I had the honor a few weeks ago of attending an international conference in Ulaanbaatar, Mongolia as a representative of the Global Foundation for Children with Hearing Loss.
I have had the honor of working with the Global Foundation several times in Vietnam but this was the first time I have gone with them to Mongolia. The government of Mongolia has decided that it will provide all the evaluations to newborns in Mongolia that are provided in Western countries. The government organized a conference in which they invited speakers who have run newborn screening programs in other countries to come and speak. There were speakers who discussed screening for metabolic disorders, vision, hip dysplasia, cardiac and hearing. I was invited to speak about hearing (of course).
The conference was in the beautiful Parliament building. The audience included all the hospital administrators in the country and pediatricians.
There were about 500 people there. I learned a lot about newborn screening. I talked about hearing loss in children as a neurologic emergency. I discussed why it as critical to move quickly to build the auditory brain. I discussed the need for technology quickly and how to know if a child was hearing well enough with hearing aids and cochlear implants.
I was very impressed with the government’s goal and with the enthusiasm of the attendees to get all these recommendations into effect. In 2½ years most of the screening programs have been instituted in some of the hospitals and the government goal is to have them all nationwide, including follow-up, within the next two years. I have to say I cannot imagine this kind of thing happening so quickly in the US.
Audiology in Mongolia
Mongolia is one of the countries in which all audiologists are ENT physicians. After some years of general ENT residency, they study audiology and become audiologists. They look at audiology from a medical viewpoint, not necessarily a rehab viewpoint but, with the help of audiologists and listening and spoken language therapists that the Global Foundation for Children with Hearing Loss is bringing to Mongolia for training, things are changing.
They are getting a much better picture of what is possible.
After the conference, I spent a day in the Pediatric Hospital. In the morning talked with the staff about managing children with hearing loss. Physicians who were learning about testing and technology, and speech-language pathologists learning about listening and spoken language attended. I talked a lot about goals for children with hearing loss – both technology goals and speech-language-listening goals.
The Global Foundation for Children with Hearing Loss had fundraised to get a test booth and test equipment so the test room is excellent and well equipped. The staffed asked me to help evaluate some children who were not doing well and they were not sure why.
I have done this in a number of different countries and even before I started testing them my guess was that they were not hearing well enough with technology. And that is what was found in this case. All of the children had aided thresholds between 40-50 dB. With thresholds at that level, children were not going to be able to do well. They have no access to soft speech and will likely not hear anything when there is competing noise – which is most of the time. After obtaining aided thresholds, we reprogrammed the technology, retested and hurrah!!! They heard better. One l of the little ones was not alerting to sound before we modified the technology, and after, she was able to repeat the Ling sounds. What a wonderful day.
This experience is a great example of how important aided thresholds are. Fitting hearing aids using real ear, and programming CI’s using NRT are a really good start. But they are not the end.
Behavioral testing is just critical.
I want to thank Paige Stringer, Founding Director of the Global Foundation for Children with Hearing Loss for inviting me to Mongolia in May and for allowing me to participate in the program in Vietnam.
They are doing truly wonderful work.