Functional Listening:

Parental Observations Key
in Audiology Sessions

Kristin Dilaj, AuD/PhD, CCC-A

When studying to be an audiologist, we study the art and science of counseling  families with regard to hearing loss, the recommendations that might be made based upon certain test results, and how to program hearing aids/cochlear implants for children  not yet able to provide us with immediate feedback as to what they are hearing.  However, the learning does not stop there.  As an audiologist working in a Birth-to-Three and primarily pediatric facility, I have learned the importance of having parents and family members as equal partners and team members.  The role of parents involves far more than passively receiving information; parents are the experts when it comes to their children and knowing what their children can do.  I have found that parental observations and input provide critical keys to success with creating supportive services and using a device well.

As audiologists, we do not go home with families. We often only see them for an hour at a time.  As a result, we do not know how well the child is performing with his/her device settings once away from the clinic.  We have wonderful tools to assess how well the hearing aids are set including real ear measures (which determine how much amplification the child is receiving through the hearing aids) and word recognition testing (testing in quiet in the booth to determine how accurate the child is hearing sounds in words).  However, these tests do not demonstrate functional performance with the device after families leave the office.

I have learned that information from parents is critical in improving access, ease of listening, and overall communication performance with devices.  For instance, a child may achieve a score of 96% correct for the words on my lists in quiet settings. However, at home the parent notices that the child isn’t detecting sounds from a distance, is unable to hear in noise, and does not respond to their own name when called.  While my results may show the child has good access to sounds in quiet, this does not match with the functional listening experiences of the child in the home.  As a result, listening observations of parents may alert the audiologist to changes to the hearing aid, cochlear implant, FM system, or bone anchored hearing aid settings that can impact functional listening abilities.

Audiologists can encourage parents to notice and respond to any behaviors that change in a child and how those changes might signal a need for device reprogramming. Recently, we received a call from a parent who believed her child needed a new MAP for her cochlear implant because her behavior had changed in school and at home.  This child tends to be very easygoing, cooperative, and energetic.  While other professionals had indicated they thought this child was continuing to perceive speech quite well, the parent reported the child was snippy, argumentative, and sluggish.  The parent scheduled an appointment due to the behavioral concerns.  Speech perception testing was good prior to the MAPPING session, however, following the session, the child’s behavior was completely different.  It was apparent that the child was having difficulty even though she could perceive words in quiet with ease.  The parent called to report that she noticed her child’s attitude and behavior had gone back to her usual demeanor.  Behavior changes, changes to speech perception, and changes in awareness of sounds are all observations that can be made by the family and other professionals that can be indicative that a device needs to be reprogrammed.  In turn, parents can help a child understand what happened so that a child’s ability to perceive changes grows with time and experience, and the young adult will be able to identify a need for device adjustments with this support.

Additionally, reports from parents prior to our sessions help me dictate which testing would be useful for obtaining services.  For instance, if a child is listening extremely well in quiet but is having significant difficulty listening at school, we may focus our session on testing in noise with different FM settings to determine which setup is most effective in the classroom.  We may also do testing in different simulated seating positions, in different types of background noise, or using different types of signals to determine what modifications may suit this child best.  A broader array of objective information can provide more specific recommendations for the school system and provide parents with greater understanding of how the child can hear in background noise.  Not only do we recommend that the parents provide observations prior to testing, but we recommend that they are involved in the testing.  Children often will compensate using different mechanisms in their home environment to continue a conversation.  During testing, they often cannot utilize their compensatory strategies, allowing the parents to see the child’s skills in an “auditory only” situation.  Parents have indicated to me that by sitting in on the session, they can understand their child’s strengths and weaknesses and can offer more specific suggestions during service planning meetings as well as supports when communicating in the home

The parent is the expert when it comes to the child.  Parents know how their child performs in everyday communication, in varying environments, and during testing.  As audiologists, we get a glimpse of how the child manages in our ideal and noise-simulated listening environments.  Parents have significant, important, and valuable information to share during audiology evaluations and rehabilitation sessions that can enhance device programming and improve listening performance, and support their child to learn how to work with their audiologists in partnership as they grow into young adults.

Dilaj serves as a board member for the Connecticut Hands & Voices chapter.