HH/Beck: Hi Dr. Kricos. Thanks for joining me today.
Kricos: Hi Dr. Beck. Thanks for inviting me.
HH/Beck: Let's start with a thumbnail sketch of your professional activities, if you don't mind. Where did you get your PhD?
Kricos: Ohio State University, back in 1973.
HH/Beck: What was your dissertation on?
Kricos: It was on vibrotactile speech perception by deaf, blind and hearing individuals, to see if there was a difference in their perception of speech through vibrotactile sensation.
HH/Beck: What did you find?
Kricos: I found that deaf people were not any more sensitive to vibrotactile speech perception than hearing impaired, and actually the blind did very well. They all did reasonably well, just about the same in fact, but the blind had a little bit of an advantage.
HH/Beck: Pat, how long have you been with U. Florida?
Kricos: 22 years. I started in July of 1981.
HH/Beck: I recall you were at the ARA* meeting in Texas and presented a paper on Audiologic Rehabilitation?
Kricos: Yes, it was Audiologic Rehabilitation Across the Lifespan .
HH/Beck: Would you please tell me about that?
Kricos: Sure. I spoke about the two ends of the age spectrum in terms of challenges, possibilities and opportunities for audiologists.
At the older age extreme, we have wonderful possibilities and audiologists will continue to be needed due to the graying of America. At the other age extreme, pediatrics, there are two primary things that really impact our profession, cochlear implants and Universal Newborn Hearing Screening. And again, these present fabulous opportunities for audiologists, and in particular for audiologists with an interest in audiologic rehabilitation. I think there are almost 40 states that mandate Universal Newborn Hearing Screenings, and approximately 2/3rds of all newborn babies are screened for hearing loss at birth, through a variety of techniques like ABR and OAE. In essence, the quantity of people requiring audiologic services at the newborn end of the spectrum is large, and getting larger.
HH/Beck: As far as pediatric cochlear implant patients, what are reasonable expectations for newly identified cochlear implant patients? What do you tell the parents?
Kricos: Excellent question! Everyone expects their child to do very well, and many will. Amazing performances are achieved by children with cochlear implants daily, but as you know, performance is not uniform across all children. And so it's a huge challenge for audiologists and otolaryngologists to appropriately counsel the family. We want to be realistic, and forward looking, but we cannot promise each child will be a superstar. So it's a challenge, but it's also a great opportunity to figure out why performance might be so different from one child to the next.
HH/Beck: I recall studies over the last few years that looked at hearing impaired children with hearing aids and deaf children with cochlear implants, and they actually perform quite similarly as long as they participated in good aural rehabilitation programs.
Kricos: Yes, that's the key. Appropriate follow-up and provision of the best auditory environment, such as a communicatively rich environment, regardless of the technology on their ears, those are the key issues.
HH/Beck: I know many children tested through Universal Newborn Hearing Screening programs are lost to follow-up. Any thoughts on that?
Kricos: Do you know how large a problem this is, Doug? It's enormous. Virtually half the children that fail the hearing screening do not come in for follow-up. So, if 100 babies demonstrate hearing loss on their newborn hearing screenings, less than 35 of them will get treatment. That's the sad thing about the status quo, and that's the biggest challenge we face at the moment.getting them back for follow-up and treatment after diagnosis.
HH/Beck: Why do you think we lose so many kids?
Kricos: There is no easy answer. Some of it's paperwork. Some parents are just overwhelmed with a newborn baby! Maybe it's the way we're approaching them, or the way we give parents test results before they're ready. There is no centralized system for contacting them. Time and time again we see parents come to large regional medical centers, have their babies, and go back to their smaller towns 50-100 miles away, and it's hard to have a system that keeps track of these families. It is very complicated and very complex, and of course, it costs a lot of money.
HH/Beck: Another problem is there may be an administrative or clerical person who delivers the news that the child has failed the hearing screening, and that person is not a health care professional. Although they may have the best intentions in the world, they themselves don't understand hearing loss and they're dealing directly with the parent, so the diagnosis, treatment and the ramifications and implications of hearing loss are not addressed professionally.
Kricos: Exactly. Administrative people cannot explain the consequences of hearing loss, because they themselves have no idea! So one important key component may be that the audiologist needs to sit down with the parents and review the screenings and the findings with the parents. Also, at that time, they should set-up a follow-up visit to review the information in detail a few weeks later, and then continue with the diagnosis and start working on AR issues as needed.
HH/Beck: Let's suppose a child has been diagnosed with moderate hearing loss and there are no surgical or medical solutions for this particular child. What are the key components of a rehab problem for that child?
Kricos: For children, the component parts are parents who really understand their child's hearing loss, and that their role as parents includes helping the child develop auditory skills through a rich auditory environment. Of course, the audiologist must be able to provide the parents lots of support in a family-centered environment. Typically, parents of newborns are in shock when they first find out their child has hearing loss, or may be deaf.
As opposed to the old days when the child was 18 months old and the parents had already been suspicious, because the baby's wasn't learning to talk, parents of newborns today are in shock when you tell them this information at such an early point. You need to give them time, and it's a good idea to say We'll talk when you're ready.
Most of them rebound quickly and pretty soon they'll say Okay, now we want the information. That's when you give them information. Give them websites like www.healthyhearing.com or other consumer and parent- friendly websites. There's a lot that can be done to effectively and successfully manage hearing loss, and if children receive appropriate and timely intervention, they have every opportunity to achieve normal milestones.
HH/Beck: When you talk about normal milestones you're talking about speech and language milestones?
Kricos: Yes, I mean speech, language, hearing and social milestones too.
HH/Beck: However, the key to achieving these goals is early identification and early intervention, right?
Kricos: Yes. The data from Colorado show the key is not to have them identified at 14 months compared to 2 or 3 years, the key is to identify them before 6 months of age! That's when the children really achieve remarkable results. This has been known for years, but only since Universal Newborn Hearing Screenings have we been able to really identify these kids consistently and early. There was a study done in 1976 I believe by the Lexington School for the Deaf in New York. They studied 5-year-old children and divided them into two groups. The one group had excellent communication skills, and excellent speech and language. The other group were the poor communicators. The one thing they found that separated these two groups of children were the children who were early identified before 16 months of age had excellent speech and language skills and communication skills. And those who were identified and had intervention after 16 months were without exception in the poor language group.
HH/Beck: The cochlear implant studies have validated that too, in a parallel universe. We know that children who are implanted very early, perhaps at 12-15 months, typically wind up being the star performers. So to summarize, early identification with early intervention is key, but waiting until the parents are ready to learn and discuss this with the professionals appears to also be very important.
Kricos: Right. We can wait a few days or a week or two. Remember, these parents are in shock, and information overload is not a good thing.
HH/Beck: Although I know we're out of time, I just wanted to ask briefly, what are you working on at the other end of the age spectrum?
Kricos: At the other age extreme, with older adults, there's a whole different set of challenges. The big thing we're working on at the University of Florida is trying to determine the older adult readiness for hearing aids, or for any kind of hearing healthcare. I think it's important to do this work because only one out of five hearing aid candidates wears hearing aids and we all want to know why is that the case? We know from studies done in other countries that you can give them hearing aids and they're still not going to wear them. So we're looking at all sorts of things, psychological theories, the transtheoretical stages of change and other things too.
HH/Beck: Thanks Pat. I know you're busy, and I appreciate your time.
Kricos: Thank you too Doug. It's always fun to catch up with you and I appreciate your allowing me to discuss these topics with the readers.
*ARA - The Academy of Rehabilitative Audiology was founded in 1966 to promote excellence in hearing care through the provision of comprehensive rehabilitative and habilitative services. Each year the ARA hosts the ARA Summer Institute which provides a forum for discussion on the latest developments in auditory rehabilitation research and therapy. ARA membership is open to anyone conducting research or providing services in the area of audiologic rehabilitation. For more information visit www.audrehab.org or call the national office at 952-920-0484.
HH/Beck: Hi Dr. Kricos. Thanks for joining me today.