Audiology Procedures and Protocols: Interview with James W. Hall III, PhD
Douglas L. Beck, AuD, spoke with Dr. Hall about auditory neuropathy spectrum disorder, auditory processing disorders, special speech tests, and his new book, Introduction to Audiology Today.
Academy: Good morning, Jay. Congratulations on the new book!
Hall: Thanks, Doug. I appreciate your interest in my work.
Academy: And, by way of disclosure, I should note we’ve been friends for decades. Nonetheless, I believe your textbooks are among the very best in the profession and certainly your ABR and OAE texts are among the most well-read and most comprehensive books on those topics. So having accomplished all that, why write an “Intro” book?
Hall: Yes, well that’s a fair question and it’s one I’ve often thought about. The main reason I write textbooks is to create a book that I wish someone had written (for me) while I was studying that topic. In particular, I was reflecting back on Davis and Silverman and their third edition (1970) of Hearing and Deafness, which was so informative and inspiring to me as a young audiologist. And so, I hope to recreate some of that enthusiasm, curiosity and intrigue with Introduction to Audiology Today.
Academy: And I believe this text is directed to undergraduates?
Hall: Primarily yes, it is for undergraduates in communication disorders and others who may want to pursue a career in audiology, but it’s also appropriate for some graduate students and international students who hold an interest in audiology, such as medical students, speech pathology students and other health-care professionals.
Academy: I agree, Introduction to Audiology Today would serve each of those populations quite well as the book is an overview of audiology presented in 16 chapters, across four major sections. The first section is titled Profession and Principles of Audiology. The second section addresses Audiology Procedures and Protocols, the third section is Patient Populations and fourth is Audiologic Management—Technology, Techniques, and Rehabilitation. So let’s examine some of the content and your thoughts on a few specific topics.
I think it’s clear that the profession of audiology has turned toward evidence-based outcomes. That is, we’re being driven more by science and proven, documented, published outcomes, which is clearly a good thing. And one issue that’s really interesting to me is that the basic audiometric evaluation has evolved for the purpose of rendering a diagnosis. That is, we do air conduction and bone conduction measures, tympanograms, reflexes, ABR, OAE, and more, for the purpose of answering: “what is the diagnosis?”
Of course, that’s very important and naturally the differential diagnosis is issue number one. However, I think as a profession, we have to understand that the diagnostic audiometric protocol was not designed to, and does not in fact, address the primary reason/issue which brought the patient in the door. Specifically, the vast majority of patients come through the door because they cannot understand speech in noise, and they come to us for a solution to that problem—much more so than they come to us seeking a diagnosis. And so my point is, none of the typical diagnostic tests give us any idea as to how the patient performs in noise, and to me, this is simply a huge disconnect. What are your thoughts on this issue?
Hall: Well, I think you’re exactly right. The audiogram was never intended to serve as the basis of counseling and it was certainly never meant to be the basis of a hearing aid fitting. Yet, it’s used every day, in most clinics around the world, for exactly those purposes. And so, as I said in the book, the audiogram is undoubtedly very valuable, but it’s not a true or comprehensive test of hearing. That is, we hear with our brains! The audiogram just measures a small fraction of the frequencies we might perceive, and it’s just a measure of detection, not comprehension or recognition, and the patient’s don’t listen to pure tones in the real world, they listen to words in noise, and so I totally agree with your core premise. The diagnostic battery needs to be recognized as just that, and then we need to perform other pragmatic, scientific and audiologic protocols to address the patient’s listening problems, many of which have a cognitive or processing or perhaps other basis.
Academy: In the book you made the point that unless one evaluates speech understanding and speech understanding in noise, their hearing really hasn’t been evaluated.
Hall: Yes, I did make that point and I believe it’s defensible. Speech audiometry is very important, and it’s even more important from the patient’ view as it’s usually how he or she recognizes and describes his or her hearing and listening problems. Typically a patient will say something like “I can hear, but I can’t understand.” And I’ll bet every audiologist hears this observation daily.
Academy: Absolutely, and to me, when a patient says: “I can hear, but I can’t understand,” that’s pretty much an invitation to do a speech in noise test!
Hall: Well, it’s not just an invitation, but I would argue it’s our obligation. Here’s something to consider…sometimes, we need to perform an audiometric test not just to come up with or confirm a diagnosis, but sometimes, it’s more important to run the test to maximally and accurately describe the patient’s auditory function and abilities. In fact, to me, it makes sense to apply this approach to auditory processing disorders (APD). That is, to me, it’s all about hearing and if there’s an apparent APD, why not call it a hearing impairment and of course, describe it as best we can regardless of whether it’s a child or a veteran or a senior citizen.
Academy: Excellent points. And in the book you address these issues in the section on Special Speech Audiometry Procedures.
Hall: That’s right. In the book, I cover APD in multiple sections with different levels and depths of discussion, and I cover speech tests from the historical and pragmatic perspective and so the book has discussions and explanations on APD, the filtered word test, dichotic listening tasks, test reliability and validity, performance-intensity (PI) functions for phonetically balanced (PB) words, distorted speech tests, speech-in-noise (SIN) tests, the listening in spatialized noise (LISN) test, sentence tests, and many others and the multiplicity of factors which often influence results.
Academy: And those factors go above and beyond hearing loss?
Hall: Absolutely. Some of the factors that influence speech tests include the quality of the test itself, the patient’s age, his or her cognitive status, ability to pay attention, auditory processing ability, native language, and much more.
Academy: I should add, your new book also serves as an update for those of us who’ve been in practice for more than a couple of decades, in that it addresses many of the classic auditory disorders and examines them with regard to brand new research findings and analysis. Further, and importantly, you also address issues that are relatively new, such as auditory neuropathy spectrum disorder and third window issues. Jay, tell me about the feature in the book called Web Watch.
Hall: Sure, well the idea behind Web Watch is that the readers can easily find and access the Internet sources that I thought were well written and very helpful, and of course they link to others source and reference materials.
Academy: And I should note you have a plethora of fun and interesting Leaders and Luminaries, which admittedly, were often the sections I read first!
Hall: Thanks Doug. Those were fun to gather and to write and I appreciate the opportunity to include some of the amazing people who have contributed significantly to our profession.
Academy: Okay, Jay, I know your time is limited and we need to finish this chat, but I want to applaud you on yet another excellent book, and I want to encourage our colleagues in academia to examine this book with regard to undergraduate education, as I believe it’s an excellent resource, easy to read, and very well written.
Hall: Thanks, Doug. I appreciate your interest and comments on the book.
James W. Hall III, PhD, is an adjunct professor of audiology at Nova Southeastern University and Salus University and extraordinary professor at the University of Pretoria, South Africa. He is also the author of Introduction to Audiology Today.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.