Audiology Outside the Box PLLC

06/28/2023

Hello to all of my followers! It’s been a while since I’ve posted, but I do plan to return. I attempted to do so a few months ago, but medical needs within my family made that impossible at the time. My spouse’s well-being always comes first. Now that things are solidly in a better place, I do want to return to engaging with you more consistently. Here’s a bit of what I’ve been up to recently. I attended the Educational Audiology Association Conference and presented a panel on audism with Dr. Kym Meyer of Rethinking Aural Rehab, Dr. Michelle Hu of Mama Hu Hears, and Dr. Tina Childress of See Hear Communication Matters. We had a wonderful time and received much positive feedback.

03/29/2023

I will always correct people about this when it comes up. I will also always tell people that although hearing devices *do* improve clarity of sound (they don’t just make it louder), they don’t provide *perfect* clarity.

(Also, I’ll be back to Audiology Outside the Box soon! My spouse’s illness and demands at my day job have slowed me down, but I’ll be back soon.)

We love this quote from a presentation by Dr. Sarah Sparks, a deaf audiologist from Audiology Outside the Box PLLC 🎯 She also explains that we can only amplify sound so much before it becomes distorted. Listening devices like hearing aids and cochlear implants do not provide the same clear, crisp input that typical hearing does.

Image description: "Hearing sound is not the same as hearing it clearly. Hearing devices do not provide clarity of sound. - Dr. Sarah Sparks

10/31/2022

For my first post after the long absence, I'm going to address a question I'm asked frequently by parents and professionals alike: what are the Ling 6 sounds, and how do audiologists use them? There are misunderstandings about the Ling 6 Sound Test. First, some background: this sound test was developed by Daniel Ling and published in 1976 as a way to perform a quick and easy check for access to speech sounds. The six sounds (/ah/, /ee/, /oo/, /mm/, /sh/, and /ss/) represent frequencies across the speech spectrum. In other words, they cover a range of different pitches that English speakers hear. The test is used by audiologists as well as speech-language pathologists, teachers, and parents as a quick way of determining whether a child or adult can hear those sounds. The person administering the test says the sounds at a certain distance from the deaf or hard of hearing (DHH) person, usually 3-6 feet and without visual cues, and the DHH person repeats the sounds they hear. For young children, picture cards and toys can be used to represent the sounds.

Because the Ling 6 sounds represent frequencies across the range that people hear spoken English, they provide an easy way to determine if someone isn't accessing speech sounds within part of that range. For example if I am mapping a cochlear implant and the DHH person is having trouble detecting or identifying the sound /ss/, I can make adjustments to their programming in the high frequencies. As an audiologist, I also use the Ling 6 sounds when I am listening to hearing devices myself: if I am performing a listening check on a device and its owner isn't present, I can use the Ling 6 as a quick check on problems with the device itself. Recently some professionals have transitioned to using 4 additional sounds (/zz/, /jj/, /n/, and /h/) to provide even more information. All these sounds together make up the LMH 10 Sound Test.

The Ling 6 and LMH 10 are great tools, and I use them every day as an audiologist. But a common misunderstanding about these tests is that if a child or adult hears all the sounds, they have perfect access to spoken language. This is not true. The ability to detect or identify all these sounds does not tell us how the person is hearing spoken words, phrases, and sentences in the real world. Also, the English language has more than 10 sounds! When administering these tests, knowing their limitations is just as important as knowing their benefits. We should not expect that a person who can hear these sounds has good hearing ability for all spoken language.

10/27/2022

Greetings, followers of Audiology Outside the Box! I’m sure that some of you have been wondering why this account has gone silent for a few weeks. I’ve been dealing with a family medical emergency since July and am just now getting back to regular life: my spouse was diagnosed with a form of autoimmune encephalitis, which is a rare disease that is challenging to identify. For the past several weeks, my full attention has been needed at home and in my full time job. But now, I’m back! I look forward to engaging with you again on social media starting again on Monday, October 31. 🤟🏻

08/20/2022

Great opportunity for audiologists to get some CEUs!

How do audiologists affect language access? What do educational audiologists have to know about the importance of early language access for their Deaf and hard of hearing students? Find out more from the amazing Mallorie Evans! Register here: https://language1st.org/events/language-access-and-audiology

08/17/2022

Teaching deaf and hard of hearing (DHH) children self-advocacy skills is important. Self-advocacy plays a significant role in my professional life as an educational audiologist and in my personal life as a deaf adult. What is self-advocacy? It's the ability to ask for what I need, explain my communication preferences and technologies to others, let people know when communication breakdown happens, and use my resources to solve communication problems. Teaching these skills to DHH kids is one of my favorite parts of my job.

But here's something you might not know about self-advocacy: it is not a magic solution to every communication problem. DHH people are often blamed when communication breakdown happens or when one of our own needs is not met. We are told that we should have asked for repetition, been clearer about what we needed, asked for an interpreter farther in advance, or used different words or a different tone to state our needs. Sometimes when we ask for accommodations that are our legal right, we are told that we have asked for too much. DHH people might find ourselves in trouble at home, school, or work *because* of self-advocacy. There are times when others become angry or frustrated because we have asked for multiple repetitions, set a boundary that we cannot attend a meeting if an interpreter is not present, or given reminders about agreed-upon accommodations.

DHH people are not perfect. Like everyone else, we have bad days. We get frustrated when we do not have our access needs met. We might not always use words that feel good to hearing people when our needs are not being met. But that does not take away the realness of our communication needs, and it does not mean that all problems would resolve if DHH people were better self-advocates. Communicating effectively with a DHH person requires effort from the hearing person too. Self-advocacy is important, but it will not get very far if our hearing conversation partners place the burden of communication fully on us. Communication is a team effort!

08/15/2022

There are many misunderstandings about what deaf and hard of hearing people are required to tell others about our deafness and hearing levels. If you live in the United States, you do not have to discuss your deafness or hearing levels with your current or potential employer or school -- if that employer or school is covered by the Americans with Disabilities Act (ADA). If you are not comfortable disclosing this information, you can decide not to -- or to share only limited parts that you choose. However, you will need to disclose if you want to receive accommodations under the ADA and other disability laws. For more information about this, read: https://www.eeoc.gov/publications/ada-your-employment-rights-individual-disability.

Even if you decide to disclose your deafness or hearing levels to receive accommodations, you are not required to discuss this topic beyond the process of arranging those accommodations. Many deaf and hard of hearing people do find it helpful when coworkers and classmates know about their language and communication needs, so you might find that you *want* to discuss this topic with coworkers, classmates, etc. In my experience, this can be helpful for preventing problems such as people assuming that I'm rude when I don't respond to their hellos and goodbyes in the hallway. But ultimately, it's up to you! A future post will address tips for disclosing deafness in the workplace and at school.

08/10/2022

Educational audiology services are an important part of the school experience for deaf and hard of hearing (DHH) children. But sadly, many parents are never told about these services. Curious about what educational audiologists do? Read on!

Educational audiologists have the same doctoral-level education and credentials as clinical audiologists, but educational audiologists work in schools. A clinical audiologist might see a child only once or twice a year, but an educational audiologist may see some children much more often. In addition to my work at Audiology Outside the Box, I am a full time educational audiologist in a large public school district. I see some of my students as often as once per week!

What services do educational audiologists provide?

- We recommend environmental changes for classrooms to improve access for DHH students.

- We evaluate students for assistive listening devices for use in the classroom and other school settings and fit that equipment according to the needs of the individual child.

- We check hearing aids, cochlear implants, and other devices to ensure they are functioning appropriately, and we educate teachers, school personnel, and DHH students themselves about how to use and care for their devices.

- We teach age-appropriate self-advocacy skills related to communication and language.

- We educate teachers about the individual communication needs of DHH students.

- We provide hearing tests for DHH students who need comprehensive evaluations and for students with suspected hearing concerns.

- We provide hearing screenings to identify the need for further testing in students who might not have a suspected hearing concern. At some point, all children regardless of hearing level may encounter an audiologist at school!

- We write the hearing- and communication-related sections of IEPs and 504 Plans.

- We monitor hearing and middle ear function for students who have temporary hearing concerns due to ear infections and tubes in their ears.

- We provide aural (re)habilitation therapy services for DHH students.

What questions do you have about educational audiology? Ask below!

08/08/2022

If you are the hearing spouse or partner of a deaf or hard of hearing (DHH) person, today's post is for you! My own spouse is hearing, and throughout our years together we have discovered many creative approaches to communication.

Respect all languages and communication modes that are part of your significant other's life. This is important for both the hearing person and the DHH person. If your significant other communicates in a sign language or uses Cued Speech, make an effort to learn.

Learning new languages and communication modes can take a lot of time. Be patient with yourself and use what you know. My spouse does not have the same level of ASL skills as I do, and that's okay. I always appreciate the effort.

Be open to using a variety of languages, communication modes, and tools. Each couple is different, and what's easiest to use may vary by situation. Speech-to-text apps, typing on a laptop or tablet, texting, and writing/drawing with pencil and paper can all be helpful. Switching among these in the middle of a conversation might be necessary. You might start off with speech-to-text technology and end with typing. Check in with each other during conversations. If the message is not being understood by one person or the other, don't be afraid to suggest changing approaches.

If your DHH significant other is a hearing aid or cochlear implant user, let them decide when to use their technology. If they are exhausted at the end of a long day and do not feel able to use their hearing devices at the moment you want to talk, don't pressure them. Use a different modality or tool, or find a good time to have the conversation later. Discuss compromises!

No matter your DHH significant other's language and communication preferences, setting times for important conversations can be helpful. Planning in advance which language(s) and tool(s) to use for the conversation is also a plus! So is discussing how to handle urgent conversations that might come up when your DHH significant other is experiencing listening fatigue.

Finally, be patient with each other! Communication breakdown happens at times. With practice, it is likely to happen less over time.

08/03/2022

Monday's post described assistive listening devices (ALDs) and benefits that deaf, hard of hearing, and hearing people might experience from them. Now, you might be wondering if ALDs have limitations too. The short answer is: yes, every technology has limitations. No hearing technology provides perfect hearing ability for DHH users. Most limitations of ALDs are specific to the type of device.

Frequency modulated (FM) systems are one common type of ALD. Sound transmission for these systems involves radio waves. Although FM systems can be used successfully in many situations, they sometimes experience interference. They have some privacy limitations as well: an FM receiver from one system can pick up the signal from another system's FM transmitter if the two systems are operating on the same channel.

Digital modulated (DM) systems are a newer type of ALD. Sound transmission for these systems involves digital signals. These systems are frequently used in schools. Although they can be set up for use with a wide variety of hearing aids, cochlear implant sound processors, and other hearing devices, DM systems are expensive. Cost may be their most significant limitation.

Infrared (IR) systems use light to transmit the sound signal from the source to the listener. Although these systems often provide high-quality sound and are not at high risk for interference, they require a direct line of sight between the receiver and transmitter. If that is blocked, then the listener will not hear the sound. These systems also can't be used in outdoor settings.

Induction loop systems use elecrtomagnetic induction to transmit the sound signal to hearing device users who have telecoil in their devices. Loops are available in many public places, making them more accessible than some other assistive listening systems. But a person who uses this system must have telecoil and stay within the looped area to hear the sound signal. It's also possible for the signal to spill over from one room to the next, so a person in an unlooped room next door who has their telecoil turned on might hear some of the sound accidentally.

Questions about ALD limitations and benefits? Comment below!

08/01/2022

Ever encountered the term "assistive listening device" or "ALD"? This week, both Audiology Outside the Box posts will discuss ALDs. Today's post will describe some of their benefits, and Wednesday's post will describe limitations.

What is an ALD, anyway? Hearing aids and cochlear implants provide access to sound, but hearing with these devices may still be challenging in noisy situations and from a distance. That's where ALDs come in! ALDs are different from hearing aids and cochlear implants. They support the listener in hearing and understanding the message in these challenging environments. ALDs reduce the impact of background noise and distance on the listener by bringing the sound closer.

How do they work? A transmitter is placed at the sound source. For example, a person who is talking to a large group might wear a microphone around their neck. That microphone is the transmitter. The transmitter sends the sound signal to receivers that the listener wears. Receivers might be attached to the listener's hearing aids or cochlear implants, worn as neckloops, or worn on the ear without hearing aids or cochlear implants. Sometimes, they look like tiny blocks. Some newer receivers are digitally uploaded! In all of these cases, sound streams directly to the listener even if the talker is several feet away.

What are the benefits of ALDs?

1) ALDs reduce the impact of background noise on the listener's access to the sound.

2) ALDs reduce the impact of distance between the listener and the sound.

3) ALDs reduce the impact of reverberation (sound bouncing off surfaces) and echo for the listener.

4) Personal ALDs allow the listener to hear the sound more loudly without others in the environment also experiencing increased loudness.

5) Some ALDs can be accessed by multiple people within the same room at the same time: one transmitter paired to several receivers.

6) Some ALDs can be used as stand alone devices without hearing aids or cochlear implants. Hearing people can use ALDs too!

Do you have questions about ALDs? Leave them below! Check back this Wednesday for a follow-up post on ALD limitations.

07/27/2022

The federal government uses the term "hearing impaired." So do many state governments. "Hearing impairment" is one of the thirteen disabilities that can qualify a student for an Individualized Education Program (IEP). Does that mean we should use the term "hearing impaired" when referring to deaf and hard of hearing (DHH) people? Not necessarily.

At Audiology Outside the Box, I use "DHH" as an inclusive term for people whose hearing sensitivity is outside the typical range. Other organizations use other terms as all-inclusive. Which term is most appropriate is a challenging issue because DHH people's perspectives vary. Some people prefer to be called a "person with hearing loss" or "person who is hearing impaired." I make every effort to call people what they prefer to be called, so if someone prefers to be called "hearing impaired," I will use that term for them. But what about others who don't prefer that term and children who are still forming their identities?

Yes, the term "hearing impaired" is used in many government documents. Yes, you might need to use it if you are writing an IEP for a student. But that does not mean the term "hearing impaired" has to be used in other contexts. Often, terminology changes within communities and cultures long before it changes in government documents. Use of a term in a government document does not mean that the same term is preferred or accepted by the community it is trying to describe. A research survey by Pudans-Smith et al. (2019) identified that most DHH respondents did not prefer the term "hearing impaired." (See reference in first comment.)

Why might DHH people prefer NOT to be called "hearing impaired"? My own perspective as a deaf audiologist is that "hearing impaired" emphasizes what I can't do instead of what I can do. It labels me as a person who isn't capable. It also implies that hearing is essential for living a high quality of life, which is not true for all DHH people. For these reasons, I would recommend avoiding the term "hearing impaired" when possible. Its use in IEPs and other government documents does not mean that it must be used when working and interacting with DHH people in everyday life.