Pediatric Audiology

The good professor doesn't mince words. "The most important thing we can do in audiology is
accurately diagnose hearing loss in infants," said James W. Hall III, PhD. "There are many things
that are important, but none as urgent as that. If we can accurately diagnose an infant's hearing loss
- describe accurately what type of hearing loss it is, how much loss is in each ear, what their
audiogram looks like - and get the appropriate treatment based on that information within the first
few months after birth, that child's life will be forever changed for the better."
Hall, one of the 34 founders of the American Academy of Audiology (AAA), is adjunct professor of
audiology at Nova Southeastern University in Fort Lauderdale, Fla., and Salus University, Elkins
Park, Pa. He also carries the title of extraordinary professor in the department of communication
pathology at the University of Pretoria in South Africa. He has taken his overarching message of
early diagnosis and treatment literally around the world to regions near and far. He is set to present
on the topic in June at HEARD 2014 Pediatric Audiology Symposium in Charlotte, N.C., before
carrying his clarion call to China and to an audiology meeting in Australia later this summer.
Development Hinges on Hearing
Emphasizing the importance of super-early diagnosis and treatment, Hall explained that without
adequate hearing, a child will not develop adequate speech and language, and will also likely lack
normal psycho-social development while lagging behind in learning, reading, self-esteem, confidence
and more.
"A normal hearing child will usually say a first word between 1 and 1-1/2 years of age. But the child's
brain is already being shaped by the speech they hear all around them within the first six months
after birth. So well before a child ever says that first word, the auditory part of the brain is being
developed," said Hall. "If babies are not hearing within that critical first six months, they are really
losing out developmentally.

Timeline for Testing

The important timeline in infant hearing screening can be captured in an easy-to-remember rule of
thumb, said Hall. "It's called the 1-3-6 Rule. By one month of age the infant should undergo hearing
screening (which is usually done in the hospital after birth in the U.S.). By three months the hearing
loss should be diagnosed. By six months, intervention must begin. That means when a baby has a
hearing loss and needs a hearing aid, it should be on the child's ears and the rehabilitation under
way by the age of 6 months. No later.
"Of course, we can do this. The technology exists, the skills exist," Hall told ADVANCE, however he
also said the unfortunate reality is that many audiologists simply do not know how to diagnose infant

hearing loss.
Hall explained that the Joint Committee on Infant Hearing provided a blueprint for infant hearing
screening/diagnosis/intervention in 2007, which remains the basis of clinical protocol. "We strive to
perform the diagnosis before the infant is 3 months old, because they still sleep a lot at that age, and
these tests are best done while the infant is sleeping," he noted. "If they are done later on, the child
may need sedation or light anesthesia, a hospital visit, and that means a much heftier financial
burden. The cost of testing goes from the $300-$500 range to the $4,000-$5,000 range."
Typically when an infant is screened and a hearing loss is suspected, the infant is referred to an
audiologist trained in pediatric audiology diagnostics. The primary tests used in this phase are the
auditory brain stem response (ABR), which can determine how much hearing loss exists in each ear,
and the otoacoustic emissions (OAE) test during which little rubber tips are placed in the ears to
record each ear's response to soundsthat are presented. "The OAE takes only a minute per ear," said
Hall. "It is used both in screening and diagnostic testing because it tells us whether the delicate little
hair cells inside the ears are working normally. There are another four or five procedures we do in
addition, to determine exactly where hearing loss is located - in the eardrum, the bones behind it,
the inner ear, the nerve, or even the brain."

Shortage of Specialists
Despite the urgent timeliness for diagnostic hearing tests, there is a shortage of trained specialists
here in the U.S., which means patients often must travel further and wait longer for needed
assessments. "In more remote areas of the country, you may have to drive three or four hours to a
large teaching hospital for these tests," said Hall. "And even in California, where half a million
babies are born every year, there just aren't enough pediatric audiologists to go around."
The need has become even more evident more since the field's recognition that not all pediatric
hearing loss occurs in infancy - some occurs or progresses later in childhood, due to genetic factors
in some cases, health and environmental factors in others. For example, children treated with
antibiotics for various infections, or with chemotherapy agents during treatment, could be exposed
to an ototoxic drug, putting them at risk for hearing loss. Pediatricians are apt to pick up hearing
loss among children of any age; when they do, they need to refer the child to the right audiologist.
Hall hopes to broaden that field of pediatric-qualified audiologists. "I have dedicated much of the last
15 years of my career to conducting workshops through the National Centers for Hearing
Assessment and Management (NCHAM), working with audiologists who know about hearing loss,
know about hearing testing, but who don't have experience in diagnosing hearing loss in infants or
interpreting the results. At the workshops we lecture on how to do it, demonstrate the testing and
give the audiologists an opportunity to practice it."
Hall said most audiologists agree that there is a lack of pediatric specialists - more opt for the
geriatric age group. Recognizing this provider shortfall, the American Board of Audiology began
offering a pediatric certification about three years ago.
Every Audiologist Is Responsible
"It is the responsibility of every audiologist, specialist or not, to contribute to the early identification
of hearing loss," reprised Hall, saying this is the "gospel" he hopes to spread. "If you don't have the

skills, either get them, or make sure to refer every infant you see for a complete diagnostic hearing
assessment if you have any reason at all for suspecting a hearing loss.
"The system is there, it's just a matter of understanding the urgency for a rapid diagnosis early in
life," said the professor. "In every day that passes when an infant has hearing loss the brain is being
affected by that loss. Every single day is important. The clock is ticking ."
Valerie Neff Newitt is on staff at ADVANCE. Contact: vnewitt@advanceweb.com

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