The many hats pediatric audiologists must wear

When fitting infants with hearing aids, pediatric audiologists have the opportunity to be vessels of hope, builders of brains, catalysts of dreams and potential, and hall-of-fame-worthy coaches!

These roles are essential elements of the path audiologists and families must follow together to help children with hearing loss develop age-appropriate listening, spoken language, and literacy skills to ultimately reach their full potential.

As providers of hope

Ninety-five percent of children born with hearing loss are born to parents who have typical hearing.¹ Consequently, parents are often uncertain and fearful of the impact their child’s hearing loss may have on their ability to listen, talk, read, and pursue their dreams and aspirations.

Fortunately, we can share the good news of authentic hope with families. As Thich Nhat Hanh, a Vietnamese monk and peace activist, once said, “Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.”

Research indicates that children born with any degree of hearing loss can develop age-appropriate Listening and Spoken Language (LSL) and reading abilities when they receive timely and ample access to a language-rich listening environment replete with intelligible, complex speech.

Notable research includes:

• Hitchins and Hogan (2018): In a study of 351 children with hearing loss, 97% achieved age-appropriate spoken language abilities upon graduating from an LSL program.² For children with neurodevelopmental disabilities, the study showed intensive pediatric audiology combined with LSL intervention strengthened their communication abilities, with over half achieving age-appropriate spoken language skills.
  
• Dettman et al. (2016): Studies show that children with any degree of hearing loss can achieve excellent outcomes. For example, Dettman et al. reported that over 90% of children achieved typical spoken language vocabulary after receiving cochlear implants before nine months of age.³

At the time of the hearing aid fitting, families are in need of hope. Audiologists can be bearers of hope and confidently share that the evidence shows excellent outcomes are probable. When we do what it takes, we can shoot for the moon!  

As brain builders

Congenital hearing loss has been described as a neurodevelopmental emergency by Carol Flexer, a LSL specialist and pediatric audiologist who has famously emphasized that hearing is about the brain. Research shows that:

• The brain’s spoken language pathways take shape during the first year of life.^4-7
  
• Significant pruning of synapses in the auditory areas of the brain occurs toward the end of the first year when auditory stimulation is lacking.⁴ Auditory deprivation during the first year or two can cause irreparable changes in spoken language networks, limiting LSL and literacy skills.
  
• Intelligible speech from nurturing adults helps grow neural networks that optimize LSL and reading abilities.  

Audiologists must help parents understand these critical connections between early hearing experiences and brain development. Audiologists and families must work together as brain builders to optimize hearing and auditory dosage from day one (e.g., hearing aids should be fitted and worn during all waking hours by 3 months of age, cochlear implants should be provided by 6-9 months of age when needed).    

As catalysts of dreams  

Robert John Meehan, a renowned educator and author, noted that an “engaging teacher is a catalyst… a spark that creates the desire to learn in students.” Research has unequivocally shown that audiologists are catalysts of excellent LSL outcomes for children with hearing loss.

A groundbreaking research initiative, the Outcomes of Children with Hearing Loss (OCHL) study,^8-10 has provided abundant evidence of an audiologist’s catalyst role. The OCHL study demonstrates that children with hearing loss achieve their greatest LSL outcomes when:

• Audiologists have selected and programmed hearing aids that optimize audibility of spoken language (i.e., hearing aids fitted to prescriptive targets).
  
• Children with hearing loss wear their hearing technology during all waking hours. In particular, the OCHL study found that children who are hard of hearing typically achieved age-appropriate LSL abilities when they used their hearing aids at least 10 hours a day.

Audiologists must educate parents of why wear time matters.  “Eyes Open, Ears On!” becomes our mantra.  Audiologists should also empower families with helpful tips to take care of devices and keep them on very young and active children.

As coaches and mentors

John Wooden, the Hall of Fame basketball coach with 10 national championships, once said, “A good coach can change a game, but a great coach can change a life.” The same is true for pediatric audiologists.

On the day of the hearing aid fitting, the audiologist should coach the family on the vital importance of creating a language-rich listening environment. A wealth of research has shown that better LSL and reading outcomes and brain development are achieved when children are exposed to a high quality and quantity of spoken language from caring and supportive adults.^11,12

Audiologists should coach parents on the importance of talking, reading, singing, and playing with their baby every day, starting on day one. Parents should be like sports radio announcers who give a play-by-play account of the happenings in their child’s life.  “We’re walking into the kitchen. I am opening the fridge door. Brrrr! It’s cold in there!” Spoken language is the nutrition that feeds brain development, and talking, singing, reading, and playing are the best ways to build little brains!

Shakespeare once said, “Brevity is the soul of wit,” so we’ll end this blog here, but there is much more that could be said about how audiologists and LSL specialists can best work with families to educate and empower parents.

Moreover, pediatric audiologists have a responsibility to be on a quest for the latest, cutting-edge knowledge that informs gold standard, best pediatric audiology practices.

If you’re looking for best-in-class pediatric audiology information, including clinical protocols, the latest research, and practical clinical insights, check out the free online learning from Hearing First.  

Another great resource for professionals is the on-demand recordings of the presentations given at the 9^th International Pediatric Conference: A Sound Foundation Through Early Amplification.

The possibilities are limitless for children with hearing loss, so shoot for the moon!

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References:

1. Mitchell, R. E., & Karchmer, M. A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies, 4(2), 138–163.
2. Hitchins, A. R. C., & Hogan, S. C. (2018). Outcomes of early intervention for deaf children with additional needs following an auditory verbal approach to communication. International Journal of Pediatric Otorhinolaryngology, 115, 125–132. https://doi.org/10.1016/j.ijporl.2018.09.025
3. Dettman, S. J., Dowell, R. C., Choo, D., Arnott, W., Abrahams, Y., Davis, A., Dornan, D., Leigh, J., Constantinescu, G., Cowan, R., & Briggs, R. J. (2016). Long-term communication outcomes for children receiving cochlear implants younger than 12 months: A multicenter study. Otolaryngology–Head and Neck Surgery, 37(2), e82–e95. https://doi.org/10.1097/MAO.0000000000000915
4. Huttenlocher, P. R., & Dabholkar, A. S. (1997). Regional differences in synaptogenesis in the human cerebral cortex. Journal of Comparative Neurology, 387(2), 167–178.
5. Kuhl, P. K. (2010). Brain mechanisms in early language acquisition. Neuron, 67(5), 713–727. https://doi.org/10.1016/j.neuron.2010.08.038
6. Werker, J. F. (2024). Phonetic perceptual reorganization across the first year of life: Looking back. Infant Behavior and Development, 75, 101935. https://doi.org/10.1016/j.infbeh.2024.101935
7. Werker, J. F., & Hensch, T. K. (2015). Critical periods in speech perception: New directions. Annual Review of Psychology, 66, 173–196. https://doi.org/10.1146/annurev-psych-010814-015104
8. Moeller, M. P., & Tomblin, J. B.; OCHL Collaboration. (2015). Epilogue: Conclusions and implications for research and practice. Ear and Hearing, 36(Suppl 1), 92S–98S. https://doi.org/10.1097/AUD.0000000000000214
9. Moeller, M. P., & Tomblin, J. B. (2015). An introduction to the Outcomes of Children with Hearing Loss study. Ear and Hearing, 36(Suppl 1), 4S–13S. https://doi.org/10.1097/AUD.0000000000000210
10. Tomblin, J. B., Harrison, M., Ambrose, S. E., Walker, E. A., Oleson, J. J., & Moeller, M. P. (2015). Language outcomes in young children with mild to severe hearing loss. Ear and Hearing, 36(Suppl 1), 76S–91S. https://doi.org/10.1097/AUD.0000000000000219
11. Romeo, R. R., Leonard, J. A., Robinson, S. T., West, M. R., Mackey, A. P., Rowe, M. L., & Gabrieli, J. D. E. (2018). Beyond the 30-million-word gap: Children’s conversational exposure is associated with language-related brain function. Psychological Science, 29(5), 700–710. https://doi.org/10.1177/0956797617742725
12. Weiss, Y., Huber, E., Ferjan Ramírez, N., Corrigan, N. M., Yarnykh, V. L., & Kuhl, P. K. (2022). Language input in late infancy scaffolds emergent literacy skills and predicts reading-related white matter development. Frontiers in Human Neuroscience, 16, 922552. https://doi.org/10.3389/fnhum.2022.922552