Stop Living In A Silo

I had an experience this week that reminded me that too many of us work in silos.

I have had double vision for years due to what we could have called a “wandering eye” if I were a little kid. I have seen lots of very good ophthalmologists to whom I complained about the problem but who had no suggestions. It was a big problem which interfered with lots of activities (like driving on a highway) which require binocular vision. I now understand that they were in their adult silos and just didn’t think about a problem that usually affects little kids. Fortunately for me, a colleague suggested that I see a pediatric ophthalmologist. I did and he said that the problem was easily fixable (easy for him to say) requiring surgery to move my eye muscles. Very scary but having double vision was very annoying and inconvenient. I had the surgery and now, one week later, I no longer have double vision. Why didn’t any of the adult ophthalmologists think about this? Silos!

Often we think a lot about what we know well. I think I know a lot about hearing loss in children and feel confident recommending who needs a hearing aid or a cochlear implant. No doubt there are things I don’t know. It is my job to try and keep up to date. When I ran the clinic at Beth Israel/New York Eye and Ear Infirmary, we were always surprised that families seeking cochlear implants were, for the most part, self referred. Virtually every adult for whom we recommended a cochlear implant had been told by their hearing health provider (audiologist, ENT, HA dispenser) that their hearing loss was not severe enough for a cochlear implant. Some of my colleagues thought that these colleagues didn’t want to refer patients for CI’s because it would mean that they would loose the patient. I didn’t and still do not agree. I think that they did not know who was a candidate for CI. The criteria for candidacy changes so quickly that unless you are working in the cochlear implant area you likely are not current. In addition, the benefit that is possible to receive from a cochlear implant has also improved astronomically. If you do not have contact with children and adults who have received cochlear implants you just will not know what is possible in 2017.


How do we prevent getting stuck in silos?


We have an obligation to our patients to assure we do not to get stuck in silos. What can we do to be sure that we don’t? I think there are two categories of things we need to do. Obviously we need to keep current. If we are dispensing hearing aids we need to know as much as possible about new hearing aids. If we only dispense one or two brands, and keep current on those, we may miss innovations that other brands are able to provide. Yes, the ones you dispense will likely catch up but it may be awhile.

Anyone who sees patients with more than a moderately severe hearing loss has an obligation to understand about cochlear implants. Attend sessions about cochlear implants and bone anchored implants when you attend a conference. Ask colleagues who work in a local CI center if you can come visit and observe. If you have families that have chosen a cochlear implant ask them to come back and help you learn about implants. They will love it.

If you work at a CI center be sure that you keep yourself informed about what is possible in hearing aids. If cochlear implants are improving so are hearing aids and that my change options for your patients.

When I go to a conference I make an attempt to attend at least one presentation that is out of my comfort range. I believe that it expands my brain since I certainly have to listen more carefully, and it gives me new information that I might apply. I am not likely to attend a talk on stuttering but I might attend a talk on vestibular rehabilitation. I am not going to do vestibular rehab but it will help me recognize vestibular issues in my patients.


Technology is not enough – and fitting technology alone does not an audiologist make!


The fact that we are audiologists doesn’t mean that we only pay attention to the technology. We need to understand social, emotional and educational issues that effect our patients. Pediatric audiologists need to recognize if a child is not developing good speech and language, academic, or literacy skills and make appropriate referrals. We need to discuss social skills and encourage families to seek assistance if social skills are an issue. We need to help both children and parents get support from other families. For adults, we will have more satisfied patients if we can arrange for auditory training and group support to help adults adjust better to hearing aids and hearing loss. Adult partners and children of adults with hearing loss will also benefit from understand more about hearing loss and getting support.

Please don’t say you don’t have the time. Research shows that more time on the non-technical issues results in more patients being satisfied with their technology and reduced need for follow-up visits as well as improving communication outcomes. We need to make the time. I know it’s complicated but audiology better be more than just fitting hearing aids.



*featured image courtesy Capitol Communicator


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.