I recently did school visits for two kids who were having problems in school. Before I went I asked the parents to get me all the recent reports so I would know how the child was doing.
Child 1 (Let’s call him John) has two cochlear implants and is in third grade. He has received auditory verbal therapy privately and seems to be doing well. When I spoke to the AVT she reported concerns about John’s functioning in any difficult listening situations. His parents reported that he did very well in school, was really good at sports, had friends, but that he was exhausted when he came home from school each day and that mom worked with him for hours each week to do the pre-view-review services that teachers of the deaf usually provide.
What does the school think?
The school said he was doing well. He receives speech services twice a week for 30 minutes and teacher of the deaf services twice a week. The teacher of the deaf comes into the classroom and provides whatever assistance she thinks is needed. The speech pathologist says she thinks his language is at age level, but he has not been tested in over two years. The school suggests that he will not need any additional services.
What does audiology show?
Testing from the cochlear implant center revealed that he had excellent speech perception (98%). However, he was tested using the PBK word list, which has a kindergarten vocabulary and he is in third grade. In addition, testing was accomplished with monitored live voice, not recorded testing, and was only at a normal conversational level in quiet.
John was retested at another center. Testing was accomplished with a test that has appropriate vocabulary for a child his age and was recorded. He had good speech perception at normal conversation in quiet (84%), fair at soft conversation (72%) and poor (60%) in competing noise.
When I went into the classroom I saw a bright alert boy who was struggling. He was able to hear what the teacher said directly into his FM system, but he could not hear what other kids were saying. Although the school has a pass-around mic, they do not use it in most situations. If you watched John’s face, it was really clear that he only heard the teacher. As we all know, by third grade, classroom discussion is an important part of learning. John was missing it.
Interpreting all this information
The second audiology test is a much better measure of how John is performing. It clearly indicates that, while he is receiving good benefit from his technology, he is not hearing as well as we would like. Is it possible to change the technology settings so that we can improve his auditory perception? I think it well may be. The testing also makes it clear that John is in need of assistance in the classroom. The teacher should be repeating all comments so that John can participate better. The teacher of the deaf should be taking an active part in teaching academic material to John, including previewing and reviewing academic material. Speech and language needs to be retested by a clinician who is knowledgeable about listening and spoken language and John needs some practice listening in competing noise. He also needs to return to the audiologist at the CI center to see if it is possible to improve what he hears.
Child 2, Susie, is also of concern. She was fit with hearing aids for her moderate hearing loss. At the most recent evaluation, the audiologist did unaided testing including speech perception testing, and then tested her with her hearing aids. She did real-ear testing and then stopped. She did no speech perception testing with hearing aids. When she was retested at another center, we learned that her speech perception in all conditions (normal and soft conversation in quiet and at normal conversation in noise) was fair to poor. She needs new hearing aids and additional therapy.
What have we learned?
We should never assume that a child is hearing well enough. If he is not, it will severely impact on what he hears and every aspect of communication, academic learning, literacy and socialization. It is our responsibility as audiologists to be sure that kids are hearing the way they need to hear. NEVER ASSUME!! Remember, real ear does not tell you what the kid hears, it tells you what is reaching the eardrum. CI maps do not tell you what the kid hears, it tells you only how much electrical stimulation is being provided. NEITHER REAL EAR NOR CI MAPS TELL YOU WHAT IS REACHING THE AUDITORY BRAIN. We need to test aided thresholds and speech perception in difficult conditions with appropriate words if we want to know how kids hear. AND WE REALLY NEED TO KNOW HOW KIDS HEAR!!!