Editors note: Pathways had an opportunity to learn about educational audiology—an area for which our Pathway readers have had a paucity of exposure. So here for your edification, is an interview with educational audiologist, Amy Bradbury.
Q Hi Amy, thanks for this interview. Tell us about your background and your employer.
Thank you, Frank, for asking for my participation.
Q Thank you Amy for taking the time. So lets get started. How did you become involved in educational audiology?
A friend and previous colleague contacted me to inquire if I would be interested in the vacant educational audiology position at the Center for Instruction, Technology & Innovation (Oswego County BOCES). The Board of Cooperative Educational Services (BOCES) is a program of shared educational services provided to school districts by the New York State Legislature. I was interested in a change of setting. This change provided me an opportunity to utilize my current skill sets from my previous work experience but to challenge me to learn new skill sets how to implement audiology within a school setting. My graduate program offered a variety of clinical experiences in hospitals, private practices, medical offices, including a placement in a factory for the industrial audiology course, however, an educational audiology placement was not available. As a preceptor for Au.D. students, these students have commented on the benefit of an educational audiology placement. Even if the new Au.D. graduates enter non-educational settings, they take with them the knowledge of the educational setting and what to consider when writing their evaluation reports and recommendations, which hearing aids may be better options, and the importance collaboration with educational audiologist to maintain comprehensive care of the child. Additionally, their educational audiologist placements gives them a background in understanding the importance and specific components of the Individualized with Disabilities Education Act (IDEA) law including specific regulations of audiologists working in the school setting, individualized education plans (IEP), and 504 accommodation plans.
Q What is your work setting & what kind of equipment do you have at your disposal?
The educational audiology setting incorporates a combination of many sites, particularly as an itinerant educational audiologist. Each day is unique in location and task when working with students from preschool through age 21. Based on what is needed for a consultation, it requires travel to a student’s home, daycare setting, preschool setting, elementary school, middle school, high school, or even a job coaching work site. Additionally, virtual consultations, phone consultations, and email consultations are utilized. What consists of a consultation on a given day or for a specific student varies and even depends on what month of the school year it is. In New York State, school starts in September. Most of the consultations are focused on programming, fitting, verification, and in service to the educational team on proper use and care of the child’s hearing devices and hearing assistance technology in addition to gaining knowledge of their student’s hearing loss or central auditory processing disorder and resulting needs. Another month can be more focused on classroom observations. Throughout the year, ongoing monitoring and an in service to staff is needed to ensure the student’s devices are functioning appropriately and providing continued access to the auditory instruction presented in the classroom and other areas throughout the school day. The educational audiologist must also ensure that any hearing aids, medical devices, and hearing assistance technology has connectivity to laptops, classroom interactive white boards, cell phones, and additional varied technology.
Educational audiology embraces many areas of Audiology and require continued education on knowledge of hearing loss, central auditory processing disorders, hearing aids, (from multiple manufacturers) monaural fittings, binaural fittings, bi-modal fittings, and CROS hearing aids. Additionally, educational audiologists need to be knowledgeable about cochlear implants, bone anchored hearing aids, hearing assistance technology (ear level FM/DM systems, remote microphones, classroom sound field systems), and classroom acoustics. Educational audiologists not only work with children of all ages, but also work with the child’s family, the educational team which can include teachers, teachers of the deaf and hard of hearing, speech-language pathologists, occupational therapists, physical therapists, speech-language pathologists, teachers of the visually impaired, the child’s private audiologist, educational interpreters, C-Print® captionists, and teaching assistants. An educational audiologist also consults with each district’s committee on special education (CSE) chairperson, 504 coordinator, case managers, clerical staff, custodial staff, and school bus drivers. Continued awareness through informal meetings and formal presentations of the importance and role of the educational audiologist is needed to ensure that school personnel are informed. Educational audiologists often provide formal presentations to school personnel on a variety of topics related to hearing loss, central auditory processing disorders, hearing aids and additional medical devices, and hearing assistance technology. The educational audiologist provides advocacy for students to ensure that they and their team have the tools needed to ensure access to auditory information and many other skill sets, while providing instruction to students on building their self-advocacy skills. The teacher of the deaf and hard of hearing plays an important role in continued development of these skills.
CiTi BOCES currently operates 3 standing clinics and 1 mobile clinic. The website link provides a video of our mobile Audiology vehicle. CiTiboces.org/Audiology Educational audiologists at CiTi BOCES have access to a sound booth with diagnostic audiometers, tympanometry, and acoustic reflexes. We have access to distortion product otoacoustic emissions (screening and diagnostic), visual reinforcement audiology, and sound field testing. We utilize hearing aid and FM/DM verification equipment, video otoscopy, and standard otoscopy. We also have access to earmold impression material, earmold tubing, hearing aid programming software, additional supplies to monitor and maintain hearing aids and hearing assistance technology, and an online hearing care and audiology practice management. Consistent remote access to our student’s audiological information, reports, and session notes is essential. Additionally, educational audiologists have access to many resources from the Educational Audiology Handbook, the Educational Audiology Association, American Speech-Language Hearing Association, and several other online resources designed to provide additional information to supports students with hearing loss and central auditory processing disorders.
Q How many students are on your caseload?
At CiTi BOCES, an educational audiology caseload is approximately 600 consult hours per audiologist for the 10-month school year. Additional consultations are often completed over the summer. School districts submit referrals for educational audiology evaluations for students with hearing loss (initial evaluation or previously diagnosed) and central auditory processing evaluation (initial or previously diagnosed). Based on the results of this evaluation, which would include any necessary diagnostic testing, classroom observation, functional listening evaluation, teacher interview, and review of multi-disciplinary evaluations the educational audiologist participates in a committee of special education meeting or 504 committee meeting to review results and recommendations of reports. Most students have 10 consultation hours per year. Consulting hours can range from 1 to 20 consultation hours and are dependent on the needs of each student. Students may have the same number of consultations; however, what is needed for an individual student varies. The educational audiologist typically works in multiple school districts and may travel anywhere from a few minutes to over an hour to a school district or site.
Q What are the most common problems that you see?
Educational audiologists work with children with hearing losses of varied etiology, configurations, and degrees. Several children have identified disorders including 22 q Deletion Syndrome, Enlarged Vestibular Aqueduct Syndrome, Auditory Neuropathy Spectrum Disorder, Connexin 26 mutation, Waardenburg Syndrome, Treacher Collins Syndrome, chronic otitis media with effusion, cholesteatomas, microtia, atresia, central auditory processing disorder (varied profiles), and Autism. Some students have multiple, complex medical conditions, requiring a multi-disciplinary approach to ensure the most comprehensive care. Poor classroom acoustics is a common problem affecting access to auditory instruction due to reflective materials, minimal absorptive materials, and often noisy HVAC units. The educational audiologist will work with the school to provide recommendations to improve classroom acoustics which can include replacing noisy fluorescent lights, repairing noisy HVAC units, adding tennis balls to noisy chairs, changing classroom seating arrangements, adding area rugs, and a variety of other solutions.
Q Do you see clients that have auditory symptoms but normal pure tone thresholds?
Absolutely. We have students who report a variety of auditory symptoms and have normal pure tone thresholds. A detailed case history and review of any medical reports are essential in addition to student, parent, and teacher questionnaires to document perceived impact of these auditory symptoms. Continued exploration into the student’s medical history, birth history, and noise exposure history is worthwhile, in addition to looking at what diagnostic tests may need to be completed or reassessed. Educational audiologists are also looking at any remediation that can improve auditory symptoms, such as speech in noise training and central auditory processing therapy of varied types. Continued monitoring to assess improvement of symptoms is also imperative.
Q What tests do you commonly use?
We have access to most equipment that would be available at private practice setting in our clinics and utilize diagnostic audiological equipment to obtain air conduction thresholds, bone conduction thresholds, speech reception thresholds, MCLs/UCLs, word recognition in quiet and noise (W-22, NU-6, PBK), sentence recognition in quiet and noise (BKB SIN, AZ BIO, HINT, etc), Word Intelligibility by Picture Identification (WIPI), tympanometry, acoustic reflex testing, aided sound field testing, and visual reinforcement audiometry.
Central auditory processing test battery which includes Staggered Spondaic Word Test, Dichotic Digits, Frequency Pitch Pattern, Random Gap Detection, Duration Pattern Test, and Phonemic Synthesis Test. Auditory processing screening tests: Differential Screening Test for Processing and Acoustic Pioneer: Feather Squadron: APD assessment/screening.
Classroom based assessments including Functional Listening Evaluation, teacher, and student questionnaires including Listening Inventory for Education-Revised, Student and Teacher version), classroom observations, classroom acoustic assessment.
FM – That is a wide array of tests procedures ! —Thanks Amy for all the great information.
As a clinical audiologist, this information is so informative and helpful, especially as I strive to provide better recommendations for my pediatric patients. Thank you so much!