Working as an Audiologist in a War Zone: Interview with Limor Lavie, PhD
Douglas L. Beck, AuD, spoke with Dr. Lavie about sequential versus simultaneous hearing aid fittings, working as an audiologist in a war zone, and more.
Douglas L. Beck (DLB): Good morning, Limor. Thanks for sharing your story with us. I read about your practice and the conditions in which you practice audiology, and I was fascinated.
Lavie: Hi, Doug. Thanks for your time, too.
DLB: My pleasure. So let's start with where did you get your audiology education?
Lavie: Well…in Israel, we have different protocols to become an audiologist than in the United States. I went to Tel Aviv University for my undergraduate degree, and, as in all the Israeli programs, audiology and speech language pathology (SLP) are taught together. It's a shared degree in communication disorders. After I received my bachelor's degree, I worked two years both as a speech and language pathologist and as an audiologist, and then I decided to focus on audiology.
DLB: So in Israel, when one attends the university, completion of the undergraduate program is what qualifies you to get a license as an audiologist?
Lavie: Yes, and our programs are entirely about SLP and audiology from day one, so the program is highly focused on communication disorders.
DLB: However, you chose to also earn your master's and your doctorate?
Lavie: Yes, I did. My second degree was a master's degree in linguistics, also from Tel Aviv University, and my doctorate (PhD) is from the University of Haifa.
DLB: And what was your doctoral work focused on?
Lavie: My dissertation was about neural plasticity, secondary to hearing aid fittings in the elderly. We looked for two things—(1) dichotic listening and (2) speech in noise—and we found that a short period of hearing aid use can induce improvements in these perceptual tasks in older adults. And of course, before you ask—and as you are always keen to point out, yes, we had a control group, and they showed no change.
DLB: Fantastic—a well-designed study, real science! I love it! And for the readers who are not aware of the reference you're speaking of, when I lecture, I often state that many "studies" in audiology and hearing aids and cochlear implants and ALDs are actually case reports or anecdotal reports. Of course, these are important, and they are good to know…and if they really are impressive, I urge the authors to subject these preliminary studies and pilot studies to scientific methodology, which means RCTs, experimental and control groups, and replicable studies to see if the findings actually pan out scientifically, or were they just an interesting case study, an anecdotal report, or a pilot study.
So when did you conclude your research and when will it be published?
Lavie: Well, I graduated in 2011, but I expanded the study after the graduation. I do hope to see it published in 2015.
DLB: And as it isn't published yet, unfortunately, we cannot talk about the details. But generally, were you able to determine if the improvements from hearing aid fittings were due to, or perhaps related to cognition factors or perhaps auditory processing issues and changes?
Lavie: We didn't really examine that directly in this study. We think that our results suggest behaviorally relevant plasticity in the elderly central auditory system. So perhaps the next step is to examine the basis of the change, and to see what this is attributable to. One of my master's students is very interested in this area, so perhaps we'll have data to share in the near future, to better address this important question.
DLB: But didn't you also just publish a related paper showing patients have better compliance and increased usage of their hearing aids if they are fitted simultaneously, rather than sequentially?
Lavie: Yes, that's right. It was titled "Better Together: Reduced Compliance After Sequential Versus Simultaneous Bilateral Hearing Aids Fitting," and we published it in the March 2014 issue of the American Journal of Audiology.
We were looking to see if the fitting protocol made a statistical difference, and it did. Interestingly, although the participants in the sequential groups used monaural aids for only one month (and then were fitted bilaterally), the differences in compliance and hours of use between the two protocols were very impressive. We concluded that bilateral hearing-aid use may be achieved more effectively with simultaneous fitting of hearing aids. We argue in the article that these results are evidence for acclimatization and plasticity.
DLB: And finally, let me ask, what is it like to practice audiology in Israel? Most of us don't face daily rocket and mortar fire! I have no idea what your day-to-day life is like?
Lavie: Well, at the time we're recording this interview (September 2014) it's been about a month since the last cease-fire was declared. And here in Tel Aviv, it's almost like nothing has happened. Everything is back to our regular day-to-day life. But we had a stressful summer and most of us were distracted and anxious. Even now, we are alert when an ambulance or a fire truck siren is heard….
So, as you might imagine, because our civilians are involved in the conflicts, in times of war or military operations the daily life between running to seek a shelter when the sirens are wailing, getting to work, going home and taking care of patients, is very difficult. It was somewhat peculiar; we practiced our regular audiology: hearing tests, ABR, tympanometry, hearing aid fittings, counselling…but from time to time we stopped all this to run to the bomb shelter with our patients….
The 50 days of this war were particularly difficult for our patients, especially for the older individuals. In the clinic we were often asked to increase the volume of the hearing aids for patients who reported that they hardly hear the sirens. People were afraid that they won't have enough time to get a shelter, and many of our elderly patients locked themselves at home, in vicinity to the nearest protective space or bomb shelter. You can imagine the social isolation and anxiety of elderly hearing impaired individuals, watching the news all day long, anxious, stressful and worried…
DLB: Yes… And the stress probably affected their communication.
Lavie: I guess it did. Long-term high levels of stress and anxiety can affect hearing and communication and can alter both peripheral and central auditory functions. Prolonged psychosocial stress can impair attention, and may have harmful effects on the ability to understand speech in noise. These deleterious effects can intensify the already exceptional difficulties experienced by elderly hearing impaired individuals.
DLB: How many wars have you gone through?
Lavie: Unfortunately we have had many times of unrest here. I myself have experienced eight wars and military operations. We hope and pray for peace, hope there will be no more wars, but I am afraid peace is still far away. However, in times of quiet we enjoy a beautiful country, nice weather, warm people, diverse culture, and good universities.
DLB: Well I can only listen and imagine what it must be like. I certainly have never been through that experience and while working in the United States, it's truly difficult to imagine. What do you do if you're in the middle of seeing a patient and the sirens go off?
Lavie: Well, we try to calm everybody and walk with them down the stairs to the protected space. We had that experience recently where one of my colleagues had just placed ear dams and was taking an impression, and the sirens went off. Of course taking out the wet material was not an option and so we all ran together to seek a shelter, and after a few minutes, under the sounds of the sirens and explosions, she took out the impression.
A few weeks ago we had a woman in a wheel chair and she actually said to me that if the sirens went off, there was nothing she could do as she couldn't take the wheelchair down the stairs to the bomb shelter. Fortunately, nothing happened that day. But, yes, we remain cautious and alert because things can change quickly and the atmosphere can be stressful and anxious. We all pull together and we support each other.
DLB: That's quite an amazing story. I am very appreciative of your time and knowledge. I wish for you a safe, prosperous and wonderful new year!
Lavie: Thanks, Doug. It's been a pleasure speaking with you!
Limor Lavie, PhD, is an audiologist and researcher with the Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Israel.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology and the director of public relations with Oticon, Inc.