Episode 9: The Importance of Sound: Audiology's Role in Child Development

In this episode of Hear Me Out, hosts Niki Lampi and Tamara Pogin interview pediatric audiologists Dr. Linda Kalweit and Dr. Amy Packer. They discuss their careers, the critical role of audiology in diagnosing and treating hearing disorders in children, and the importance of early intervention. The conversation covers types of hearing tests, the impact of hearing loss on language development, hearing technologies like cochlear implants, and common myths about hearing loss. The episode emphasizes the need for community support and donations to offer these essential services for free.

Transcript

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Welcome to Hear Me Out, a Masonic Children's Clinic podcast where we discuss all things related to communication disorders and how to best help our kids. We will hear from different SLPs Clinic families and other professionals, and from our donors who enable us to offer free speech, language and hearing services to children and families. I'm Nikki Lampi SLP and clinic director. And I'm Tamara Poin and SLP specializing in working with autistic children and their families, and we are the hosts of this podcast. Hello. Today in our studio, we have two pediatric audiologists. Dr. Linda Kalweit and Dr. Amy Packer. They have been huge contributions to our clinic and by working for many years in the field and with our kids. Hi guys. Hi. Hi. Nice to be here. Thanks for having us. We're so excited that you're here today. Mm-hmm. I have so many questions. Well, the first one was, we were, we were just talking about it before we started recording. Linda, You were here before I was. So how many years did you work for the clinic? Right, so the clinic started up at UMD mm-hmm. And the University of Minnesota Duluth, in their speech and hearing clinic. And, I started there as the ISD 7 0 9 Duluth Public Schools audiologist in 19 94. And at the same time I started at the Masonic Children Clinic, which was at the time was the Scottish Right Clinic for Childhood Language Disorders. So, um, my second job was at the Mankato Clinic, which is now the Mayo Clinic in Mankato. And I worked in an ENT department. That was wonderful for me because I learned a lot about, some of the clinical things. And I had, I worked with ENT physicians who included me in their counseling, who let me watch surgery, who truly. Knew that an audiologist should be part of the decision making team. And so often they would bring me in and I would, help with the counseling aspect. So four years in I decided, I'm seeing a lot of audiologists that don't know what they're doing. So I decided I'm gonna teach, I'm gonna go to a university and I'm gonna teach. And so I applied to, Ohio University in Athens, Ohio, which is right on the West Virginia border. And I was hired as their, clinical instructor, in their graduate program teaching audiologists. And I loved that job. I did it for two years and, but then I missed home which is, lake Superior. Lake Superior is my home. That's your home. So, I grew up in the up and then, my best friend and her husband live here in Duluth and they scoped out a job for me, to do audiology, and it was in the schools I worked for the Northeast Service co-op, which was a grant funded program, that the governor at the time had initiated it and it was to provide services to rural kids special needs. I did it for six years because then that was the year that, I recruited Amy Packer, Dr. Packer to replace me in that position, which was a, a driving everywhere you could ever imagine position. International fall. I mean, it was a huge all over 20. All over 24,000 square miles. Oh my gosh. So, well, and just to put it in perspective, people don't realize that the largest school district in Minnesota is district 2142, which goes from. You just above Cloquet all the way up to the tippy top. Yes. And then, and that wasn't the only school district, The North Northeast Service co-op coop didn't cover just that school district. It covered that whole area. Plus, right. Grand Mara. Grand Portage went all the way down to Moose Lake. So yeah, large, large, thin Deer River. Oh, west. Yep. Yep. So anyways, I did that for six years and then the Duluth Public School's job position opened up. I left the Northeast Service co-op and I joined, Duluth Public Schools. And at the same time I joined the Scottish Right Clinic for Childhood Language Disorders because they were also housed at the University of Minnesota Duluth Clinic. And that's also where the Duluth Schools audiologist is host. So I was there, I don't know for, well, you said if you started around 94 there four. Yes. They were, we were based at the oh UMD until about 1998. Thank you, Tamara. So in 1998, we moved downtown Duluth and we took over a credit union And Amy, you. you worked in that space too. Didn't, didn't you? I did, yes. We rented space. Um, this will sound like all I did my career was follow Linda, but I did, I was contacted by Linda at that time when she took the Duluth job and I was not looking for a job. I was at the Duluth Clinic at that time. Now Essentia Health. But anyway, yes, I ended up, taking the position of Northeast Service Cooperative and, never regretted that move at all. But, we ultimately were housed at the, at the, Scottish Rite there, and then continued to rent space as Masonic Children's Clinic moved to this beautiful new building. Mm-hmm. Yeah. And so Amy, what was your background? Because you said that you, when you graduated, where'd you graduate from? university of California in Santa Barbara. I had spent my, twenties in California and, um, got my master's and my undergrad completed there at UCSB. And then I worked the first year in the Palm Springs area, and then in a desert ear, nose, and throat clinic. I moved to Sacramento and I worked there for about three years and they were downsizing and I was the last one hired. So. long story, but I had a sister working here as a rheumatologist and on a lark I interviewed for an audiology position and lo and behold, I moved here, and that's been 32 years. So I worked, a couple years at the Duluth Clinic, nice group of ENTs and two other audiologists. And again, wasn't looking for a job, but, I found myself after five years of clinical experience. Really, really enjoying the challenge, of working with children and, identifying hearing loss and fitting them with hearing technology. And I found that to be the most fulfilling part of audiology, which is ironic because I was very close to my grandmother who, had hearing loss from an early age. And, and I thought I would just love working with seniors. But, I found my passion working for, with children and, going into the educational setting every day was different. And then an opportunity came up to go back into the schools, and that was not grant funded, and it was 12 school districts. So I completed my full-time career with Northern Lights Special Ed Cooperative out of Cloquet, and now Esco. And again, so, grateful that Linda recruited me to go into the schools, and that was the last thing I was gonna do, but I just really found my passion, deep passion for, for pediatrics and audiology doing that in that position. Mm-hmm. So I think it's fun that Linda, you recruited her when you left Northern Lights and partially retired. And then when you decided to step back from Mason Sonic Children's Clinic. You recruited Amy to fill your place here. We appreciated it. Yeah, yeah. Love it. Both of you have just been such a tremendous help to our families, to our staff. I've learned so much from you. I put on here on the, for the title audiology legends. I'm thinking you would laugh at that, but honestly, like these two women have so much experience. Yes. And also just the difference it between pediatric and adult treatment. Mm-hmm. Can you talk a little bit about what that is? Like Tamara and I have mentioned, for speech therapy, we need to embrace the silly and we need to, you know, think on our feet and, and it's such a different world. How do you see that happening in audiology? So, I think the creativity part in taking a child just where they're at. Because you know, you're gonna have a kid in there that's screaming in the booth, or you're gonna have a mom that's super nervous 'cause they've never had a good audiology appointment, because the child doesn't wanna be in the booth. I mean, just being creative. Maybe we don't get in the booth the first time, the first day that they come. And I think that is one of the things about the Masonic Children's Clinic that is unique, is that we can spend that time that the child needs, that the parent needs. because unfortunately our poor clinical audiologists, not it's at no fault of their own. Mm-hmm. But they're limited by a certain amount of time that they can spend with the families and that mission that we have here to truly, provide what the child and family needs. Also occurs in audiology as well as in the speech pathology. I love that you said the child and the family needs. I think that you guys both do such a great job of explaining to parents what you're trying to get mm-hmm. And what you'd need from the parent. I've been in the other side of the booth, like with Linda, and with Amy to, just kind of help them interpret what the child's doing. Maybe if they're nonverbal or I've also been invited into the other side of the booth and, and I've sat on the floor and like put little foam blocks up on the table just to keep them entertained. And we can do that. We can collaborate and then they can talk to me like, Tamara, what kinds of behaviors are they, you know, are they exhibiting? What are the, you know, and then you have the time to talk to parents about what kinds of behaviors are they seeing are their concerns. And so you're doing as much with the family as you are with actually getting. Hearing results. Right, right. You know, we have a lot of kids that they're not gonna raise their hand when they're here to beep. You know, we see a lot of the two year olds or the children who have special needs that they're not able to do that. So we have to rely on watching behaviors mm-hmm. When we present different stimuli. Sound stimuli. Mm-hmm. I think that's so important for a lot of families to recognize that their children, especially if they're younger, the toddlers, they're not gonna know to say, I can't hear. Mm-hmm. They don't know that they can't hear. So picking up on what behaviors that your child is doing can be a key to figuring out, you know, should I see an audiologist? Should I not? But, but also. To know that there is an option for the kids that aren't speaking yet to still get their hearing checked. Because a lot of times when there's a language delay, we're thinking it could be a hearing loss, it could be a language delay, it could be a global delay, it could be cognition issue. There's so many things, and we really have to know if hearing's an issue so that it's not a barrier to helping these kids gain the language that we're, that SLPs are equipped to help parents and families with. And so it's like, we need you first. It's very true. Absolutely. So important. Very true. Um, we have to rule out hearing loss or determine what the hearing levels are so that speech pathologists can, optimize their work together with the child and the family. it's so often that I have seen children in the schools or, birth to three. We used to go to the homes and, They would have been told even in today and after, you know, 2020 plus that their child is too young to have their hearing tested. Mm-hmm. And, um, I think that's one of the greatest disservices and miss that still exists. or, um, I've even had a child who was sick, she was on my caseload and actually went to an emergency room over a weekend once and, had her hearing aids in and the physician just said, why does your child have hearing aids? Children don't wear hearing aids. So just, just not being aware that. Um, we know from universal newborn hearing screening, three children in 1000 across the United States are born with educationally significant hearing loss. But now we know another three in 1000 develop hearing loss that's educationally significant by the time they enter kindergarten. So, years ago we wouldn't find those kids until, that 3-year-old plus hearing screening. well, they weren't talking by three, then we better check the hearing and that is no longer appropriate. so that's a good change in the field. It's absolutely. To identify that. So I think a, a question that we get a lot too is how do you test a toddler? How do you test someone who's a year? Mm-hmm. Okay. One year, two years, years. Can I jump in there? Yeah. Mm-hmm. A year is very different than a toddler. Mm-hmm. So, um. At beginning at six to eight months, um, a baby with normal hearing will do localization to sound in the booth. They'll do, they'll do beautiful head turns. And it's not that you put earphones in and they raise their hand, but we can get a, a rough estimate. It doesn't tell us right or left ear, although now we're having some technology that the even a baby will accept, over the ear, super oral earphones and we can put them in the booth, on mom or dad or caregiver's lap or in a high chair, and we can present. Sounds and speech, through speakers or through the earphones, and we reward them with a video or a picture that lights up in the corner of the booth. and just last summer in August, equipment was updated here. I think the audiometer was the original one from the Scottish right building that was a credit union. I don't think it's the original Audiometer when the clinic started, but pretty old. But it was over a decade old. It was time. Yes. It was very old. And one of the video, monitors didn't work anymore. Anyway, we have a beautiful state of the art. actually two monitors. That will do a picture or provide a light stimulus or a video, short video clips. And so it's variable. The child never gets, doesn't get tired of seeing the same thing. Mm-hmm. And then the other thing we can do is there's a third monitor and it helps to center the child so that they're ready for the next presentation. So we can light up a third one where we want their visual field to be centered so that they're not staring at one monitor or the other. Waiting for that next stimuli. Mm-hmm. Then we can get a better gauge on the response. Can, can I add to that? So that would be a younger one in a, in a high chair sitting on a lab. Right. The other thing that's so cool about this new visual, reinforcement system that, that the clinic got is that some kids don't do well with certain rewards, and may not be interested. They might not be interested or maybe they have a sensitivity to maybe their vision. They have issues with that they might not, like, they don't care about videos. So we had a video reinforcement system and they don't really care about that, but maybe they like. Lights or, some of the other choices. So the, the evaluator has an opportunity to kind of find out from the parent now, what are some things you know, that your child might like, a slightly older child, like to put money into a piggy bank, you know, a toddler. And so I would always bring out the pig and the pennies, and then we got good results. Mm-hmm. So it, the, that's another factor is just testing and rewarding where the child is at. Mm-hmm. And that currently, and what is, what they. Or, or like Tamara coming and bringing, um, some characters that they like to make them feel more comfortable mm-hmm. In the booth. So that creativity again, right? Yes. Again, creativity and flexibility. Right. As Linda mentioned, um, pennies and a piggy bank or, putting a car down a car ramp. Um mm-hmm. So it's something that they can do that they'll Right. They'll stay So they'll, so they hear the sound. Yeah. And then they do something. Yeah. And one thing that I've always loved about having a pediatric audiologist here in the same clinic is that we can collaborate together, but also, you haven't like, kept your lab like, mm. It's tight, it's closed. When we're not here, it's like, you know, go in and like, 'cause sometimes we've gone in and just closed that door. Sometimes that soundproof, like that deadening is just such a shock to some of our kiddos that we just go in and we're like, we're just gonna do some of our speech session in here. And that has made all the difference. Or, or Linda and Amy, you've both done that too, where we're like, we're gonna end on a good note and maybe you got three, frequencies that you tested and you would love to get the whole speech spectrum, but you're like, we have that flexibility to be like, let's come in, next week or next month. And, and that's, that's absolutely just such a relief because then you, you're not like, you're not stressed trying to get all the results and then the parents aren't like, Ooh, we just want them to do it. And then their stress, is pouring over into their, their little kids' stress. So Absolutely. We really appreciate that, that gift of time. And our children here, they, they really pick up on that too. Yes. And then you see them start to, not know what to do and, right. Yes. So keeping it short and, being able to have the flexibility to come back in a week or two, and not wait another three months because now we've lost three more months of their valuable. Lifetime of not having language or not developing language at the same rate. Mm-hmm. And three months in the world of a child is a lot. Mm-hmm. Yes. Mm-hmm. That's right. Yeah. So we don't wanna miss that time. Mm-hmm. Or if we do have a hearing loss identified, ultimately we need to get, the proper technology on that child so that they have, optimal access to spoken language and we don't wanna lose any, any precious time. Right. So, so with that, for families that are listening, could you talk a little bit about the difference between the hearing screenings that they might get at school or at the doctor's office compared to the full audiology, exam that you do here? And also, another question I had is how often do you recommend that the children get tested? You want me to go? Yeah, go ahead. Fill in. Okay. This is Linda. Um, so screenings in like the nurse's office or at the school is just a pass fail. They don't see how quietly you can hear and you can actually pass that and be missing certain speech sounds because for one thing, they're not testing in the booth, so they can only go so low in terms of the decibel level for the actual assessment. So they might pass your child at 20 decibels, and yet we know that 20 decibels, if that's how their actual hearing, like their lowest level of hearing, that they're missing certain speech sounds. So in the soundproof booth we might do a screening, but we're gonna do it like at 15 or 10. You know, just to get as much information as we can. And then optimally we're gonna wanna find out what the actual, hearing levels at the various pitches or frequencies of speech to make sure the child's hearing across the board. Does that mm-hmm. Mm-hmm. Make sense? Mm-hmm. And then also, in a nurse's, not to belittle anyone, but I don't know with the barriers, can the child see the buttons? Can the, you know, we don't know exactly. And, um, sometimes the nurses, they have so much responsibility today in our schools that they don't have a lot of time to do a proper training and make sure that the child understands what you're asking for. And then also in a booth, even for young children, we have wonderful, picture pointing tasks, that even young children can do. But as a child gets older, and again, we serve children here up to age nine, but. Getting speech, understanding how well can a child understand a word? Did they hear fifth or did they hear sixth? Or things like that. Very subtle differences. And then also Linda and I, were big, fans of doing word understanding in the presence of some background noise similar to being in the cafeteria. So like Linda was saying, yeah, a child might pass a hearing screening at school at 20 decibels, but how are they hearing from the back of the classroom with background noise, presence, what else is going on in that classroom that's disruptive to the child's auditory processing? Mm-hmm. So there's a number of factors that we can get into mm-hmm. That will affect, especially when you look at the children we're concerned with any, spoken language disorder or delay or voice issues. So that's right. Right. And you know that whole, like what you say Amy, is um, what is that functional listening ability? how is the child functioning? And then even asking the family about the home environment. Do you have high ceilings? You know, we're looking at some of the acoustics that these kids have to listen in. do you have carpeting? 'cause some of those things will kind of tamper down the actual sound level so the child will hear more clearly. We're looking at a lot of kids that have middle ear fluid and ear infections mm-hmm. And fluctuations in hearing. And we might think that, oh, well, they'll grow out of it, but we do want kids to not be hearing underwater. And that's what, what it's for. Bringing that up. Mm-hmm. Yeah. so if a child passes their screening at the doctor or the nurse, but parents still have concern, that would be an appropriate time to Yes, that would be excellent question. Yes. And what are some of the red flags? What are some things that families should be looking for or notice? I would say, I'll just throw some out, Amy, you can throw some out too. the loudness of their voice, if they're increasing their loudness, that could indicate that they're trying to monitor themselves. some families might think, oh, I think my child has attention deficit disorder 'cause they don't pay attention. That can also be a sign of hearing loss, because it takes a lot of energy and a lot of attention to hear when things are muffled. Right. Or not when you're not hearing. Right. Right. if the family is observing the child, make sure you're talking behind them so they're not seeing you talk because. the other thing too that, you know, well, I asked him if he heard me, he said yes, or I called his name and he turned, but did he hear Bobby or did he hear, uh, e And you can't discern that from that. So that's another thing is we want kids to hear clearly and all the speech sounds, and not just parts of them, which is why it's so, so important that our kids here see audiology first. Absolutely. To either identify or rule that out because we, they come in and we know they have a speech language disorder or difficulty going on. But why? Right. Is it because the audiology? Because if we start to treat mm-hmm. Without correcting that root cause mm-hmm. It's gonna be a long, hard road for that child. Mm-hmm. Not only in therapy, but at school and out in life. So I, that audiology piece is so important. So important. And it, it's also a, a bit of a Venn diagram. So Linda and I have worked with many, many children who have other spoken language disorders. or are on the autism spectrum. Just because you have another language delay cause does not mean you do not have hearing loss. And it will really impact that hearing loss will really impact their speech disorder in a way that a child who doesn't have hearing loss is not impacted. So, again, like Linda said, it's what we do is so much more functional. And how does it relate to their ability to develop spoken language? Because if it's not done at a certain time and frame. They're going to be delayed in their reading skills. We all think reading is a listening thing, hearing the speech sounds or it's a visual, but it is an auditory thing. So we want our children to hear the subtle differences in different sounds of speech, so that they are able to read given at one. Should we give some examples like the S and the F sound? Yeah. Mm-hmm. Those are very quiet sounds in our English language. CH you know, the cha sound. So if a child's not hearing the s sound, they're missing plurals. They're missing Yep. some of those markers of speech. Yeah. One thing that was kind of funny, one of, one of my friend's daughters had some conductive hearing loss. So it was, um, do, uh, and she'd insisted when she was three years old that it was brutal, the red nose reindeer. Oh. Because she didn't hear Rudolf. And so that was just another indication to them that even though, her ear infections had resolved. Mm, that there was still right. Some hearing issues that needed to be resolved. And I think that Venn diagram, that's such a great analogy because you think about, yes, they need to hear, they need to understand the language, they need to know how those sounds work together. And then as they're older, that's where they bring it into literacy, the reading piece. So all of that is tied so closely together. Right? Absolutely. And that early intervention is, and for me. How hearing is so involved in socialization. Absolutely. If there's hearing loss, there's gonna be social isolation. They're gonna be missing those opportunities to socialize with others to follow a conversation. And so they will be, might be behind their peers in negotiation, in conversation skills, in play time, pretend play because they don't have the same access. That's a really good point. That's very true. Our children don't get the subtleties of speech when there's hearing loss present, so they're not going to get a joke maybe, mm-hmm. That another child gets because they didn't get the nuance in the way that the word in the joke made a difference. Or, idioms. It's reigning. Cats and dogs is the one that we always use. Right. But that means nothing to a child that has hearing loss. So you have to just teach things. Directly 'cause they're not going to get it by osmosis, like a child without language disorders. Mm-hmm. Or hearing loss. Mm-hmm. And again, yes, that severely impacts. Mm-hmm. The other thing about our children with hearing loss is in general, when you're working with them in schools, they don't have a classroom full of kids just like them. Mm-hmm. They don't have a friend that has hearing aids too, or cochlear implants, or they don't have the same experience that a child without any, issues developing speech and language has. So again, that's another isolation. They're the only one that has mm-hmm. The hearing aids or the, technology accommodations in the classroom. Right. And they don't want to be the only one. Right. They don't want to have that attention on. On their technology. I was thinking about, what we call the listening bubble. Oh, yeah. And, it's like the distance that a child can hear clearly, and it could be due to a conductive or middle ear infection type of hearing loss, a temporary one or a child that's got more permanent hearing loss that has, hearing aids or cochlear implant. And so that's one of those functional things that I like to get a, get an eyeball for the family to know maybe that child's hearing only clearly at three feet distance, but if you go to six feet, you sound very blurred and underwater or, and you can't clearly hear all the speech sounds. So, that speech bubble or listening bubble is so important. And once a child's hearing loss is identified, even if it's temporary, because they can't eavesdrop and learn through eavesdropping, which is a huge part of, uh, learning languages. We learn by just listening in on conversations. So, yeah. Yeah. And then how your listening bubble is diminished in any background noise. Or some of our kids, if it's too dim with the lighting or Right. They can't put it all together. Right. So the listening distance shrinks shirts, oh, uh, shrinks up. So I was saying, um, that, can you explain the different ways that, different kinds of hearing loss are identified, like the conductive hearing loss, which is like the middle ear fluid things and the sensory neural hearing loss, which is more of the nerve, hearing loss. Can you explain that and then talk about kind of like the differences of how kids might present? Okay. That's a good question. and again, I'll just start with middle ear, but again, you asked how often should a child be checked and we know children who have chronic middle ear. there's so much fluctuation and you can't test 'em every day to, it's a snapshot where they're at. But we have good, Logical things that we can share with parents how to work with their child while they're experiencing a decrease in hearing. But um, one of the things about audiology that is kind of fun is putting the puzzle together. So we look in the ears, and again, here at Masonic, maybe I don't look in the ear first thing with an otoscope and come at my child or, or the child I'm going to see, right? Because that's kind of invasive. It's very invasive. So you might not be able to do that. But we have tools. here at the clinic we have a way to test the ear drum mobility. It's called tempo. And we also have a very good quick measure to do a basic hearing screening called otoacoustic emissions. If you pass that, great, but it doesn't mean you have perfect hearing, but it gives us a ballpark. But if you pass an OAE screening. We know because of the mechanism that gives us that signal. You have eardrum mobility and you do not have fluid behind the eardrums. So that's one piece of it. if you have an abnormal tympanogram, which is the test that tells us about middle ear pressure and eardrum mobility, then we right away suspect, middle ear. Now in the booth, we typically will do air conduction first. So you put the sound through the eardrum, through the ear canal, through the eardrum. It goes across the three small. Ear bones called the ossicles, and then it crosses into the cochlea, which is our nerve, which is our sensory organ. We have about 20,000 hair cells in there that react at different tones. And then you have, after the cochlea, you have the hearing nerve, and we have two sets of those right and left for most people. and that brings up a whole nother thing if we want to get into unilateral or one ear hearing loss. But, so after we do, air conduction testing through either, insert earphones, little tiny pillows, or. Headphones. then we do another test with some more tones or, and or words called bone conduction test. And many people now know what bone conduction testing is because you see so many people wearing bone conduction earphones, headphones when they're running. It goes right behind the actual ear that you see on people, the outer ear or the pinna or the oracle. And that is a way for us to see if the child is hearing the same as they hear through the air conduction, through the ear canal. Or do they hear better? So if they hear better, then we can tell where the sensory organ and the hearing nerve are functioning. Is it same or different from how they're hearing through the ear canal and the eardrum and the small three bones? And if there is, if they are hearing better through bone conduction. Plus they have a tympanogram that's abnormal and they did not pass an OAE. Well then it's a slam dunk that we have middle ear issues. and it can be confirmed by looking in the ear, or I've looked in the ear first, depending on the child, depending what the child will, will let us do. Mm-hmm. Um, infants, as I mentioned, universal newborn hearing screening is now, uh, nationwide, but it was a huge deal in Linda and I in our career when it came along. It got mandated in Minnesota in 1998. And what they do is, um, back then we didn't have handheld O AEs. It was a screening, um, using another technology called a BR, auditory Brainstem Response. And, when a baby is real young up to, two, three months, you can do the A BR, while the baby's sleeping. And, that's a real nice test. so they're never too young, but if they refer on their newborn hearing screening in the nursery, then they go to, then they go to audiology in the clinic and we can do some more things. my best friend, her thesis for masters was working with a child who got one. Cochlear implant because we were never going to do two ever. And this child at two, it wasn't FDA yet approved. and all it gave you was the presence of sound. And now we reach routinely work with families whose child receives two cochlear implants, one for each side by the age of, you know, nine months, 10 months, 11 months, 12 months. And as you all know, there's someone that you have worked with here that, after she receives some therapy, she was both receptively and expressively above her. Same age peers who had no hearing loss, so. Mm-hmm. That's awesome. I would've never, ever imagined that that what our children would end up being able to do. Right. And develop spoken language. Right. Mm-hmm. Right. Can you explain a little more about cochlear implants? Oh, yeah, go ahead. And then I'm gonna talk about hearing aids too and half. Perfect. Okay, good. okay. Cochlear implants, it is a surgical procedure. and I won't get, there's several parts to it, but the main thing to know about cochlear implants is you receive or you are a candidate for cochlear implant. Under certain conditions. One of the main conditions, especially when we're working with young, young children is that, hearing aids provided no benefit to you. So the hearing loss is great enough that you are not benefiting at all from the use of traditional hearing aid technology, even with the excellent hearing aid technology that is available in 2025. So that's the first thing. and there are a series of, measures you have to go through to make sure that if you do receive. A co cochlear implant or two cochlear implants that, that your hearing nerve and everything will be able to work with that. So it's a small wire device, looks like a snail, and it has these electrodes on it that goes into that inner ear, which is the cochlea, which is the snail shape sensory organ. and you have a pickup mic and you have a small processor. And again, the processor used to be a body worn, square thing, about four inches by two inches or three inches. And now it's just all built into a very small behind the ear. Device. So, some kids who have two cochlear implants, if you don't know, they look just like hearing aids, even if, or yeah. With hair, you don't even often see cochlear implants anymore. So, yeah, we've got some great tools and Masonic Clinic here has some wonderful, upgrades to the equipment, which is exciting to see. Everything state of the art, everything is, exactly what you would want. If it was your child being fit or being evaluated for hearing and, and had hearing loss, this is where, mm-hmm um, you would feel confident because you're getting the right tools, you're using the right tools to obtain the right. Data information for the best for your child. Yep. And a huge thank you to our donors out there. They're the reason that we can do this. Mm-hmm. Yes. We really, and there's, there's a lot of need too for our children mm-hmm. Who have hearing loss and need hearing aids. There's a lot of need, in this community. Yes, for sure. In this community and the extended surrounding area, we are under identifying, even today in 2025, we're under identifying and under fitting, the number of children who are probably out there with, with need for hearing technology. and then the other thing is we do see Linda and I both, as our careers went on, we were seeing noise induced hearing loss that was educationally significant at younger and younger ages. Mm-hmm. So something to really be, aware of and to share with our families. and make sure that they take care of the ears that they do have, that they're protecting 'em, protecting, you know, they're going to the racetrack. You make sure your kids are wearing mm-hmm. And adults are wearing headphones. Appropriate headphones. Yeah. I like that how you were saying. Yeah. Like where kids typically go, but even just like mm-hmm. 'cause a lot of times people are thinking, oh, concerts or, you know. Mm-hmm. Or people who work in like, industry, like, you know, like paper plants or like, that's when it's like OSHA's mandating hearing protection. Mm-hmm. But you're like, yeah. But there's so many places that even certain places in parks or or music concerts or sports arenas mm-hmm. Sports arenas. Just think about how loud they can be. Yeah. So just consider the, and those little hair cells, once they're gone, they're gone. They don't come back or even, I've seen some like PSAs about, we do have so much in inner ear technology and things like that, and to have those, those decibel reducing things because kids don't know that they're listening to it at a too loud volume for a long period of time that's causing damage. Right. Good point. Good point. And younger people have more tolerance to loud sounds, so you do not That's a very good point. You have no idea that you are harming your, your hearing. Mm-hmm. So, yep. I was thinking about, um, you know, as we look at who needs to come for a hearing test Yeah. And we look at those red flags. Mm-hmm. And, when we look at children who are neuro diverse or have autism, some of the, the behaviors that you see are similar to what we would find with this child with hearing loss. Like not responding to your name. Right. Or, or seemingly not. Engaging with someone not actively right in front of them. Right. Or, you know, um, exploring toys in a way that someone else wouldn't if they had hearing, but more curiosity with toys that might look different from another child. More visual, maybe more visual. Right. And that might be something that a child on the autism spectrum might do as well. Right. Things like that. Right. I would definitely say that. And we also know that there are kids who have hearing loss and autism. So, uh, kind of a dual kind of situation. So that's the other reason why even if you have your child has that diagnosis, make sure their hearing is tested to make sure that that's not an additional component, to your child's diagnosis. And you know, I, I'm just thinking back when we were over at the, at the credit union, I'll never forget a, a child that had been identified with autism and was in the hallway. 'cause that's where we did the you the lab work. And, she was maybe five or six, she was being held by her mom and she kept moving her mom's face so she could see it. Mm. And I saw that and I thought, oh my goodness, we gotta test her hearing. And she needed hearing aids. Mm-hmm. Mm-hmm. Are there any other audiology myths out there that either parents bring to you or that you've seen in media that you would love to bust? The myth buster, I think the big one is, is oh, it's just fluid, so I don't have to worry. 'cause you know, it's not an ear infection that child has, so they don't need an antibiotics. Oh, it's just fluid. Well, nothing is just fluid because the child's probably not hearing the way they're hearing underwater. Mm-hmm. It's impacted, it's impacting their speech language, learning ability. So that is a big myth. I, I would really like to add on to that. So if a child has just fluid mm-hmm. They're fired up. That's a big one. Medically it's referred to, and please use quotation marks, a mild hearing loss, quotation marks. And honestly, Linda has been such a good friend and mentor, but we never, ever, ever used the word mild. So what is normal hearing was when it was first identified, what is normal and what is not normal. It was based on very young adults who are 18, 20 years old, college age. Well great, but college age. You're already in college and you're getting your hearing tested to determine what is normal. You already know how to read, you already know how to fill in the gaps. If you've missed something, you've already, you already know if the topic switches and you're already able to pick up on language nuance. But our kids, learning language, learning to, have access to language, they can't do any of those things. So if you are missing even a small portion of that speech range frequency, and then you're in background noise and you're trying to learn to read, it can have a devastating impact mm-hmm. On a child who just has fluid. Mm-hmm. So I really try never, ever, to use that term, that term, mild. It's always relevant, it's hearing loss no matter how slight it's relevant. And it's, and it's critical. Mm-hmm. So mild does not mean mild level, not significant or not impactful. Mild not impactful. Yeah. Mild is still very impactful. Right. That's a very good myth to bust. Right. That is a huge one. Yeah. Well, he's fine. He'll grow out of it. Or he won't need hearing aids until he gets to school because Yeah. That's a big myth there too. We're still hearing that. Yes, yes. Yeah. 'cause it's a mild hearing loss, so until you get to school, you won't need 'em. Mm-hmm. And then, so all that, that early development is being Right? Yeah. And you know how with some adults, they just put their hearing aids in when they wanna listen. Sometimes we see that with fa young kids with a, we're going out to the park, or we're going to church, we're gonna put the child's hearing aids in. Well, you need to hear all day when you're learning language and. You're learning in all environments, right? Not just all environments. Right. Or not just at school. And you're, we're treating the brain. Yes. We're not treating the ears, we're treating the brain. Yes. If you're not wearing those hearing aids 10 hours a day. We have excellent data. There's a long term, childhood hearing loss, and it was a done, a study had done across many, many states over many years across all socioeconomic, levels. And what was found was if a child who once identified with hearing loss does not wear their hearing aids every day for a minimum of 10 hours, they cannot stay on track with their language and social and reading development, same as their normal hearing peers. Mm-hmm. It's critical. 10 hours a day to feed the brain. And they've even studied, they've looked at the scans of the brain and how there's, The importance because what happens is it's auditory deprivation that occurs and the brain actually changes. And so yeah. Well, we'll put the hearing aids in later when they start school. Well, there could be some damage there in the brain already. And, uh, yeah, that's good point, Amy. Thank you. And same thing. Yep. Same thing with adults who, even today with the exceptional technology that's available, most adults wait 10 years too long before they go get hearing aids. And now the brain scans do show, again, deprivation as an adult who has language in place. And we also know now, cognitive decline is related to not feeding the brain with auditory stimulation. Mm-hmm. So we know this. That's a bonus one. We usually talk about kids here, but that's a good one. Mm-hmm. It's a good one. Yeah. So really the key point is all ages, all ages, all age. If you need, if you need hearing aids, cochlear implants, get 'em, wear 'em all the time. Yeah. And get 'em, soon. Get 'em as early as possible. Yes. Yeah, yeah, yeah. And then also too, is there anything that you'd wanna say to parents that are, you know, kind of like, nervous about that or, or, you know, and like the emotional piece mm-hmm. Of learning. Mm-hmm. Your child might have a hearing loss, um, that you guys are really good at that. Yeah. What I would say is, a couple things. I would, it's so much information. Often our families are still being identified in medical clinics, which is great. They're doing their job, but. All, all they can hear is a snippet of that. So making sure either clinically or with your school audiologist or another audiologist, even here if, if available, make another appointment. And all you do is talk about the hearing aids, how to use them so that you do not leave this appointment, or, or if you need two of 'em or if you need three of them. Mm-hmm. That the parent is empowered and feels confident to take the hearing device apart. Know how to wash the ear mode, know how to care for it, know everything about it confidently because if the parent's not confident, they're going to be afraid to break it. Right. We have warranties, you know? Mm-hmm. Or, we have ways of clipping it to your child that's unobtrusive so you don't lose the hearing technology. Giving that parent and family and caregiver and daycare person the confidence to use hearing technology and to put it in and out as needed. And, that I think is a huge thing. I think people are really afraid to get started 'cause they haven't had the time and experience, you know, to, it's something new. It's something new, something new, something new. It's expensive. And yeah, and the other thing is, is I think sometimes, especially with a new newly identified child with hearing loss, is that need to, connect with another family who has gone through it. You know? And I think here at the clinic, we've, we've done that. We've tried to, you know, pair, pair, some parents together so they can share stories and mm-hmm. Help each other. And because, professionals, you know, we can't understand what a family goes through. And so, um mm-hmm. Yeah. And many of our parents, once they get over that initial fright and develop that confidence, they truly become natural mentors. Mm-hmm. To their another parent and they want to share that. 'cause I think if you're a parent, and again yes, not from personal experience, but if you're a parent and you've been through that, you wanna help someone else not have to go through that for as long of a time or as make you wanna help them have an easier time of it than you did. Right. Building community. Right. Yes. Exactly. And that's really cool that we get to be a part of that sometimes with our families. Yes. Yep. Yep. for anyone out there who might be listening, who's really passionate about hearing loss and helping these kids, we would love to add audiology hours to our clinic. Mm-hmm. Um, and again, everything we do here is free to the families. We are funded solely through grants and donations. So contact us, make a donation if you, if this is something that, is close to your heart and you want to support. Yeah. Mm-hmm. Or if you're an audiologist out there and interested in being part of this team, this fabulous team, we are looking for our next audiologist legend. Yes. Yes. We're, yeah. And we thank you for your years of service. Yes. It's been a pleasure. You've helped so many kids and families, so thank you. Thank you for having us. Bye-Bye. That wraps up this episode of Hear Me Out. Thanks so much for listening. Be sure to subscribe, share the podcast with others, and join us next time as we continue learning from the professionals, parents and donors who make this work possible and celebrate the amazing kids we serve. To learn more about the Masonic Children's Clinic or to support our mission of providing free speech, language and hearing services, visit our website and consider making a donation. Every gift helps us give children the voice they deserve. Visit us at masonic children's clinic.org.