Issues in Pediatric Audiology, Hearing, Reading, and More feat. Dr. Jacqueline Rogers Scholl

In this episode of the Hearing Matters Podcast, we discuss how hearing influences a child's education and future prospects with Dr. Douglas Beck and pediatric audiology expert Dr. Jackie Rogers Scholl. 

This episode takes you on a journey through auditory processing and literacy, shedding light on the stark reality that many children face when undiagnosed auditory issues lead to struggles in learning and reading. We tackle how inadequate hearing, reading and listening screenings in schools fail to detect and treat hearing loss, listening disorders, auditory neuropathy spectrum disorder, dyslexia and many other otherwise detectable and treatable problems, setting the stage for long-term academic challenges.

Dr. Scholl reveals the startling genetic and environmental contributors to hearing loss, as well as the impact of fluctuating hearing loss on speech and language development. We discuss groundbreaking research that links these auditory challenges to higher rates of incarceration, emphasizing the importance of stable auditory input for healthy brain development. 

The dialogue also addresses the outdated and sometimes non-existent current screening hearing protocols, which often do not detect fluctuating hearing loss, asymmetric hearing loss, extended high frequency hearing loss, poor word recognition scores, speech in noise problems, and other auditory  problems which can drastically affect a child's ability to process spoken language and succeed in the classroom.

As we look to the future of pediatric audiology, we express concerns over the potential impacts of budget cuts on the ability to effectively screen and support children with communicative disorders. We review early results from an upcoming study that promises to inform our understanding of hearing loss statistics, particularly regarding high-frequency loss in young children. 

Stay tuned for how to better manage and safeguard our children's hearing and, consequently, their educational and personal development, with insights from these leading experts in the field.

While we know all hearing aids amplify sounds to help you hear them, Starkey Genesis AI uses cutting-edge technology designed to help you understand them, too.

Using innovative Neuro Sound Technology, Genesis AI mimics how a healthy auditory system hears. This allows the hearing aids to better replicate how the human brain processes sound.

Click here to find a hearing care professional near you to try Genesis AI! 

Transcript

Dr. Jacqueline Rogers Scholl: 0:00

Over eighty five percent of the people in our criminal system don't read, can't read. Say that again. Over eighty five percent You'll see it different reports will show different numbers, but it's always around eighty five percent of the population within our criminal system, they are either reading below proficiency or illiterate altogether.

Blaise M. Delfino, M.S. - HIS: 0:29

You're tuned into the hearing matters podcast. The show that discusses hearing technology, best practices, and a global epidemic, hearing loss. Before we kick this up, a soda off, a special thank you to our partners. Redux, faster, drier, smarter, verified, cycle, built for the entire hearing care practice, Auto Set, the modern ear cleaning device, fater plugs, the world's first custom adjustable ear plug. Welcome back to another episode of the Hearing Batter's podcast I'm your founder and host, Blaise Delfino. And as a friendly reminder, this podcast is separate from my work at Starke. On this episode, you're going to hear a conversation between our cohost, doctor Douglas Beck and our guest, doctor Jackie Rogers shoulder. Now as a hearing care professional, my number one takeaway after listening back to this episode is we have the opportunity to do better. So without further ado, enjoy the conversation between doctor Beck and doctor Jackie Rogers Scholl.

Dr. Douglas L. Beck: 1:37

Good day. You're listening to the Hearing Matters podcast. My name is doctor for Douglas Beck. I am an audiologist and I'm pleased that my cohost today is Dr. Jackie, Roger Scholes from Oklahoma. Thank you for being here, Jackie.

Dr. Jacqueline Rogers Scholl: 1:50

Thank you, Doug. It's a pleasure.

Dr. Douglas L. Beck: 1:52

Thank you. And and I'm so glad you're here. We have so much to talk about. I wanna just give a brief intro. I know you've been an audiologist for a couple of decades. And you started a not for profit just before COVID. So you were in private practice doing primarily pediatrics, right, in in Oklahoma?

Dr. Jacqueline Rogers Scholl: 2:10

Yes. We did pediatrics and we had a full we did hearing aids, cochlear implants, balance, tinnitus. We did all of it.

Dr. Douglas L. Beck: 2:17

Did all of it. And then you, about four years ago, sold that practice, and you started soundworks dot org which is enough for profit in are you in Oklahoma City?

Dr. Jacqueline Rogers Scholl: 2:28

No. We're actually in Tulsa.

Dr. Douglas L. Beck: 2:30

Tulsa. Okay. The opposing the opposing major city in Oklahoma. It's pretty, please. What I'd like to do is I wanna talk to you about screening in general, but in particular, we'll talk about screening in pediatrics. So why don't you set the stage for us? Are children in America screened for vision and hearing as they enter elementary school?

Dr. Jacqueline Rogers Scholl: 2:53

Well, some are some have the benefit of getting vision and hearing screenings, but that's not everyone. There's about eight states that do not require hearing screenings and Oklahoma happens to be one of those states. We require vision testing because you need your eyes, I guess, but you don't need your ears.

Dr. Douglas L. Beck: 3:13

You know, that's interesting. I remember many of my pediatric colleagues. I'm thinking of Jane madelele, Colonel Flexor, people like that who would say that probably eighty percent of everything you know, eighty percent of everything you've learned comes in through your ears. Now I'm not dissing vision screening. I think that's great. Nothing that's appropriate. But to have vision screening in the absence of auditory screening that Children could have absolutely normal thresholds or could have a mild to moderate loss and nobody would necessarily know that. But the challenge of having auditory neuropathy spectrum disorder dyslexia, auditory processing disorders, a d d, a d h d, undiagnosed with great vision, that does not guarantee that you're going to do well in school.

Dr. Jacqueline Rogers Scholl: 3:56

I have pondered that so much over the past four years. Most everything we do, it's an auditory world. It's also a visual world. I don't want to take away from that. But I think the reason why there's and I'm speaking now as someone who also my favorite courses were my physics courses. Right? What I know about vision and optics is that it's pretty straightforward. It's not as complicated and it's the auditory system. You know, I've spent the last however many years studying the auditory system and I still am amazed at the new things I discover. I think that it's really difficult for people to talk knowledgeable. Most people about the auditory system because of its complexity. Howard

Dr. Douglas L. Beck: 4:43

Bauchner: And and, you know, part of this is that we often confuse, not you and me necessarily, but but the public teachers physicians confuse hearing and listening. Hearing is just perceiving or detecting sound. The fact that somebody can detect that pounding does not mean that they can appropriately process that pounding for some people that could be a hammer for some people that could be a pen tapping on a desk. The ability to understand and to assign meaning, that's listening. So we have hearing as perceiving or detecting sound, which is the only thing tested in most screenings is just press the button when you hear the beep. Listening is the ability to make sense out of sound, to comprehend, to understand sound. And when we assign meaning to sound, then we start to get a more holistic, a a more universal understanding of what those phonemes word sentences mean. And so what you've just said to me is that eight states don't even test hearing. Do you have any appreciation for how many do any sort of listening or understanding tests?

Dr. Jacqueline Rogers Scholl: 5:43

I'm going to say something and it's just I I have nothing to back this up. I want you to know. So if someone calls and says, hey, our state does it different, than bad as me. But as far as I know, there are no states that are doing anything other than pure tone testing at just a few of the frequencies. That's another issue, Doug. When we talk about newborn hearing screenings, and we go, well, there's a real standard, there's a criteria, there's a follow through. I mean, really, they they got that down. You hit school, there's no standardizing. There's no monitoring. There's no we should do this across the board. We do the same thing we've done for over a hundred years.

Dr. Douglas L. Beck: 6:24

Let me take some of that apart. When you talk about we don't do a full set of pure tones, that that's absolutely true. Because when we're doing adult audiology, we're looking at two hundred and fifty, five hundred, one thousand, two thousand, four thousand, eight thousand hertz. We're looking at six. We should be doing ten, which would include the mid which would be seven hundred and fifty, fifteen hundred, three thousand, and six thousand. And in adults, we know that listening disorders, speech noise, or disorders and hearing loss often shows up in the extended high frequencies first, but again, we have no standards on this. So if you were to test ten, twelve, fourteen, sixteen thousand hertz or just just do twelve and you start to see asymmetries there, that can often be prescient or or predict who's going to have troubles later. And and, you know, unfortunately, extended high frequencies haven't come very far in the last four to five years. We've known about it since I was in graduate school forty years ago. And it's still not part of a standard audio metric comprehensive evaluation. Now I want to go back to what you said about newborns. Newborn infant screening to me is absolutely brilliant. That's always screening that I personally endorse. And all that does is that finds hearing problems and children doesn't find listening problems. What we're saying in a newborn infant screening is can we put sound into the ear canal on a newborn literally at the moment of birth and measure a response from their brain. And if the answer is yes, we can presume that they're probably fine. If the answer is no, then that's a referral for a diagnostic evaluation. And then follow-up with an, hopefully, a pediatric or a laryngologist or somebody, you know, in the medical world who will say that, yes, here's the diagnosis, here's the treatment, and let's engage that right away, as soon as possible, given that child's state, so that we can avoid the problems associated with hearing loss and listening disorders and things like that. But so universal newborn hearing screening absolutely one hundred percent brilliant. I totally endorse it always have, always well. But that's not the same thing that we need to do. With a child who's learning reading and language and spelling and pronunciation and grammar, those are much more advanced skills And in fact, I think you've written quite a bit about this on your website. They're reading as an auditory skill. Howard

Dr. Jacqueline Rogers Scholl: 8:35

Bauchner: Correct. And and there is a caveat, like yourself, I am and have always been a big fan of Mary Anne Downs. Wes, her. She was amazing. There's a caveat to the to the newborn hearing screening. First of all, we miss mild hearing losses.

Dr. Douglas L. Beck: 8:49

Sure.

Dr. Jacqueline Rogers Scholl: 8:50

So, the numbers that always reflect, you know, three per thousand, that's children who have a moderate to severe to profound hearing loss.

Dr. Douglas L. Beck: 8:59

Great point. Great

Dr. Jacqueline Rogers Scholl: 9:00

point. That's not a mild hearing loss. And there are over one hundred and nineteen genes now, which have been mapped to hearing loss, there's over four hundred syndromes that have hearing loss as part of the second wave of the syndrome. So the acquired hearing loss is far greater than what we find at birth.

Dr. Douglas L. Beck: 9:24

Absolutely. And CMV is that omega virus is a great example of that. I hate to say this number out loud because I could be way wrong, but I think something eighty percent of adults have some sort of herpes infection. And CMB side of megawatt virus is within the herpes family. And a lot of people have this. And you could be born with CMB and be perfectly normal at birth. And then, you know, twelve months, eighteen months later, you could have a moderate or severe hearing loss.

Dr. Jacqueline Rogers Scholl: 9:52

That's right.

Dr. Douglas L. Beck: 9:53

Yeah.

Dr. Jacqueline Rogers Scholl: 9:53

That's exactly right. So so my I believe the new frontier I mean, and I'm not saying we stopped advancing and doing all the things for newborns because I like yourself, I endorse it and I'm equally you know, Gun Ho. I was there to help pass it in Oklahoma. I think our next frontier, our frontier that has to happen now is kids finding those kids from the time they're born and for whatever reason have acquire hearing loss even if that is chronic middle ear fluid. Gotta find those kids early because they're being missed, I believe they're being missed at very large numbers.

Dr. Douglas L. Beck: 10:32

And it's interesting when you talk about children with fluctuating hearing loss. So these are typically children who might have allergies, they might have eustachian tube dysfunction, they might have otitis media, they might have a lot of things. But the indications are that children who get a non stable sensory input have a higher rate of failure later in life. Now, I I don't have current data on this at all. I will I will mention my mentor from forty years ago, Dr. Jack Katz, who studied otitis media, and he pointed out that children with untreated otitis media at a much higher rate of APD auditory processing disorders. And the presumption was that because their brain is not getting a stable signal to learn from because it's louder, it's softer, it's distorted, it's not that the brain's pathways, the neuronal pathways throughout the entire brain, not just the superior temporal lobe, don't have the ability to grow and learn and and maximize that auditory input because it's always changing on them.

Dr. Jacqueline Rogers Scholl: 11:35

Nina Krause has found the same thing. The auditory experience whether it be great and really stabilizes that auditory pathway. Or have a negative influence whether it be not having language rich environment, having, you know, chronic middle ear fluid, it can go the other way too. So

Dr. Douglas L. Beck: 11:53

And Nina talks about rhythm and and the ability to have timing and rhythm and timbre and things like this. Can you talk about that a little bit?

Dr. Jacqueline Rogers Scholl: 12:01

Sure. Sure. She's published several pieces of literature that where she has gone in and they've looked at the rhythm of entering, you know, like, preschoolers And what they have found through their research and other people have done this as well is that those children who had poor abilities to keep time as a preschooler were more at risk because they were the ones that fell behind because their auditory pathway is already showing this synchronization.

Dr. Douglas L. Beck: 12:30

That is very cool. Now we should mention that Nina Krause is a biologist. She's got a PhD. She's a Northwestern. Her book is called of sound mind. And I I wrote a review of that book when it came out a few years ago and it's great. I wanna recommend it. But it's not just that book. Dan Levaten, I think it was two thousand six in his best selling New York Times book. This is your brain on music. He talks about rhythm and percussion and timing as primary auditory functions and they developed before, probably by thousands of years, before language. And so I think that this makes good sense that children who can't keep good stable rhythm are probably at a disadvantage as far as language development.

Dr. Jacqueline Rogers Scholl: 13:11

I think you're right. And I think the research shows it. And I think the ability going forward to find those kids, man, if we can find them at three,

Dr. Douglas L. Beck: 13:19

you

Dr. Jacqueline Rogers Scholl: 13:19

know, can go in with an FFR, you know, but we all know that that's very difficult to do in a school type setting.

Dr. Douglas L. Beck: 13:26

FFR is frequency following response. That's a neurophysiologic signature.

Dr. Jacqueline Rogers Scholl: 13:30

Yeah. And that'll actually show what's going on on the it's like a middle latency. Show on the auditory pathway. But, you know, trying to get those kids early, I don't have a great sense for grabbing them at three and four and five, I I got

Dr. Douglas L. Beck: 13:46

But what what I think the speech and language literature has shown pretty clearly is that we need to intervene really fast. So Jackie, I think it's clear that we have some issues in how we go about screening, testing, evaluating the communicative disorders that are often present in children. I think nationally, we know that about fifteen to eighteen percent of children are going to have hearing and listening difficulty. And if these are not caught early, if they're not screened, if they're not diagnosed, if they're not treated, they do lead to larger problems later and that could be respiratory processing disorders. And I think there's an abnormally high amount of people who are in prisons and jails who have auditory processing and hearing problems. Can you comment on that at all?

Dr. Jacqueline Rogers Scholl: 14:35

I have not really done much in that population. I do think about it a lot. Because there is a - although there's not been a study that would directly correlate, you will hear people say a lot that you look at the fourth grade levels of kids who aren't reading and that kind of can project how many beds you're going to need in correction facilities later on.

Dr. Douglas L. Beck: 14:58

That's amazing. Right?

Dr. Jacqueline Rogers Scholl: 14:59

Over eighty five percent of the people in our criminal system don't read, can't read.

Dr. Douglas L. Beck: 15:07

Say that again, that's that's a step.

Dr. Jacqueline Rogers Scholl: 15:09

Over over eighty five percent. You'll you'll see it different reports will show different numbers, but it's always around eighty five percent of the population within our criminal system. They are either reading below proficiency or illiterate altogether?

Dr. Douglas L. Beck: 15:26

That's astounding. And and as you say often, you know, reading is an auditory issue.

Dr. Jacqueline Rogers Scholl: 15:31

Yeah. It is. It's absolutely an auditory skill. It is also, you know, we talked about vision earlier. You need your vision as well. But you can learn to read using braille, so it's not like you have to have it, but it is primarily an auditory skill and yet we are not screening kids to find those problems. We're still using pure tones, which is really just hearing acuity. It doesn't tell you what they're hearing. It just tells you they're hearing sound.

Dr. Douglas L. Beck: 16:05

It's a great point because I'll tell you in my personal life. So I'm color blind and and people who know me well know that I normally just were black or white till I can't see those colors at the other colors. And So I never had a screening test when I was a kid of Visual Acuity. So I could see things, and I knew what the letters were. I couldn't tell you what color they were. You know? And anyway, so this this becomes remarkably important because if we're just testing acuity, we're just saying that the sensory system is working we're not addressing how well is it working? How accurately is it working? How sensitive is it? We don't know any of those things. We're presuming that if sensory system is working, then everything's okay. And that's a huge leap of faith. Howard Bauchner:

Dr. Jacqueline Rogers Scholl: 16:45

It's a very dramatic leap of faith, actually. I had And if you're not testing and if you're not testing for it, you're not gonna know it's there. I had a I set a cross from a new PHD literacy expert that's working at state who basically told me that she knew if they had a hearing loss. I said, wow, I've been doing this thirty plus years and I don't know unless I test them. That's pretty magical.

Dr. Douglas L. Beck: 17:12

For an administrator or a teacher or a parent to think that they would know if the child has hearing loss. That's that's really not accurate at all. I'll tell you, after forty years as an audiologist, I can't have a conversation with a child. And know what their hearing levels are. I can tell if they're grossly normal or grossly abnormal, but that's not the biggest issue because most kids with hearing loss don't have a profound loss. They have a mild or a moderate loss. Those are the ones that we'd like to work with as soon as possible. Not not saying we wouldn't wanna work with the others. Of course, we would But there are many more children with mild, moderate, and severe severe loss than profound as a matter of fact, children with severe and profound loss are probably fewer than ten percent of all kids with hearing loss. Nonetheless, you know, there's a recent report by the They

Dr. Jacqueline Rogers Scholl: 17:56

get the most attention. They get the most attention.

Dr. Douglas L. Beck: 17:59

The the children with profound loss.

Dr. Jacqueline Rogers Scholl: 18:01

Yes. Okay. So it's so obvious, but the ones who have mild and in the words of Fred Best, Mild is not inconsequential. You know, mild is huge. Mild is huge. Yeah. And so what happens is those kids get undiagnosed, unidentified. They get labeled as a reading delay. They're taking speech for years, never progressing their behaviors in the classroom. And wow, no one thinks that maybe they have a hearing loss.

Dr. Douglas L. Beck: 18:28

That's exactly right. And the hearing loss masquerades as a million other problems. And and it depends on the discipline and the education, the knowledge of the person who is working with that child to come up with the right referral source, and that's not an easy task. There was a new report out of the World Health Organization, and let me give you the year of that, but people who wanna look it up, let's see, twenty twenty one world report on hearing came out of Geneva World Health Organization twenty twenty one, so people should be able to find it by that. But the recent report, the one I just quoted, said that pure tone audiometry, despite being considered as the gold standard for hearing evaluation, does not provide the best insight into hearing capacity in everyday life situations. And when we talk about things like auditory processing disorders and suprathreshold listening disorders. All of those will be invisible to practitioners who do not test for them because it's not going to be something as easy as a detection task. Press the button when you hear the beep. You actually have to engage that brain so you can see how the brain is sorting things out and making sense of the world.

Dr. Jacqueline Rogers Scholl: 19:37

And here's the really interesting thing about that. This drug. If you think about least ringing, hearing birth, because it's one of the leading birth defects.

Dr. Douglas L. Beck: 19:48

Sure.

Dr. Jacqueline Rogers Scholl: 19:49

By the time they start school, if you look at the big pie of disabilities and how they are classified and categorized, hearing becomes a low incidence. It's less than two percent. It's not even a piece of the pie. Right. So where do those kids go? Because we know that because of acquired hearing loss, there's going to be even more of them, but then you look at these categories of specific learning disorders, which really kind of means smart kids who can't read. It's like thirty three percent. You've got speech and language. So what we're doing is we're treating the symptoms and not treating what the real problem is.

Dr. Douglas L. Beck: 20:27

I agree. And you did a recent pilot study and a follow-up study. Can you talk about that? What did you find? What did you look at?

Dr. Jacqueline Rogers Scholl: 20:34

One of the things that we're trying to do at SoundWorks is to change policy. Create policy for all the kids in Oklahoma. We kind of fall at the bottom of most indicators for child health, child well-being, child education. So we're trying to change policy, create policy. We did an interim study at the capital in twenty twenty two. Basically, stating we're not looking for these kids. And this is what is happening to the reading. This is why intervention is not working. To back that information up, we then went out and did a pilot study in conjunction with Oklahoma State University and their grad students. And we did an urban and a rural school. And we had eight different screeners. And the purpose for that was, well, if we're gonna create policy, we don't want to be doing the same thing that's been done a hundred years. And Ashen, AAA have it up updated their guidelines and deck

Dr. Douglas L. Beck: 21:30

So so you had eight screening tools is what you're saying. Mhmm.

Dr. Jacqueline Rogers Scholl: 21:33

Yep. Yes. Pure Town acoustic reflexes, OAEs. Blah blah blah. We had a whole one of those tools was something called SoundScout. By our friend or Mary Dillon. Mhmm. And Carolyn Me. And that that actually screens speech and quiet. Speech and noise and tones and noise. So the whole point was we went out, we did these screeners, and then as part of this pilot workup, we went back to do diagnostic testing. Because now we can actually carry some of those tools on us now. Because of, you know, after COVID, some of the headphones, what we're looking at now is the sensitivity and specificity of those screening tools and what what I found so far. I'm not quite finished, but what I found was that out of the eighteen kids that we rescreened, just in first grade, not second grade yet, but in the first grade, we had four diagnosed hearing losses since we enrolled. I had six, what I suspect, to be auditory processing, and three kiddos that seemed to be those kids that had chronic middle ear. And it's become educationally significant and really slowed them down. Of those children, if we had been doing one of the guidelines as projected by ASHA and or AAA, we would have found one of those kids.

Dr. Douglas L. Beck: 23:02

Howard Bauchner: So it was thirteen out of the eighteen who were identified with some sort of auditory issue. So that would be seventy two percent of the children.

Dr. Jacqueline Rogers Scholl: 23:13

Yes, we're not done in that school. We still have to do second grade.

Dr. Douglas L. Beck: 23:16

Howard Bauchner: And you have to understand that when you're thinking about screening, We're not just talking about press the button when you hear the beep. Audiology, auditory processing is a whole brain event. When we talk about press the button when you hear the beep, raise your hand when you hear the beep, you could argue that that's just, you know, ear and superior temporal lobe on me. Comfortable and obsolescence. Okay. But when you start adding language and phonemes and making sense out of speech and noise and and looking at things, language and pronunciation and vocabulary and grammar. These are whole brain events. It's not just did you hear it. And did you detect it? It's what can your brain do with it? Again, going back forty years. When I was in graduate school, well, actually, that was more like forty four years ago.

Dr. Jacqueline Rogers Scholl: 24:02

No one's counting Doug.

Dr. Douglas L. Beck: 24:04

Yes. Sure. Yeah. Sure. So doctor Jack Katz is a very, very famous audiologist, and he's the fellow who created essentially phonemic synthesis training and the SSW staggered funding were a test. So Jack, it had this wonderful definition that he used in the mid sixties of auditory processing disorders. And I've always held that as Deer Incorrect, and the definition of APD, auditory processing disorders, is what you do with what you hear. And if we're just looking at hearing, we're gonna miss the forest for the trees. We have to look deeper Audiologists, speech language pathologists, other professionals are involved in these things, know how to do these things, and to not avail these skills and these tests and these screeners and these treatments to children in school means we're setting ourselves up for a giant failure.

Dr. Jacqueline Rogers Scholl: 24:56

I think we're already seeing a giant failure. If you look at the reading scores, every single one of these kids identified are struggling readers. Two of them are getting retained this year. It's just not rocket science. You know, we need to be looking at these kids. I don't like a wait to fail model. I don't like it at all. But seems to be where we are right now. I think getting in and getting those three and four year olds, you know, getting more of a consistent working with EDI program, you know, looking at all those things. But right now we're in a situation where our kids are failing at great rates. And

Dr. Douglas L. Beck: 26:53

The edit the edit program for people who haven't heard that term, that's the early hearing detection and intervention program.

Dr. Jacqueline Rogers Scholl: 27:00

Yeah, I think there needs to be a bridge between that and starting school. I don't know what that looks like, but I know that the people that have developed all of them newborn hearing screenings, they've done a remarkable job of really doing best practice for finding babies.

Dr. Douglas L. Beck: 27:16

So, Jackie, if you're a parent, and you have a two year old child at home and and you may have some concerns that he or she is not attending to sound, turning their head, when a sound comes from the left or the right or or you're noticing something that that has your concern. I love the idea of bringing that child into an audiologist for comprehensive audio metric evaluation. But on a two year old, that's challenging. What is it that you would do with that child in the office? Because I think one of the big areas that that is often neglected is functional hearing. In another Oh

Dr. Jacqueline Rogers Scholl: 27:52

my goodness. Yes.

Dr. Douglas L. Beck: 27:54

Right. So we we wanna test detection, of course, but we wanna also have an analysis or at least a best approximation of how is that child child doing in the real world with the hearing they have and the situation they're in, that would be a functional sort of listening test. Can can you elaborate on that?

Dr. Jacqueline Rogers Scholl: 28:12

Absolutely can. Because what we're talking about in this whole in this whole thing that we're doing this morning is about functional listening. It's about how well does a child hear in the classroom. It's not do you hear a pure tone at twenty DB?

Dr. Douglas L. Beck: 28:28

Right.

Dr. Jacqueline Rogers Scholl: 28:28

How can a child be successful in the classroom? With a little one like that, if the parent has a concern and and I I trust moms. Homes know their kids so well. I may not see what's going on in my office, but we have good questionnaires and things that we can have them fill out and get a better sense for how the kids performing in their own home. In your toolbox of referrals. You can refer, you know, to a speech pathologist who is familiar with pediatrics. I think you kind of gather around the family with the resources that you have. And again, some places are very our deserts in in terms of of resources. But, you know, you you look at things even, like I said earlier, something as simple as paticate.

Dr. Douglas L. Beck: 29:20

Right. Right.

Dr. Jacqueline Rogers Scholl: 29:21

Can they keep her the can they can they cross their hands over their body? You know, there's this whole midline. You know, you've got right and left hemispheres. And you know, what what are you seeing functionally? Am I developmental specialist, I am not, but I know enough, and I know to refer.

Dr. Douglas L. Beck: 29:39

Howard Bauchner: And that's a critical step, of course. So as we look at pediatrics and geriatrics, you know, we we screen for a lot of things because, again, they can masquerade as auditory problems, whether it's cognition, psychological, emotional, ADD, ADHD, dyslexia, speech, and language problems. They they can show up in the arena of auditory processing or auditory capacity issues. So I told you about this paper This came out in European archives of OTO RHINO laryngeology. It's the one we talked about a little bit earlier. And they do say diagnostic assessment should go much further than pure tones. They say for younger images and other cases where pure tone is challenging, there are other diagnostic tests that could be done. They say that in cases with suspected hearing difficulties, but normal pure tones, assessments of speech perception in quiet and in noise should take place and we should be looking at things like auditory processing disorders, auditory neuropathy, spectrum disorders, hidden hearing loss. I don't care for the term hidden hearing loss, but ANST, auditory neuropathy, spectrum disorder. So that's why many children, many adults, many older folks might have normal appearing oniograms but they can't understand speech noise as a manifestation of auditory neuropathy spectrum disorder because they may not have a full complement of neuronal representation that is needed to listen, not just to hear, to hear. You only need twenty percent of those fibers. To listen, you need a great deal more.

Dr. Jacqueline Rogers Scholl: 31:16

And you don't necessarily need synchronization to hear a sound, you need synchronization to understand a word.

Dr. Douglas L. Beck: 31:23

Yeah. And and this same report, I agree, and Charlie, in cases with sport, poor speech perception, or with reported listening difficulties despite normal audiograms, a auditory processing evaluation should be implemented. The minimum APD test battery includes assessments of speech perception and noise or bowel, psychotic listening, and temporal processing. And the questions, questionnaires should be considered. And cognitive and language factors may inform test selection and appropriate approaches similar to determining the appropriate conducted pure tone audiometry. Anyway, so it's a fascinating topic and I wish I could say that the future looks bright. I'm a little concerned that as we move forward in time, because this is twenty twenty four, we do know how to screen, we do know how to diagnose we do know how to treat children with communicative disorders, whether they'd be hearing, listening, speech, language, you know, whether it's receptive or expressive. We we have a lot of knowledge about this, yet my concern is that school budgets school personnel, audiology, speech language pathology, medicine. These things are very, very expensive. And when you reduce screenings and the diagnostics of children, we're gonna pay a much bigger price later.

Dr. Jacqueline Rogers Scholl: 32:45

So in the words of one of my favorites, Chuck Berlin, we need to have literate taxpayers. And in order to do that, we are going to have to I say step up our game. We have to change our game. There are people out there that are working very, very hard. There's approximately seven to eight hundred educational audiologists, and you've got a public school population of about fifty two million children. So, you know, what is that? Forty three, forty four thousand kids per audiologists. I mean, we've got to recognize that they're you know, people keep saying there's a shortage in audiology. I think there's a shortage in positions is what I think I could be totally wrong about that, but I've done a lot of people that wanted to go into educational audiology, and there wasn't a job for them. So I think that when we start realizing that the millions of dollars that we're spending on remediation, intervention for reading alone could be appropriated differently. I'm not saying that you don't still need to have the method of instruction and that's what the science of reading tells you. All these different methods of instruction. But what the science of reading does not tell you is the real science and the real biology behind why the child is not reading. So For some kids, intervention may work. You may just hit that nail right on the head. But right now, it's Skatter Shop. I mean, they're just doing intervention, calling it the science of reading. And I disagreed that there's much science in it all. Yeah.

Dr. Douglas L. Beck: 34:26

That so it's the tip of the iceberg scenario. Right? Where you're taking the sign and symptom and you're treating that, but you didn't actually get to the diagnosis. And the diagnosis is frequently an auditory diagnosis that goes undiagnosed. And so then we take the secondary complications, the comorbidities that occur as a result of that, and we start treating that. So it's a little bit of a dog chasing its tail. You're just kinda never gonna get there.

Dr. Jacqueline Rogers Scholl: 34:52

Howard Bauchner: And here's the interesting thing I found through this whole process. Of doing this pilot study. I've learned tremendous amount about our diagnostic tools. But one of the things is when you are testing. And I saw this a couple times. When you're testing speech, which in my opinion is the gold standard. Yes. Speech and speech in noise. Your brain does this really cool thing. And with kind of always known about it, it'll fill in gaps where you may not hear it, but your brain goes, oh, I know enough about this subject that I think it's this. Kids who have high frequency hearing loss can pass a lot of the speech and speech in noise. You have to go back and test six and eight k to make sure I did four six and eight, but make sure that you haven't missed till missed a hearing loss. Okay. Sounds fascinating. Yeah.

Dr. Douglas L. Beck: 35:49

Yeah. Very, very well stated. Jackie, I wanna thank you for your time and for your presence and for your knowledge. I I think this is a very, very important subject. I'm so glad you're involved. When does the study come out?

Dr. Jacqueline Rogers Scholl: 36:01

We are finishing the study. We've got two more diagnostic collection dates. And then all of the information. So I will let you know. Okay. I I think it's gonna be a little shocking for people when they realize that the numbers that we see published, everyone goes to the fifteen percent for the CDC. That was published in nineteen seventy nine.

Dr. Douglas L. Beck: 36:22

You

Dr. Jacqueline Rogers Scholl: 36:22

know, it's a pretty old study. It really doesn't take into account some of the new new things that we deal with like high frequency see hearing loss because of headphones and earbuds. That's a whole another conversation we're talking to our kids about. But I will let you know because I think I think the information is gonna be a little shocking for people.

Dr. Douglas L. Beck: 36:40

Alright. When the study comes out, let's talk about it and we'll review it here on hearing matters podcast. And I I would love that. In the meantime, I wanna urge people, go to sound, work dot org and they can learn more about you and and your protocols, and thank you so much for your time today.

Dr. Jacqueline Rogers Scholl: 36:54

Thank you, Doug.