BATOD
The British Association of Teachers of the Deaf
Promoting Excellence in Deaf Education

Crucial developments in Audiology: How will they affect Teachers of the Deaf?

Peter Preston on behalf of BATOD A&ICT Committee

At a time when there is increasing pressure to devolve funding for Support Services and to promote the generic SEN function of mainstream schools, Audiology is a key specialist area in which our skills and knowledge set us apart from other teachers. Yet, many experienced Teachers of the Deaf (ToDs) find audiology challenging. Over time technological advances have facilitated developments in assessment and amplification hardware which, although ultimately beneficial to the children, have added to this challenge.

Teachers of the Deaf have had to become familiar with increasingly sophisticated hearing aids, analysers and diagnostic systems. We are currently at the dawn of an era which is characterised by a relentless and unprecedented spate in developments across a significant range of audiological contexts.

Many ToDs are not actively involved in these developments. Some may not be well informed or even be aware of the very rapid progress which is currently taking place related to:

  • The Modernisation of NHS Hearing Aid Services Project (MHAS)
  • Digital Sound Processing (DSP)
  • other Advanced Technology Hearing Aids
  • Universal Neonatal Hearing Screening (UNHS)
  • Cochlear Implants

Hearing Aids and the MHAS Project

Many children are currently fitted with high quality, technologically advanced hearing aids involving complex fitting procedures which take advantage of acoustic feedback management systems, gain and output limitation controls, systems to provide optimal use of a limited dynamic range, methods of providing improvement in signal to noise ratio and ‘signal processing’ strategies.

Hearing aid developments are moving, it seems, at an exponential pace. Many children are already using digitally programmable or DSP hearing aids. Through the Paediatric Arm of the MHAS project 9 centres will develop and evaluate the provision of DSP aids for children. Four high specification contract hearing aids are to be used for 7-15 year olds and three additional models are being considered for small babies.

Hence we must expect more and more children to be using digital aids. Indeed, it has been suggested that, mainly due to economics and design flexibility, it is likely that within the next few years all new hearing instruments will be ‘digital’.

How familiar are Teachers of the Deaf with the concepts mentioned and how does this impact on their crucial rôle in monitoring and promoting the effective use of children’s residual hearing?

The training needs of Teachers of the Deaf are unknown at this time but we can make predictions.

  • ToDs will need to have an understanding of how these hearing aids work - what they can and cannot do.
  • Due to the sound processing potential, ToDs will need to consider how they will evaluate children’s use of these advanced technology hearing aids, particularly in the case of very young children.
  • There are important implications for checking and testing such hearing aids. New and modified strategies will need to be utilised.
  • Consideration will need to be given to the arrangements which are developed for repairing/replacing faulty aids.
  • There are issues related to the re-programming of replacement digital hearing aids: who will undertake this?
  • If quality support is to be maintained, it seems inevitable that Educational Services or individual ToDs will have to be involved in this. Effective links with providers will be necessary and detailed information related to the settings for each hearing aid will need to be available. Services or individual ToDs will require access to dedicated or PC-based programming systems.
  • ToDs will need to be very familiar with the new strategies which are being developed for balancing FM systems when used with DSP aids.

Universal Neonatal Hearing Screening (UNHS)

Much national and international attention is being given to UNHS. It was a key topic at the BATOD Cardiff Conference (see BATOD Magazine, May 2001). During 2001, twenty UNHS pilots are expected to become operational across the country. It is recognised that the concept of very early diagnosis brings a logical necessity for early family support.

The key question is, 'Are ToDs sufficiently aware of what UNHS involves and the potential implications for the profession?'

Whilst BATOD would argue that ToDs should be at the core of the response to UNHS, there is some debate as to who will be the provider.

Clearly ToDs will need to enter the partnership with parents much earlier than is the current practice. Whilst it might be assumed that this will simply be an extension of current LEA Service provision, it is by no means certain that this will be the case.

There may be issues regarding the availability of funding to staff this additional commitment which may be exacerbated by uncertainties linked to educational funding for 0-2 year olds. It is also necessary to consider the provision of ToD support for 52 weeks of the year.

The concept of Family-Friendly Hearing Services for Children (FFHSC) is actively promoted as a pre-requisite for successful audiological rehabilitation of children and families and for the introduction of Universal Neo-natal Hearing Screening (www.unhs.org.uk/documents/ffhs6). It is suggested that this may require a significant change in working practice within the Health Services. Effective multi-agency collaboration and working practice will be at the core of FFHSC and is likely to involve multi-agency funding strands.

We might ask, 'Do ToDs have the skills and knowledge to work with infants and families at this stage and within such a multi agency framework?'

It cannot be taken for granted that the existing professional skill base will be appropriate to this earlier involvement and there will be a need for revised practice and the acquisition of new skills.

There is a real risk that if LEAs and Education Services do not proactively anticipate these issues and react in a positive, constructive manner, other agencies may take the initiative. It needs little imagination to realise that with the potential for multi-agency funding, radical proposals could see ToDs being frozen out of this vital rôle. More likely, however, is the possibility that ToD support could be provided by other agencies. This could involve independent agencies or the Health Service as is common practice in most Cochlear Implant Programmes.

Cochlear Implant Programmes

The wealth of experience gained from successful implant programmes at UK Centres and those in other countries has led to changes in candidature due to the establishment of revised criteria. Ongoing research and development by the implant manufacturers have produced a gradual but consistent flow of improvements in both hardware and software. New surgical procedures and improved audiological practice are enhancing benefits for implanted children. Bilateral implants are on the horizon.

Such developments are at the leading edge of technology in a field that already challenges the knowledge base of many ToDs, including some who are closely involved with the centres! However, ToDs cannot ignore the likely impact of such development on the expectations we have of deaf children.

What implications do all these crucial developments in audiology have for ToDs?

  • ToDs can expect some changes in working practice
  • ToDs should raise their expectations of what deaf children can achieve using new technology
  • there is a real risk that ToDs may become de-skilled in audiological issues
  • if ToDs do not keep up to date with developments in audiology a vital aspect of our skill base will be eroded and may lead to the specialism being vulnerable.

Whilst this era of change presents some significant threats and challenges, it also offers major advantages for deaf children and new opportunities for the professionals that work with them. It is vital that ToDs seek to keep pace with the developments in audiology as a means to highlight our skill base and promote the unique and essential nature of Teachers of the Deaf.

ToDs should ensure that they alert managers to their specialist training needs and seek access to funding for appropriate training. BATOD will continue to inform members of developments in the field and of forthcoming training opportunities. BATOD will also promote training in key areas. Hence, ToDs are encouraged to participate fully in the activities of BATOD including involvement in the CPD log scheme.

BATOD Magazine September/October 2001