out, especially with children who can wear a hearing aid in the opposite ear and potentially an FM system on one or both ears.
It is unknown exactly how much benefit we are getting in this population. I think we do suspect that if a child cannot get access to binaural amplification because of their degree of hearing loss that we certainly would put them high on the list for bilateral cochlear implantation, and we do have some data about kids that do a little bit better. Christine wants to comment as well.
Yoshinaga-Itano: I think all of us would agree that two ears are better than one; therefore, as much as possible, with whatever technology we can use, we would like to have two functioning ears for these children.
What I am excited about is we have been having a lot of success with pre-linguistic infant speech discrimination of both our cochlear implant and our hearing aid babies from six months on, and the technology is such that it should be possible for us to measure their speech discrimination in noise. If we can do that, then I think we will really be able to document the advantage of binaural hearing.
Hood: I think that Christine brings up something that is very important relative to figuring out the answers to this problem. There is a need for more sensitive measures of binaural function, looking at things like speech understanding in noise and localization ability and being able to do both with behavioral measures and also possibly some objective measures that we can then extend to some of our youngest patients.
Downs: Okay. You heard the experts. They have given you the answer to that. I love it! They were all right!
Fabry: Okay. Next question. Some audiologists are saying that a child with a normal audiogram, normal immittance, normal OAEs, but an abnormal ABR should be fit with amplification. Please explain why.
Hood: This is certainly a point of discussion. There is so much variation in auditory neuropathy/auditory dyssynchrony that it is difficult at this point to know which child is going to benefit from amplification and which child is not. As clinicians, we are really faced with using a clinical trial approach. I think as we begin to understand more of the underlying mechanisms, we will be able to sort out those that may have more inner hair cell involvement and those that have poor audibility versus those that seem to have good audibility.
Thinking back through the literature and what has been published with this, I think that most of the children that have had some benefit from amplification have been those who have demonstrated poor detection ability or poor audibility. The important thing there is to be sure to sort out whether or not we are simply improving awareness of sound by itself, which is not really our ultimate goal. We want to improve the ability to understand sound and discriminate sound. We know that the type of temporal processing difficulties that many of these children have will interfere with that. I think we need more ways to assess this.
There are several efforts looking at ways to measure temporal processing ability in children. If we can look at that, it may give us some insights into speech understanding and help us to sort out which children might derive some benefit from amplification. Right now, we have to respect the wide variation and really look at it on a case by case basis. We also need to follow these children very, very closely, keeping in close contact with their parents to see what they are doing and to see if that is the appropriate intervention.
Fabry: This is awesome, to be able to pick all of these brains en masse. Another question, what can school based speech language pathologists do to assist a child's audiologists for the best outcomes?
Downs: I wish Cheryl were here to talk about that. This is very important, because there have been a lot of studies showing the deficiencies that are going on in the schools. Christine can talk about that.
Yoshinaga-Itano: The school based audiologists have been really a vital part of our Colorado system, and it has taken us many, many years, but we now have an audiologist in every school district in the state, which is really an amazing thing. They also all have access to us, and they have good equipment in their program. Our school based audiologists play a variety of roles for us. In some cases what will happen is that babies from universal newborn hearing screening will be fit by the hospital settings, and the follow through, maintenance, and all of the checks will be done at the schools through some of the school based programs.
Probably the most important roles that the school based audiologists have had are related to the support of our cochlear implant children, making sure that they are getting what they need in the school systems. We have had a lot of professional development of both audiologists and speech language pathologists. This has helped us develop guidelines for the collaboration between the diagnostic centers and the mapping centers and what can be done in the school.
Our school based audiologists are the communication with the speech pathologists and with the classroom teachers in trying to make sure that the programs for all of our children with hearing loss are really maintained.
Everything from making sure that the technology is working to verifying that the IEPs are appropriate for all of these children, they play a major role with our children. We are now having more and more of our children from early identification being mainstreamed completely on 504s, and it is happening as early as five years of age.
I am not sure if that answers the question. Our speech language pathologists have a very close working relationship with the diagnostic audiologists and with our babies. They can help us with conditioning the children if they are not yet giving us behavioral audiograms. They give us all the reports on the auditory behavior of our children. We have done a lot of training on auditory checklists and auditory evaluations that can be done in the home and in the classroom to verify whether the communication is developing.
Our speech language pathologists in our schools have asked for a lot of professional development, auditory training, and auditory skill development; therefore, we have ongoing workshops for them.
Fabry: I see, as usual, we are going to be close to running out of time, but there are a few topics that I want to make sure we hit on before we are done. Marion, what is on your wish list for the future of audiology during the next ten years?
Downs: Well, I really have not gone ahead that far because I just live from day to day. You know, every day is wonderful. I hope that we continue to do what we are doing. Children are where it's at, babies are where it's at, and I hope we concentrate on that and find out more. I think you young people are just going to find out so many interesting things, and I want you to know, I am going to be up there cheering you on! You are going to be doing it, and I am so proud of you all!
Fabry: Excellent. Thank you. Do you have any favorite memories you can share with us from the many conferences you have attended?
Downs: Oh, I do not have any. It has all been wonderful.
Fabry: Okay. Now, I want to move to your book that was published I believe last year, Shut Up and Live! (You Know How). Why did you write it?
Downs: Oh, I wrote it to tell people how to get into their 90s and to survive. It is all survival, you know. It is not easy. It is not easy at all, because when you are about 80 years old, all of a sudden, you are ambushed by all of these physical problems. You just have to learn how to live with them and get on with your life, which is why I wrote that book.
Shut Up and Live! (You Know How) by Marion Downs
By the way, Penguin Publishers wanted to republish it in another form; therefore, since April, it has been out in another form with Penguin. I added quite a few things. The men will be happy too; I added some things on sex, a sex chapter. There are some very interesting things in here, and most book stores have it because Penguin is publishing.
Fabry: It really is a very entertaining and informative read, and I think a lot of people who see you are tempted to think that you have great genes and have never faced any adversity in getting to this age, but I know you have faced your share of adversity in order to get to this point.
Downs: That is right. The research shows that only 25 to 30% of longevity is due to your genes, so forget about that. Seventy five percent is up to you, and you had better work hard on it. I certainly have.
Fabry: We are getting down to the end, and I want to just point out here, your book, Hearing in Children, is published now in its 5th edition.
Downs: Yes, Jerry Northern has been so wonderful about this. He and I have both decided, though, no more; we have done it, and younger people can take it up from here on and carry it through. We have done it.
Fabry: I already know the answer of this one. Do you ever see yourself retiring fulltime?
Downs: I hope not. God willing!
Fabry: Well, we are just about to the end here, and I have a couple of quick questions. What person who lived in the 20th century do you admire the most other than your parents?
Downs: Well, of course, my father was ideal, but I think Einstein is the number one, what a brain and what an inventive thing. I hope that we all have inventive minds.
Fabry: What do you think the greatest invention of the 20th century is?
Downs: Radio.
Fabry: Radio? More so than the computer or television, etc.?
Downs: Well, nothing would have started until the radio was in. It is the basis of everything, and I saw it first when I was in grade school.
Fabry: In grade school. Fantastic! Well, then we will close out with some quick hits in terms of the first thing that comes to mind. Insert earphones or supra-aural cushions?
Downs: Inserts.
Fabry: ABR or otoacoustic emissions, if you could just have one?
Downs: ABR.
Fabry: BTEs or ITEs?
Downs: BTEs. I wear them.
Fabry: Okay. Excellent. Wax or waxless skis?
Downs: Waxless, of course.
Fabry: Yes. Make it easier on yourself, and then finally, favorite exercise, knowing that you have participated in many.
Downs: Well, of course, tennis is my game. I just love tennis. I just hope I can do it until the day I die.
Fabry: Excellent. Well, that concludes this session, and I want to thank the entire team up there in Vail, Marion and the whole group. It is just fantastic to have you all take the time out of your busy schedules to be with us today, and, again, thank you to all of the attendees for joining us today. Any final words Marion?
Downs: Thank you all for listening. Have fun and take care, whatever comes first.
Fabry: Thanks. We hope to see you online or in person sometime soon. Take care, everybody. Have a good afternoon!
More about Marion Downs
Marion Downs received her bachelor's degree from the University of Minnesota, her master's degree from the University of Denver, and an honorary doctorate of human services from the University of Northern Colorado.
She is currently a Professor Emerita at the University of Colorado Health Sciences Center. She has spent her professional career promoting early identification of hearing problems in children, publishing nearly a hundred articles and books on this subject and lecturing extensively around the world. She pioneered the first universal newborn hearing screening project nearly 30 years ago.
Her honors include two gold medals of achievement, one from the University of Colorado and the other from the University of Minnesota, a medal of the Ministry of Health of South Vietnam, the American Auditory Society Carhart Memorial Lectureship Award, the International Audiology Society Aram Glorig Award, and honors from the American Speech Language Hearing Association.
Most recently, in October of 2007, Marion received the Highest Recognition Award from the U.S. Department of Health and Human Services (HHS). HHS annually recognizes a handful of individuals and organizations in corporate America for their advocacy, arts, education, and public service for advancing the goals of the Americans with Disabilities Act and the President's New Freedom Initiative, which eliminates barriers that prevents people with disabilities from participating fully in community life. Marion was honored for her groundbreaking work and lifetime dedication promoting the early identification of hearing problems in children. This is quite an honor for someone in audiology to receive and was certainly a well deserved award.
She defines the way that many of us would like to grow old, with grace and also in defiance of anyone who would dare say that we should act our age. To that end, Marion took her first skiing lesson on her 50th birthday, became a serious runner at age 59, and now does the annual Bolder Boulder race. She is a serial gold medal winner in tennis at the Senior Olympics, and she recently jumped out of a plane to celebrate her 90th birthday.
In her 94 years, Marion Downs has lived through a depression, the space race, and countless political scandals. She has influenced the development and profession of audiology in myriad ways as a passionate and tireless advocate for universal newborn hearing screening in pediatric audiology. She has been an inspiration and mentor to many.
More about the Marion Downs National Center for Infant Hearing
The Marion Downs National Center for Infant Hearing is dedicated to pursuing the mission begun by Marion Downs more than 30 years ago. Early identification and intervention of hearing loss is a basic human right which should be available to all infants who are deaf and hard of hearing. Marion's vision and enthusiasm continue to be a driving force, fueling the activity of the Marion Downs National Center for Infant Hearing.
For more information on the Marion Downs National Center for Infant Hearing, you can go to www.mariondowns.com
Dr. David Fabry: Hello everyone. This is Dr. Dave Fabry. I would like to welcome you to the Live Expert e-Seminar, Words of Wisdom from Marion Downs, a perspective on hearing in children.
It is my great pleasure to moderate this live seminar featuring Dr. Marion Downs. I think she probably sets the record for the most mature presenter on Audiology Online, doing web conferencing for the first time today. She is truly a living legend, a rare gem, treasured by all who are fortunate enough to know her. I am honored that she has taken the time to be with us today.
We asked for the MVP, and we ended up, I believe, getting the entire All Star Team. With us at this session today, in addition to Marion, is Drs. Linda Hood, Christine Yoshinaga Itano, Sandy Gabbard, and Cheryl DeConde Johnson. With them in Vail, Colorado is Dr. Paul Dybala. On that note, I want to turn it over to Marion Downs and have her say a few words before Paul introduces everyone else.
Dr. Marion Downs: I sure will. Thank you for having me and for your kind words. Here is Paul Dybala to introduce everybody.
Dr. Paul Dybala: Thank you, Marion. Hello everyone, this is Dr. Paul Dybala with Audiology Online, and I am sitting here in Vail, Colorado with an amazing panel of audiologists. Just wanted to say thanks to all of the participants for taking time out of your busy schedules to login today. We have over 130 participants in this event, and all of you are in for a great presentation! With our group of presenters, I think what would be best, is instead of having me introduce everyone here, is to let them say hello directly. First, I will turn it over to Linda Hood.
Dr. Linda Hood: Thanks, Paul. Well, it is really great that we have a chance to be here with Marion up in Vail and also be with all of you. I am looking forward to the discussions in the next hour. Here is Christine Yoshinaga Itano.
Dr. Christine Yoshinaga-Itano: Thank you. It is always a treat for me to be with Marion, especially having just celebrated her 94th birthday.
Dr. Sandy Gabbard: This is Sandy Gabbard, and do not let us kid you, it takes a village to walk in Marion's shoes, and that is why we are all here. Unfortunately, Cheryl DeConde Johnson had to leave early due to the snow we are having and could not be here.
Now, here is Marion Downs.
Downs: Thank you. I cannot believe this. Here we are in beautiful downtown Vail with four feet of snow, and I am just delighted to be talking to my fellow audiologists this morning. It is a real pleasure. I think there is a little bit of a generation gap between us, but I don't mind if you don't. I just had my birthday on Saturday, and I feel no pain. You know, when I was 80 years old, my doctor said an 80 year old woman should not be playing tennis, I took his advice, and I could not wait until I was 90 to get back to it.
Today, I want to share with you some of my observations on the contemporary scene in newborn hearing screening. I see that almost 93% of all babies are being screened in the United States, which just pleases me.
Another observation that has simply delighted me is the number of spinoffs that keep popping up from newborn hearing screening. I would like to list them for you. I think the first one, of course, was auditory neuropathy/dyssynchrony, and it just so happens that we have the one person here in the United States who knows more than anybody else, and I am going to let her give you an update on what is happening.
Hood: Thank you, Marion. I think that auditory neuropathy and dyssynchrony is certainly a spinoff of newborn hearing screening because without looking at ABRs and otoacoustic emissions, we would not have identified this in the first place.
Certainly, we still grapple with the ability to identify this, but we are starting to get a handle on the incidence of it, which, at great surprise to all of us, is about 10 to 12% of all infants who fail their ABRs in their screening testing, We are starting to look at some of the factors that may be contributing to this in infants, but I think we still have a ways to go on that. We see a lot of variation across infants and adults, and we have actually been talking about that some over the last day up here.
One big step is that we are starting to identify some of the genes, and I think that is going to help us explain some of the variations we see in the disorder. We will understand more once we learn the source and what the gene does.
It should help to guide us more in management as well. Right now, we are fortunate with the success that patients have had with cochlear implants, and I think we certainly know so much more than we did ten years ago, even five years ago. We are learning at a very rapid rate, and I think there is a lot to continue to learn through studying newborns. With that, I am going to pass this back to Marion.
Downs: That is great! I cannot believe this is happening up here!
The next spinoff, of course, is the detection of unilateral hearing loss and how important it is to follow these children and provide them treatment. We happen to have the expert on this, Dr. Sandra Gabbard. Sandy, here you go!
Gabbard: Thank you Marion. I would just like to share a couple highlights for all of you. Some of you may be aware that the Marion Downs Hearing Center, partnered with the Centers for Disease Control and Prevention (CDC), had a conference a couple years ago to try and bring together the experts in mild, minimal, and unilateral hearing loss. The results of that conference are being published in a Seminars in Hearing edition that John Eichwald and I just finished editing. I believe the goal is to have that out by AAA, and it will include the proceedings from that conference as well as several chapters from experts in the area.
I will refer you to that for the details, but the highlights are that we now know that about 20 to 25% of children identified with unilateral hearing loss in the newborn period actually progress to bilateral hearing loss in the first three to four years of life. This makes the identification of unilateral hearing loss probably the biggest risk factor for significant bilateral sensorineural hearing loss; therefore, we certainly want to follow them for that reason. The statistics also show that approximately one third of children with unilateral hearing loss are at risk for language delays.
We now have made it a goal to identify unilateral hearing loss in the newborn period. We do not consider it a pass on a newborn hearing screening if they pass only in one ear. Their follow-up should be as aggressive as children who refer bilaterally.
Many of us are looking at early amplification options with a fair amount of success, and we are finding that kids with aidable hearing in the unilateral hearing loss ear can be very successful users of amplification if they are fit early and are enrolled in an early intervention program. We are beginning to collect some data on the kids that are fit versus the kids that are not fit with amplification, and hopefully, with some of Christine's follow up data, we will be able to get a better idea of how much it may help them.
We also know that the more significant the hearing loss in the hearing impaired ear the more at risk the child is for significant communication and educational delays. If Cheryl were here she would tell you all about the risk factors that we see in school aged children, but I think it is definitely on our radar screen.
There are a lot more questions to be answered than answers that we have, but certainly we are looking forward to shifting our focus for both unilateral and mild to minimal hearing loss. We are watching for possible progression to bilateral hearing loss, and we are assessing the effects of otitis media on these kids. We need to have an aggressive follow up as well as awareness of potential middle ear problems in this population.
I would definitely encourage you to look at that Seminars in Hearing issue if you are particularly interested in what is new in that area.
Before I give the microphone back to Marion, I would like to mention our upcoming symposium. Many of you are aware that we had a symposium on infant hearing directed historically by Marion Downs. We are continuing the symposium, and it will be this summer in Breckinridge, Colorado. If you would like to get up here when there is not white stuff on the ground, we invite you to come join us on July 10th through the 12th. The information will be on our website (www.mariondowns.com/and it is a wonderful meeting that combines our scientific knowledge and our clinical practice into one meeting. We talk a lot about what we are doing beyond the screening process. We do attract multiple types of participants, including medical professionals, early interventionists, teachers, and speech pathologists, but it is mostly audiologists.
Downs: Well, I guess that is all the news that is fit to print from you. Thank you, dear.
The most significant spinoff from newborn hearing screening has of course been the research on what has happened to the kids that are identified early. Has it all been worthwhile? We have Christine Yoshinaga Itano here, who is more than an expert and has devoted her life to it.
Yoshinaga-Itano: Thank you, Marion. Before I talk about the outcomes, I would just like to talk about some of the issues. I think we can congratulate ourselves nationwide for the amazing job that we have done in a very, very short period of time of screening every newborn. However, one of our biggest issues now is that we have a problem with our follow-through, and I think we need to really get the support of all the audiologists throughout the nation. We are really the only ones that can fix this problem.
At this point in time, we have a 50 to 60% failure to follow through from referral at screening, and that is not an acceptable rate. Now, we know that there are models in some states that are able to get it up to 80 and 90% follow through rates, which is what we are aiming for nationwide.
One of the things that I want to report about is that Vickie Thompson has just finished some amazing work on the results in the state of Colorado, and you will be pleased to find out that her most important finding is the way that we can improve follow through rates. If audiologists are involved in and particularly aware of possible impeding factors for follow up including cultural and linguistic issues, transfers from one hospital to another, etc. there is an improved follow through rate. Specifically, the programs in which the audiologists are really involved in the protocols of the hospitals yield amazing follow through from the difficult populations.
Hopefully, what will happen is that we will see more audiologists engaging in every state system nationwide to try to improve the quality of this follow through rate.
One of the big things that we have to do is reduce the refer rate to diagnostic audiology, the outpatient rescreening has done a great job at doing that, but if we send 6% of the kids to diagnostic audiology, we need a lot of diagnostic audiologists and we are going to be passing a lot of kids. If we can reduce the refer rate to 1%, which many of the good programs have been able to do, diagnostic audiologists can do what they need to do, which means that we are going to get a 40% hit rate of the kids that we do the diagnostic follow through on.
Overall, we need your help to mobilize the state system so that we can finally get these kids diagnosed and into intervention, because we know that every program throughout the United States and throughout the world now has seen what a difference it makes to identify children in the newborn period.
I would have never believed 20 years ago that we could not only screen babies in the newborn period, but identify them within weeks and get a hearing aid on them and into intervention soon after. I used to think six months was wow, how can we do it in six months, and now I see programs all over the United States doing it within four weeks. It is really remarkable what audiologists have been able to do in a very, very short period of time.
We will hopefully be publishing our outcome data on our kids that have been identified through universal hearing screening. We are really pleased about the evident advantage that these children had based on the fact that they were identified early. We now have data to show that children that are early identified and enrolled in an early intervention program are able to maintain throughout the school age period a one for one growth, meaning that their academic and language growth is one year for one year of life, which is comparable to hearing children.
I still am amazed that identifying this early in life has this amazing impact on the entire development of children, but I guess we should not be so surprised with the flexibility of the brain at this period of time.
The other place where we need help is developing professional development plans, because the information that we are gaining is coming in at such a rapid rate, it is hard for all of us to keep up to date with it and to keep our skills up.
State systems need to be able to develop better programs for professional development for our audiologists and for our interventionists.
Thank you for all the work that all of you are doing. It is really an amazing thing to watch how fast we have accomplished what we have accomplished.
Downs: Is that not the truth? I tell you, the audiologists of the United States have really risen to the front on this, and thank you all for doing it.
To go on talking about the spinoffs, of course we know that there are going to be spinoffs in the screening of genetics and CMV. I do not know whether I will be around to see it, but it is going to happen. There is no question about it; they are riding on the back of the newborn hearing screening, which is very satisfying.
Then we come to another spinoff that struck me as being very important and that is the finding that SIDS susceptibility can be identified using DPOAE in the screening program at birth. I am sure you all have seen or heard about the article that was published in the Journal of Early Human Development. Dr. Daniel Rubin was the author, but our dear friend, Dr. Betty Vore, who really in Rhode Island was the first to do universal newborn hearing screening, is responsible for this too.
This article identified the fact that in using DPOAE, the signal to noise ratio of infants with SIDS was higher in the left than in the right ear, whereas in controls, the right sided ratios were higher than the left. This has been reported by many people.
What I did not know, something that has been known for years, is that the vestibular system plays an important role in respiratory control during sleep. Vestibular stimulation has been shown to modulate firing of the respiratory central pattern generator. This goes back 30 years in the literature.
Well, why am I interested in this? I started looking into it, and I found that the studies in SIDS are really a growing importance. It seems that the method that they use to prevent SIDS, placing the infant on the back, may not have been the effective prevention that it was supposed to be.
There has been an investigation by the Scripps Howard news service which reported that the success of that technique has been substantially overstated and the figures may not be accurate. There is a renewed need to study both the identification and the prevention techniques, and it looks as if we have a role in this as audiologists, and I would like to encourage you to do that.
That study points the way, of course, to replication. It certainly should be replicated, and there should be further investigation of the identification at birth of susceptible infants by us. I think we can do that.
Fortunately, I found in the literature that for years there have been studies on the fact that just rocking the infant helped to control the respiratory brain; therefore, there is a possible prevention of SIDS available to us.
All of these things are coming together now, and we should take advantage of them. This is fascinating that it goes back as far as 1954. Of course, I have been interested in this because I see that we all have a stake in it, and I urge you all to look into it and perhaps do dissertations on it, and so forth. I think it is a great source of research for us in the future. I want you to dream up some new ideas. Perhaps you have learned some new ideas on identifying this thing.
I think we are through with what we were going to say on that, and Dave, I understand you have some questions for me.
Fabry: Yes. Several attendees have submitted questions. First, you have been a mentor to so many audiologists over the years; did you have any professional mentors when you started?
Downs: I came into this field so early that there were not really any women to have as a mentor. It was all men in the field when I came in; this was 1947, remember? For years, I was the only audiologist in Colorado.
Over the years, however, my mentors have been everybody in the field who has contributed to audiology, and particularly pediatric audiology, and, of course, Jerry Northern, who has inspired me and pushed me. I will always tell him, you made me what I am today. I hope you are satisfied. [laughter]
Fabry: Great! Now, I understand that you are the honorary chair of the ABA Pediatric Audiology Certification initiative. Can you tell me why you think it is a good idea?
Downs: Anything that promotes pediatric audiology is right up my alley, and I will give a hundred percent to it, if I can do anything for them. Of course, everybody in that committee is so smart and so much smarter than I am now; therefore, I just back them a hundred percent.
Fabry: What is the most important piece of advice that you would give an audiologist at the beginning of his or her career?
Downs: Well, I think that the one thing that you should do if you are starting out is to learn to think about everything that you see. Do not just do your testing and then pass it off. Think about what is happening there. It is like a detective study to me, really. What is going on there? Keep it in your mind, and if you see the same thing the next time or another time, hey, you can do a little research study on this. I think that is what we all should be doing. Therefore, my answer is think!
Fabry: Excellent! What one piece of advice would you give for the experienced audiologists, and how do you keep the passion for audiology alive over such a sustained period of time? How do you guide experienced audiologists to prevent burnout?
Downs: I think that is true. After a while, the experienced audiologists may get a little bored or tired with the whole thing. Again, I would say, think about the new things to do. Think about it. You see something, put it together, then research it, and see if it is something that would interest you.
New areas of research are what we should be looking for constantly. We see that in the spinoffs of newborn hearing screening. New areas of research are popping up all the time. Never get bored with it, because you can look for all of these wonderful new ideas in research and search them out. Be a detective. Search everyone out. It has just been a wonderful, wonderful profession to me, right up right up to this time! I still just think it is the greatest thing in the world!
Fabry: I completely agree. If you can make a living fulfilling your passion, then work will not seem like work.
Now, what is the most enjoyable thing you have done in your lifetime, that you can discuss online of course?
Downs: That I can discuss online, well, that limits it a little bit I am afraid, but actually, you know, everything has been enjoyable in my life. It has been wonderful! Every day I think about what new and exciting thing is going to come around the corner next? Something new usually does come, and everyday has been exciting. I think it is going to be exciting right up to the last day, and I am going to enjoy every minute of it.
Fabry: The next question is more clinical. What is your view on directional microphones on infants?
Downs: I am going to ask Sandy Gabbard, who is an expert on this, to answer this question, because she is fitting the infants every day!
Gabbard: Well, thank you, Marion. One thing I have learned from you is we do not settle for anything less than the best for babies. That being said, we certainly want to get advanced signal processing in some form, even to the babies. I think the bigger question of multiple memories, noise reduction circuits, and directional microphones is a bit more challenging, and I do not know that we have a lot of research data except perhaps in school children.
For the babies, one thing we do know is that babies learn from incidental listening, and I say babies, but that really goes up until the age when they are getting directed education, one on one, when they are looking at you. That age varies by the child, but I would say at the very least, they probably need to be 5 to 8 years old. Before that time, they need to get input all the way around them. They learn incidentally, and it is very important that we do not limit their access.
With that being said, we are fitting advanced signal processing hearing aids, but we are not fitting directional microphone technology. There is not a lot of research data on directional microphones and young children at this point. We do have a lot of anecdotal observations, and we are watching those kids very carefully to decide when to transition them. It really has to do with how they are learning, their learning style, are they directing their attention, and can they move themselves around in their environment to help optimize a directional microphone or a noise reduction circuit.
This seems to be the general trend in all of the pediatric clinicians that I talk to, and hopefully we will have more research and new circuits come out as to what age needs advanced signal processing. We do believe that the high fidelity, high frequencies, and the multiple bands are all very important to the fidelity of the sound, but not so much the noise reduction circuits.
Fabry: Very good. What are your feelings on the issue of bilateral implants as the standard of care?
Gabbard: I just have one comment on this topic. There are a number of studies being completed right now in that area. One interesting study that has been recently published by Schafer and Thibodeau does look at children that have unilateral cochlear implants, then assesses them after adding a second implant or using a hearing aid, and then on top of that they added FM. Although we do know that binaural amplification seems to be better for all children, I think the jury is still out, especially with children who can wear a hearing aid in the opposite ear and potentially an FM system on one or both ears.
It is unknown exactly how much benefit we are getting in this population. I think we do suspect that if a child cannot get access to binaural amplification because of their degree of hearing loss that we certainly would put them high on the list for bilateral cochlear implantation, and we do have some data about kids that do a little bit better. Christine wants to comment as well.
Yoshinaga-Itano: I think all of us would agree that two ears are better than one; therefore, as much as possible, with whatever technology we can use, we would like to have two functioning ears for these children.
What I am excited about is we have been having a lot of success with pre-linguistic infant speech discrimination of both our cochlear implant and our hearing aid babies from six months on, and the technology is such that it should be possible for us to measure their speech discrimination in noise. If we can do that, then I think we will really be able to document the advantage of binaural hearing.
Hood: I think that Christine brings up something that is very important relative to figuring out the answers to this problem. There is a need for more sensitive measures of binaural function, looking at things like speech understanding in noise and localization ability and being able to do both with behavioral measures and also possibly some objective measures that we can then extend to some of our youngest patients.
Downs: Okay. You heard the experts. They have given you the answer to that. I love it! They were all right!
Fabry: Okay. Next question. Some audiologists are saying that a child with a normal audiogram, normal immittance, normal OAEs, but an abnormal ABR should be fit with amplification. Please explain why.
Hood: This is certainly a point of discussion. There is so much variation in auditory neuropathy/auditory dyssynchrony that it is difficult at this point to know which child is going to benefit from amplification and which child is not. As clinicians, we are really faced with using a clinical trial approach. I think as we begin to understand more of the underlying mechanisms, we will be able to sort out those that may have more inner hair cell involvement and those that have poor audibility versus those that seem to have good audibility.
Thinking back through the literature and what has been published with this, I think that most of the children that have had some benefit from amplification have been those who have demonstrated poor detection ability or poor audibility. The important thing there is to be sure to sort out whether or not we are simply improving awareness of sound by itself, which is not really our ultimate goal. We want to improve the ability to understand sound and discriminate sound. We know that the type of temporal processing difficulties that many of these children have will interfere with that. I think we need more ways to assess this.
There are several efforts looking at ways to measure temporal processing ability in children. If we can look at that, it may give us some insights into speech understanding and help us to sort out which children might derive some benefit from amplification. Right now, we have to respect the wide variation and really look at it on a case by case basis. We also need to follow these children very, very closely, keeping in close contact with their parents to see what they are doing and to see if that is the appropriate intervention.
Fabry: This is awesome, to be able to pick all of these brains en masse. Another question, what can school based speech language pathologists do to assist a child's audiologists for the best outcomes?
Downs: I wish Cheryl were here to talk about that. This is very important, because there have been a lot of studies showing the deficiencies that are going on in the schools. Christine can talk about that.
Yoshinaga-Itano: The school based audiologists have been really a vital part of our Colorado system, and it has taken us many, many years, but we now have an audiologist in every school district in the state, which is really an amazing thing. They also all have access to us, and they have good equipment in their program. Our school based audiologists play a variety of roles for us. In some cases what will happen is that babies from universal newborn hearing screening will be fit by the hospital settings, and the follow through, maintenance, and all of the checks will be done at the schools through some of the school based programs.
Probably the most important roles that the school based audiologists have had are related to the support of our cochlear implant children, making sure that they are getting what they need in the school systems. We have had a lot of professional development of both audiologists and speech language pathologists. This has helped us develop guidelines for the collaboration between the diagnostic centers and the mapping centers and what can be done in the school.
Our school based audiologists are the communication with the speech pathologists and with the classroom teachers in trying to make sure that the programs for all of our children with hearing loss are really maintained.
Everything from making sure that the technology is working to verifying that the IEPs are appropriate for all of these children, they play a major role with our children. We are now having more and more of our children from early identification being mainstreamed completely on 504s, and it is happening as early as five years of age.
I am not sure if that answers the question. Our speech language pathologists have a very close working relationship with the diagnostic audiologists and with our babies. They can help us with conditioning the children if they are not yet giving us behavioral audiograms. They give us all the reports on the auditory behavior of our children. We have done a lot of training on auditory checklists and auditory evaluations that can be done in the home and in the classroom to verify whether the communication is developing.
Our speech language pathologists in our schools have asked for a lot of professional development, auditory training, and auditory skill development; therefore, we have ongoing workshops for them.
Fabry: I see, as usual, we are going to be close to running out of time, but there are a few topics that I want to make sure we hit on before we are done. Marion, what is on your wish list for the future of audiology during the next ten years?
Downs: Well, I really have not gone ahead that far because I just live from day to day. You know, every day is wonderful. I hope that we continue to do what we are doing. Children are where it's at, babies are where it's at, and I hope we concentrate on that and find out more. I think you young people are just going to find out so many interesting things, and I want you to know, I am going to be up there cheering you on! You are going to be doing it, and I am so proud of you all!
Fabry: Excellent. Thank you. Do you have any favorite memories you can share with us from the many conferences you have attended?
Downs: Oh, I do not have any. It has all been wonderful.
Fabry: Okay. Now, I want to move to your book that was published I believe last year, Shut Up and Live! (You Know How). Why did you write it?
Downs: Oh, I wrote it to tell people how to get into their 90s and to survive. It is all survival, you know. It is not easy. It is not easy at all, because when you are about 80 years old, all of a sudden, you are ambushed by all of these physical problems. You just have to learn how to live with them and get on with your life, which is why I wrote that book.
Shut Up and Live! (You Know How) by Marion Downs
By the way, Penguin Publishers wanted to republish it in another form; therefore, since April, it has been out in another form with Penguin. I added quite a few things. The men will be happy too; I added some things on sex, a sex chapter. There are some very interesting things in here, and most book stores have it because Penguin is publishing.
Fabry: It really is a very entertaining and informative read, and I think a lot of people who see you are tempted to think that you have great genes and have never faced any adversity in getting to this age, but I know you have faced your share of adversity in order to get to this point.
Downs: That is right. The research shows that only 25 to 30% of longevity is due to your genes, so forget about that. Seventy five percent is up to you, and you had better work hard on it. I certainly have.
Fabry: We are getting down to the end, and I want to just point out here, your book, Hearing in Children, is published now in its 5th edition.
Downs: Yes, Jerry Northern has been so wonderful about this. He and I have both decided, though, no more; we have done it, and younger people can take it up from here on and carry it through. We have done it.
Fabry: I already know the answer of this one. Do you ever see yourself retiring fulltime?
Downs: I hope not. God willing!
Fabry: Well, we are just about to the end here, and I have a couple of quick questions. What person who lived in the 20th century do you admire the most other than your parents?
Downs: Well, of course, my father was ideal, but I think Einstein is the number one, what a brain and what an inventive thing. I hope that we all have inventive minds.
Fabry: What do you think the greatest invention of the 20th century is?
Downs: Radio.
Fabry: Radio? More so than the computer or television, etc.?
Downs: Well, nothing would have started until the radio was in. It is the basis of everything, and I saw it first when I was in grade school.
Fabry: In grade school. Fantastic! Well, then we will close out with some quick hits in terms of the first thing that comes to mind. Insert earphones or supra-aural cushions?
Downs: Inserts.
Fabry: ABR or otoacoustic emissions, if you could just have one?
Downs: ABR.
Fabry: BTEs or ITEs?
Downs: BTEs. I wear them.
Fabry: Okay. Excellent. Wax or waxless skis?
Downs: Waxless, of course.
Fabry: Yes. Make it easier on yourself, and then finally, favorite exercise, knowing that you have participated in many.
Downs: Well, of course, tennis is my game. I just love tennis. I just hope I can do it until the day I die.
Fabry: Excellent. Well, that concludes this session, and I want to thank the entire team up there in Vail, Marion and the whole group. It is just fantastic to have you all take the time out of your busy schedules to be with us today, and, again, thank you to all of the attendees for joining us today. Any final words Marion?
Downs: Thank you all for listening. Have fun and take care, whatever comes first.
Fabry: Thanks. We hope to see you online or in person sometime soon. Take care, everybody. Have a good afternoon!
More about Marion Downs
Marion Downs received her bachelor's degree from the University of Minnesota, her master's degree from the University of Denver, and an honorary doctorate of human services from the University of Northern Colorado.
She is currently a Professor Emerita at the University of Colorado Health Sciences Center. She has spent her professional career promoting early identification of hearing problems in children, publishing nearly a hundred articles and books on this subject and lecturing extensively around the world. She pioneered the first universal newborn hearing screening project nearly 30 years ago.
Her honors include two gold medals of achievement, one from the University of Colorado and the other from the University of Minnesota, a medal of the Ministry of Health of South Vietnam, the American Auditory Society Carhart Memorial Lectureship Award, the International Audiology Society Aram Glorig Award, and honors from the American Speech Language Hearing Association.
Most recently, in October of 2007, Marion received the Highest Recognition Award from the U.S. Department of Health and Human Services (HHS). HHS annually recognizes a handful of individuals and organizations in corporate America for their advocacy, arts, education, and public service for advancing the goals of the Americans with Disabilities Act and the President's New Freedom Initiative, which eliminates barriers that prevents people with disabilities from participating fully in community life. Marion was honored for her groundbreaking work and lifetime dedication promoting the early identification of hearing problems in children. This is quite an honor for someone in audiology to receive and was certainly a well deserved award.
She defines the way that many of us would like to grow old, with grace and also in defiance of anyone who would dare say that we should act our age. To that end, Marion took her first skiing lesson on her 50th birthday, became a serious runner at age 59, and now does the annual Bolder Boulder race. She is a serial gold medal winner in tennis at the Senior Olympics, and she recently jumped out of a plane to celebrate her 90th birthday.
In her 94 years, Marion Downs has lived through a depression, the space race, and countless political scandals. She has influenced the development and profession of audiology in myriad ways as a passionate and tireless advocate for universal newborn hearing screening in pediatric audiology. She has been an inspiration and mentor to many.
More about the Marion Downs National Center for Infant Hearing
The Marion Downs National Center for Infant Hearing is dedicated to pursuing the mission begun by Marion Downs more than 30 years ago. Early identification and intervention of hearing loss is a basic human right which should be available to all infants who are deaf and hard of hearing. Marion's vision and enthusiasm continue to be a driving force, fueling the activity of the Marion Downs National Center for Infant Hearing.
For more information on the Marion Downs National Center for Infant Hearing, you can go to www.mariondowns.com
