Alex Murra and Radha Velamuri host Dr. Elizabeth Walker and undergraduate student Evita Woolsey for a discussion about hearing loss as a critical public health concern, specifically among children.

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Alex Murra:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Alex Murra and I am joined today by Radha Velamuri. And if this is your first time with us, welcome. We are a student-run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health.

Alex Murra:

Today, we are talking with Dr. Elizabeth Walker and Evita Woolsey. Dr. Walker is an associate professor at the University of Iowa in the Department of Communication Sciences and Disorders. Dr. Walker’s research areas include pediatric audiology and oral rehabilitation. Specifically, she examines how limited access to sound affects the development of children with hearing loss. She earned her PhD in speech and hearing sciences from the University of Iowa. Evita is currently a fourth-year speech and hearing science major. Alongside her studies, she is an undergraduate research assistant for the pediatric audiology lab and the cochlear implant lab. Dr. Walker and Evita are here with us today to talk about their research in pediatric hearing loss. Welcome to the show, Dr. Walker and Evita.

Elizabeth Walker:

Hello, thanks for having us. I’m very excited about this.

Evita Woolsey:

Me too. Thank you.

Radha Velamuri:

To start us off, can you both tell us about your journey to becoming a researcher studying pediatric hearing loss?

Elizabeth Walker:

You want me to start, Evita?

Evita Woolsey:

Yes, you can start.

Elizabeth Walker:

I’ll start with that question. I started off actually in undergrad. I would say that’s where my journey started. I was a psychology major to begin with and in one of my introductory psychology classes, somebody came and talked about cochlear implants in children and I was fascinated with the topic and I remember coming home, it must have been a lecture right before Thanksgiving. I came home and I told my parents all about it and I said, “I want to change my major. I want to do speech pathology,” because it just sounded like such an interesting area to work in. I became a speech pathology major and through that I learned about audiology and audiology also really piqued my interest. And so I ended up doing kind of a different path than most people do. When I went onto graduate school, I ended up studying both speech pathology and audiology because I was really interested in the intersection of how hearing loss impacts language acquisition in children. And so that’s kind of how I’ve come along this path of studying pediatric hearing loss.

Evita Woolsey:

For me, my interest in pediatric hearing loss started when I took ASL in high school and I was really interested with American Sign Language and just the deaf and hard of hearing community. And during my ASL class, we learned a little bit about cochlear implants specifically. I had never really been interested in hearing aids but then when I came into college, I knew I wanted to do speech and hearing sciences. I thought speech language pathology was really interesting and I thought that getting involved in research was a really great idea. And when I saw the words pediatric hearing loss, I thought, okay, Dr. Walker’s lab seems interesting.

Evita Woolsey:

I met with her and most of my conversation was actually focused on American Sign Language and the deaf community. But through being in this lab, I’ve learned a lot more about, oh, I love the intersection between language acquisition and pediatric hearing loss. I didn’t realize that would be my interest and I’ve gone back and forth between audiology and speech language pathology because I just really love the two fields so much. And now I’ve found a really awesome area that I want to pursue in speech language pathology, in oral rehabilitation because I really have a passion for working with deaf and hard of hearing.

Alex Murra:

Yeah, that’s so cool. I think that the research opportunities too at the university are amazing. Can you give our listeners just a little bit of background about what pediatric hearing loss is? We have a lot of questions here, for one thing, maybe you guys were throwing out terms like audiology or speech pathology. What’s the difference? Where’s the overlap? How do we test for if there’s hearing loss in children? And then also how big of a problem is hearing loss in kids as well?

Elizabeth Walker:

That’s a lot of questions. Let me see if I can unpack those a little bit. First of all, audiology is a field focused on individuals with hearing loss. It involves obviously adults and children. It involves both diagnosing hearing loss in individuals, also involves hearing conservation, so trying to protect your hearing so that you don’t acquire hearing loss. And then it involves what we call oral rehabilitation or rehabilitative audiology. Providing intervention for individuals who are deaf or hard of hearing. Speech pathology is a separate field although we are housed in the same department, communication sciences and disorders and speech pathology is working with individuals who have communication disorders. Perhaps someone with an acquired communication disorder, like someone who’s had a stroke or a traumatic brain injury but then it can also be children who have typical hearing who have language delays or cleft palate or children who stutter. There are a lot of different areas in speech pathology. Again like audiology, it involves both diagnosing the communication disorder and then providing intervention for it.

Elizabeth Walker:

The intersection between the two fields is pediatric hearing loss. Children who are born with a hearing loss, we know are very likely to experience communication delays because they don’t have full access to language when they’re born. We’re both going to have to diagnose the hearing loss, determine how severe it is and also we’re going to want to provide intervention. And as Evita said, that maybe in the form of teaching them sign language, so they may use a visual mode of communication. They also may try to increase their access to sound through hearing aids or cochlear implants.

Elizabeth Walker:

I think your other question, now I’m trying to remember, was about newborn hearing screening programs. Newborn hearing screening programs are the way that we go about trying to identify infants with hearing loss. And I guess I should back up and say how prevalent is hearing loss in children? For infants with a congenital hearing loss, so that would be a child who’s born with hearing loss, it’s actually the most prevalent health condition that we can screen for at birth. The estimates very slightly but the prevalence rate is around one to three children per 1,000 children who are born will be diagnosed with some degree of hearing loss. As children get older, the prevalence rate increases because we have then children who have a late onset hearing loss, who acquire hearing loss after they’re born. The prevalence rates for that vary quite a bit. And so I’ve seen it vary from about 5% of school aged children, to up to 15% of school aged children have again, some degree of permanent hearing loss.

Elizabeth Walker:

We’ve had newborn hearing screening for decades, I guess I kind of think of it as the 1960s but even probably for that but really around the 1990s, there started to be a really big push to try to screen all infants for hearing loss at birth because we knew that having a hearing loss from birth can lead to language delays. And so starting in the late 1990s and then early 2000s, we started to see states implementing legislation. Some states just like Iowa implemented newborn hearing screening programs without the legislation and then the legislation actually came later. And this was to try to screen every baby who was born. Those programs again, started to be implemented around the early 2000s. By 2007, about 98% of all infants are now screened for hearing loss at birth.

Elizabeth Walker:

And then our goals are to try to do what we call 1-3-6. And so 1-3-6 means that we want to have all babies screened for hearing loss by one month of age, we want to diagnose the hearing loss, confirm it, try to figure out if it’s in both ears and how severe it is by three months of age and then we want to enroll the child in a family centered early intervention by six months of age. Those are the goals for every state in the United States and around the world. Evita, do you have anything to add?

Evita Woolsey:

I do not. That was very well explained.

Radha Velamuri:

I didn’t expect the prevalence rate to be that high in newborns. In my classes, I learn about all different prevalence rates for different conditions. And usually it’s one in a 100,000 and this is one to three in a 1,000 which is a lot. That’s why your research is super important and it focuses on limited access to sound and how it affects development. But we were wondering if you could delve a little further into just what limited access is. Limited access to sound and is there a spectrum for it? Is it yes, no, you have limited access or you don’t? And how this development even occurs.

Elizabeth Walker:

I love this question because I think it gets at what I feel like is a basic misunderstanding of hearing loss. A lot of times I see this frequently. People often interpret loss is either you have normal hearing or you are deaf. But like you said, there is a whole spectrum in between there, just like we have with vision. And so we have different degrees of hearing loss. You can have a mild hearing loss, you can have a moderate hearing loss, you can have a severe hearing loss or you can have a profound hearing loss. There’s this whole range in there and the majority of kids with hearing loss, actually I think it’s about 80% of kids who have a diagnosed hearing loss actually fall somewhere in the range that we call hard of hearing. Somewhere between mild hearing loss to severe hearing loss and it’s actually a pretty small proportion of kids with hearing loss who fall in that profound range that we would consider to be completely deaf.

Elizabeth Walker:

In terms of limited access to sound, again, it gets to this idea that there’s a spectrum. And even within the varying degrees of hearing loss, so within the mild category or within the moderate category, those children can vary in terms of their cumulative auditory experience or how much access that you have to sound. And the reason for that is we have this technology, we have things like hearing aids for children who are profoundly deaf. We have cochlear implants but children may vary in how much they use those devices. We know from our research that some kids wear their hearing aids during all waking hours, just like some people wear their glasses all the time. And other kids may only use their hearing aids at school.

Elizabeth Walker:

Some children have hearing aids and they may not use them very frequently at all. Also, we know that there can be variation in how well fit the devices are. And so this gets at basically evidence based practice, what technology, what techniques audiologists are using to program the hearing aids to make sure it’s fit appropriately for the child’s hearing loss. And again, we know from our research that kids can really vary in how well fit their hearing aids are.

Elizabeth Walker:

When you put all those things together, the severity of the hearing loss, are the hearing aids fit appropriately, and are the children using the hearing aids on a consistent basis? We get individual differences in the amount of access they have to sound. That in turn we know from our research can influence language acquisition. One thing that we’ve found in how limited access to sound influences language development is that children with mild to severe hearing loss, who are in this hard of hearing range, the children that use their hearing aids on a more consistent basis, so more than 10 hours per day, actually show deeper growth trajectories in terms of their language acquisition. They will show faster rates of acquiring language than children who use their hearing aids less consistently.

Elizabeth Walker:

We also know that how well fit the hearing aid is can also have an impact on your rate of language growth. Children who have better fit hearing aids will show these steeper growth trajectories. They actually are closing the gap between themselves and their same age hearing peers, whereas children whose hearing aids aren’t fit as appropriately will actually show an opposite pattern where they’re over time increasing the gap between themselves and children with typical hearing.

Alex Murra:

I’m actually going to ask a question about one of your specific studies that I saw when I was kind of looking into your guys’ background. We came across this study and it was the outcomes of children with hearing loss study. Can you guys tell us a little bit more about what that purpose was, how it was conducted and maybe what some of the findings are? I know you just said so many findings but we want more findings.

Elizabeth Walker:

The outcomes of children with hearing loss study, whereas we refer to it as an acronym OCHL or O-C-H-L, started around 2008 and it began because the National Institutes of Health had put out a request for applications, asking research teams to submit research proposals about children with mild to severe hearing loss. And the reason for this was because the NIH had identified this was an area of study that we really didn’t know a whole lot about. We didn’t know much about outcomes of children with mild to severe hearing loss, particularly after the implementation of universal newborn hearing screening programs where we were seeing these kids getting identified at much younger ages than they had before we had newborn hearing screening. And so a team of researchers from the University of Iowa, Boys Town National Research Hospital in Nebraska and University of North Carolina Chapel Hill, got together, put together a research proposal to study a large sample of children with mild to severe hearing loss.

Elizabeth Walker:

And the application was accepted by the NIH and that’s basically where the study came from. The purpose of the study, like I said, was to try to figure out why we see individual differences in children who are hard of hearing. What are the underlying factors that are accounting for variation in language outcomes? And the way that we went about conducting this study was we had what’s actually called an accelerated longitudinal design. This was not something I was familiar with prior to working on the OCHL project but we recruited children between six months and seven years of age. We started off with a pretty wide age span and then we followed those children over time. That gave us both cross sectional data and it also gave us longitudinal data so that we could examine the rate of growth in language acquisition for these children with hearing loss. We also recruited a sample of children with typical hearing and these kids were matched on socioeconomic status, age and nonverbal IQ.

Elizabeth Walker:

All of the kids in the study had nonverbal cognitive skills that were either average to above average. They didn’t have any additional disabilities. English was their first language and they also either didn’t use any technology, the kids with hearing loss, so they didn’t use hearing aids or cochlear implants, or they used hearing aids. And so what we were trying to do then was really isolate the impact of hearing loss on developmental outcomes, taking into account a lot of the other factors that may influence language development, such as having another disability or learning English as a second language. And I talked a little bit already about some of the findings related to how auditory access influences language development and growth rates. Some of the other things that we have found are that, well, one thing that I think that’s kind of been a big takeaway point is what an impact service delivery can have for children with hearing loss.

Elizabeth Walker:

Particularly if audiologists are using evidence based practices to fit the hearing aids on kids, then that can have a real impact on how much auditory access they have. But if audiologists are using other techniques that aren’t necessarily backed up by research evidence, children they may have hearing aids but they may not be fit appropriately. That was one of the I think major takeaway points is how important doing evidence based practices in audiology services.

Elizabeth Walker:

Another take home point is the importance of early identification and early intervention for kids with hearing loss. We already were pretty aware of this. We knew that getting kids services earlier can have an impact but our data has provided further support of the importance of making sure that we are getting the hearing loss diagnosed at a young age by three months of age and then getting the children enrolled in early intervention that involves the family. You can provide early intervention services and have the interventionists working, the speech pathologist working with a child one on one but we also know from this study and from other studies that involving the parents in the intervention process is going to lead to better outcomes for children.

Radha Velamuri:

I had a quick follow up question that I kind of wanted to ask. Maybe you could tell me your opinion on it. When I first heard or saw limited access to sound, when I was doing research for this podcast, I actually didn’t think about the hearing loss spectrum, which is weird because that’s what people would think when they think limited access to sound. But I actually was thinking more about the stories that I’ve heard of individuals who have quote unquote normal hearing but are deprived of sound during their developmental years due to know unfortunate circumstances.

Radha Velamuri:

I’m sure you kind of know what stories I’m talking about of people we see in the news or people we learn about in our psychology classes but I was kind of wondering how do you think, because it also has to do with development with speech and hearing, I was wondering if you know, of any correlation with speech and hearing studies for people who have internal hearing loss versus people who are deprived of sound as they grow up, despite having quote unquote normal hearing function. And I know it’s a really weird question but do you have an opinion on that?

Evita Woolsey:

Are you talking about if they’re born with hearing loss and then due to their language acquisition, not having access to language? Is that kind of what you’re saying?

Radha Velamuri:

Yeah. Is that similar to accounts we’ve heard of people who [crosstalk 00:21:32].

Evita Woolsey:

I know in your psychology class, you’re probably thinking of Genie. I think that is where kind of personally, I think maybe cases Genie is where the basis for oh, maybe. Because I don’t think people would originally think, oh, hearing loss has to do with language acquisition, how those actually are really correlated. Similar to things I’ve learned about it doesn’t matter what your first language is, whether it’s visual or spoken, you just need some form of language early in your years because before the age of four, you are rapidly learning language. And so that’s why in cases like Genie that you probably have heard in your psychology classes, she couldn’t get past a certain vocabulary range or even I believe if I’m remembering correctly, that she had trouble putting sentences and words together because she didn’t have that linguistic foundation.

Evita Woolsey:

And so the same thing goes for children with hearing loss, children that acquire profound hearing loss. And that’s why Dr. Walker said those 1-3-6 steps are super important because that is going to show the best outcomes of language development. And I’ve seen that over time through running participants that are now seventh, eighth grade, 11th and 12th grade in a longitudinal study that she will probably discuss later on called LOLA. And that is looking specifically at literacy outcomes of children who are hard of hearing. And you can tell wow, these children with hearing aids, those that got their hearing aids early on and were given family support and given so much access to sound, all the things she mentioned about having your hearing aids on for 10 hours or longer a day, how impactful those aspects are to having a quote unquote normal language acquisition or close to your same age peers.

Radha Velamuri:

You bring up a really good point about language is not just sound and that it’s all forms of communication, which include visual, like you were talking about ASL, how you took ASL classes and there’s touch, communication, there’s all sorts of communications. And when you have sensory input still, it’s you still manage to get your communication and your language development across. And that’s super important for developing children. I guess if we can switch gears a little bit to talk to you about your research and how you focus on development of an eye tracking technique to study spoken and written word recognition in cochlear implant users. I was wondering, can you just give us your three minute elevator pitch and maybe how this fits into the bigger picture of your lab’s mission?

Evita Woolsey:

This is really interesting because in Dr. Walker’s scientific writing class that I just took, she had us do elevators pitches on our research, which was very challenging so bear with me. I don’t think it will be the 60 seconds that she would’ve wanted it to be. But first I think for podcast listeners to know what cochlear implants are is really important. And so cochlear implants, I think people are oh yeah, I know what a cochlear implant is. I’ve kind of heard about it. It’s probably the same as hearing aids but yes, they are both devices to help restore hearing in some way. But cochlear implants are more for people who have severe to profound sensorineural hearing loss, adults and children and it’s a surgically implanted device. And so what happens is that sound signals go into a receiver and then go into a stimulator that is underneath the skin and then pretty much stimulates the auditory nerve through electrodes that are placed surgically in the cochlea, which a cochlea is in the very inner part of the ear.

Evita Woolsey:

It’s surgically implanted, which I don’t think a lot of people know that. I think they may think, oh, it’s brain surgery or something like that. But everything really has to do with your ear and hearing aids is more of just that small electronic device that is on the external part of your ear and that is really helpful to communication skills but also just to being able to hear more in quiet and noisy situations.

Evita Woolsey:

In terms of my research, I just think cochlear implant users are very interesting how, especially with children, because again at an earlier age, more language acquisition can be possible with cochlear implants. And cochlear implants are not perfect. They’re not going to 100% restore your hearing immediately working with cochlear implant users in the cochlear implant language lab. I have had really meaningful conversations with them about how even on their first day of activation, when they first get their cochlear implant activated, it’s a whole process to getting used to that. It’s an electronic input. Some people like to say that it may sound like you’re hearing Mickey Mouse noise at first. Everyone has different intonation and pitch in their voice and so that can be really challenging with all the talker differences and there’s research even on that as well with cochlear implant users.

Evita Woolsey:

And I’m specifically interested in written word recognition. I have spoken word recognition in there because I’m also looking at that as well but my long-term goal is to look at the reading difficulties in cochlear implant users. But my research right now is more focused on cognitive science and the underlying mechanisms behind how cochlear implant users recognize written words. And that’s why I’m using an eye tracking paradigm versus with some of Dr. Walker’s work, we use a lot of standardized assessments which are more offline.

Evita Woolsey:

And so I’m more focused on real time measures. When they see a written word hear or hear a word, how they are processing that and eye tracking can look at that and see, oh, where do their eyes move on a computer screen to activate a final competitor? When we hear the word wizard and we hear the wu sound, our brains activate all the different words that start with wu. And so it’s interesting to look at how our eyes are more, if we’re looking at a computer screen with some pictures and words on it, that’s kind of how the eye tracking technique looks. When we hear the word wizard, our eyes may go to the whistle before going back to wizard to activate that final word, if that makes sense.

Evita Woolsey:

And so that is just kind of the paradigm that is used in the cochlear implant language lab but also Dr. Walker’s offline measures that are standardized assessments are really impactful too, to learning about written word recognition or even literacy outcomes in general. And so how I got interested in this topic is in journal group with Dr. Walker’s lab, we started reading a lot more about literacy outcomes with children with hearing aids and children with cochlear implants and I was really interested by it. I decided to do my honors thesis on this topic and make it more of a cognitive science psycholinguistic study. But I am more interested in the translational research as well.

Evita Woolsey:

And what really supplemented my interest was assisting with her longitudinal study on literacy outcomes of children that are hard of hearing that I believe you might have read in Iowa Now that we went around the state of Iowa and other states in general and tested middle-schoolers and high schoolers with hearing aids and did six hour test batteries, which is very long, of standardized assessments. And that has just started up. And that’s a combination of how I’ve really been supplementing my research interests and then also been actually in the process right now of running cochlear implant users for my study.

Alex Murra:

I’m thinking actually that study that you were just talking about when you were going around Iowa, I was looking at those Iowa Now stories and I saw you guys are in a van. Can you tell us about that more? What was it like to conduct research in a mobile unit essentially? It’s really the typical bench or even lab work that we think of.

Evita Woolsey:

Going around in a van is very convenient and it honestly adds a lot more of personal contact with the families. I know Dr. Walker has kept in contact with these families. And so having it be so easy to drive to in front of their house, yes, it may look a little scary because we have a white van but we sit outside of their house. And especially since we’re there for around six hours, you can really make a connection with the child. And also it’s really accessible for the parent to come out, check on the kid and that just adds a lot more. It’s more personal in that way and I think it makes children and their families more apt to wanting to do research more in the future. And I think that’s why a lot of the families have stayed in contact since OCHL to now the new study, LOLA, they’ve stayed participants in it. I think it’s amazing.

Alex Murra:

Yeah. I think that’s really cool. I know in my classes all the time we talk about lost to follow up, how do we keep participants in the longitudinal study?

Radha Velamuri:

Both of you have really nicely sort of in a little package described what each of your research focuses are and overall the lab’s goal. But I kind of want to get both of your perspective on this. As a head researcher and as a student within the lab, how do you hope in a perfect world that this lab’s research and more specifically what you focus on, will serve the community and public health in general?

Evita Woolsey:

I can start for this one. I think even during this podcast, talking to you both about how hearing loss is actually a spectrum. I think that’s something that a lot of people when I talk to them about, oh yeah, I do research with pediatric hearing loss. First off, they don’t realize that kids can have hearing loss and they automatically think of older adults. And then second, they automatically think about someone who’s deaf. And so I think that educating the community about how there’s mild hearing loss and even telling the community that mild hearing loss is impactful, this is something that is really prevalent in our lab, talking about how mild hearing loss is not just what we might think of as mild.

Evita Woolsey:

It’s actually really impactful and how we can change our terminology or change how we talk to families that have children with hearing loss and say, “Oh, actually this is their audibility percentage. This is how much they can hear with their hearing aids as a percentage versus what they can hear without their hearing aid.” And saying, “Oh, actually mild hearing loss is really impactful on their communication and language skills.” I think that it really will impact the community that is uneducated and then also will be helpful to educating even peers that have other peers with hearing loss and being able to have those kids recognize, oh yeah, my friend has hearing loss. A hearing aid is helpful. I’m not going to like stigmatize them due to their hearing aid.

Evita Woolsey:

And almost, I’ve seen how and heard stories from OCHL how some kids are really proud to have their hearing aids. And I love hearing those stories because that is how it should be. If it’s helping them so much, they should be proud to have their hearing aids and say, “Wow, I can be super successful in all these different academic areas and even outside of academics having a hearing aid.” I think the research that we’re doing is really impactful to people inside and outside of the area of hearing loss.

Elizabeth Walker:

I love that answer. That was great. How do I help that our labs research will serve community and public health? And I think that’s a great question. I think that really drives what we’re trying to do as part of this longitudinal research study. One thing that I have become more aware of as I’ve been involved in this project and I’ve been involved in this project pretty much since the start, so for over a decade now. And one of the things I’ve really become aware of is the disparities that we see in accessing pediatric hearing healthcare. We have seen that lower income families have a harder time getting their child diagnosed according to those guidelines that we’re trying to meet where we’re trying to get the kids diagnosed by three months of age. Lower income families, their kids tend to be delayed in terms of diagnosis. They also tend to be delayed in terms of when they are fit with hearing aids.

Elizabeth Walker:

We also see a rural urban divide. Children who live in more rural settings also have more difficulty accessing pediatric hearing healthcare because families have to travel a long way to be able to see a qualified pediatric audiologist. For example, we have families up in the northwest corner of the state that have to drive all the way to Omaha or Des Moines or even Iowa City in order to be able to do a diagnostic hearing test or get their child fit with hearing aids. And so one thing I’m hoping that happens is just the awareness that we need to be able to provide adequate, appropriate services for children across the state of Iowa, not just children who are in more urban settings.

Alex Murra:

I think your guys’ research is super interesting. I know that for me, sometimes I just do take my hearing ability for granted. And breaking that stigma, education, increasing access, that’s all so important. To finish up this, so far it’s been great and we always ask one final question to our guests. The question is, what is one thing that you thought you knew but were later wrong about?

Elizabeth Walker:

This is a really hard question but I love it. one thing I think going into the project that I’ve been working on for the last decade that I would’ve assumed and I think was a common assumption is that degree of hearing loss should correlate with outcomes. And by that I mean, if your hearing loss is more severe, if you have a moderate hearing loss or a severe hearing loss, you should have poorer outcomes compared to children who have a more mild hearing loss. One thing that we found in the study is actually, that’s not the case.

Elizabeth Walker:

We consistently see in our data, what we have started calling the sweet spot. And what I mean by that is we seen that the children who have hearing loss in the moderate range, tend to look like they have actually the best outcomes of the children in our cohort and the children with mild hearing loss seem to fall slightly behind those kids. And then the children with severe hearing loss seemed to fall slightly behind the children with mild hearing loss. And this was not a pattern we were expecting to see. Some people had found this in previous research but not with such a large sample of subjects. And what we think may be going on here is that the children with moderate hearing loss are really getting the ideal service delivery. And by that I mean they have hearing loss that is amenable to amplification so we’re able to those kids with hearing aids, they wear the hearing aids consistently because we have a lot of buy in from the parents about the importance of wearing the hearing aids and they get services such as speech pathology.

Elizabeth Walker:

The children with the mild hearing loss, there may not be as much buy in from families. The audiologist may say, “Oh, it’s just a mild hearing loss.” Or their physician may say, “It’s just a mild hearing loss. It’s not really something to worry about.” Even if they are fit with hearing aids, it may be later than when other kids with hearing loss are getting fit and they may not wear the hearing aids as consistently. Even though they would respond well to the intervention, there’s not as much uptake to the intervention for these kids with mild hearing loss and so we seem to have this picture of them performing just a little bit worse than kids who have actually more severe hearing loss.

Elizabeth Walker:

And then in the case of the kids with severe hearing loss, it may be the case, they’re wearing the hearing aids but the hearing aids may not be providing enough amplification for their hearing loss and so we may need to think about changing the intervention for some of these kids that have the most severe hearing loss in our sample. And so I think what really speaks to is that our findings have kind of gone against conventional wisdom, which is mild hearing loss isn’t something we really need to be that concerned about. And we’ve been trying to raise more awareness of that any degree of hearing loss can have a negative impact on language and communication outcomes.

Evita Woolsey:

I’ll just add on top of that. That that’s what I thought too and kind of what I was saying earlier about it’s a spectrum and you shouldn’t take things for granted. Oh, if you have worse hearing loss then you are going to fail in all these different aspects. I definitely agree with that and want to change the idea that people with mild hearing loss also can have really drastic struggles as well.

Alex Murra:

Well, thank you both again for coming onto our podcast with us, for spending this time with us and answering all of our questions. I had a wonderful time. Thank you.

Elizabeth Walker:

Thank you so much for inviting us. This was really great. I love it.

Evita Woolsey:

Thank you.

Alex Murra:

That’s it for our episode this week. Big thanks to Dr. Walker and Evita Woolsey for coming on with us today. This episode was hosted and written by Radha Velamuri and Alex Murra, edited by Alex Murra, and produced by Alexis Clark. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy and keep learning.