Health Sciences Report Summer 2006

Learning to Really Listen
(without relying on lip reading)

By Chantelle Turner
Photos By Tim Kelly and Steve Leitch

Celeste Tipiani, who received a cochlear implant last year, worked on listening skills during weekly aural rehabilitation sessions at the U.

Celeste Tipiani, born deaf, relied on her finely honed lip-reading skills to function in the hearing world. Reading lips and using hearing aids to distinguish some sounds, she functioned well, homeschooling her three children and holding down a part-time job as a tax auditor with the Internal Revenue Service. But when Tipiani had cochlear implant surgery in January 2005 with the hope of restoring her hearing, she was forced to awaken a skill that lay dormant for 36 years: listening. The surgery was successful, but after four months, the Roy, Utah, resident was not making the progress she'd expected. That's when Tipiani's University Hospital audiologist, Lisa Dahlstrom, Au.D., recommended she try the U of U's Aural Rehabilitation program, the first of its kind in the Salt Lake Valley for adults. Tipiani met weekly with audiology graduate student clinician Adrienne Jackson at the U's Speech-Language-Hearing Clinic, where she learned a series of exercises to help her acquire and practice new listening skills and improve her ability to understand speech. In one exercise, Jackson would show Tipiani a card with a word written on it. Then, with her mouth covered to prevent Tipiani from reading her lips, Jackson said the word or used it in a sentence, asking Tipiani to repeat what she heard.

"I had to take baby steps at first; I couldn't even comprehend a sentence," noted Tipiani. Those baby steps paid off. After three months, she was using the phone and understanding more conversation, because as Tipiani explained, "my brain had been re-trained to "listen" instead of relying on lip reading."

According to audiologist Lisa L. Hunter, Ph.D., associate professor in the College of Health, being fitted with a hearing aid or receiving a cochlear implant does not by itself solve a patient's hearing problems. "It's not like being fitted with a new pair of glasses and immediately seeing better. You can't just stick a hearing aid in someone's ear," she explained. "Someone with hearing loss must learn or relearn their hearing skills."

Celeste Tipiani

The U's Aural Rehabilitation program was launched a year ago by Susan Naidu, Ph.D., CCC-A, assistant professor of audiology and coordinator of audiology at the Speech-Language-Hearing Clinic, operated by the Department of Communication Sciences and Disorders. Naidu, who supervises approximately 15 doctoral students who receive training in Aural Rehabilitation, says the specialty area is just one example of recent changes in the audiology program that better prepare students for professional practice as specialists in evaluating and managing individuals with hearing loss and balance disorders.

The most significant change is replacing the master's degree with a professional doctoral degree (Au.D.) for students pursuing careers in clinical practice. "With advancements in technology, legislation requiring newborn hearing tests, and more complex patient issues, students need the additional training offered through a professional doctoral degree," said Bruce L. Smith, Ph.D., professor and chair of the Department of Communication Sciences and Disorders in the College of Health, which administers the audiology program. Students who plan careers in research and academia enroll in the traditional master's or Ph.D. programs.

The U's first official Au.D. graduating class, in 2008, will meet all national accreditation and certification requirements mandated by the American Speech-Language-Hearing Association (ASHA)and the American Academy of Audiology (AAA) to become effective in 2012. Beginning that year, an Au.D. degree will be required for national certification.

Audiology is one of the fastest growing health-care professions in the United States, according to the Department of Labor. Around the country, there are 13,000 audiologists working in public and private schools, hospitals, rehabilitation centers, nursing care facilities, community clinics and centers for the developmentally disabled, colleges and universities, private practice, state and local health departments, government agencies, and research laboratories.

During the first year of this new four-year doctorate program, students focus on diagnostic audiology and the basic sciences, such as anatomy, physiology, and hearing science. Several courses are held jointly with students in other health sciences disciplines, including the neuroanatomy course with physical and occupational therapy students, and a class on the temporal bone and hearing devices (i.e., cochlear implant) with the otolaryngology division of the medical school. The next two years entail a series of externships with a variety of community hospitals, private practices, and state agencies. A full-time traineeship is completed during the fourth year of study.

Jackson, who will specialize in pediatric audiology after graduating in May 2007 with her professional doctorate in audiology degree, says she has benefited from training in various on-campus health-care settings and local community organizations. She is conducting research on newborn hearing screenings for her final project and will complete her fourthyear traineeship at Primary Children's Medical Center.

Her interest in pursuing a graduate degree in audiology came while working as a special education teacher. In a life skills program for 16-21 year olds, a few students had hearing losses. "I sat in on meetings about these students and became fascinated with how their hearing loss affected almost every aspect of their life," she explained.

The opportunity to help patients, like Tipiani, improve their communication, one of the most defining human characteristics, is what drew Jackson to the profession. "It was rewarding to help Celeste reach her goals, become a better listener, and learn to use this wonderful technology to her benefit," said Jackson.

So Little Ears Can Hear

By Chantelle Turner

Lisa L. Hunter, Ph.D., associate professor in the U's College of health, left and research assistant Adrienne Jackson perform the quick and painless, newborn hearing test.

Early diagnosis of hearing impairment is critical to ensure that children don't fall behind in speech and language development. For infants with hearing problems, that magical exploration of the world around them is hampered. First words are slow in coming; following directions is difficult.

Utah was one of the first states to mandate that all hospitals perform newborn hearing screenings; now all but six states require them. But the screenings aren't foolproof. Often they can fail to distinguish major hearing problems suffered by three of every 1,000 newborns from minor disorders, such as fluid blockage, that may disappear in a few days.

A new test being evaluated by the University of Utah College of Health may improve screening accuracy. Through a $150,000 grant from the National Institutes of Health, Lisa L. Hunter, Ph.D., associate professor of audiology, is testing a device designed to identify profound hearing problems related to the middle ear. Known as the wideband Middle Ear Power Analyzer, the device measures how much acoustic energy is reflected and absorbed in the middle ear, providing more accurate results and reducing the number of false positives.

Hunter has had success with the analyzer in clinical studies with toddlers and hopes for similar results with infants. "It's a very quick test," she said. "It takes just a few seconds to get a reading. There is no pressure in the ear like there was with the older tests, and children seem to tolerate it very well."

Over the next two years, Hunter and her research assistant, audiology graduate student Adrienne Jackson, will enroll 500 newborns into the study.

More children are born with hearing loss than with Down's syndrome or spina bifida. Through grassroots efforts over the last four years, more than 95 percent of newborns are being screened, according to the American Speech-Language-Hearing Association (ASHA). Prior to this change, the average age for a hearing screening was 2 years old, well into a child's formative years.

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