Best results for kids will be obtained when everyone who works with kids communicates well. So what do families, auditory verbal clinicians, speech-language-pathologists and others need to know from the audiologist? Too many families and clinicians have complained to me that they just can’t read audiology reports. They are written in some foreign language and are not intelligible. We write for other audiologists and for otolaryngologists. Some pediatricians have trouble understanding our reports too. So what do we have to do?

Degree of hearing loss
What does it mean to say a child has a moderate hearing loss? It would be good if, after describing the hearing loss (mild, moderate etc.), we described how this will affect function in some detail. For example, with a moderate hearing loss, Trixie will be able to hear speech if the talker is standing next to her and speaking into her ear. She will not be able to overhear conversation when she is more than 2 feet away from the talker. This means she will have much less language exposure, which will result in poor language development and poor literacy skills. This kind of information is much clearer. It helps the family understand why we need to move to technology and helps the pediatrician, teacher, speech-pathologist etc., understand the need and help the family accept both technology and therapy.

Is the technology providing sufficient auditory access?
Once a child has technology, we need to know if it is working well. It is not enough to say, he has hearing aids. The question is, how well do they work? So audiology reports need to include information about what a child is hearing with the technology. Is he hearing softly enough? If aided thresholds are not within normal hearing levels we need to report that. For example, if aided thresholds are at 40 dB (moderate hearing loss levels) we might say With hearing aids Josh will be hearing at moderate hearing loss levels. He will not hear soft speech. This means he will have much less language exposure, which will result in reduced language development and poor literacy skills.

Does the technology provide information throughout the frequency range?
Is the child hearing high frequencies with technology? It is really important to hear high frequencies. So if a kid hears well at low and middle frequencies but does not hear high frequencies is that okay? Not if you want him to hear /s/, /sh/, and /f/, to name a few phonemes (See HEARING S published in this column April 17, 2012). The report needs to clearly report what a child is and is not hearing with technology.

Can the child hear soft speech?
What exactly is the child hearing with technology? Life is, unfortunately, not conducted in a quiet room at normal conversational levels. The audiology report should test speech perception at normal and soft conversational levels in quiet and in competing noise. The report might say Rosie has excellent speech perception at normal conversational levels but speech perception is fair at soft conversation and poor in competing noise. By clearly stating the facts we can justify the need for an FM in school and for therapy to improve skills. (Not to speak of the need to modify technology.)

Does the child have the necessary technology?
Test results discussed above will provide justification for an FM system. It will help kids, families and schools, in understanding what they need to do to help a child hear in school.

Justifying the need for auditory based therapy
If a child is not doing well, we can justify the need for therapy. If audiology has done all that can be done with the technology, if we have provided sufficient auditory access, if it is working well, and if it is being used full time, we need to move to therapy to help kids improve skills. Therapy needs to be auditory based.

How does this help?
All the above test information helps everyone really understand the child’s auditory status. Audiologists are frequently reluctant to say that a child is doing poorly. “Well, he has a severe hearing loss. I do not expect him to hear soft speech or speech in noise.” If that is the case, we are not helping the kids. We also do not want to disappoint parents. But, if we have high expectations and are honest in our reports, we can motivate everyone to work to improve services so kids can be the best they can be. We can do it, and so can they!!



About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 7 books, and written numerous books chapters and journal articles, and is a well known international lecturer.