Audiologists are integral allied health professionals. In fact, demand for audiologists is expected to increase by 20% between 2016-2026 due to better outcomes for pre-term babies and an increase in the elderly population (ASHA).
This is an interview with Sarah Darwish, Audiologist based in Dubai, UAE.
I would highly encourage every parent to read it so you can find out how to be pro-active in managing your child’s hearing.
Tell us a little about you and your background. I’m originally from Australia and have been living Dubai since 2009. I graduated from my Bachelor of Science degree in 2003 and then completed my Master’s in Clinical Audiology in 2005. Since practicing in Audiology I have specialized in adult rehabilitation and hearing aids, vestibular assessment, audiology practice management and pediatric assessment. I was lucky to become a mum in 2012 and I now have two beautiful children who inspire me everyday!
What is an audiologist? An Audiologist is a healthcare professional responsible for the non-medical management of hearing loss and balance disorders. They are rare but wonderful creatures that can often be found hiding in medical practices and hospitals with Ear, Nose &Throat (ENT) departments. Sometimes Audiologists also work in industrial settings, schools and universities.
In an ideal world, what would be an audiologist-recommended timeline for a child to have their hearing screened and assessed? Ideally, within a few days of birth and if all is well, at 6 months and then annually until school entry (which in general is around 3.5 to 4 years of age in Dubai). This may seem a lot however during such a critical time of speech and language acquisition, a simple hearing test can make all the difference.
If the hearing screening at birth is normal, at what point would further testing be necessary, if at all? After a pass result at the newborn screening, there is no program in place to dictate what testing is needed or when. As you can imagine though, a whole lot of speech and language development opportunity takes place in those first few years of life and there is much demand on children to perform at their best in educational settings, so the onus is on the family to seek out further testing if they develop concerns for their child’s hearing behaviors to ensure optimal hearing at all times. This method would undoubtedly fail to detect hearing loss that develops after the newborn hearing screening. I suggest that as a bare minimum a full assessment using a battery of tests should be conducted at 3.5 years of age for every child.
If my child fails the hearing screening, what would you suggest? Don’t panic! Screenings need to be checked before anything is certain. You should have a follow up visit (usually within a month) if your child did not pass the screening and this will help to clarify things. For a child of any age, a diagnosis can not be made using a single test and certainly not from a screening, so it’s very important to make it to that second visit and to keep going until the hearing levels (normal or otherwise) are confirmed.
If a parent is concerned about a child’s hearing (perhaps due to speech and language difficulties), what are the different kinds of assessments would the audiologist conduct, and what do they each test for? There is a lot of testing available and it is decided based on the developmental ability of the child rather than their age. For newborns I use automated equipment to take measurements and give readings of ear function, for babies and toddlers I use a look and listen style of game using toys and lights plus some behavioral observation, for preschoolers we play a listening game and build towers or make pizza (so fun!), and for school aged children through to adults we use a simple hearing test where we use a button or clap hands when we hear the sounds. In addition, there are speech tests available to cross check the findings, measurements of ear drum activity and of course, using a scope to look in the ear is vital!
Is it necessary to put one’s child under anesthesia to conduct an ABR in order to obtain accurate hearing results? Under what circumstances would this be necessary? Not at all, in fact, the ABR is my least utilized test! There is so much more that can be determined by behavioral testing and using a test battery to crosscheck findings against one another, that I find ABR to be quite time-consuming and often less revealing without all the other cross checks. Not to mention the counseling aspect for parents to actually see how their child responds to sounds during the games; it’s invaluable!! I do however employ ABR and other evoked potentials testing in cases that truly need it, when there are no other means available to test a particular child or when a hearing loss diagnosis is made very early in life. This sometimes needs anesthesia in a hospitals’ operating theatre if natural sleep (like a solid nap!) is not possible, but it is certainly not common in my daily practice.
If a child does suffer from regular ear infections, what is your protocol? Why? It is best to treat any active infection or symptoms through a medical professional and then we watch and wait to see if the ear clears on it’s own in the month that follows. If it doesn’t clear or if the infection recurs, a medical professional such as an ENT is best equipped to manage the case from there. From my perspective, we need to manage the hearing levels and try to optimize things as soon as possible, so a hearing assessment after the active infection is treated (once discharged from ENT care) would be ideal to check if the ear has recovered.
How is fluid detected in the middle ear? What tools and professionals are best suited to make this determination? I use a piece of equipment called a tympanometer. It is a small, non-invasive device that has a little mushroom shaped tip on it. I place this at the ear canal entry and take a pressure reading and this tells me what I need to know about the middle ear function at that moment. To back this up, a good look in the ear with an otoscope is also an essential crosscheck. ENTs and Audiologists in possession of these two pieces of equipment, and of course the training to interpret the results, are best suited to determine if there is fluid in the middle ear.
What is an Auditory Processing Deficit (APD)? And what should a parent look out for? Auditory Processing is not an indication of hearing ability; simply put it is ‘what we do with what we hear’. There are a number of fundamental auditory processing skills and a child may have a weakness in any or all of the areas. Some of these skills include hearing in background noise, recall of sound information and processing sounds arriving at both ears together. My tip would be to look out for difficulties in noisy or busy situations, inconsistencies with how children are hearing at home versus in school, and for children who need frequent clarification or re-instruction of what has been said.
Can fluid in the ears lead to difficulties processing auditory information? Yes, it is common to observe a deficit in auditory processing skills if a child has a history of middle ear fluid or ear disease in the first few years of life however it can also occur without such a history.
How would you treat APD? Who would you refer to? There are many different patterns and types of APD so it really depends on the assessment results. I frequently recommend classroom based and educational strategies, tips for the child to manage the difficulties and also suggest communication tips for the family. Personal amplification systems are useful in some cases. I often refer on to speech and language or occupational therapists also. Sometimes there are computer based programs and apps that come in handy too. The management varies on a case-by-case basis.
Can you speak about auditory stimuli in the environment. What has the potential of damaging my child’s ears? Anything can damage the ears if it is loud enough. There are guidelines available that determine the intensity (volume) of a sound and how long it is safe for and it is particularly important for people working with heavy machinery. For children, I would suggest 30 minutes of listening to any one sound source and to keep the volume below 80% on any device. Headphones are ok (for 30 minutes) and volume limiting or noise cancelling ones are even better.
Can you speak a little bit about auditory hygiene – how do I keep my ears safe? Allow the ears to do their job; they are self-cleaning. Cutips are not for the inside of the ear canal but are useful to clean the folds of the outer ear, but you can also use a tissue for that.
In what case would you suggest hearing aids for my child? Hearing aids are wonderful and life-changing but they are not suitable for every child with hearing loss. I prescribe hearing aids for children who have confirmed, permanent hearing loss (a sensorineural hearing loss). Occasionally a hearing aid is useful for chronic middle ear conditions too such as in cleft palate cases or in syndromic conditions.
What is a cochlear implant (CI) and who would be eligible for this? A CI is a specialized device that is suitable for significant hearing losses in the severe to profound range. It is extremely advanced medical grade implant that requires major surgery; it is placed into the top layer of skull behind the ear. From there, an electrode is passed through to the hearing organ where it will, once activated (‘switched on’), electrically stimulate the hearing nerve. Candidacy is suitable or not for a particular child however from an Audiologists’ perspective, a hearing loss that looks like it won’t benefit from a hearing aid would prompt the beginnings of a CI assessment.
What general advice to you have for parents when it comes to their children’s ears
and their listening skills? Follow your gut instinct, protect those precious ears and always practice good communication skills as your child’s language role model. Test hearing regularly; children are very clever little beings and they can lip read far better than you or I, not to mention how quick their minds can be! They can put information together so fast, that even if they have missed sounds, they have read your lips, your body language and facial expression before you have even finished the sentence. Therefore, even though it may appear to us that our children are hearing well, this isn’t always the case and only a hearing assessment can tell us for sure.
If you had access to all the funding and resources required, what initiatives would you ensure were in place so that no child with impaired hearing goes undetected? Mandatory hearing screening at birth for each and every child would be a wonderful place to start. Screening protocols for babies and toddlers to keep on top of hearing loss that develops after birth. Annual testing at school. Hearing aid/ cochlear implant funding for all who need it.
You can contact Sarah at: firstname.lastname@example.org, 0561059894
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