Pediatric Audiology and Project TALK: Interview with Joan G. Hewitt, AuD
Douglas L. Beck, AuD, spoke with Dr. Hewitt about pediatric private practice, Project TALK, and more.
Academy: Good morning, Joan. Thanks for your time this morning.
Hewitt: Hi, Doug. My pleasure.
Academy: Joan, for readers not familiar with you, I'd like to note you've been in private practice since 1995 and earned your doctorate from A.T. Still University in 2004. Your private practice is named Pediatric Hearing Specialists and you're affiliated with Project TALK in Encinitas, CA. Assuming I've got those notes correctly stated, would you please tell me a little about the two entities?
Hewitt: Sure. As you said, our practice, Pediatric Hearing Specialists, is located in Encinitas, CA. In addition to our private practice, we're proud to be affiliated with Project TALK, which is a not-for-profit program started by parents of children with hearing loss back in the 1970s. Their goal was to provide their children with the opportunity to listen and talk. Our office works with Project TALK to assist children who have hearing loss, but may not have financial and/or other resources, such as health insurance, which would otherwise provide their diagnostic services and hearing aid and cochlear implant programming.
Academy: And to be clear, you and your business partner (Laurie M. Owen, MA) are both working moms and began working together in an audiology-based pediatric private practice in 2003—which is a little unusual, as most audiologists seem to go into more or less of a general practice.
Hewitt: Yes, that's true. In 2000, when Laurie was working at an auditory-oral preschool and I was in private practice, we started putting our heads together about some difficult cases we shared. By 2003, we were working more closely together and were really starting to see the impact cochlear implants were making on our pediatric patients so we decided to attend cochlear implant programming training. We originally thought we would use our CI training for a small number of patients attending the auditory-oral preschool in our area, but we quickly learned that a number of children with CIs were not performing up to expectations. As these parents sought second opinions for their children, the demand for our services exploded. Now, diagnostic audiology, cochlear implant programming, and hearing aid fittings form the basis of our pediatric practice.
Academy: And how do moms, dads, and families find you? Where do the referrals come from?
Hewitt: Great question. We actually don't do any marketing or advertising. All of our referrals come from word-of-mouth from the families we've worked with, auditory-verbal therapists, teachers, speech-language pathologists, audiologists, and others in the community familiar with our work.
Academy: That is simply amazing! And I wanted to also add that you studied to be a teacher of the deaf before you became an audiologist—is that right?
Hewitt: Yes. Well, my first master's degree was from the Smith College/Clarke School auditory-oral program. I have worked as a teacher of the deaf and as an aural rehabilitation specialist so I know how important it is to coordinate our audiological care with the child's AVT, SLP, and teacher.
Academy: Is there a particular pediatric age limit that your practice focuses on?
Hewitt: Not really, as the problem with children is they tend to grow up! So, we see children from birth on and do have adults in our practice who started with us as children. We also have some adults who are pre-lingually deafened adults, as we believe their needs are vastly different from those of post-lingually deafened adults. So even though the focus of our practice is pediatrics, we do have some pre-lingually deafened adult patients, too.
Academy: And what about the percentage of patients who are cochlear implant recipients versus the percentage of patients who are hearing aid users?
Hewitt: About a year ago, the last time we officially counted, our patients were pretty evenly divided between hearing aids and cochlear implants. However, this year it seems the balance has tipped such that slightly more than half of our patients are cochlear implant recipients and a little less than half use hearing aids.
Academy: Joan, what's been your experience and what's your thought process related to bilateral cochlear implants in appropriate pediatric candidates?
Hewitt: The difference between unilateral and bilaterally implanted children is dramatic. We strongly believe that children with two implants experience the benefits of binaural hearing: louder, clearer speech reception; improved hearing in noise; better localization; and more auditory "redundancy" so the child can listen with more ease.
I had an experience recently with an Usher's Syndrome patient that was really moving. His first implant literally changed his life overnight; he went from isolation to conversations on the phone! However, when he asked about a second implant, I told him it would more-or-less be the "icing on the cake." That is, I counseled him that the second implant would be give him some of the benefits of binaural hearing, but that he should not to expect as dramatic an improvement as with the first.
Academy: And what happened?
Hewitt: I learned that, even as audiologists, we don't realize how important TWO ears are! He came back the day after his second implant was activated and told me, "Don't ever again tell anyone that the second implant is not as amazing as the first!" He said his life was immediately richer and fuller and to him, the difference between one and two implants was night and day! So I now tell patients that the second implant really is as amazing as the first!
Academy: And I know we're running out of time…but I'm pretty sure you see children with auditory processing disorders, too?
Hewitt: Yes, we see them through the local school districts, although we do not complete the APD testing.
Academy: And I presume the vast majority of them have normal hearing?
Academy: And have you fit any of them with FM systems?
Hewitt: Yes, if that is the recommendation of the audiologist who completed the APD testing. We do see that the children benefit from a better signal-to-noise ratio and are more readily able to attend to the teacher.
Academy: Joan, as someone who faces these decisions daily, please tell me your thoughts about digital noise reduction and adaptive directionality technology for children with mild-moderate sensorineural hearing loss and digital hearing aids and for children with severe-to-profound hearing loss using cochlear implants?
Hewitt: We recommend both technologies all the time. We know that children are in challenging listening environments all day long and can benefit from these technologies, but they are not always good at assessing their listening needs and don't know when to change their programs.
With today's hearing aids, smart technology algorithms are used that engage adaptive directionality if and only if the signal-to-noise ratio can be improved, and if not, the system stays in the omni-directional mode. The same is true for advanced digital noise reduction systems. So the point is, if we turn them on and leave them on, they will improve the child's auditory access in appropriate situations. However, if we don't turn them on, they're not beneficial at all at any time!
We also find that our pediatric and adult patients all want to put on their hearing technology in the morning and not think about it again until it's time for bed. By activating the appropriate automatic features in the patients' regular listening programs, we hope to attain maximal auditory ability in every situation they find themselves in! So to us, for children and adults, environmentally adaptive technology is desirable and beneficial.
Academy: Do you think we'll see a trend toward more pediatric-based private audiology practice?
Hewitt: I hope so. As insurance reimbursement decreases and as the time constraints increase such that professionals in large clinics have less time to spend with each child, I believe that those who work in private practice and specialize in pediatrics will be able to work more efficiently and will be better able to provide the time and support our children with hearing loss need. So I hope we'll see more and more pediatric specialization.
Academy: Thanks very much for your time and knowledge. It's a joy to speak with you and I wish for you and the children you work with continued prosperity and a happy and healthy 2012!
Hewitt: Thanks, Doug.
Joan G. Hewitt, AuD, is a pediatric audiologist with Pediatric Hearing Specialists, Inc, in Encinitas, CA.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.