Ryan McCreery Discusses the Importance of Research In Audiology

Join me in the latest empowEAR Audiology episode as I sit down with a respected leader in the field of audiology, Dr. Ryan McCreery.  Dr. McCeery is the Director of Research at Boys Town National Research Hospital. During this episode, we take a deep dive into the importance of research in the field of audiology as well as his own research directly related to clinical outcomes that have ​led to optimized clinical protocols for fitting hearing aids in kids with hearing loss.  Also, a huge congratulations to Dr. McCreery for receiving the prestigious ASHA Fellow Award in 2020!  You will not want to miss this episode. For more information about the work Dr. McCreery is involved in please visit:

https://www.boystownhospital.org/research/faculty/ryan-mccreery

www.ochlstudy.org

For more information about Dr. Carrie Spangler- check out her LinkedIn at https://www.linkedin.com/in/carrie-spangler/

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Episode 15: empowEAR Audiology - Dr. Ryan McCreary

[00:00:00] Welcome to episode 15 of empowEAR audiology with Dr. Carrie Spangler.
[00:00:16] Welcome to the empower your ideology podcast, which is part of the 3C Digital Media Network. My name is Dr. Carrie Spangler, and I am your host. I am a passionate audiologist with a lifelong journey of living with hearing challenges in this vibrant hearing world. This podcast is for professionals, parents, individuals with hearing challenges and those who want to be inspired.
[00:00:45] Thank you for listening, and I hope you will subscribe, invite others. Some listen and leave me a positive review. I also wanted to invite all of you to visit and engage in the conversation on the empowEAR Facebook group. transcripts for each episode can be found at. Www three, the number 3Cdigitalmedianetwork.com under the empower your podcast tab.
[00:01:18] Now let's get started with today's episode today. I have a special guest, Dr. Ryan McCreary. He is the director of research at Boys Town National research task hospital where he’s the director of the audibility perception and cognition lab, and director of the Center for Audiology. Dr. McCreary completed his PhD in 2011 at the University of Nebraska where he researched bottom-up and top-down processing of auditory information in children.
[00:01:51] His lab's current research is focused on various aspects of hearing, hearing amplification, language processing, and language development. Dr. McCreary’s research has contributed to our understanding of the importance of auditory experiences on language and sensory development. Findings from Dr. McCreary's research is directly related to clinical outcomes and have led to optimize clinical protocols for fitting hearing aid and children with hearing loss.
[00:02:21] Dr. McCreary has authored 56 peer-reviewed publications and has numerous research collaborations. He has a regular speaker at scientific and clinical meetings and is an active member of the American speech-language-hearing association. Because of his significant scientific and professional contributions.
[00:02:41] Dr. McCreary was recognized in 2020 with a prestigious ASHA fellowship award. Congratulations! Ryan is going to be presenting at the American Academy of audiology's. Marion Downs, lecturer and pediatric audiology on April 15th, 2021, virtually. And, um, thank you Ryan. I am for being on the podcast today.
[00:03:07] What a, uh, incredible resume that you have, and I'm so excited to have you on this podcast today. Oh, it's so great to be here. Um, I think I told you that I'm like a huge fan of your podcast, so it's really fun to be on here and to get to talk to you. Cause I always enjoy talking with you. Well, I always enjoy talking with you too.
[00:03:27] And I was trying to remember when we first met. Yeah. Thinking about this and um, I think it was an educational audiology association conference. Um, and it might've
been. Even when, uh, the educational audiology association had their summer conference in conjunction with the ASHA schools conference. Oh, I think you're right.
[00:03:48] It was, that was a lot of years ago. Um, but yeah, I, and then you and I have stayed in contact at, at EAA and ASHA meetings and, and things since then. So it's, and it's always good to see you. It's always good to see you. And I hope someday we'll be able to see each other in person again. I know won't, that'd be awesome when we can have actual meetings again, uh, even the most introverted members of our.
[00:04:13] Science team here are looking forward to going to meetings coming up. So, and I feel the same way. Yeah. It really brings you can relate to people a lot better when we can actually see them. So I always like to ask my podcast, guests, how they actually got started in the field of audiology. I feel like everyone has such a different journey of how they got here.
[00:04:39] Yeah, mine's kind of weird. It's a little, uh, indirect, but I, uh, when I was in high school, my high school had a program called community resource training and it was basically a way for students in my high school when they were juniors or seniors to identify. A field that they wanted to work in. Um, and the way that my schedule worked out, I had the CRT class at the very last part of the day.
[00:05:07] And what that meant was that by the time I went to class the first week, when we got to pick what our assignments were. Um, all of the other options that I had in my small town were already taken. And so the teacher of the class said, well, now you have to take a test to figure out what profession that you're going to end up in.
[00:05:26] And so I took this vocational aptitude test and, you know, it basically listed off all these things. That would be interesting based on what my interests were and what I wanted to do. Uh, and audiology and speech language pathology was like one of the higher. Rated things along with some really strange ones that, that I won't mention.
[00:05:46] But, um, so I got assigned to work with an audiologist and a speech language pathologist. He was dually certified and he was a school based, um, SLP and audiologist. And he worked with kids in the afternoons when I had class, um, that had hearing loss and it was the first exposure that I had to, uh, to. Seeing someone work with kids who are deaf and hard of hearing and see what a huge difference it could make.
[00:06:13] And I was really into it. Like at first I thought, I don't know, I'm not really going to be interested in this. And it was fascinating. And I've been fascinated with helping people who are deaf and hard of hearing ever since, because I just feel like it's something that you can do that makes such a huge difference.
[00:06:30] So I went to the University of Northern Colorado as an undergrad, thinking that I would. Um, be dually certified and be a speech-language pathologist and be an audiologist. And then I met Dr. Steve Ackley, who was an audiologist, uh, in a faculty member there. And, uh, he really turned me on to audiology, but I've always had that speech-language pathology sort of undercurrent in my, uh, in my life.
[00:06:55] And it's funny because now that I'm doing research, it's, you know, it's really, I, as you mentioned, I'm doing research, that's sort of right at the intersection between audiology and speech-language pathology. And I love it. Yeah. I hear a lot of people who audiology who work with kids. So they had a hard time deciding whether they wanted to go into audiology speech because they wanted to work with kids with hearing loss.
[00:07:19] And there was a lot of intersection and I think that's amazing, but your high school have gotten that experience. And it just makes me think sometimes as an educational audiologists, we go in and do a presentation about what we do. And you never know who you might impact. Right. Absolutely. Yeah. I mean, it's one of those things where, when we talk about trying to get people interested in the field, that's always one of the first things that obviously comes to my mind because of my personal experience.
[00:07:45] But I do think it's a really pivotal time before you go to college and you haven't really decided what you want to do. Um, can you know, that, that, that speech-language pathologists and audiologists that I work with, uh, he was really, um, You know, dedicated to what he was doing and really enjoyed it. Um, and, uh, you know, I don't know that he even knows that he has had that impact on my career because I don't, I don't know.
[00:08:12] I haven't kept in touch with them. So I have no idea. Well, maybe he'll listen to the podcast and then he'll find out. Yeah, John Calper. If you're listening to this podcast, I hope you know that you're responsible for all of this. So that's awesome. So you went at Northern Colorado, for undergrad. And then where did you go for your graduate work?
[00:08:36] Yeah. So I finished my undergrad at Northern Colorado and I loved Northern Colorado, but, um, I was applying for both PhD and masters in audiology programs. And, um, I made a decision that I was just going to go and get my clinical master's degree, uh, and work for a little while rather than going straight into a PhD program.
[00:08:55] So when it came down to it, um, I decided that I was going to go to the University of Nebraska at Lincoln. I had some family in this area. Um, And so I thought it'd be really great to get out of Colorado and go to Nebraska for a little while. And then, um, so I did my masters, yeah. Audiology at the University of Nebraska Lincoln.
[00:09:14] And then in my last semester of on-campus at the University of Nebraska, I got a clinical placement at Boystown, which was a real competitive, um, difficult place to get a placement. But I was interested in Pediatrics and BoysTown obviously well known for pediatrics. And so it's funny because the, um, audiologist who is now our director of the clinic in the audiology program was the woman who hired me, um, as a student.
[00:09:42] So, um, it's fun to, to joke around with her about the fact that, um, she ended up hiring her future boss. And, um, it, I learned so much, uh, during that. A process that I then applied to do my clinical fellowship at Boystown. Um, and I worked as a clinical audiologist, um, in Omaha and then moved to Seattle for a few years and then came back to Omaha and, uh, in 2004.
[00:10:06] And I'd been at Boystown since 2004, so. Wow. Yeah. Yeah. That's, that's awesome though. You've made a big impact and. I know you said you did your masters and your PhD, but audiology as a whole needs, more researchers and PhD, um, experience or, you know, uh, individuals out there. So what is your experience and what advice would you have for maybe an audiologist who is out there who might be thinking about getting that PhD?
[00:10:40] So my advice would be to work for a little while. Um, if you, if you can, the hard part about working for a while and your professors will always advise you not to do this, um, is that you have like a nice job and you're, you're earning a living and then you go back to school and then you're not earning a living as much anymore.
[00:10:59] Um, and so that's really challenging, but working in the clinic before I went back, uh, for my PhD was really. Really good for me, because I think the research questions that I have and the, the areas that I'm interested in are really heavily influenced by my clinical experiences, working as an audiologist, working with families.
[00:11:20] And I think it just gave me a lot of perspective on. What families and, and people who are deaf and hard of hearing think are important outcomes. And I think that was really shaped by those experiences. And I don't think that it would be the same if I hadn't had that clinical experience. So I didn't go back for my PhD until I was, I had been practicing for like seven years.
[00:11:42] Um, and it was hard. Um, but my advice would be if you want to do research and that's what you're really passionate about, then the PhD is the right. Degree in the right way to go because it's, uh, you know, it, it gives you a whole different kind of training. Uh, that a clinic that my clinical background didn't give me so training in statistics and how
to design studies.
[00:12:04] And, um, it's, it's a really complementary skillset and, and I love what I do right now, but there are times that I miss seeing patients in the clinic. Yeah. The experiential learning part was very beneficial to your PhD. And so another question, kind of a side note, would you advise. Audiologist who had already had the AuD to go get their PhD in audiology or another related field.
[00:12:34] That's a great question. So my own PhD is in this weird sort of multidisciplinary category that the university of Nebraska offered called human sciences. So it allowed me to focus on, um, Some aspects of audiology. So I did take some coursework in the audiology program, but it also opened up the opportunity for me to take coursework in experimental psychology, in educational psychology development, um, biology, engineering.
[00:13:01] So. I was able to really get a sort of cross-disciplinary PhD experience where the research questions that I have were not something that I was going to learn about in my and taking more audiology classes at that point. And so, um, I, I wouldn't recommend that anyone limit themselves to an audiology PhD, if they're already an audiologist to think about other fields, um, where you might be able to.
[00:13:30] Apply neuroscience is another area that I think right now in particular, um, would be a great crossover for a person with a background in audiology because, um, there are just so few people doing neuroscience research, um, in the auditory system. I mean, there's
some great people in our field who are doing, doing that work, but compared to other fields where, um, like the visual system where there's.
[00:13:54] You know, uh, entire conferences that are bigger than many of our own conferences that are on visual research. We just don't have the same level of cross-pollination and the auditory system. And so you find that your expertise is really valued by other scientists because there's just not as many of us in the auditory field.
[00:14:12] Wow. So I think, yeah, that's great advice for someone that might be pursuing the PhD to kind of think about what are they interested, invested in and kind of look at a PhD in that area to, uh, to cross-pollinate basically, right. Know, knowledge. Um, so one of the things that I really admire about you and your research is the fact that I think you have that clinical experiential learning.
[00:14:39] Piece that you have, and you bring that into your research world, but everyday kind of application for people like me who are out there on the field, like we can take it research and, and know what it is, um, and apply it. So I think. You know, that's such a strength of yours to be able to effectively communicate all of that and keep everybody engaged in that.
[00:15:01] But can you tell us a little bit more about the current research that you are doing that focuses on pediatrics and advancing that field? Yeah, well, first of all, thank you. That's, that's the biggest compliment I feel like I can get is when people feel like the work that we do is useful because, um, I didn't become a researcher, uh, for any other reason than wanting to try to help, uh, clinicians and help children and families.
[00:15:28] And, and being able to do that with your work is extremely important to me. And, um, there've been some really interesting studies that I've been a part of that weren't. As fulfilling on the clinical side. And whenever that happens to me, I always find myself trying to go back and find something that I can work on that that does have that clinical link.
[00:15:49] So the big projects that we're working on right now, we have. We have several that were, that were involved in. So I would say the first one is an extension of a project that we've been working on for the last seven years. Um, and the basis of that is to try to look, to see, you know, we take. Uh, children with hearing aids and we do an audiogram and we fit those hearing aids based on the audiogram.
[00:16:13] But is there a way that we can customize that a little bit more rather than just the audiogram? Because as you know, and, uh, as many of your listeners probably know, uh, you can have children or adults who have the same audiogram, but have very different experiences with their hearing aids. And to me, that's always been fascinating, um, that, and I think for some people it's frustrating because.
[00:16:37] Uh, you know, it would be great if the ear were like the eye and you just put glasses on and everything were kind of resolved. But to me, it's sort of an interesting, um, problem. And so we're trying to figure out, are there ways that we can customize amplification to better, you know, uh, meet the needs of the individual listener rather than using the same audiogram and the same prescription for all listeners?
[00:17:00] So we have a big NIH grant that's starting its third year, this summer. Um, and that is our goal is to try to figure out what are the individual factors that are gonna. Predict success with hearing aids for kids. And, uh, and that's just, it's such an exciting project. And then the other big one that we have going on right now is called fast track, which is an acronym, uh, and that stands for finding appropriate solutions for treating reduced audibility in kids.
[00:17:28] Wow. A mouthful. Um, And that is a really cool collaboration with the University of Iowa, Boston children's hospital. Um, Arkansas children's hospital in Washington University in St. Louis, um, where we are, uh, essentially trying to develop some new clinical tools that would be useful for audiologists in the diagnosis and treatment for kids with mild bilateral hearing loss.
[00:17:56] We know that children with mild bilateral hearing loss often. Experience poor outcomes than we would expect, even though we described their hearing loss as being mild. We know that it's not, and we've known that for decades. Um, but we still don't have clinical tools that are really tailored for the specific challenges that kids with mild bilateral hearing loss face.
[00:18:18] And so we're developing a sort of suite of tests that an audiologist could do in a clinical setting. That would help to identify which kids with mild hearing loss are going to need more support and intervention, which ones are going to, um, be able to do well, um, with, with different kinds of support. So it's an exciting project and that one just started, um, last summer.
[00:18:39] And so we've got several years left. Um, on that one. And we're in that early development phase where we're still developing the software and things for those tools. Um, and then what we'll do is test them in the laboratory this year. And the next year we are, those tools will get deployed to pediatric audiology clinics for them, uh, for audiologists to use and tell us what works and what doesn't work.
[00:19:00] So it's cool because it's, it's a collaboration that starts with the lab, and then it's going to be out in the clinic. Um, and I, I really enjoy those kinds of projects because you're taking something that's very scientific, and then you're going to put it out. And the audiologists and the clinicians who are going to work with it are going to tell you everything that's wrong with it.
[00:19:18] And that's what we want, because that's how it makes things better. Yeah. And I, I'm glad you're doing that because as an educational audiologist, I feel like a mild bilateral kids end up being our hardest kids to, to work with and for reasons. And maybe, and I'm sure you already know this, but this is my just experiences one sometimes if the parents, um, because they see their kids in a home environment and they seem to be doing fine and they don't wear their hearing aids at home because they don't seem to be needing them at home.
[00:19:54] And they're missing out on a lot of incidental learning. And then again at school, um, they, they get. Enough to look like they're doing okay. But then there are these gaps that show up later on. People are attributing it to other things. Honestly, I think it's the lack of intervention and consistent intervention that happened early on.
[00:20:23] I completely agree with you. And I want to know who the person is that decided to call that category of hearing loss mild, because they have done a, such a huge disservice, um, because there's nothing mild about it. Um, you know, you described something as mild and people sort of think it's innocuous or not a problem.
[00:20:42] And we know that children with mild hearing loss, um, are at risk for all kinds of language delays. And in some of our recent research studies, We're finding that kids with moderate hearing loss are actually doing better than the kids with mild hearing loss, because they're getting more consistent intervention.
[00:20:58] And that finding that we had in a collaboration that I had with, um, Dr. Beth Walker from the University of Iowa, who was recently on your podcast, one of my favorite episodes, but, um, but. What we found was that these kids with mild hearing loss were doing more poorly than the kids with moderate degrees of hearing loss.
[00:21:18] And when we looked at why it was because they weren't getting the same intervention, the kids weren't wearing their hearing aids as much. And I think to some degree, they're not wearing their hearing needs as much because they don't need to. Right. They can hear in certain situations without their amplification.
[00:21:33] And so the thought process is if they can get by without it, then we should let them. But the problem, as you mentioned already, Is that they're missing out on all of these wonderful opportunities for incidental learning. Um, we know that they need that auditory stimulation and that auditory experience, um, to sort of develop the listening skills that they're gonna need to listen in classrooms and in social situations of restaurants and things as they get older.
[00:22:00] And so one of the things that we're trying to do. In the fast track study, but also overall just in our clinics and in the work that we do with families is really talking to families about audibility and trying to get away from that terminology of mild hearing loss, because it just doesn't convey the significance of it.
[00:22:19] And what we're finding when we talk to parents about audibility is that, um, parents are shocked. At the fact that you can have a child who has a mild hearing loss and in an average, conversational listening situation in, in a quiet environment, they're missing half of average speech. And no one thinks that that's mild when you explain it to them that way they think, wow, that's a pretty significant problem.
[00:22:45] And it's a real, um, when you start to. Use that as a tool for the parents instead of the audiogram, which is not very relevant to parents or really anybody other than audiologists, then you know, you start to talk about how it affects] communication and the light bulb goes on and they say, Oh, you know, this makes sense.
[00:23:03] And this is why when he's in the other room, I can't, you know, he doesn't respond. It's not that he's being obstinate. It's that he can't hear me. And it's a really useful
tool for parents. And I think. If we can start to change our terminology and our approach around that, we might have an impact. Um, I don't want to say that we're going to solve the problem because it's complex and there's a lot of things there, but, um, but I do think the way that we described mild hearing loss from the get-go just really works against what we're trying to do.
[00:23:34] And then. We try to play catch up with these kids when they get to school age, and they don't have the skills that they need to function in a classroom. And I'm sure you see that in the work that you do. Oh yeah. And I think the other population that needs to be educated more is even I, um, otolaryngologists.
[00:23:51] Well, they, I still see reports that, Oh, well, just mild. So if you want to do something about it, You can, but if you hear that from a ENT w I, as a parent, I would probably want to be more the glass half full. I don't want to put my kid through this if I don't have to. And so it becomes a challenge from an audiology perspective to educate the parents differently.
[00:24:23] Yeah. And when, when we talk to our otolaryngologists, we hear things like this all the time, you know, and again, I think you have to remember that the, the ENT is that you work with only have about two hours more education in audiology than the parents that you're working with because ENT is spend most of their career learning about surgery.
[00:24:44] And I helped to train the ENT residents in audiology from the University of Nebraska medical center. And I can tell you, they don't get that much. Time on the audiogram or on the impact of hearing loss, you know, they have to sort of learn it through experience. And, uh, and so I think we have to continue to educate them.
[00:25:04] On those things as our research evolves and as we get better tools so that they can be our partners in helping to counsel because they carry a lot of weight with families and their opinions are valued by families and they should be, they're very important part of our team, but it's, it's always hard when we're at cross purposes and they're saying, this is no big deal.
[00:25:25] And we're saying it's totally a big deal. Um, and we have had a couple cases where. In our clinic that have become conversation points with our ENT, because we have kids, there was sort of a mild hearing loss that was presumed to be like a residual conductive problem, not a big deal. And the child went on and got older and older and you know, that conductive loss never really went away.
[00:25:50] And it was actually not conductive. It was sensorineural, but it was mild. And. The child had had tubes. And so there was this, all these contributing things that sort of led to that uncertainty. And so just trying to get everyone on the team, the parents, the physicians, the audiologists, to think about the impact that's going to, I think that's our big challenge.
[00:26:09] Yeah, I agree. So getting back to the hearing aids and study and with that, are there different. Components that you feel are unnecessary and choosing hearing aids and appropriate technology for children. Yeah, I think. That the most important thing. And this is
going to sound weird is connectivity. Um, I think a lot of audiologists think about the technology level first because that's sort of what we've been marketed to think about.
[00:26:43] And indoctrinated to think about is the technology levels of hearing aids, but there's still no compelling evidence that I'm aware of. And I would love to read it if anyone has it, please send it to me that these technology levels that the hearing aid manufacturers use are. Sort of helpful in any way, shape or form.
[00:27:00] We know that the higher-end technology is more automatic and that can be convenient and it can be very useful, but it's not going to improve benefit for an infant, for example. So we really have to think about. Um, the function of the device. And so my biggest priority for kids is finding something that is going to work with all of the technologies that they need, uh, throughout their day and approaching it from that standpoint rather than, you know, how does it look or, you know, uh, I'm very practical.
[00:27:34] So it's like, does the, what's the battery life? Is it durable, you know, is it going to connect to their remote microphone system in the school with seamlessly? Is it going to allow them to talk with their friends? You know, can we make it work with their gaming system at home? If that's something that they want.
[00:27:51] So I like in the audiologist, when I was seeing patients that was always asking those questions about, you know, what, how do we make this work with. Whatever. I mean, cause if you want to get a teenager to wear their hearing aid, it's very hard. But if you can make it work with their X-Box, that that will help.
[00:28:11] Right. Well, it's streaming to YouTube all the time. Exactlyk Yeah. Yeah. I mean, I'm sure you see it all the time in what you do where, uh, you know you, but if you can make it functional, you know, I think that's the key. I mean, I had a parent come to me one time and say, yeah, he will wear his, you know, his. Um, air pod, the Apple earphones all the time.
[00:28:34] And they're, those are big and noticeable. And, and I said, yeah, but people think they're cool and we have to figure out a way to make the hearing aids. Cool. And I'm not cool. So I shouldn't be the person to try to figure out what that is, but they should find someone really cool and ask them, how do we make hearing aids?
[00:28:50] Cool. Because I think that would be, um, you know, That would be a big, a big help there for, for getting people to use their hearing aids, even adults. Right. Well, I think the newer, the Bluetooth capabilities are certainly helping a little bit with the teen population. I've had a couple of teens recently who I I'm really into streaming.
[00:29:16] I'm like my teachers are based out like, you know, saying nodding their head back and forth. They might be listening to music and not to you. Yeah. And you know, I was probably. If I had had that capability when I was a teenager, absolutely. Would have taken advantage of that as well. So, um, you know, but that, uh, that's, that's how I think about it, because again, my goal.
[00:29:42] Is what can we get that this child will be able to use? That's going to help them. It's going to give them the best outcome. And that's, that's really what it boils down to. And
if it's, if it helps them to stream their favorite music or, you know, something that they really enjoy to me, that's the most important thing.
[00:29:58] Yeah. So for parents who happened to be listening, how would you, what advice would you give them to determine if the hearing aids are functioning as expected? I mean, either different red flags that they should be looking at or. Yeah, I think that's a really, I think that's a really great question. And, um, you know, I, I'm always wanting to be very careful about giving other parents advice.
[00:30:24] I have kids, um, and you know, there, there's nothing worse than unsolicited advice from other parents. Right. But I think. Uh, to me, the things that I would look for, um, would be, first of all, I always tell parents to trust your gut. If something doesn't seem right with the way the child's responding, if something seems like it's changed, even if the child says, Hey, everything's fine.
[00:30:49] Um, you know, look into it, check into it, do a listening check. Um, even for an older child where you wouldn't normally as a parent be doing a listening check because you, you know, you're relying on the child to sort of manage the amplification. I think that's really important, uh, because of the number of times that we've had parents.
[00:31:08] Come in and say, I don't think this is working right. It doesn't sound right. And they're absolutely right. We put it on our test box and it's, there's something really subtle wrong with it. Um, I would just tell parents to trust their intuition and, uh, about that and not to write it off as a bad listening day or, you know, I think it's easy to do that.
[00:31:27] Um, but I think parents know how their children are. And they're the best judge of what that level of engagement is. And if there's a change there, then we really need to look into why that is. And, um, fortunately, a lot of the parents that we work with are excellent at that. They, you know, they bring the hearing aids in right away if there's a problem and that's, that's excellent.
[00:31:48] And then the other thing I think is just, um, I just encouraged the parents that we work with to have conversations with their kids about. They're, you know, kind of their hearing story so that they can appreciate their identity and the good things that, and the fun things that came along with raising a child that you know, was deaf or hard of hearing so that they can kind of learn to appreciate that.
[00:32:12] I mean, we all hear those stories about us from our childhood that sort of make us laugh or make us appreciate it. You know, even if we don't remember them, Uh, you know, I just try to encourage, um, a lot of the parents that we work with to have those open conversations with, with their children about it, because I don't know how much, um, you know, that happens.
[00:32:33] And I just think. You know some of the best parent examples that I've seen in my work are parents that have those conversations with their kids and, and they're very engaged. And, and I think it just helps with people's confidence and their identity. And knowing that, you know, there are a lot of positive things and fun things that come along
with, um, with having a hearing loss and, um, you know, it it's, it, it can be really challenging and, and parents can have a lot of complicated feelings around that, but.
[00:33:01] But, um, it, you know, it's just such a, uh, we had, uh, a child who we follow in our clinic who became an Eagle Scout last year. And it was such a cool, I mean, it's cool. Anytime, anyone does enough to become an Eagle scout, but it really, we were really proud and it was just cool to see the family, you know, see this huge accomplishment because, um, this was a child who had a severe to profound hearing loss.
[00:33:26] And, um, you know, and I think in the beginning, the parents were. We're had no experience whatsoever. And then, you know, to have it sort of, to see that was just so awesome. And it's, it's, it's really cool to when, when you can follow a child from the time they're an infant until they become an Eagle scout.
[00:33:42] That's that's pretty neat. Yeah. No, I think your comment about having those open conversation is well-taken, because then. The child or the, you know, doesn't feel like this is something I have to hide. This is something that I can talk about. I can share about when the family sets an example that way too.
[00:34:02] So I think that's powerful. Yeah. And parents enjoy it too. I mean, I think, I think sometimes parents, there's a little bit of a taboo for them to talk about it and, you know, sometimes just, you know, making it lighthearted and fun, um, can really, can really help. You know, it can help to see that. And, and, um, that's something that a friend of mine who is hard of hearing told me a long time ago that his parents did, and I thought that's such a great, you know, thing.
[00:34:28] Um, and so that's, that's just something that we've, that we've adopted and, and talking with our families, because, and that's probably one of the funniest parts of my job is just getting to know, you know, the families and the kids and, and that's. You know, I did see adult patients, uh, when I was an audiologist and I enjoyed working with adults, but working with kids and families is just a lot more rewarding.
[00:34:51] You get to see the kids grow up and, um, And, uh, you, you really feel like you're helping them like all the whole, the whole time, you know, and you see and become an Eagle Scout, right? Yeah. Well, I don't think that anything had anything to do with, with the audiologists, but, um, you know, because the amount of work that's involved with that is, is just unbelievable, but it is cool to see, you know, you, you get to see that compressed timeline that you don't often get to see with.
[00:35:19] What's adult patients that I think is just very rewarding. Yeah, no, I agree. So one other question that I had that kind of relates to the hearing aids and parents and functioning would be, what are some questions that you ask if a child is not making progress with them hearing aids? Yeah, that's a really, really good question because.
[00:35:42] It's really easy in retrospect, to look back and say, why didn't we do something sooner? Um, and so one of the things that we talked to audiologists about is developing consistent functional outcome measures, it's questionnaires or speech recognition or
whatever. And I know the functional listening assessments that educational audiologists do, all of those things, um, should improve over time.
[00:36:09] Up until kids are 12 or 13 years old. So if you have a child who. Is not making progress, even if they're sort of staying at the same level on some of those things. Um, don't ignore that. That's why we know kind of now that we've had some experience, what the sort of trajectory looks like when we fit a hearing aid and the child wears their hearing aid.
[00:36:32] Um, and that is that they should continue to progress in terms of their auditory development. Um, and we should continue to see improvements on those questionnaires and on those. Um, those speech recognition measures and, and we see that until kids are in middle school and some children are on different growth trajectories than other kids.
[00:36:53] But the point is, if you have a child who sort of plateaued, it doesn't seem to be making progress. You don't want to wait for them to fall further behind. So that it's really noticeable. So I just try to. It never hurts to ask the question. Um, and, and so as
audiologists, I think looking at, looking at the big picture, talking with the parents, talking with other professionals, it's so important because I think.
[00:37:17] Kids are complicated and they have a lot of really interesting things going on in their development and audiologists. We only see one little piece of it. Right. But if we open, if we expand how we think about it and talk with other professionals and talk with the parents, I think sometimes we can sometimes as audiologists, we write it off as you know, Oh, they were just having a bad day or, you know, I see this a lot.
[00:37:40] But if they're not making progress and they're not, you know, then we need to investigate why that is. Because I think one of the most inspiring things that we found in our research is that a lot of the kids that we see who are deaf and hard of hearing are reaching levels of performance for language and academics and things that are on par with their peers, with normal hearing.
[00:37:58] So we shouldn't, we shouldn't set the bar low and say, well, you know, the reason that this is happening is because they have a hearing loss. It, we need to really. You know, challenge ourselves to say, is there more that we can be doing? Um, is it hearing aid use? Is it that the hearing aids aren't fitted well, did their ear canal get bigger?
[00:38:19] Because they're growing like, are all of these things are things that we need to track down and investigate, and we just have to sort of be tenacious about it because it's that child's development that's at stake and you can't, you don't want to wait. Till two or three years down the road, and then you find out, Oh, you know, we could've really done something differently to help.
[00:38:39] Um, and sometimes you look into it and it's, you know, it's sort of a mystery, but I always felt like as an audiologist, that was my job was to try to. Figure out how to get the most out of every situation and provide the most support that you can. And if you're going to be doing that, I think we're at a stage for audiologists are doing outcome measures consistently.
[00:39:00] But I think a lot of us aren't sure what to do with that information. And that's where some of our research looking at things over time has been really helpful for me because you do see that these kids have these positive trajectories. And so if you don't see that. Then, um, then that to me is a red flag and that's something that needs to be, you know, investigated with the parents, with the speech language pathologist, maybe with the ENT, um, you know, but taking that team approach.
[00:39:28] Right. Yeah, no, that's good. That's good advice about that. And then one other question I had about hearing aids too, and especially kids is what's the impact of part-time use of hearing aids. I, and this is just kind of a story. You know, I have some families who are like, well, they don't wear their hearing aids over the summer.
[00:39:50] So how does that, how does that impact, like that growth trajectory that you were just talking about? Yeah. So I think that's a really good question. Um, and I think there's sort of right now, there's sort of two competing schools of thought that I think we're, we're trying to help. To see if we can do some research to resolve.
[00:40:13] So there's sort of a group of people in our field who, um, are of the mind that if you're awake, then your hearing aids should be on or your devices should be on. And I understand where that's coming from. Um, but when we look at actual use data from children across the age range, children don't do that.
[00:40:36] Kids take breaks from their hearing aids, um, and. There are a few kids who that we work with who are sort of what we would call all waking hours, kids, and that they wear their devices all waking hours. But I would say that's maybe 10 to 15% of the kids that we work with. And then there are kids who don't wear their hearing aids consistently at all.
[00:40:57] And then there's sort of this group in the middle that they wear their hearing aids 10 to 12 hours a day, which is a lot. And, and they're, they're getting a lot of benefit from their devices. And I think one of the important things is we don't really know what the critical amount of hearing aid use is.
[00:41:14] And so. There's no question that not wearing your hearing needs during the summer is not a good plan, but, but I do think we need to figure out, like, is there a critical amount of hearing aid use that is, you know, that benefits kids and because telling people to wear their hearing aids all day, um, all, all the whole time that they're awake is not, I, I don't think it's reasonable and I don't know that it's actually necessary, um, to do that.
[00:41:44] But it's hard because nuance is something. I think that doesn't get a lot of credibility these days. So you either have to be like extreme one way or extreme the other way. And. What I try to talk to families about is like, I'm not going to be upset if, if the child's wearing the hearing aids 10 to 12 hours a day, especially if they're wearing the hearing aids at times that are really important for communication.
[00:42:06] So I think school is really important. I think family time, time with your family time with your siblings is extremely important. You know, any time it's important to be listening. You know, if, if they go to church or if they're, you know, part of a group where communication's really important, but if the child's at home in their room, reading a book
and they want to take their hearing aids off for a little bit, I don't think that there's any, I think it's reasonable to say, yeah, that's fine.
[00:42:34] Um, they don't need to be wearing their hearing aids when they're in their room. They need a break. That's fine. They're in the room. It would probably be really nice to be able to turn off our ears in those listening situations and just focus on reading a book sometimes. So. I tend to fall somewhere in the middle where, you know, I, it worries me when I talk to families who say, well, they wear their hearing aids at school, but they don't wear them at home because to me you're missing out on so much important communication when that happens or what you just said, where they're wearing the hearing aids during the school year.
[00:43:04] But in the summer, we don't really worry about it. And, um, and I think parents are usually good, a good judge of, of that, but we just want to. If they're not using their hearing aids, we want to keep the amount of time that they're not using them to short sort of reasonable episodes of time. So, you know, a couple hours at night when they're winding down.
[00:43:26] Down. And they just want some time off the air. That's totally reasonable. But if the child is interacting, communicating, those are times that we want them to have their amplification so they can access that communication and get the most out of it. And so that they're not struggling to try to, um, communicate with their family or, you know, it, you know, Or those kinds of things.
[00:43:46] So, so I, I tend to fall somewhere in the middle, but it makes people on both sides mad because some of the parents are saying, well, you know, aren't you saying, it's okay that they're not wearing the hearing aids. And I'm not saying that. And then the people who are all waking hours are saying, why aren't you encouraging to wear them all the time?
[00:44:03] And it's like, well, because I don't know anyone who has hearing aids that does that. So I think at some point we needed to talk to the people. Like adults with hearing loss and say, well, what was your experience? And what do you feel like was helpful? Because I, and I don't know what your personal experience was, but I would guess that you probably didn't, you know, where your hearing aids or, you know, or now your cochlear implant, you don't probably wear it all the time.
[00:44:27] And I think that's probably okay to give yourself a break, you know, and not be in the all waking hours. Um, But what do you think about that? I agree with you for most of it, I would say, you know, at night after. about eight o'clock I'm like I'm done. I've had enough auditory stimulation for my day and I just don't of course, that's the time when my husband wants to talk to me, is that okay?
[00:44:55] Can I have anything off? I'm like, could you have talked to me like three hours before this, that we were together? Uh, but you know, he tends to come up with. conversation after I've decided that it's time to take off all my equipment and then it's
too much of a hassle to get it back on again. So, uh, but I do agree like probably after eight o'clock, like, I just need, I am done for the day.
[00:45:20] I put it on at seven in the morning and I, yeah. So it's a long time, I think, where I struggle sometimes with. with that aspect of it is when families do take it like, Oh, well he takes a break and then that never gets put back on again. So, you know, they come home from school and they take them off. And then there was a lot of conversation that happens, like you said, the dinner table or extra activities that, and they don't put them back on because it is kind of.
[00:45:55] That's a hassle. I need to go get them again and put them back on. I mean, I know it only takes a second, but it's still like, I gotta go back upstairs or wherever I keep them and get them back on my ears again. So just easier to do without, so I think it's finding, it just depends on the family sometimes.
[00:46:15] Yeah, totally agree. And I don't want to make it sound like, I don't think it's important that, um, That we encourage consistent use. I just think our messaging around it is not very nuanced, right? Like, you know, we, we really don't have any evidence that you have to wear your hearing aids, all waking hours to help you.
[00:46:35] Right. And in fact way I'm during critical periods communication to help you. Yeah, the thing I always use. So, you know, anytime you work with families, especially of infants and young children, you, you realize the real challenge here. And that is like getting an infant to wear a hearing aid. And one of the things that I always used to emphasize to families was quality time over quantity of time.
[00:47:01] So. You know, if a family was really struggling with hearing aid use and their child, what I would say is pick the times during the day. That you're engaged and that your child is in communication with you and focus on those first. I don't care if your baby wears the hearing aid during nap time. I really don't.
[00:47:23] I don't think there's any benefit to that. Um, and in fact, it probably helps them sleep better and it probably helps you to relax. If you know that you're not going to walk into the childs crib and see the hearing aid in their mouth. Right. But some of these parents take the all waking hours piece. To be, you know, I can only take it off after they fall asleep.
[00:47:42] I mean, there are parents who are worried that they're going to hurt their kids, if they don't try to get them to wear the hearing aids all the time. And, and I think we just need to build on success and say, what are the times in your family's routine that are, that, you know, are the most interactive. So is there reading going on, do you read to your child?
[00:48:01] That's a really good time for hearing aid use. I think mealtime having, you know, And then it allows you to have conversations about, you know, if there's interaction where the TV's not on, you know, in the home. I mean, there's just lots of things that we can do to
help families sort of build success. And because it's going to be, uh, a challenge that paper that Beth published with infants showed that, um, the infants were wearing their hearing aids about four hours a day.
[00:48:30] And the parents were telling the audiologists that they were wearing them about eight hours a day. Hm. And I don't think that's because parents were trying to deceive the audiologist. I think the parents wanted to make the audiologists happy and they wanted the audiologists to think that they were doing a good job.
[00:48:47] And that's because the audiologist says they need to wear the hearing aids all waking hours. When I think what we need to say is, you know, what can we build on, what are the successes that we can build on with hearing aid use over time? And I think that's just, it, it's going to become a more positive thing for parents and they won't feel ashamed if.
[00:49:05] Because it's hard, you know, like it's really, really hard. And, um, and that's, we tried to start all of our conversations about hearing aid use with that. Like it's difficult. You know, the analogy that I always use is I can never keep shoes on my kids when they were little. So the idea that you can keep a hearing aid on them is sort of remarkable, you know?
[00:49:24] So just sort of giving parents the, the freedom to say. You know, what's what, what do you think is going to work best for your child? And then letting them, you know, take the lead? I think that's so important, but you're right. We do have to reinforce that if
they're taking breaks, they're short, we don't want extended periods of time without hearing aids more than more than an hour or two, you know, without the hearing aids, as a, as a choice is, is, is a problem.
[00:49:53] And, and, and so we do have to. Be strict about that and say, it's not a free for all where you can just wear the hearing aids when you want. Um, but, but, and then having that link for them that that it really is important for their development that they wear their hearing aids. Right, right. Yeah. No, this was good.
[00:50:11] I'm so glad you guys are doing all this research on hearing aids and kids and, and what, what they need. Is there anything Ryan, I didn't ask you that you want to share with listeners today as a takeaway. No. I mean, I just think, uh, it's such a cool time, uh, to be in our field and to be working with families of children who are deaf and hard of hearing, because, um, when I started out as an undergrad at Northern Colorado, I was still seeing kids in the lab school there that were identified with hearing loss when they were two or three years old.
[00:50:49] And they were wearing these big bulky. You know, body aids that sent one signal to both years. Right. And that was pretty, I thought that was pretty cool, but now we're fitting babies and we're, I mean, and that, I don't feel like I'm that old. And I feel like things change really, really fast. And it's been a challenge because we've had to have research to kind of keep on top of those changes.
[00:51:12] Right. Because before that, we didn't really fit infants with hearing aids and now we're doing it all the time. So. I just think it's such a cool time right now. I don't think there's ever been a better time to be in our field and to be helping people. And, um, it's just, I'm really excited to see like what the next 20 years are like, because if we make as much progress as we did in the last 20 years, it's going to be amazing.
[00:51:34] Like it's, it's just, it's going to be cool. So that's. I just, I'm so excited about it and I really appreciate the opportunity to come on your podcast and talk your ear off. It's it's, uh, it's been fun. Well, thank you for coming on. I really appreciate it. And I know I listened to if they're going to gain a lot from listening today.
[00:51:53] So, um, Ryan, what I'm going to do and I show notes is put a link to your webpage. So] I know you guys at Boystown have so many great resources to share with professionals and parents and the like, out there. So I would definitely link that to the show notes. And again, thank you for being a part of empowEAR Audiology.
[00:52:14] Thank you, Carrie. I really appreciate it. All right. Thanks again. This has been a production of the 3C Digital Media Network.