Audiologists

Frequently Asked Questions

1. We don't have an audiologist in my school system. How do I get services for my students?

Georgia regulations require a comprehensive audiologic evaluation at least once a year for any student identified as deaf or hard-of-hearing. This evaluation must include otoscopic inspection, unaided and aided pure tone and speech audiometry (as applicable), immittance testing, word recognition, hearing aid check and electro-acoustic analysis of the hearing aid (if amplified), and an analysis of a frequency modulated (FM) system check (if utilized). If your school system does not have an educational audiologist on staff, they may contract with an audiologist licensed by the state of Georgia to provide the required comprehensive annual evaluation. For a list of audiologists licensed in Georgia, contact the Georgia Board of Examiners in Speech-Language Pathology and Audiology at (phone, website).

In addition to the Georgia regulations, the IDEA Federal Regulations list the following services under the definition of audiology. These services are also described in Section V, Audiology, in Georgia's Resource Manual for Hearing Impairment (pp. 40-63).

(i) Identification of children with hearing loss;
(ii) Determination of the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the habilitation of hearing;
(iii) Provision of habilitative activities, such as language habilitation, auditory training, speech reading (lip-reading), hearing evaluation, and speech conservation;
(iv) Creation and administration of programs for prevention of hearing loss;
(v) Counseling and guidance of children, parents, and teachers regarding hearing loss;
(vi) Determination of children's needs for group and individual amplification, selecting and fitting an appropriate aid, and evaluating the effectiveness of amplification.

If you have one or more students in need of the services described above, this need should be documented in the student's IEP. Recommended services could then be provided by an educational audiologist (full or part-time) hired by your school system or, again, by the school system contracting with an audiologists licensed by the state of Georgia. For more information on educational audiology services or a list of educational audiologists currently practicing in the state of Georgia, contact the Educational Audiology Association, 4319 Ehrlich Road, Tampa, FL 33624, 800/460-7322 http://www.edaud.org.

2. What are some good resources for auditory training?

With an increasing number of children using cochlear implants in our schools, there has been renewed interest in the development and improvement of auditory skills. A number of auditory curriculum guides are listed below, together with both new and older publications including techniques and strategies that have practical application in our school population.

Curriculum Guides:

• Auditory Enhancement Guide (1992). Alexander Graham Bell Association for the Deaf and Hard of Hearing, 3417 Volta Place, Washington, DC 20007-2778

• Auditory Skills Curriculum (1976). Foreworks, Box 9747, North Hollywood, CA 91609 · Auditory Skills Curriculum Preschool Supplement (1986). Foreworks

• Bringing Sound To Life: Principles & Practices of Cochlear Implant Rehabilitation (1999). York Press, Inc. P.O. Box 504, Timonium, MD 21094.

• CHATS: The Miami Cochlear Implant, Auditory & Tactile Skills Curriculum (1994). AG Bell Association.

• DASL II (1992). Resource Point, Inc., 61 Inverness Drive East, Suite 200, Englewood, CO 80112-5128.

• SPICE: Speech Perception: Instructional Curriculum and Evaluation (1996). Central Institute for the Deaf, 818 S. Euclid Avenue, St. Louis, MO 63110.

Sample books and videos available from the AGBell Association, www.agbell.org:

• Estabrooks, W. & Marlowe, J. The baby is listening. (Video and guidebook).

• Montgomery County Public Schools. Cochlear implants, a choice for listening. (Video)

• Cole E. & Gregory, H. Auditory learning. Volta Review Monograph 88.

• Erber, N. Auditory training. (Book)

• Northcott, W. I heard that! A developmental sequence of listening activities for the young child. (Handbook)

• Sindrey, D. Cochlear implant auditory training guidebook.

• Sindrey, D. Listening games for littles.

• The ABC's of AVT: Analyzing auditory-verbal therapy. (Video)

3. My student won't wear his hearing aid. What should I do?

First, depending on your student's age, try sitting down with him to see if the two of you can figure out why this is happening. Some questions to consider include the following:

1. Is the earmold uncomfortable?

2. Does the hearing aid fall off easily?

3. Is the hearing working OK?

4. Is the hearing aid doing what it should for your student, and does he know what his hearing aid is for?

5. Does your student seem to take his hearing aid off to get attention?

6. Is your student concerned that the hearing aid makes him "different" from his peers?

If you have concerns about questions 1-4, contact your student's audiologist for recommendations. A remake or another earmold style could be a quick solution for question #1. Audiologists, manufacturers, and creative parents have come up with a variety of ways to stabilize behind-the-ear (BTE) hearing aids and those with bone-conduction (B/C) oscillators. The student's audiologist may have specific suggestions for his aid(s). Concerns about questions 3 and 4 may require an updated audiological evaluation and/or some one-on-one informational counseling with the student and/or his family. Question 5 may also indicate a need for parent counseling or a behavior management program. A positive response to question 6 is typically an issue for upper elementary, middle, and high school students, and each student may ultimately choose to handle peer reaction differently. Counseling about the student's hearing loss and its consequences (both information and support for social/emotional/self-esteem issues) may be helpful. Resources for working through these issues include the KIP (Knowledge is Power) program, available from Mississippi Bend Area Education Agency, 729-21st Street, Bettendorf, IA 52722-5096, and Self-advocacy for students who are deaf and hard of hearing, published by Pro-Ed, 8700 Shoal Creek Blvd., Austin, TX 78757-9965.

4. Is there any source I could use to get some loaner hearing aids for my students when theirs are broken?

If a student's hearing aid is broken, each school system must have appropriate amplification available for instruction as specified in the student's IEP. In many cases this will be a personal FM unit, but some school system audiologists also keep a stock or "bank" of loaner hearing aids on hand for these situations. It is important that any loaner hearing aid provided for a student is fit to the individual's hearing loss. In addition, a loaner hearing aid bank requires funding to insure that the aids are working correctly.

If a student is followed by Children's Medical Services, this state agency may have an appropriate loaner hearing aid for use until the student's own aid is repaired. Contact the CMS audiologist for your area for details on their loaner hearing aid program. Private audiologists also can maintain loaner hearing aid banks, or they might be able to access loaner aids from a variety of manufacturers or companies that repair donated hearing aids. Again, a direct contact with the student's audiologist may result in an appropriate loaner for him or her.

Many of us have had the experience of siblings or parents who have informally "loaned" a student their hearing aid(s). If this happens, contact the student's audiologist immediately to check on the appropriateness of the fitting. More often than not, this isn't the best solution for the student.

Finally, if a student's hearing aid is broken repeatedly, follow the steps described in answer to Question 3 above.

5. How do I know if my student is really benefitting from his hearing aid?

First, the student's audiologic evaluation report should include information concerning benefit from his/her current amplification. The Georgia State Regulations for students who are deaf and hard or hearing state that "...The annual audiological evaluation shall include...unaided and aided pure tone and speech audiometry...hearing aid check and electro-acoustic analysis of the hearing aid...(and) written report shall include...an amplification evaluation including the student's ability to understand spoken language with and without amplification, as well as an interpretation of the results as they apply to the student in his or her classroom setting." Check your students evaluation reports for current assessment information related to benefit you should be seeing when they are using their hearing aid(s).

Second, if the student's hearing aid is nor working correctly, the student can't receive maximum benefit from it. As a quick informal check, you can use the Ling 6-Sound Test to see if the student is hearing all 6 sound (oo, ah, ee, sh, s, m) at the same distance he or she normally does. In order to use this tool effectively, each student should have a baseline Ling check with his hearing aid(s) that indicates at what distance (in quiet) each sound is heard (e.g. across the classroom, @ 10 feet, 6 feet, 3 feet, 1 foot, NR). These results should be compared with the student's aided audiogram, and if there are inconsistencies, contact the student's audiologist for an explanation. Once you have a baseline, a quick check can be done throughout the day to see if the student is hearing as you would expect. (This check should take no more than 15-30 seconds.) If his or her response changes, this may indicate a need for a more detailed hearing aid check or re-assessment of the aids.

Other signs of a need to check the operation and/or fit of the hearing aid and/or earmold include the following:

• The student constantly fiddles with the volume control

• There is frequent feedback or squeal (this should be rare for a school-aged child)

• The student frequently complains that the aid isn't working, cuts on and off, or sounds "funny"

• The student complains of discomfort

• The hearing aid flops around or falls off frequently

• The student doesn't respond to sound that he or she typically reacts to (e.g. calling name by peers, routine classroom instruction, unexpected environmental noise such as a door slam, book drop, etc.)

Student complaints can be a result of needing attention, but complaints about amplification should be addressed quickly before they are dismissed.

Finally, benefits from amplification can be seen as students progress on their auditory goals. They may respond differently when using different forms of amplification (i.e. personal hearing aids vs. FM units), but if there is an appropriate fit and amplification is being used full time, progress should be evident.

6. Can you refer me to some sites where I can find out more about trouble-shooting hearing aid problems?

Your best source for information on troubleshooting hearing aids is your school audiologist who should be able to provide information, forms, and procedures that will work effectively in your classroom.

If your school district doesn't have a school audiologist, try contacting the audiologist(s) who fit your students' hearing aids for information and written instructions.

Hearing aid manufacturers supply trouble-shooting information with each hearing aid they supply to a local dispenser, and a copy of this should be available to the teacher as well as the family. Many manufacturers also publish teacher guides that include instructions and/or forms for general daily hearing aid troubleshooting. Three examples of these are from Oticon www.Oticon.com (click on USA, then Oticon4Kids), Phonak www.Phonak.com (click on Consumers and Children) and Unitron www.Unitron.com (click on Consumers, then Kids Klub).

Another suggestion is to request an inservice from a local audiologist for all staff members who are working with students with hearing aids.A

dditional forms and suggestions for daily troubleshooting of hearing aids can be found in the Educational Audiology Handbook, by Johnson, Benson, and Seaton (1997), published by Singular Publishing Group (www.Singpub.com).

Finally, there are many more websites that provide information and/or forms concerning hearing aids and their use and maintenance including www.listen-up.org, www.lhh.org, www.utdallas.edu/~thib/rehabinfo/, and www.boystown.org. For each of these websites, click on the designated link for hearing aids or amplification.

If you have additional questions, submit them here.