Elizabeth Walker, PhD Discusses the Significance of Mild Hearing Loss In Children

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This week I am thrilled to sit down with a great friend and colleague, Dr. Elizabeth Walker who is an assistant professor at the University of Iowa where she teaches and is the director of the Pediatric Audiology Lab.   In this episode, Dr. Walker shares why “mild” is MORE than mild as it relates to hearing loss and the need to optimize access to auditory information.  Dr. Walker has a wealth of knowledge and research through her work as an investigator on the Outcomes of Children with Hearing Loss (OCHL) study.  Whether you are a parent, audiologist, speech language pathologist or educator; you will want to hear key take-aways to help children with hearing loss achieve optimal outcomes.  

For more information be sure to visit these websites: 

www.ochlstudy.org

https://www.facebook.com/PediatricAudiologyLabUIowa

https://pediatricaudiology.lab.uiowa.edu/

For more information about Dr. Carrie Spangler- check out her LinkedIn at https://www.linkedin.com/in/carrie-spangler/

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

00:00:00] Welcome to episode 10 of empowEAR Audiology with Dr. Carrie Spangler.
[00:00:16] Hi, everyone. Welcome to the empowEAR Podcast. My name is Dr. Carrie Spangler, and I'm your host. I am a passionate audiologist with a lifelong journey of living with hearing challenges and this vibrant and hearing world. I just want to thank all of you for listening and I hope that you will subscribe that you invite others to listen and leave a positive review.
[00:00:39] I also want to invite all of you to engage on the empowEAR Audiology Facebook page. So let's get started with today's episode of empowEAR Audiology. As educational audiologist. One of the words that I really have a problem with in our profession is the word mild. And if you'd look up the word mild in the dictionary, you will find that.
[00:01:04] Um, as it relates to illness or pain and it's described as not serious or not dangerous. And I feel like this description has significant consequences. If we equate mild hearing loss as not serious. So today, um, the podcast, I am really excited to have Dr. Beth Walker with me. And I'm going to tell you a little bit about Dr.
[00:01:31] Walker before we get started. So Dr. Walker is an assistant professor and the department of communication, sciences, and disorders at the university of Iowa in Iowa city. Iowa. And she's the director of the pediatric audiology lab. Her research focuses on pediatric aural habilitation, specifically examining factors that relate to individual differences and listening and language outcomes for children who are deaf or hard of hearing.
[00:02:02] She is an investigator on a number of research projects funded by the national institutes of health, including the 10 year longitudinal investigation. The outcomes of children with hearing loss study, she has authored over 50 peer reviewed publications and coauthored a textbook on pediatric amplification.
[00:02:24] So it is my honor and pleasure to introduce to all of you, Dr. Beth Walker. So welcome. Hi, thank you for having me could see our faces right now. Cause we have these giant grins on our faces and we can see each other.
[00:02:49] exactly. Yes. So
[00:02:56] So how we met. So we were in Florida, it was the educational ideology association and they had this little, it wasn't Cheryl DeConde Johnson had this little, it wasn't a conference. It was like this little mini meeting before I remember that. And I can't remember where we were in Florida. I remember it was super hot outside and I was, yeah, it might've been.
[00:03:20] And we, so we were at that meeting and I that's where I, that's where I met you the first time. Cause cause then honestly I remember that we went to the bar afterwards
[00:03:36] each other a lot better. I only came for that day. I didn't stay for the conference. I just came for that little meeting that one day. Okay. We're off each other ASHA and Memphis, right? That was another one. Oh yeah. That Memphis one. Yeah. And then I got to bring you to Ohio and then I got to come to Ohio last year.
[00:04:04] Pre COVID. And then I was supposed to be in Ohio this fall too, for the, Oh, I don't remember what it was for. I knew I was supposed to be in Ohio. Um, and I think that got bumped off to next year. Something I can't remember. Sorry, we'll be back in Ohio again. So, because we will get connected again, for sure.
[00:04:27] So I have another question for you before we kind of dive into that. The meat of the podcast, but could you tell all of our listeners how you actually got started into the audiology? Is it a good story? I wondered if you'd asked me this question. So I don't know if it's a good story. Like most people, I kind of fell into audiology.
[00:04:49] It was not like I dreamed of being an audiologist when I was a little girl, but what I. tell All my students was I actually, when I was a little girl, I dreamed of being a detective and an author. And my favorite things were Nancy Drew mysteries. And so I loved reading them and I wanted to solve mysteries and write books.
[00:05:10] And then I got to grad school realize that was not really a very good or not grad school. Undergrad realized that wasn't a very good career plan. Um, so I went into psychology instead, and then from psychology, somehow fell into speech pathology and audiology. Um, I think what actually happened was I was in psychology.
[00:05:29] I knew I wanted to go into more of a healthcare field and somebody on my dorm room floor was like, If I don't get into pharmacy school, I'm going to be a speech pathologist. And I thought, Oh, that sounds cool. I'll try that too. Cause I knew I didn't want to stay in, I didn't want to be a psychologist. So I ended up going into speech path and then kind of like what happens with a lot of people.
[00:05:53] I was taking the communication sciences and disorders classes and got really interested in audiology. Um, through that, even though I thought at first and with me, the thing was, um, I honestly couldn't decide if I wanted to be a speech pathologist or an audiologist. And in the back of my mind, I still wanted to be a detective and an author.
[00:06:13] So what I ended up doing was, uh, getting dual certification. I'd never made a decision. I just became, I went to grad school for speech path and audiology. I did. Two CFYs in Indiana. So I was, um, I went, I worked at Riley children's hospital and did a CFY and speech pathology then audiology, and then ended up getting my PhD , which is where I was able to become.
[00:06:38] It sounds corny, but that was where I was able to become a detective. And. A writer. So I really do feel like that's what I do. Like, I feel like it sounds, it's so cheesy, but I feel like when I'm doing research, I'm really like, kind of, I've got all these facts and I can put together this puzzle. And that's what I love about research and I still get to do the writing aspect of it, but I get to do it in this field that I think is super cool, which is audiology and speech pathology.
[00:07:07] Exactly.
[00:07:11] Just, um, I think we're speech pathology and audiology really overlap so much. So it's great to have both perspectives with all of your research. Yeah. And that's why I am really glad I ended up doing both because what I'm really interested in is how hearing loss impacts listening and language and reading development.
[00:07:34] And so I feel like if you're going to be a good pediatric audiologist, you need to understand the language. Out of things. And if you're going to be a good speech pathologist that works with kids, with hearing loss, you need to understand audiology. So that would not, I wouldn't recommend nowadays the dual certification, because it would just take too darn long, which is unfortunate.
[00:07:56] Yeah. So one of the things that you have been very involved in, and I didn't realize it until I've read some of the bio is the Outcome for children's with hearing loss study for over 10 years now. So can you tell our listeners a little bit more about how you got involved with this study? So this was just.
[00:08:20] Actually, I was kind of in the right place at the right time. So I was working, I was finishing my PhD. I was probably a year away from finishing my PhD and I was working as a speech pathologist on the cochlear implant team over at the hospital. Yeah. At the university of Iowa and I was actually doing, um, I love doing transcriptions like phonetic transcriptions, which sounds really weird, but I just think it's kind of fun.
[00:08:44] And so somebody was actually Bruce Tomblin. Who's a professor here at Iowa was paying me to do these transcriptions for him. And so I happened to be down in his lab one day and his project coordinator looked at me and she was like, Hey, you're an audiologist too. Aren't you? And I was like, yeah, she's like, Oh, we have this new research.
[00:09:02] grant call the outcomes of children with hearing loss study and we need an audiologist for it. And she handed me the job description and I looked at it and it was like, I think I looked at it for like 30 seconds and I was like, this is what I want to do. This was my dream research project to be involved.
[00:09:23] Because it was looking at children with mild to severe hearing loss. It was working, it was a multicenter study. So it was working with people at Boys town National research hospital, and University of North Carolina. And it was all these people. I kind of knew. That honestly, like some of them, I had academic crushes on like Mary Pat Moeller.
[00:09:42] Yeah. But I didn't know him really well. And so I, but I knew like this would be such a cool job to have, because I get to work with all these people that I had really admired. Um, also at North Carolina, um, uh, melody Harrison was somebody at North Carolina and she was another person I just looked up to for such a long time.
[00:10:00] And so I think I went home. Um, and I told my husband, I'm like, okay, I'm changing jobs. I'm going to take this job. They hadn't even offered it to me, but I was like, okay, this is what I want to do. And so that was how I fell into it. It was real literally, like I happened to be in the right room, all the stars aligned and cause they had just, I think they just started the funding for the project.
[00:10:25] And so that would have been in 2008. So actually we're going on now? 12 years of the study, we didn't start collecting data till 2009, I think. But yeah, the funding started for the grant in 2008. Wow. And it's such a, all of the research that all of you have done has been so instrumental in everything that we know now as audiologists and educators and those working with kids with hearing loss, um, but kind of going back a little bit to 2008, what was.
[00:10:59] One of the main question that you and your team and the researcher has had, um, for going into this study? Well, the main thing was, um, there was a lot of research out there on children who are deaf children who use cochlear implants. And we really didn't know very much about children with mild to severe hearing loss, particularly, uh, what we call the current generation.
[00:11:23] of kids, kids who were born after 2000, who had access to early intervention, um, were identified at fairly young ages, um, had been fit with hearing aids. We didn't really know if those kids were able to keep up with their same age hearing peers, or if they were showing delays in terms of their language skills.
[00:11:44] So, and we also, it sounds weird. I always say this when I give talks, we really didn't know what the effect of hearing aids were on outcomes, which sounds stupid. Like we would really hope that hearing aids would make a difference, but we didn't, we honestly didn't have evidence for that because. Almost all of the research studies that have been done in the past, past on children who are hard of hearing, hadn't really described the hearing aids very well.
[00:12:10] So it didn't that we would say, okay, there were 20 kids in this study. Some of them had hearing aids. Some of them didn't, it wouldn't say anything about how much they wear their hearing aids or how well fit the hearing aids were with the audiologists. You using real ear measures to program and fit the hearing aids
[00:12:29] And so those were the questions we really had are the kids able to keep up with their hearing peers because we knew they were pretty much all using spoken language and they were pretty much all in regular education settings. Um, and then, um, what impact did the hearing aids have on, on there Success. So, and what made some of these kids?
[00:12:49] We knew there was going to be lots of variability. So what made some of these kids succeed and what made some of them struggle? So, right. So going back to some of the, not the. I guess in variability, what would like the ages that the kids and how many years did you follow these kids? And, and you said they all had hearing aids.
[00:13:11] So then we no cochlear implant. So, uh, the way the study started, the kids could be, we had what was called an accelerated longitudinal design. So the kids could be anywhere between six months. Age at seven years of age, when they enrolled in the project, which was going around like 2009, 2010, and then we followed them longitudinally.
[00:13:33] So we started off with a wide age range and that gave us cross sectional data from basically infancy to. First grade, but then we had longitudinal data that tracked. So then we could track their language growth, their listening growth, um, just how they were doing over time. Um, and we're still following these kids.
[00:13:52] So now a lot of, some of them are like juniors and seniors in high school, which is crazy to me. Um, but, uh, yeah, I mean, some of them were six or seven years old when they started and it has been. 10 years. Uh, we just completed a study with a lot of these kids participated in that study on listening effort. It was, and it was a project I'm listening effort.
[00:14:16] Um, and then we are hoping we submitted a grant last week to the national institutes of health to try to follow these kids into junior high and high school. Yeah. That's important too. I know it is. And I realized I. I realized writing that grant there, we don't know much about adolescents at all. So, um, I hear anecdotally that within this makes sense to me.
[00:14:40] Um, when they get to junior high, they don't want to wear their hearing aids or they don't want to wear the remote microphone system. Well, but, um, but we don't really have good evidence research evidence for that. And if they do decide not to wear their equipment, we don't have evidence for why or what impact that has.
[00:14:59] So, um, so I'm excited. I hope, I hope the NIH likes the grant. We never know . One of my passion areas is teens. Then I feel like that would be great information. Yeah. So one other question, like how many kids did you recruit for this? And I'm sure it's been over time too. And how many have actually stayed in the study?
[00:15:23] So we recruited, uh, three, well, okay. So we have. I want to say it was like four to 500 people responded to participate. We did not. So the kids in the study all had to have a bilateral hearing loss. We didn't include anybody that had a unilateral hearing loss. Initially we did. And then we didn't keep following those kids.
[00:15:44] So everybody had a bilateral hearing loss, studied. It all had to be between the, in the mild to severe range. And, uh, they couldn't have any additional disabilities or, um, English had to be their first language. And also we, we wanted to look at the impact of hearing aids. So we did not include kids that had cochlear implants when they started in the study.
[00:16:05] We had some that got cochlear implants as the study progressed. So. With those criteria, like I said, we had about 500 people for 450 that. Contacted us. And with the inclusionary exclusionary criteria, we had ended up with 317 kids that were in this study that actually enrolled. I collected data on them because some, um, ended up not qualified because they had additional disabilities or had a cochlear implant.
[00:16:31] And then we also had a group of 117 children with typical hearing that were matched on socioeconomic status and age. And that was ended up being really important because one of the things that we've found pretty consistently as well, when we've looked at the data of our kids who are hard of hearing that were in the study.
[00:16:54] If we just look at them compared to test norms, like. How they did on the Peabody picture vocabulary test, they look like they're doing within the average range, but when we compare them to our 112 group of hearing kids, um, they're doing significant they're significant delays compared to that population.
[00:17:11] So that ended up, it was good that we had that normal hearing control group. Um, in terms of, uh, retention, like who has stayed in the study, I want to say we've. I can't remember exact number and I should know this because it's had to go in the grant. Um, I think we've kept about 200 of the kids in the study.
[00:17:30] Some of them are no longer in the study because they didn't get cochlear implants and we quit following them. Some of them moved away. Some of them we lost to contact. But we've still got a lot of the kids that started in the original study that we're still following. So contact with. Yeah. Right.
[00:17:46] Especially over that period of time, be able to keep, you know, get out data and information about it's helped at a lot of the some of the original people that started on the project as working on the project are still with the project. So I'm still on the project. Um, Ryan McCreery, who's at boys town. He started on the project pretty early and Mary Stratford, who is his, uh, research audiologist and his, um, director of his lab.
[00:18:15] She's still on the project. So we have a lot of the original, um, which helps. Yeah. Yeah. So, so I think one of the things as an educational audiologist kind of being out in the field is that I always. Have this reaction from teachers and sometimes parents and others, even speech pathologists sometimes.
[00:18:40] And they're like, they read a report and they say, Oh, who just has a mild hearing loss. Or, and for me that like boils inside of me because I understand the impact of my mild. Um, but. I guess I wanted to ask you, you know, what are some of those key factors that you found in this study about the impact of mild hearing hearing loss and access to language basically?
[00:19:10] Yeah. So one of the early papers that we published, well, one of the first papers we published as part of the OCHL outcomes of children with hearing loss study, which I call OCHL just for your. The ads, people at Boys town, for whatever reason, call it OCHL, which takes me too long to say, so I call it, um, I'll I, when people call it OCHL.
[00:19:32] So, uh, one of the first papers we published was looking at how much kids wear their hearing aids. And the big takeaway from that was the kids with mild hearing loss were wearing their hearing aids. So that was one of the big predictors for hearing aid. Use time was the severity of the hearing loss. As the hearing loss was more severe.
[00:19:50] The kids. More, their hearing aids more often. And we measured hearing aid use from parent report and from a data logging with the hearing aid. And so from that, we did a follow up paper because we were really interested in like, okay, well maybe these mild kids don't need it to wear their hearing aids. I didn't know.
[00:20:10] Like maybe we're over hearing aids are expensive. We ha I've seen as a cause I, as a clinical audiologist, I've seen. pushback from physicians and other audiologists sometimes about fitting. Hearing aids on kids with mild hearing loss. Um, and so we, so from that, I decided to look at, um, just our mild cohort.
[00:20:31] So the kids in the study that had a mild hearing loss, and it just so happened that it, we had a group of kids with mild hearing loss who never wore hearing aids. And then we had a group and our data kind of worked out and then. A group that we're, um, about six hours per day. So they're probably wearing them at school and not a lot of people say, well, they just need a map score.
[00:20:50] Yeah. And then we had a group of kids with mild hearing loss that really did wear them full time. And we could tell from the data logging. And so we, I ended up taking that data set and just publishing a separate paper on that in, I think. 2013 or 2014. I can't remember when that paper came out. And what we found was really large differences between the kids with mild hearing loss who never wore the hearing aids and the kids with mild hearing loss who wore the hearing aids full-time.
[00:21:18] So the kids with mild hearing loss were the hearing aids. Full-time, we're actually about one standard deviation. Above average in terms of their vocabulary and their grammar skills, but they look just like our typical hearing kids. Cause the typical hearing kids were also about one standard deviation above average, which gets to that issue.
[00:21:39] I was talking about where the norms don't always reflect how the kids are doing. Whereas the kids with, um, the kids that didn't have hearing aids or didn't wear their hearing aids, um, they were more like. They were about one to two standard deviations delayed compared to the full time hearing aid wearers.
[00:21:58] And then they were kind of in the average range compared to the test norms. But to me, that indicates they're not really meeting their full potential. They should look like these kids. They should look like the typical hearing periods that they don't need hearing aids. And they should look like these. My other kids with mild hearing loss that are wearing the hearing aids full time.
[00:22:16] So it does indicate to us hearing aid can help even with just a mild hearing loss. Um, we had another paper we published last year, where we looked at called hearing aid dosage, where we measured, how much the kids were wearing their hearing aids in combination with how much access they got through the hearing aids.
[00:22:33] Um, Based on the speech intelligibility index. And we kind of see this, the data seems to like acetone e around speech intelligibility, index of 0.8 or 80%. And what that means is kids who have access with without no hearing aids on unaided. Audibility. Um, if they have access to 80% of the speech spectrum, it doesn't seem to make a difference if they have hearing aids or not, or if they wear the hearing aids full-time or not.
[00:23:01] But for the kids that were, that had, um, less than 80% access to the speech spectrum without hearing aids on, they seem to need the hearing aids. So, so there seemed to be kind of this like split in the data. Like there is a point at which you have a mild hearing loss and you may not need to wear hearing aids, but just grouping it all in this big category of mild.
[00:23:23] Doesn't really reflect that because mild is kind of actually kind of a broad range. So, so that's where the speech intelligibility index. We're also really into audibility in this research project and how much access you're actually getting through your hearing aids. And that can be measured with the speech intelligibility index.
[00:23:42] So I just kind of reviewing some of your study before it, and you had an acronym ACCESS, so, Oh yeah. That's I can't take credit for that. That was Mary Pat. She was the one that came up with that. Mary Pat is really good at coming up with acronyms and by Mary Pat, I mean, Mary Pat Moeller. Yeah. She was the principal investigator on the original OCHL study.
[00:24:08] She's now retired. She's living in North Carolina with her near her grandkids. Um, I miss her every day. Um, so yeah, Mary Pat came up with an acronym. And are you going to ask me what? I can't remember what it stood for. I can tell you what it means. That's what we've got this grant on mild hearing loss.
[00:24:27] And just as you were doing the introduction, I thought, Oh, I bet she's going to ask me about the acronym for our mild hearing loss grant. So I pulled up Facebook cause I knew I had it on Facebook. And you asked me a different acronym. Well, that's okay. We can do the acronym for mild because I didn't think, I didn't know.
[00:24:45] You have that acronym actually. Yeah. But I can't, we have so many acronyms. I can't keep them all straight. Tell me the acronym that I have for mild. Cause no, no. Let me see if I can remember the access first. Yeah. Okay. Is a for audibility? Yes. Okay. One point C. He for consistency. Um, that's the third one.
[00:25:11] Let's see, I guess what's the first C I can't remember. So that gets it out of bill. Okay. Carefully fit Hearing-aids, consistency of hearing aid use. Um, he is, uh, I know one of them is like supersized services. Is that one of them? Yeah. So, um, he was environments conducted learning. Okay. I to remember that one.
[00:25:39] Yeah, S remember one of the S's is what I want to be. So super something about supersize service. Is there something to that service provision. Oh, okay. And then another one was selected areas of language. The morphology is weakness while I did really bad with that. I got one letter. Well then tell me about that one, the newest acronym.
[00:26:05] So the newest acronym is called fast track. And this F a S T R a K And this is our new grant that we just got funded through the national institutes of health this summer. And it's looking at kids just with mild hearing loss. And I don't mean just a mild hearing loss. I mean, Only mild hearing loss is the focus of the research study.
[00:26:35] Uh, so, and a lot of it came out of the research we've been doing where we, I mean, the paper that we published, looking at the non-users versus the full-time users, and then the, um, the articles that came out this past year, looking at kind of this. Speech intelligibility cutoff and what the criteria should be for fitting hearing aids.
[00:26:54] So the purpose of the fastrak grant, which stands for I'm gonna look at it, cause I can't remember finding appropriate solutions to treat reduced audibility in kids. Uh, the purpose of that grant is to focus on improving diagnosis and intervention for children with mild hearing loss. And one of our, I would say one of our goals is to try to do like we're a little bit of.
[00:27:19] I don't know, our, one of our crazy goals is to try to get rid of the term mild hearing loss. Although I still find myself using it all the time, but we would, we would like to just get rid of that term. Cause it's, it's a misnomer. I just, I hate it. I use educationally significant. Yes. At times, because I feel like that can be very broad in the degrees of losses, but yeah.
[00:27:47] Yeah, yeah. Trying to do we use educationally. That's what I've always said to use the term educationally significant. Um, the other thing that we're advocating for audiologists to do in counseling is to talk about what is the child's speech intelligibility index. Because to us that seems like a really salient concept to parents.
[00:28:06] Like how much access does this child have without hearing aids? The speech spectrum, which is what the SII can give you. And then how much access do they have with their hearing aids? So you could have a kid with a mild hearing loss. Um, we looked at our dataset and if we took all of our mild kids, um, the average SII was around 0.6.
[00:28:27] So they, on average kids with mild hearing loss access to about 60% of the speech spectrum and with hearing aids, they have access to about 90 to 95% of speech. And, and we feel like that concept can really click with parents because one thing, again, as a clinical audiologist, I used to, I was at the VA a long, long time ago, and people would always come in and they'd say, What percentage hearing loss do I have?
[00:28:53] And that would drive me nuts because I'm like, well, we don't measure hearing loss as a percentage. And I'd always cringe when I get that question or I'd have someone come in and say, well, the doctor told me I have a 50% hearing loss. I'm like, where, where did you get that? Like, who told you that? Um, but then I started realizing when we were really looking.
[00:29:12] This SII stuff. I mean, that really is what the speech intelligibility index is telling you. It's not saying you have a 50% hearing loss, but it's saying that's how much access you have to the speech spectrum. And I close when you're close to the speaker at a conversational level. So it's not taking into effect, background noise, or distance
[00:29:33] And that's why I think it's good concept for counseling with parents, because you can say, okay, when you're speaking to them from a meter away at a conversational level, they'll be able to pick up maybe about 60% of what you say when you add in background noise. When you walk further away from your child, that SII.
[00:29:53] I is going to go down and they're not going to have, they're going to have access to maybe 20% of the speech spectrum. And this is a kid with a mild hearing loss. So, so I, I think that it's, I think that the SII is brilliant and I love it. And we talk in my lab about how we have an audibility cult. because we talk about audibility all the time in my research lab.
[00:30:13] But, uh, uh, but I just, I think it, it, it makes sense to families like to parents, to teachers too. Yeah. And just, we, and maybe that goes into my next question is, you know, we know that. These different factors need to be in place to optimize opportunities for children who have different degrees of hearing loss who are wearing hearing aid
[00:30:39] But what. Advice, would you give audiologists out there right now? Um, obviously, maybe joining your audibility, speech intelligibility cult
[00:30:58] So we all have to join the cult. I have this speech intelligibility. I call it. But what advice would you give to audiologist right now? So, one thing we're trying to talk to audiologists about in this kind of, I mean, this would be changing practice, practice patterns, but you can measure the SII. You don't, it doesn't have to be part of the hearing aid fitting appointment.
[00:31:21] You can do the diagnostic testing with the baby, um, like with ABR or when we, when you do, um, VRA when the baby is six months old, you can get their threshold. You can plug that into a Verifit or some other machine, and, um, it'll calculate the SII for you. And so you could use that. You can put it in their report, you can talk to the parents about it.
[00:31:45] It doesn't have to be tied into the hearing aid appointment. It can be part of the diagnostic appointment as well, but that would take. Pretty big change because a lot of audiologist may not have access to the audioscan, machine that we use to calculate the SII. And, uh, especially the diagnostic appointment.
[00:32:06] Like you just may not have one handy. So you can't really punch the number in one thing. I know Boys town and I I'm probably gonna totally explain this wrong, cause I don't know. The details. I know Boystown has been developing a program, they call Sharp. That would be like an app that you could use to calculate the speech intelligibility index.
[00:32:24] So, um, but yeah, to have it be more, a part of the diagnostic visit would be one big change that we haven't really been doing. The other thing that I think is really important is, um, making sure that we're using either. Really are measures when we're fitting the hearing aids or simulated real ear measures like measuring the SREA and babies, as opposed to using things like, um, aided speech, aided sound, field testing, or functional, what we call functional gain when we're doing hearing aid fitting.
[00:32:55] Big thing that we found in a study was there was huge variability and how wow. Well, the kids' hearing aids were. So we had some kids who were fit to target, fit to prescriptive targets for their hearing aids And we had other kids that were way off target. And, um, and the thing that we found, this was a paper by Ryan McCreery, Ruth battler, and Pat Rousch.
[00:33:17] I think again, it might've been in like 2013 or 2014 that was published in the ear and hearing. Um, but one of the things they found was it had to do with how the audiologists were fitting the hearing aids, if they were using, um, really or measures or simulated really, or measures to program, the hearing aids tended to be fit closer to target.
[00:33:43] entirely. We had very, that, that. We've had very, very few kids that we've seen that were, overfit like a couple out of 317 children who we're seeing across multiple visits. So they were wearing ear plugs at that. They were essentially wearing earplugs. Yep. Yeah. Yeah. So bad, extreme. I don't know if they were, I mean, they were probably getting some audibility.
[00:34:08] It just wasn't to the, and we were using that as our targets, the DSL targets. So desired sensation level. Yeah. And we're just below target. Yeah. So what about parents? What would you, what kind of advice would you give parents who have these kids with mild degrees of hearing loss? So one of the big things I would say is, um, don't rely on their articulation skills, their speech production to tell you if they're doing okay.
[00:34:40] Because one thing we found really across all of our kids with mild to severe hearing loss, but especially the kids with mild, moderate hearing loss, their speech production sounds really good. They're very intelligible and people take those speech production skills as a sign that they're catching everything.
[00:34:58] Their language is fine because sometimes it's kind of hard to differentiate between speech and language. And so we would see these kids that had great articulation, perfectly intelligible speech, and then, but they would have these underlying language deficits in areas like morphology. So adding word endings, grammatical markers, um, That, that seems to be a weakness.
[00:35:22] We've also seen some weaknesses in vocabulary. And our theory is that that's going to cascade into like problems with reading comprehension, because vocabulary and grammar are so important for reading comprehension. Once you get to junior high and high school. So we don't have evidence for that yet, but we suspect that there's that's, what's going to happen.
[00:35:40] So, so that would be one of the big things is, and I would say that for speech pathologists too, like, just because they've met, they can do the Goldman Fristoe test of articulation and not have any errors on it doesn't mean that they need to be. Out of, out of speech therapy, speech, language therapy. I mean, there's this whole language component to it too.
[00:36:01] The other thing I would say that we've found is, um, just how important self-advocacy is teaching these kids pretty early on to take care of their equipment. That it's a part of them that, uh, that they like by the time they get to elementary school, they can be doing things like. Checking the batteries and, and they do need to wear the devices.
[00:36:26] So, um, but also being able to advocate for themselves in the classroom with their peers, with other teachers, I think that self-advocacy piece is just so important and some of the kids I've worked with are just so amazing. At the self-advocacy like, I just, I love seeing them because my, one of my favorite I'll tell you a little story.
[00:36:45] Um, I always say this when I'm giving talks, we had this little girl and I think she was in first grade at the time. And so for a school project, she had to talk about something that was special about her and she picked her ears and she had her teacher take a picture of her ears with her hearing aid on.
[00:37:01] And, and she wrote this little passage and it said, I can't remember. It was like, um, my ears are what makes my ears are what makes me unique. My hearing aids help me hear. It was, it was something like that. And it would just, I loved how she was only like seven years old, but it was just. Like she knew that was something that made her special in a good way.
[00:37:20] Good way. And she wanted to talk about it and to talk about, yeah, we're going to empower them early on. Then hopefully when they get to that junior high or middle school period of time, they become a part of them instead of like, I'm going to take them off and I don't need them. Yeah, and I should be embarrassed of it.
[00:37:39] Exactly. I have one girl who was in junior high and we saw her not too long ago. And I said, I was just like, well, so what do people say about your hearing aids? She's like, Oh, I tell everybody that it's this cool wearable device, like a Fitbit, but it's just on my ear that it's just like, so everybody. Yeah, it's cool.
[00:37:56] It makes it it's really cool. Yeah, I'll have to remember that one.
[00:38:03] And one of my other last questions would be like, what would you tell advice for educators or SLPs who are in the schools about mild own hearing loss? Well, one thing. So I already said the thing about this articulation, um, another, okay. So there's kind of two things. One thing that we've found that I think speech pathologists and teachers should be aware of is, um, that we do see this weakness in morphosyntax or grammar, particularly high-frequency.
[00:38:36] high pitch, low intensity sound. So English is not a very friendly language to hearing loss. So because like a lot of the English morphological markers are these very high pitched sounds like S so, um, plurals past tense, ed. Third person singular, like he walks to the store. Those are really hard sounds.
[00:38:57] They're just not very salient. We have, we say they don't have a lot of phonetic content. And so it's hard for these kids to be able to perceive those sounds. So they may be able to produce an S sound pretty well, but they may be not necessarily recognizing when you need to use a plural marker when you need to use these different grammatical.
[00:39:16] markers. So paying attention to more syntax is really important. Um, another thing that we've found, I could say a lot of things, but because I get very excited about this topic, um, uh, is, uh, vocal with vocabulary we've found. And this, again, doesn't just apply to mild hearing loss, but we've seen this with.
[00:39:36] Kids with mild hearing loss, we have different measures. We use to measure vocabulary. A common one is the picture Peabody picture vocabulary test, which is a receptive language measure where you see different pictures on a page. You hear a target word you're supposed to point to it, the problem. And I love the Peabody.
[00:39:51] It's great measure. The problem with that is it's really only testing their surface. Of all knowledge of, of words and how it's testing, how many words they know, but it's not really getting at how much do they actually know about those words? What's the depth of their knowledge. So one thing we've found, um, is that how much access they have to the speech spectrum through their hearing aids.
[00:40:13] Again, all comes back to SII will predict their long-term growth in the depth of their vocabulary knowledge. So we, and we see that they just. Kids with, um, mild and moderate and severe hearing loss, um, seem to, they seem to be catching up over time in terms of how many words they know, but they never quite catch up and how much they know about words, the depth of their knowledge and their audibility seems to be really tightly linked to that.
[00:40:41] Mm. So, um, and then there was one other thing with the mild hearing loss that I wanted. Oh, okay. So then this other thing that we've found that's really, I think is very interesting. We've seen this consistent pattern with our mild kids where, um, there we call it, we call it our sweet spot. So our kids with moderate hearing loss on average look just like our typical hearing kids.
[00:41:06] The kids with mild hearing loss are just a little bit below that. So, um, and then the kids with severe hearing loss have more of a deficit. And so we call these kids with moderate hearing loss our sweet spot, and we think that's kind of, because they're probably getting pretty consistent intervention. They're wearing the hearing aids and they can be fit appropriately for their hearing loss.
[00:41:25] Whereas the kids with mild hearing loss, um, It's almost not enough. It's not enough of a delay to cause a concern, but enough that I would be worried they'd fall through the cracks. Um, so they're just kinda like coasting along, but I don't think they're really reaching their full potential. And that is probably the result of maybe not wearing the hearing aids or not being fit with hearing aids and maybe not getting consistent special education services.
[00:41:57] And then over time, that gap probably widens. That's what our question. Yeah. We wonder that's why we want to look at them in adolescents, because we do wonder if that gap widens over time or not, because right now it just, it's just this, like, you can see it. If you look at any of our papers, um, especially the last couple of years we've been publishing on, um, how these kids are doing in second and fourth grade.
[00:42:21] And you can see this trend where. It's just the mild kids are just a little bit lower than the moderate kids. They really should be at the same level. They should be performing at the same level as, and that we see that, especially in morphosyntax, but we also see it in vocabulary measures and reading comprehension measures.
[00:42:43] So, um, but we haven't really tested the kids past fourth grade, so we don't know what happens after fourth grade. Okay, which is why you need to get this other grant
[00:42:58] anything like, or you can't talk about a grant that you just submitted. I think I'm allowed to do that. We didn't talk that much. No, there's no embargo or anything. So is there anything that I didn't ask you that. You want to make sure our listeners know whether their parents are educators and speech pathologists and audiologists.
[00:43:22] Just anyone out there? I guess I would just say, Oh, I don't know. I feel like I should come up with something really profound here, and I'm not, nothing's really coming to mind, but, um, don't overlook these kids with these mild to severe hearing loss. And that is our big take home message that we do. We can see that these kids can like going back to what our original question was, the way we started off the podcast today, what was the original purpose of this longitudinal study was to see, can these kids keep up with their same age peers and what are the factors that seem to support, um, resilience, kids that are keeping up.
[00:43:58] Versus the kids that falling behind and it really seems to get back to, we can, kids can definitely keep up these kids with mild to severe hearing loss they can do as well as their same age peers. Um, But, but it's not, but they can't just do it on their own. Like, we need the support of teachers, which propel, just parents.
[00:44:20] Um, we need to be teaching these kids. Like I said, these self-advocacy skills and, and realizing again, like what you said, the, the device is just a part of them and they're going to need that in order for the classroom to be accessible. That's going to be a part of life, but, uh, but they can succeed. They can meet, they can meet, um, high, high goals, whatever the parents goals have for them.
[00:44:44] And I've definitely seen that with these kids that have been in the study. They've done amazing things. Yeah. No, I'm so thankful for all of the information that you have and all of the resources that. Your group has pulled together and made accessible, on the websites. Um, and I'm going to post that in the show notes too, and on the Facebook page so that people can click on that and get all of your amazing brochures.
[00:45:09] Oh yeah. I was going to say, make sure you post something about the infographics. Graphics, we do. We love infographic and we spent a lot of time coming up with these infographics and they are available still. We have money, Phonak donated money to us so that we could ship the infographics to whoever wants them.
[00:45:30] And so we still have some of that money left. And so if you just. No to our webpage www.ochlstudy.org, which Carrie will post in the show notes. I will. Um, you can, there's like a little thing you can click. If you want any of the infographics for your office, for your home, share with family to share with family.
[00:45:58] Right. And you can download them as well. And you can email them. I have them in like six different languages. Now it's funny because I think every time I give a talk, somebody comes up to me afterwards and they're like, I can translate that into Dutch for you or Arabic or. So, so yeah, so we've been translated into multiple languages as well.
[00:46:18] Good. Very much accessible. Yes. Very, yes. Infographics are very accessible. That's good. But I just want to thank you for coming on to the podcast today. I hope our listeners gained a good perspective that mild is not mild not my own and that we really need to look at these kids in a different way so that they can reach their fullest potential.
[00:46:43] And they. They can, it's just a matter of how we approach it and how we support them. And, um, And everything else that kind of goes into that village and that child, that whole child. So, um, again, that bath, I am so thankful for you coming on today and I really appreciate everything that you had to share and all of the work that you do.
[00:47:07] Thank you. I cannot wait to see you in person at ASHA someday. I know, I know.
[00:47:19] Yes, this has been a production of the 3C Digital Media Network