by Rebecca Kooper
Audiologists who provide services to the schools go beyond merely providing audiological information about students with hearing loss. They participate in the development of an educationally appropriate program and work with a team of professionals whose goal is to help students with hearing loss maximize their educational potential.
When providing services to schools, audiologists write reports that detail the educational effects of a hearing loss, give in-services to faculty and staff, work with SLPs to develop appropriate auditory training goals, and design organizational systems to manage amplification equipment.
Complete audiological evaluations should include information that will help describe how the student with a hearing loss is functioning in the classroom. Traditional word recognition testing is only the beginning of speech audiometric testing. It needs to be expanded to include more detailed information such as aided word recognition scores testing at conversational levels in quiet and noise. If a student does not have the skills for standard word recognition testing, the audiologist should probe further in an effort to determine the student's functioning level. Simply noting "could not test" will not help the educational staff understand the student's current stage of auditory skills. Further assessment might include an evaluation of pattern perception or detection of phonemes in isolation such as the Ling Six Sounds (Ling, 1976).
Some students do well on traditional speech audiometry. They have excellent auditory skills and/or have excellent closure skills and can accurately "figure out" the whole when hearing only parts of the word. To explore higher levels of auditory skills, the audiologist might ask the student to repeat nonsense consonant-vowel-consonant patterns (CVCs). This is challenging as the student cannot depend on linguistic information to help identify the stimulus item. Additionally, an analysis of the error pattern will identify those phonemes to which the student does and does not have auditory access. Since these evaluations are performed in the aided condition, results can be considered in the calibration of the student's amplification to provide audibility of these sounds. If the severity of the loss precludes audibility of certain sounds, the student can be counseled regarding the need to supplement the auditory signal with visual clues.
Determining Support Services
Audiological reports should provide more information than merely a summary of pure tone and speech audiometric results. The presence of a hearing loss does not automatically entitle a student to support services. A causal relationship between the hearing loss and its impact on educational performance should be affirmed. The effect of the hearing loss on language acquisition and educational performance should be addressed. For example, studies by Bess et al. (1984, 1986) report the effect of unilateral hearing loss on educational performance. A summary of these findings should be included in the audiological report to enable school personnel to provide appropriate support services. If a student has a high frequency hearing loss and does not have auditory access to high frequency sibilants such as /s/ or /sh/, it is important to indicate in the report that this will adversely affect the student's ability to understand the concept of possessives and plurals. Providing information regarding the deleterious effects of noise and distance on the auditory signal should also always be included.
Working with professionals within the school is an ongoing process. In-services are best done at regular intervals. Too much information in the beginning of the school year can be overwhelming. Teachers have very challenging jobs, especially in September. At the beginning of the school year, they struggle to meet students, distribute text books, and develop a daily routine. It is difficult for them to take in all the information that is needed to meet the needs of the student with a hearing loss in their classroom.
The educational audiologist's initial goal is to ensure that the classroom teacher is comfortable with the FM equipment and that this equipment is in good working order. A first meeting should include a demonstration of the FM, how to perform a daily check, and how to troubleshoot the equipment. Once the class has settled into its routine, more detailed information can be provided to the teacher. Maximizing the use of the FM unit by demonstrating more sophisticated ways to use the transmitter or by demonstrating the use of the FM with computers, CD players, or cassette players used in the classroom can be reviewed in subsequent meetings.
A Functional Listening Evaluation (FLE, Johnson, 1997) should be performed to demonstrate to the teacher (and the student) the negative effects of noise and distance on the student's ability to hear in the classroom. As a result of early detection of hearing loss and early intervention programs, many students with hearing loss have excellent communication skills. To the lay person, these children appear to "hear everything" in the classroom. The FLE is always effective in helping the teacher understand the auditory challenges faced by the student with a hearing loss.
Audiologists should work with the SLPs to develop an appropriate auditory training program. The results of the audiological evaluation will help the audiologist identify the student's auditory skills. Knowing the hierarchy of auditory skill development is essential for developing auditory goals.
Selecting and Managing FMs
When selecting the appropriate FM system for a student, the audiologist needs to look beyond the audiogram. Finding out what systems are in current use, how many students currently use FMs in the school, and if there are other students with an FM system in the same class as the student who is being evaluated are necessary bits of information that will be needed in selecting an FM for a student.
Finally, developing an FM management system is crucial if the FMs are to be kept in good working order during the school year. Often, FMs are purchased by a school district and no one knows what to do if there is a malfunction. Broken equipment is often stored on classroom shelves until someone finally contacts the right person to take care of the equipment. Weeks can go by before the audiologist is contacted regarding the need for a repair. The audiologist needs to work with the school staff to select an appropriate person to "own" the equipment. The speech-language pathologist often takes on this role, yet nurses, psychologists, assistant principals, or guidance counselors have been known to volunteer if the SLP is not in the school daily. The necessary criteria for selecting the appropriate person should include their willingness, their comfort with technology, and their availability in school every day. This person will know how to perform simple listening checks, simple troubleshooting tasks, and will know where to send the equipment if there is need for repair. This volunteer and the audiologist should be in contact with each other on a regular basis to ensure that the FMs are in optimum working order. At the end of the school year, the FM manager can collect the equipment for summer servicing.
Rebecca Kooper was an educational audiologist at the Nassau BOCES Hearing and Vision Services program for more than 20 years. She serves on the board of the New York State Speech-Language-Hearing Association and has previously served on the board of the Long Island Speech-Language-Hearing Association. Contact her at rekoop1213@aol.com.