Episode 17 Show Notes
All Ears at Childs Voice Podcast
(Transcript below)

On episode 17 of All Ears at Child’s Voice: A Hearing Loss Podcast, Tatum and Wendy interview Dr. Anne Marie Tharpe. Dr. Tharpe is a Professor the chair of the Department of hearing and speech sciences and associate director of the Vanderbilt Bill Wilkerson Center for Otolaryngology and communication sciences. She has authored more than 90 journal articles, books, and book chapters on the topic of pediatric audiology and presented on childhood hearing loss worldwide.

Tatum and Wendy talked with Dr. Tharpe about:

  • How she became interested in the field of Audiology and pediatric hearing loss
  • The definitions of minimal, mild, and unilateral hearing loss
  • Newborn hearing screening
  • Amplification for children with unilateral and mild hearing losses
  • Characteristics of children with unilateral and mild hearing losses
  • Challenges to counseling families
  • Current and future research in these areas
  • Listening fatigue
  • And more!

Intro (Carol):      Welcome to All Ears at Child’s Voice, a podcast discussing all things hearing loss. We aim to connect parents of children with hearing loss with the professionals who serve them. I’m Carol Morency and I am the marketing associate at Child’s Voice. I am most excited to get and tell the community about Child’s Voice. Last week on the show Tatum and Wendy interviewed Dr. Nancy Young, a cochlear implant surgeon at Lurie Children’s Hospital. Go back and listen if you haven’t yet.

Tatum:                  Welcome to another episode of all ears at child’s voice. We aim to connect parents of children with hearing loss with the professionals who serve them. We’re your hosts. I’m Tatum Fritz.

Wendy:                and I’m Wendy Deters. Today on the show, Dr. Anne Marie Tharpe joins us to discuss unilateral and mild hearing loss. So far on this show, we have focused more heavily on severe to profound hearing loss and cochlear implants. So we’re really excited to be covering this topic today with Dr. Tharpe.

Tatum:                  Dr. Tharpe joins US remotely today from Vanderbilt University in Nashville, Tennessee. She is the chair of the Department of hearing and speech sciences and associate director of the Vanderbilt Bill Wilkerson Center for Otolaryngology and communication sciences. She has authored more than 90 journal articles, books, and book chapters on the topic of pediatric audiology and presented on childhood hearing loss worldwide. Her research focuses on the developmental impact of hearing loss and impact of hearing technology interventions in young children. She Co-edited the textbook, The Comprehensive Handbook of Pediatric Audiology with Dr. Richard Siebold. The second edition of which was released in 2016 recently, Wendy and I were both able to hear Dr. Tharpe speak on mild and unilateral hearing loss as she was the keynote speaker at the early hearing detection and intervention or EHDI conference this past march. Dr. Tharpe welcome to the show.

Dr. Tharpe:         It’s a pleasure to be here. I appreciate the invitation. I’m a huge fan of podcasts and listen to them all the time, but I’ve never been the subject of a podcast, so this is a great new experience for me.

Wendy:                Dr. Tharpe, can we start by you explaining a little bit more about your role at Vanderbilt?

Dr. Tharpe:         Of course. And as you had said, I am the chair of the department of hearing and speech sciences here at Vanderbilt University Medical Center. We are one department within the Bill Wilkerson center. The other department is the department of Otolaryngology. So we have both departments who serve children from birth through older age. And of course, the benefit of that is that we provide rehabilitation for individuals with, communication disorders and related disabilities and our colleagues in Otolaryngology can when possible, treat those conditions medically. So it’s a really great teamwork. And then, um, and, and of related to the topic of this show, we have a big focus in, uh, pediatric hearing loss including a preschool for children with hearing loss. And in addition, my role encompasses a training program. So we train audiologists and speech language pathologists and deaf educators within this department as well. And we conduct a large amount of research.

Wendy:                Well, I’d like to personally thank you for your amazing educational program because Child’s Voice has been the benefit of that. We have many excellent staff members who have come through your program, um, Tatum included. And, uh, our other podcast creator, Jessica Brock, among others on our staff. So thank you for being an excellent educator.

Dr. Tharpe:         Oh, well thank you. That it’s always a pleasure to see what our graduates are doing and how they’re reaching out in the community to, to help children with hearing loss. So I’m thrilled.

Tatum:                  I definitely loved being at the program. I love child’s voice, but I miss all the time how everything is housed in one building. You just go on the medical record and there’s there audiology reports and there’s their speech reports and you could just walk down the hall and talk to the teacher of the deaf that’s working with the child. it’s amazing like how collaborative it is.

Dr. Tharpe:         One has to be collaborative and interdisciplinary. We, none of us know everything about, uh, how to best serve these children, but together we can do so much. It’s fun to watch you guys go through training together because it’s, it’s been my philosophy that if we don’t train disciplines together, they won’t know how to go out and work together. So that’s kind of been the motive for the training program here.

Tatum:                  Yeah, yeah, I definitely had the benefits of it. And then before we go into the main discussion, could you also share some about how you got into the field of hearing loss?

Dr. Tharpe:         Well that is not very exciting but I am happy to share. But I feel it was really more by accident than anything else. I was one of those students who couldn’t figure out what she wanted to do. And so I changed my major many, many times and finally decided that I wanted to work in deaf education, deaf and blind education and ended up at the University of Arizona. And kind of at the last minute I transferred over there because I heard they had a deaf and blind program. And then when I got where I was told I couldn’t, couldn’t do that, um, take that major on the undergraduate level. I had to wait for graduate school. So I said, well, I’m already in Arizona. What am I going to do? And they said, why don’t you just enroll in the audiology program? And because it has to do with hearing loss I said okay, it was really serendipitous. And then once I got into the audiology program at the University of Arizona, there was no turning back. I became smitten with the topic area.

Wendy:                We’re glad that that happened because you’ve made a lot of excellent contributions to our field, so thank you. We also like to start this show with asking our guest every week for a story from their past week. It could be anything, something cute, something funny, something heartwarming. Does anything come to mind for you?

Dr. Tharpe:         I am right off of vacation. We went up to Maine, which is very far, as you know, from Tennessee, but we always take our dog with us. So we had to drive. So it was 22 hour drive and obviously 22 hours back. And on the way back in the last week we were coming and we thought, okay, let’s drive about while we’re, we’re gonna stop in Syracuse and spend the night. And we got to Syracuse and they said, we’re sorry, we don’t, you know, there are no hotels available. I mean, we called every hotel. Syracuse couldn’t get in and said, okay, well maybe we can drive on to buffalo. So we’d drive to Buffalo, no hotels in Buffalo. We said, okay, next town, Erie, Pennsylvania. We get to Erie. So Lo and behold, we could not get a hotel room to spend the night until seven 30 the next morning. It was certainly the first time in my entire life that I could not get a hotel. I mean any of the small towns in between all night long. So, so there you go. That’s my, that’s what’s on the forefront of my mind yesterday.

Tatum:                  That’s so funny. I wonder what was going on. Like, if there was some kind of event or something,

Dr. Tharpe:         you know, I have no idea, this is, you know, this is vacation season and I’m going but this is a town that has, you know, like 500 people in it. What is happening here? So. Anyway, there you go.

Tatum:                  Yes, that’s so funny. Why don’t we, um, go ahead and get into the main part of our conversation then. Um, so before we go any further, do you mind defining both mild hearing loss and then also unilateral hearing loss for our listeners?

Dr. Tharpe:         Sure. When we talk about any hearing loss, we often talk about the pure tone average, which as you know means the primary speech frequencies the primary frequencies that compose speech and when they’re averaged together we refer to that as a pure tone average. So mild hearing loss would refer to those losses that are greater than 25 decibels, pure tone average and less than a 40 decibels pure tone average. And then unilateral hearing loss. The definition is a bit more interesting in my mind because it has as much to do with the configuration as it does to the degree because any degree of hearing loss in one ear is a unilateral hearing loss. So it could be a mild hearing loss or it could be a profound hearing loss in just one ear and it’s still referred to as unilateral loss.

Tatum:                  And then maybe for our listeners to be able to like contextualize the difference profound would be greater than, 90 Db. So there’s that range, just so listeners know, this is the mild end of that range. I don’t know if this will be that interesting to our listeners, but I think about this often. So in graduate school, I also remember learning about minimal hearing loss. Is that something that’s still used? I’ve never run into that. Like outside of an academic setting.

Dr. Tharpe:         Yes. Yeah, because it’s, an important area in my mind because maybe because you’re not hearing about it. When we think about what adults hear versus what children hear, there’s a huge difference. I think about it like this. If I am in a crowded room and someone is whispering something to me and so there’s background noise, and they’re whispering. I’m not going to hear everything that that person says. I won’t hear every single sound and every single speech sound, but because of my understanding of language, I will be able to fill in the gaps. I will be able to understand as long as I get most of the words I’m going to understand and be able to fill that in. But young children, if they don’t hear every sound, they’re going to miss it because they don’t have the vocabulary that we have. They can’t fill in those gaps and they can’t take the context to know that perhaps if, if we’re talking about, let’s say for example, if someone is talking to me about shopping and they say the word shoes and I only hear “oo”, I will know that you were talking about shoes based on our conversation, children don’t have that ability to fill in the gaps. So when we talk about minimal hearing loss, we are talking about losses that are even less than a mild hearing loss. We are talking about losses that are between about 10 decibels and 25 decibels, which technically is in the normal hearing range for adults. But for children we consider that a minimal hearing loss because of the impact on their ability to understand.

Wendy:                I think that brings up a good point of defining for our listeners, normal hearing for children and normal hearing for adults. What are the pure tone averages that, that we use to define those?

Dr. Tharpe:         Right. So adult we can set her normal hearing anything 25 decibels and below for children. We consider hearing loss if you will, anything over 15 decibels because of what I was just talking about. Because they’ll have difficulty if they can’t hear those very soft sounds. So, there’s a 10 dB difference between what we consider normal for adults and what we consider normal for children.

Wendy:                Yeah. I think that’s such an important point, just to reiterate to everyone and to ourselves, because, and I know we’re, we’re talking about mild and unilateral losses here, but when we think about hearing aid and cochlear implant programming, we get really excited when we’re in that 20 dB range. But I think we’ve gotta be mindful of the fact that it may not be normal or perfect hearing. So we have to be mindful of the acoustic environment around us and around kids. So thank you for defining that for everybody.

Dr. Tharpe:         You’re absolutely right and we’re often concerned (inaudible) about when children receive cochlear implants and there’s an assumption perhaps by like teachers and families and others that the child now has perfect hearing when in fact they are functioning more perhaps like a child who has a minimal hearing loss. And so they still may need a supplemental assistance like an FM system or what we refer to now as a remote microphone system.

Tatum:                  We’ve kind of touched on this already, but I want to make sure that we fully cover this for our listeners. What we’re talking about unilateral and mild hearing losses today. So can you kind of go into why we should be concerned about these types of losses as a field? I feel like sometimes when we’re working with families and sometimes even other professionals, we get the response of like, it’s just a unilateral loss. It’s just mild. Especially that term mild even kind of downplays the importance of the type of hearing loss it is. Can you go into like why this is so important for us to be paying attention to?

Dr. Tharpe:         Absolutely. We have found early on with initially it was when we were looking at unilateral hearing loss. Our early studies in the 1980s surprisingly revealed to us that children with unilateral hearing loss were at an academic disadvantage relative to children who had normal hearing in both ears. Basically what was happening is that for us here at Vanderbilt, families were coming in and they were saying, you know, my, my child has this unilateral hearing loss and we have been told that it won’t be a problem, that our child just needs to turn his or her head towards the teacher and receive preferential seating and everything will be fine. But my child’s having trouble in school and I know they can understand what’s going on the schoolwork because I go over their homework with them the night before. They good understanding that they’re in school and they’re having trouble and your grades are slipping in this kind of thing. So we did a study and one of the seminal studies looking at the academic outcomes for children with unilateral hearing loss. And we found that at children with unilateral loss, we’re 10 times more likely as their normal hearing peers to have to repeat a grade in school or receive supplemental help. And that came as a great surprise. I was a research assistant at the time, and I can remember, you know, this, I hate to say it, I’m going to sound like I’m 112, but we didn’t do this kind of work on computers back then. We did this fund on an Intel and liters. So I was calculating my office, you know, my on my calculator and, and um, I remember, uh, I did this work with, Dr. Fred Bess. And I’d run up to his office and I said, you know, Dr. Bess and these, these children are having a great deal of difficulty. They’re, you know, having to repeat school at a rate 10 times of normal hearing peers. And he didn’t believe me. He said, you know, Anne Marie you’ve messed something up, go back down and calculate again. Yeah. Well, it again, this wasn’t a push of the button. This meant that, you know, a few hours of my going back through. So we did it several times and the results really were shocking, not only to us but, but our colleagues across the country, when we came up with that finding.

Wendy:                I’m not trying to age you, but can you, I, I have a point. What year was that study done? Okay.

Dr. Tharpe:         When did we do that?

Wendy:                Yes

Dr. Tharpe:         We published those first studies in the early 1980’s when many of you were not even born.

Tatum:                  Yes, before me.

Wendy:                I was born. Um, but still young.. So my follow up question to that is, so now it’s 2019 and this has really become a huge part of the conversation in working with children with hearing loss. Why has it taken 40 years for it to be at the forefront of what we’re doing in terms of working with children with hearing loss.

Dr. Tharpe:         I wish I had a good answer. I feel that we have been working on this topic, you know, and in some, some pockets of researchers have been working on this topic for some time and periodically it becomes popular again and then it fades away because other things become hot topics. So it has been something that I have worked on somewhat consistently. I’ve done other work as well, but since the 1980s, we’ve been doing this work. I think another perhaps one reason is that the numbers of children with unilateral or mild losses is so much larger than the number of individuals with a severe to profound loss. I think because of the many more children with these, these milder losses who are in our clinics, it has gained more attention and, and you know, we’ve become so successful with cochlear implant interventions for those with more severe losses that perhaps it has given us the luxury of being able to divert our attention back to those with milder losses.

Tatum:                  And I would think with the advent of universal newborn hearing screenings, these are being diagnosed more frequently and would be missed less often.

Dr. Tharpe:         So that’s a very good question. I’m not sure that’s necessarily the case. So certainly it is the case for unilateral loss because we weren’t able to identify unilateral hearing losses prior to newborn hearing screening until around age five when children were going into kindergarten and they would get their hearing screen because children with just a loss in one ear are responding to their parent’s voices, they’re able to hear the TV, all of those kinds of things. And so, before newborn screening the one way that a child with unilateral loss would be identified is that, for example, a parent would hand the telephone to their child and say, okay, talk, talk to grandma. And the child would move the phone from one ear to the other so that they could hear and parents would notice those things. You are correct. Unilateral losses can be picked up in newborn hearing screening, screening, milder losses. However, mild bilateral losses are difficult to pick up with newborn hearing screening because we don’t screen for mild losses, mild or minimal losses in the newborn nursery. We really are screening for a moderate or greater losses in the newborn nursery because if tried to identify those very mild and minimal losses in the newborn nursery, we would have a lot of false positives. In other words, we would be saying that more babies were not passing then really had hearing loss. And so that would be a problem for screening. When you’re screening for something, you’re just trying, you’re trying to capture the bulk of the population you’re looking for, but not every single case.

Wendy:                At what a decibel level does the newborn hearing screening take place?

Dr. Tharpe:         So screening takes place, and it varies a bit but screening takes place somewhere around 30 decibels. So, if you have a hearing loss that is hovering around that net level, it might be missed. I think the takeaway here is that just because of baby passes a newborn hearing screen, it does not mean that they do not have a very mild hearing loss. And so we need to make sure that all of the care providers, that families and physicians and speech pathologists and others understand that and that they are not thinking that because the baby passed the screening. Let’s not worry about hearing if there is a speech problem or the baby doesn’t seem to be hearing. Let’s not assume that it must be something else.

Tatum:                  Yes, that’s a great point. And speaking of kids getting missed. I remember in your class speaking a lot about how these kids are perceived especially if they’re undiagnosed and they go on and to, to school and how they’re perceived by their teachers and others, so how can they be perceived if they are undiagnosed?

Dr. Tharpe:         So, as part of the study that we did, early studies that we did in the 1980s, part of what we did was to go into the school systems and talk with teachers. And when we would ask them about specific children or example, a child who we knew had unilateral loss and we notified the teacher, this child has hearing loss in one year or this child who has a very mild loss, they would say, oh, I know you say that, but Johnny, hears he wants to hear. And he doesn’t have trouble hearing his friends when they’re outside playing, there or when he can tell that I’m angry, he pays attention. And of course if someone’s angry, but likelihood that they are increasing the volume of the voice. So, so my point being that these children appeared to not be paying attention. They seem to be kind of goofing off, if you will. Sometimes teachers describe these children as being class clowns. And the assumption there is that if they’re not understanding what’s going on in class, it’s easier to try to be a class clown and pretend like you don’t care about what’s going on as opposed to feeling like you can’t understand it. We have often seeing that these children have behavioral, uh, problems as well. Uh, particularly in group settings, classrooms, settings.

Tatum:                  I have another question that goes still further into screening. So if these kids are missed at birth, when are they when is it picked up on that they have a hearing loss. Would a school screening be effective in picking that up?

Dr. Tharpe:         The school screening can be effective if it is done well. So some screenings unfortunately are still done kind of in mass where, you know, all the children go to the cafeteria and, and they’re standing in line and waiting to get screened under those conditions these children are likely to be missed because there’s background noise and therefore the screeners will raise the level of the sounds that they, they are asking the children to respond to because none of them can hear them. So, because none of the children can hear these very soft sounds in the noisy environment, the screeners will raise the intensity level of the of the screening sounds and then everybody can pass it. So, these children as they are older can be screened effectively. They should be screened at approximately 15-20 dB and then they would be picked up. But they do have to be in a quiet environment and preferably using earphones that will mask out the background noise.

Wendy:                It sounds like many children may be missed through this screening. And when families become concerned with speech and language development, that’s when we start to pick up on the hearing loss. And again, like you said, sometimes families and professionals, unfortunately will look back to the newborn hearing screening and say, Oh, they passed and not consider that as a cause of speech and language delays, which is a problem.

Dr. Tharpe:         Correct. I think the other reason what should be considered for alerting families and educators is just having difficulty in school because sometimes these children will develop normal speech and language and there may not be anything, you know, indicated, especially in some of the more general speech and language tests. Their deficits will not show up, but they will be having some difficulty in different educational areas. So anytime a child is not performing as they should be, either speech and language or educationally, uh, thorough and diagnostic hearing test would be recommended.

Tatum:                  I think that’s a great point about the behavioral challenges leading to an audiology referral. I feel like a lot of professionals don’t think of that.

Wendy:                Or even attention issues are so commonly diagnosed in, in schools now. ADHD is such a huge topic of interest for teachers and families. And I wonder how often those kids are also getting their hearing screened too. Probably not as often as we would like them to.

Dr. Tharpe:         that’s right. It’s not as routine as we would like to see. Right. And sometimes not always. Some schools do a beautiful job of screening of course, but we would certainly want them to be screened in a quiet environment. My rule is always if a child is having difficulty, they shouldn’t get a screening. They should get a full evaluation.

Wendy:                So since we’re on this topic of unilateral hearing loss by professionals, I’m always talk about by the binaural advantage of, or in layman’s terms, two years are better than one. So can you speak to some of the advantages of hearing with two ears and why this is so important for children?

Speaker 3:           Absolutely. So one of the primary binaural advantages that we think about is localization and that is identifying where a sound is coming from. This becomes particularly important for safety reasons because if we, think about the child needing to cross the street, if they can’t hear a car coming from one side that can be a safety concern. Having two ears allows us to identify where the sound is coming from because the sound, even though we don’t think about it like this sound hits the ear closest to the sound source first and loudest and that on that side and then it travels to the other ear and it’s a tad softer and it’s a tad later. And those cues allow us to identify which slide the sound is coming from. So there are loudness cues and their timing cues that allow us to identify that. and that’s important not only for safety things like crossing the street and recognizing that sounds are coming but also for social. So children, it’s important if someone calls their name to be able to turn towards, you know, who is calling them are, if they need visual cues to be able to identify where a sound source is. So, so that’s a very important binaural advantage of localization. Now another important, binaural advantage comes from being able to listen in the presence of background noise. Those of us who have normal hearing and two ears are able to kind of use one ear to focus if you will on the background noise, kind of push it out of our mind and, and use our other ear to focus on the voice we want to hear. So if we’re in a noisy restaurant or we’re at a party, we can talk to one person, focus on their voice and tune out the rest. And when you have hearing and only one ear that is an advantage that you don’t have. So you kind of break down in background noise.

Tatum:                  So we’ve talked a lot about the reasons why we should be concerned about mild and unilateral hearing losses and the impact that they can have on children. Let’s talk a little bit about like the intervention approaches and the options there. So what kind of amplification options are available for these kids? Maybe both mild hearing loss and then also unilateral. And I know those will probably differ a bit.

Dr. Tharpe:         They do differ. Let’s start with the basics, which would be a traditional hearing aid. So we can put traditional hearing aids on mild losses as well as unilateral losses. The ear needs to be what we would refer to as “aidable.” So let’s think about unilateral for a minute, because I had, I had already said that again, a unilateral loss could be a very mild loss in one ear or severe to profound loss in one ear, if the ear is severe to profound and there is not good understanding of speech in that ear, putting a traditional hearing aid and just making everything louder in that ear is just gonna make the distortion of that ear louder. In other words, if they can’t understand speech well and if you put a hearing aid on it, you’re just making that lack of understanding louder. And so in those situations we would rather not use a traditional hearing aid but if the loss is mild or even moderate than a traditional hearing aid would work just like it works with other bilateral losses, which is that it just amplifies speech and other sounds that someone wants to hear so that they can hear them. And so, so all of that can work quite, quite nicely.

Wendy:                I think one of the struggles that we have as professionals, and I’m sure families obviously have the same struggle even more so is almost justifying the hearing aids for a mild hearing loss. You know, hearing loss can be an invisible disability. But if you look at children with more mild losses, it’s, it’s even more so because they sound so good. So can you help us think of some good strategies to help professionals, help families understand why hearing aids are important for a mild hearing loss?

Dr. Tharpe:         Yes. And you really hit the nail on the head there. People often say that it’s sometimes difficult to counsel families when they are talking with them about their child having a severe or profound loss. I think it’s much more difficult when we’re talking to them about minimal or mild losses for the reason that you just mentioned. And that is that parents don’t really see what’s going on and their child seems to hear well or well enough and they’re developing language and it makes it quite difficult. I think one of the more effective tools for talking with parents is to play simulations of slightly reduced speech so that they can hear for themselves. But that sounds like there are some very good programs on the Internet provided by some of the hearing aid companies where the audiologists can actually enter in the child’s audiogram into the program. Then it will modify speech so that the parent can hear the difference in other words that will play it with no filtering and then it applies their child’s hearing loss and on top of it so they can hear what speech sounds like to their child. And I think it’s a very effective form of counseling for those families.

Tatum:                  I agree with Wendy sometimes feel like two parents are waiting, um, for a delay to develop. So we work with the kids in early intervention. That’s what Wendy and I do. And sometimes they are doing really well. Um, but we know like when they get into a very noisy classroom that might not be the same case or they might not be able to meet their full potential if they were to have, um, some kind of amplification.

Wendy:                Right. I feel like such a buzzkill as an early intervention therapist working with families with mild and unilateral losses because they just want to enjoy their baby and we’re saying, oh, but you need to think about this. You need to think about this. And we’re not trying to take away the joy of their baby or celebrate the speech and language that they do have, but we just want to use our knowledge to help give that child every opportunity that they can.

Dr. Tharpe:         Yeah, I agree it is very difficult. And it really takes very well trained professionals to help families through the understanding of what it means long term to have some of these losses.

Tatum:                  Yeah. so we talked a little bit about like families accepting the recommendation for our device. Um, is a device always recommended though for these types of hearing loss? And does it vary by like professional? I feel like I’ve seen different recommendations from different places.

Dr. Tharpe:         It does. So I understand that that families are facing quite a dilemma. I think it’s even more difficult with unilateral than it is with mild. I think most audiologists would recommend hearing aids for mild bilateral hearing loss in children. When it’s minimal, it’s a little bit difficult and we can talk more about that. But let me focus a bit on the unilateral because I do think this is more of a challenge with unilateral. So I’ve told you that about 50% of these children have difficulty well the other way of course it of looking at this is that 50% do not have any difficulty academically or speech language. Will they have continued to have difficulty with localization and being able to tell where sound is coming from. Yes. And we can educate children over time about ways that they can accommodate that, that slight deficit, but some children aren’t going to have trouble. And that’s where an audiologist was saying you don’t need to do anything. Let’s just watch and wait. So it’s very difficult and I understand it. One problem is we don’t have strong research on the different management options and their outcomes for children. So that is a deficit in our research. We don’t know which children are going to have difficulties with unilateral loss and which ones are not. And we also don’t know which, if any of the hearing technologies will help in that regard. And that that’s unfortunate. I want to have a positive note here. We do know that FM systems are going to benefit a child when they are in in the presence of background noise. That is undeniable. And so in classroom settings, I think that FM systems are a wonderful intervention probably for all people, not just children with hearing loss, but because, so many children also have ear infections, I think for all children they’re going to do well, especially in those elementary grades using an FM system. But the problem is and I think the confusion comes in on what should I, what should I do with my child outside of the classroom setting? And should they have traditional hearing ae, should they wear one of those hearing aids that routes the impaired side over to their normal hearing ear? And that is called the CROS hearing aid. So that’s a different type of technology. And unfortunately, we don’t have the research to, to be able to tell people, if your child has this loss on this ear, then you should do x. And so right now what we’re recommending is an individualized approach where we walk through different aspects of a child’s outcomes and make decisions for that individual child. And what I mean by that is that we look at their speech and language. We look at their academic or in the case of early intervention, their pre academic skills. We look at their behavior and we take all of those things into account in making a decision about whether or not a child needs to use technology outside of the classroom.

Tatum:                  Yeah, I think about too, um, I remember at EHDI you end at your keynote, like the most important thing we need to learn is like how to differentiate these kids that are going to do well versus the kids that don’t.

Dr. Tharpe:         It is. It is really difficult. I will tell you this I’m happy to let you know, um, that there was a consensus conference on unilateral hearing loss back in fall of 2017. After the conference we convened an expert panel of individuals around the world, um, and came up with a what we call a practice parameter of what audiologist should consider when making recommendations for technologies and other things for children with unilateral hearing loss. And that is going to be published in the International Journal of Audiology sometime soon. We just got that acceptance recently and following that publication we are also putting out a family guide. So for parents to be able to understand some of these complex issues better and also to understand what questions they should ask their audiologist about when their child is identified with a unilateral loss. So I’m really looking forward to getting that out.

Wendy:                So are we, that sounds amazing. We will definitely be on the lookout for that and make sure to distribute it to students and our staff and families, so that will be amazing. I wonder if at that conference when you were talking about unilateral hearing losses, if you sort of talked about the future of what we call single sided deafness and the new trend that we’re seeing in cochlear implantation for children with single sided deafness.

Dr. Tharpe:         Well it’s your, your timing is good. You may know that just this month, um, cochlear implants were approved by the FDA for, what I call unilateral profound hearing loss. So that’s, that’s a big step. To get FDA approval, there has to be a fair amount of research done to, to back up the safety of, of doing that. So I’m looking forward to seeing more research on cochlear implantation for unilateral loss. There hasn’t been a whole lot published, um, on that topic in children to date. And so I think that this approval will stimulate a lot more results in that area. So I’m looking forward to seeing that.

Tatum:                  I think I’m in graduate school hearing about that. I always thought it was so fascinating and exciting and such a new development. Um, and we won’t get into it cause I’m sure it could fill a whole episode, but now as someone who is practicing, I realize like on a personal level when you’re dealing with real families, it’s a very difficult choice for families to make but on an academic level it is very exciting for me. So speaking of new trends in the field, something else I’ve been noticing a lot is um, professionals speaking a lot about, um, listening fatigue and listening effort., I think research is being done on this at Vanderbilt by Hillary Davis. Could you speak some about listening fatigue and listening effort and how that applies to kids with mild hearing loss and unilateral hearing loss?

Dr. Tharpe:         Absolutely. So work that you’re referring to. We’re going to go back to Fred Bess again, who started those early unilateral hearing loss study. So the work you were referring to is coming out of Fred’s lab. He and Ben Hornsby and others. And that lab has had begun to, to publish pretty extensively in this area. And it is very interesting for a number of reasons. Now listening effort and, and fatigue are slightly different. But you can imagine that listening effort basically refers to the the amount of attention that one has to pay in order to understand what they’re listening to. And if you’re exerting a lot of effort, then that would lead to fatigue and fatigue can be, you can imagine mental fatigue, you know, if you studied for a while you just wipe down and you say, Hey, I’m mentally fatigued. Sometimes there is objective fatigue so you can actually take measurements from individuals up their saliva where their blood to, to measure, um, certain aspects in their blood that would indicate that they’re actually fatigued. So that’s looking at cortisol levels. This is something that they’ve been looking at with regard to what is the fatigue in children with hearing loss. Some of the work that has been done that’s very interesting out of out of the labs here indicates that there’s really no association between the degree of hearing loss and fatigue. Which is very interesting with regard to our subject today. So it doesn’t require, in other words, that a hearing loss be severe or profound to induce listening fatigue, which I find really fascinating. So that’s been some work in children with mild degree of hearing loss. And again, we see that that children with mild losses have significantly more fatigue than children who have normal hearing. Now, they haven’t specifically looked at children with unilateral hearing loss, but given that there’s no association between degree of hearing loss and fatigue I’d guess that the children with unilateral losses would be just as subject to that fatigue as those with bilateral hearing losses.

Wendy:                Well, we’ll look forward to that study for sure. And then finding out. Well, if it’s not degree than, than, what is it? I don’t know if that’s something that you can speak to just yet.

Dr. Tharpe:         I can say that it is very much associated with language. As you might expect. So it kind of goes back to the early part of our discussion when I was talking about how difficult it is for children fill in the blanks. And if they miss part of a combination, it’s harder for them to fill in the blanks than it is for an adult who has better language. So you can imagine that it’s more difficult for you to fill in the blanks that you are going to exert more effort to try to understand and therefore become more fatigued. So the relationship that they found here at Vanderbilt in the Bess lab was the relationship between language and fatigue. So those children who had poorer language had higher levels of fatigue. They are coming out with what’s called the Vanderbilt fatigue scale. So pretty soon, I hope that you will have something in your hands that will allow you to measure self-reported fatigue in children with hearing loss.

Tatum:                  That I was aware of that and I’m excited for it to come out. It makes sense about having stronger language skills would lead to lesser fatigue.

Wendy:                I think it’s helpful for us as professionals to think about the type of intervention that we give and knowing, you know, what the risk factors are knowing that language plays such a huge role than we can really focus on, um, expanding language and not just, you know, focusing on nouns and verbs, but really that language rich environment through things like theory of mind and executive function sort of opening up kids and families to think about language in as a whole. That’s just as important as, you know, getting a really good score on a vocabulary standardized test.

Dr. Tharpe:         I think it also goes back to, you know, your, your questions about, um, what technologies and what intervention should we be doing and what about these children who are doing just fine. Should we be treating those children the same as children who are having difficulty? Well, putting together all the pieces of this puzzle would help you know. So for example, you, you have a child who has a unilateral loss, their speech and language skills are fine. You administered the fatigue scale and they’re not exhibiting any problems with the fatigue Their academics are fine, their behavior is fine. So maybe you’re not going to be quite as aggressive with saying, okay, I want this child to be in a hearing aid or use a CROS aid or get a cochlear implant. Maybe we’ll be able to start to differentiate treatment according to those very individual profiles for these children instead of treating them all the same.

Tatum:                  Before we go into our very last question, is there anything that we haven’t touched on on this topic, Dr. Tharpe that you feel like our listeners should hear?

Dr. Tharpe:         I think I’ve covered almost everything. Two points that I would like to end on. One is that I don’t, and I think we’ve done a good job, but I just want to highlight that parents need to remember that not all children with unilateral or mild hearing losses are going to have difficulties. While we want parents to be alert, to the possibilities and ensure that they’re doing everything they can to, to follow and monitor these children with the appropriate professionals. Many of these children do just fine so they can enjoy and relax a little bit as they monitor the progress of their children. And I also to mention one area of research that I think is going to be very positive as we move forward and that is looking at large data to help us understand these children better. now we more in most of the study we’ve done in the past have had, you know, maybe 25 children or 50 children because of the electronic medical records that we now have on children. We’re able to look millions children. And so we are starting to work at millions of medical records here. Now of course that means I hope we’re going to be able to look at thousands of records of children with unilateral hearing loss that hopefully will help us understand which children need which kind of treatment. So I do think answers can be forthcoming. They’ve been slow in coming over the past several decades, but I think with this big data option that we now have that we’re going to start to answer some of these questions.

Tatum:                  That sounds so exciting. So, obviously the field has come a long way since you were working on your handheld calculator.


Wendy:                Before we close out, do you have any advice for either families or professionals on this topic? It could be any additional advice that you feel that’s important for our listeners to hear?

Speaker 3:           Well, and then at risk of being redundant, I want professional to recognize that every one of these children is individual. And this, because you have seen one child with unilateral or mild hearing loss who rejected intervention doesn’t mean that the next child doesn’t need it and it wouldn’t welcome it and it wouldn’t be incredibly beneficial. So I would hope that there are no professionals out there who are saying, I always do this with this group of children, or I never do that. I hope that we look at these children as individuals and for parents. I hope that they demand that from the professionals with whom they work.

Tatum:                  I think that’s a great note to close on. Absolutely. So why want to wrap things up there. Thank you for joining us, Dr. Tharpe.

Dr. Tharpe:         Oh, thank you so much. It’s a pleasure.

Tatum:                  Before we end the show, Dr. Tharpe. Do you have any contact information that you’d like to share with our listeners if they want to get ahold of you?

Dr. Tharpe:         I don’t mind at sharing that information. And they can reach me at my Vanderbilt email address, anne.m.tharpe@vumc.org

Tatum:                  Okay. And we’ll also put that in our show notes. Thank you for sharing that contact information Dr. Tharpe and we’ve really enjoyed having you on the show. Thank you for fitting us into your schedule and also figuring out the technology with us needed to connect to you remotely.

Dr. Tharpe:         Thank you. It’s been a pleasure.

Wendy:                Yes, thank you. We’ve learned so much in this hour and we look forward to, um, these publications that are forthcoming from you and from your colleagues and, and we just really appreciate your contributions to our field and, and for talking with us today.

Tatum:                  So listeners, thank you for joining us for another episode of all ears at Child’s Voice.

Wendy:                As always, we release episodes every other week on Wednesdays.

Tatum:                  So look out for our next episode in two weeks. And if you’d like to reach out to us, you can find us on Twitter and Instagram. I’m @tatumfritzslp and Wendy is @wendydetersslp

Wendy:                You can also email us at podcast@child’s voice.org and you can find episode show notes and archived episodes at our child’s voice website, childsvoice.org and if you’re interested in learning more about child’s voice, child’s voice is on Facebook as well as Twitter and Instagram with the handle at Childs_Voice. No apostrophe. We’ll see you next time. Bye.

Outro (Carol):    Thanks for listening. Be sure to join us for our next episode on 2 weeks on Sept. 18th. Wendy and Tatum will be having another great discussion so don’t miss it.

Child’s Voice Students: Bye! Thanks for listening.


We thank Dr. Tharpe for her time, it was a wonderful conversation. Dr. Tharpe discussed hearing loss simulators:



If you would like to learn more about Dr. Tharpe and Vanderbilt University, please look here: https://medschool.vanderbilt.edu/hearing-speech/person/anne-marie-tharpe/


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Special thanks to John McCortney & Michael McCortney for their work recording All Ears at Child’s Voice episodes. Episodes of All Ears at Child’s Voice are graciously edited by John McCortney.

Disclaimer: Child’s Voice is a listening-and-spoken-language program for children with hearing loss. All Ears at Child’s Voice: A Hearing Loss Podcast is a resource provided by Child’s Voice. Reference to any specific product or entity does not constitute an endorsement or recommendation by Child’s Voice. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent. Views and opinions expressed by Child’s Voice employees are those of the employees and do not necessarily reflect the view of Child’s Voice.