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November 21, 2011

Best Practices in Audiological Management

November 21, 2011—This article was featured in the September/October 2011 issue of The Mainstream News. Clarke publishes The Mainstream News five times per school year as a resource for educators and families. Timely, practical articles help professionals and parents provide students with effective support and access in educational settings. Subscribe today.

Sound Advice

(from The Mainstream News) Students who use hearing aids or cochlear implants and FM systems depend upon them to gain better access to information and communication throughout the day. In order for students to receive optimal benefit from these devices and develop good listening skills, the equipment needs to be appropriately fit, worn consistently and in good working order. Audiological management is a key component to a student’s educational program, but what this support looks like often varies, ranging from thorough and consistent monitoring to sporadic check-ins. In addition, we often find students using unsuitable or broken equipment on school visits. Whether receiving a new student with hearing loss or working with one or more returning students, it is important to have an effective system in place for purchasing, monitoring and troubleshooting equipment, as well as educating staff and students on proper use. With a new school year underway, Clarke Hearing Center audiologists encourage school teams to consider the following:

Assistance from an educational audiologist

If an FM system is deemed appropriate for your student, purchase the system through an audiologist, not directly from the manufacturer. FM systems are not “plug and play” devices, meaning they need to be fitted with the child’s hearing aids or cochlear implants, tested and verified to ensure the student is receiving the right amount of volume from the FM microphone compared to that of the hearing aid or cochlear implant microphones. The audiologist should adhere to the American Academy of Audiology’s Pediatric Amplification Protocol, which includes these verification measures. An audiologist who follows these national standards will also perform functional listening tests, providing the educational team with more information about how the child fares in the presence of background noise with and without FM support. When a child is tested in quiet conditions only, basic information about the degree of hearing loss is obtained, but it doesn’t tell us how that child performs in more challenging listening environments.

Training for staff and peers

Provide an inservice for teachers and other key staff members on the student’s hearing loss. Staff should have a good understanding of how the equipment works, how to maximize its use in a variety of situations and how to troubleshoot when issues arise. It is important for those who have worked with a past student with hearing loss not to opt out of an inservice for a new student. Prior experience with hearing loss is helpful, but each student’s hearing loss is unique. Two children with the same degree of hearing loss can function very differently in the classroom and other learning environments.

Likewise, consider providing an inservice for students. Our experience has been that these sessions help raise awareness and sensitivity among peers and empower the student with hearing loss. With permission and participation from the student, preferred communication strategies, accommodations, and proper use of the FM (particularly if the primary or pass around microphone will be used in group settings) can be explained. Taking time to address their questions often satisfies curiosity about a student’s listening equipment and can help reinforce the importance of personal space, especially with young children whose inquisitiveness may lead them to touch a student’s hearing aids/implant without permission. The student’s teacher of the deaf or educational audiologist can offer ideas for planning a presentation appropriate for the student’s age and comfort level.

Daily listening checks

Performing regular listening checks of the student’s equipment takes just a few minutes and can prevent problems from going undetected for an extended period of time. Ideally, one staff member, along with a back-up person, will take on the responsibility of daily checks. Having the same person listen to a child’s hearing aids, for example, allows this person to become familiar with how the aids sound when working properly, making it easier to notice changes or problems.

To assist school teams, Clarke audiologists are creating step-by-step video demonstrations of listening checks with students of different ages/listening levels who use hearing aids, cochlear implants and FM systems. A check for a student with bilateral cochlear implants, for instance, should be conducted with the student listening through each side separately. It can be easy to assume a child is listening with both sides, when in fact one side has a dead battery that has gone unreported. This cannot be discovered when testing both sides simultaneously. Another common assumption is that listening checks are not as important for older children, but they are pertinent across age groups. Young children may not be fully aware that their amplification is not working properly. Older children may not want to bring attention to a problem, and even when they are good advocates for their hearing needs, they may not be able to recognize subtle changes that can impact how they hear.

Troubleshooting protocols

School teams that have a plan in place for investigating equipment problems and communicating with parents and the managing audiologist will help keep “down time” to a minimum when equipment breaks. Teachers and support staff should know whom to contact with equipment issues or when changes in the student’s speech intelligibility, attention or responsiveness are suspected. While such changes can often be explained by the child not feeling well or simply having an off day, they can also be indicative of a shift in hearing or an equipment issue and are equally important to investigate.

Positive reinforcement

The attitude projected from the teacher to the student is often the greatest determining factor in the student’s willingness to use his or her listening devices consistently and to report problems. A teacher who accepts the FM system with a smile, who is responsive and patient when problems occur, and who maintains an environment that is respectful to a variety of learning needs will best serve the student with hearing loss. If a student gleans from a teacher’s body language or facial expression that the equipment is a bother, this can be internalized to mean that the student is a bother. As a result, the student may be less likely to speak up and may downplay the importance of their equipment and other essential accommodations.

Classroom accommodations

Consistent use and maintenance of personal hearing aids/cochlear implants and an FM system does not preclude the need for additional accommodations. These devices are a great help, but they do not fix the student’s hearing loss. Good classroom acoustics, knowledge and implementation of effective communication strategies, visual aids, note taking assistance, and captioned media are examples of accommodations that will be important to consider throughout a student’s education.

Compiled by Melissa Griswold, M.E.D., with special thanks to Clarke Hearing Center audiolgists Dr. Kathryn Girardin, Director, and Drs. Christine Kelley, Joni Skinner and Amy Catanzaro.

A Sampling of Audiology Resources

Acoustical Society of America

Advanced Bionics Tools for Schools

American Academy of Audiology

American Speech – Language – Hearing Association

Cochlear Americas online seminars

Educational Audiology Association

Hearing Loss Association of America

Oticon Pediatrics


Quiet Classrooms

United States Access Board - Acoustics